Tehran University Medical Journal

---

Background: Education is the main mission of teaching hospitals, but the residents’ learning in acquiring new techniques does interfere in the overall treatment process of patients. Studies pertaining to the effect of anesthesia residents’ training in operating room on treatment procedures have reported conflicting results. Therefore, this study was performed to investigate the effects of anesthesia residents’ training on start time operative delays. Methods: This cohort study was done in neurosurgical operating room, Imam Khomei-ni Hospital, Tehran, Iran during 2010-2013 on a population study comprising of sec-ond year anesthesia residents. Patients were classified into three groups with 30 cases in each one according to the anesthetic team. Group I: one anesthesiologist in charge of two operating rooms and two anesthesia assistants Group II: one anesthesiologist in charge of one operating room and one assistant Group III: one anesthesiologist with-out an assistant. Patients in these groups were compared in terms of American society of anaesthesiologists (ASA) class, induction difficulties and type of surgery. Studied variables included :1) Interval between the patient lying on the bed to till anesthesia, 2) the time devoted to teaching residents, 3) time from the start of anesthesia until the start of surgery. An observer that was blinded to the type of intervention and the study design, recorded the times. Results: ASA class (P= 0.94), induction difficulties (P= 0.66) and type of surgery (spinal cord or brain operation) (P= 0.41) were not statistically different between patients in groups. Preoperative preparation time for the first group (23.5±8.1 min) was longer than the other two groups (21.5±6.2 min and 15.8±9.1 min), respectively (P= 0.001). Differences between the times from start of anesthesia to surgeries in three groups, based on ASA class and type of surgery were not significant (P> 0.05). There was no re-lationship between the times devoted to teaching residents in the first and second groups (P> 0.05). Conclusion: Anesthesia residents’ training in neurosurgery operating room may in-crease the time required for preparing for surgery, but this time expended is hardly of any significance.

---

Background: Identifying risk factors for conversion to open surgery laparoscopic cholecystectomy and factors are difficult to predict cholecystectomy surgery is required. The aim of this study was to evaluate the findings of preoperative ultrasound in predicting the length of laparoscopic cholecystectomy surgery.
Methods: The present study was performed cross-sectional on 122 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti, Forghani and Nekoei’s Hospital in Qom from September 2016 to September 2017.
Inclusion criteria: All cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones and biliary pancreatitis underwent laparoscopic cholecystectomy. The exclusion criteria included patients undergoing laparoscopic cholecystectomy at the same time were other procedures. Before surgery patients' information such as age, sex, ultrasound findings including gallbladder wall thickness, compressed stone and the presence of fluid around the gallbladder were recorded in the checklist. Finally, the duration of cholecystectomy was divided into two degrees of easy operation (less than 60 minutes and without complications) and difficult operation (above 60 minutes with complications) according to the mentioned variables. Data were analyzed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). In this study, a significance level of less than 0.05 was considered.

Results: 28 (22.4 percent) males and 97 (77.6 percent) females with a mean age of 44.66 13 13.85 years were studied. There were 35 difficult cases (28 percent) and 90 easy cases (72 percent). Conversion to open surgery occurred in three cases. Among the sonographic findings, there was a significant relationship between the increase in gallbladder wall thickness and Impacted stone with the duration of operation (P≤0.05). But no significant relationship was found between the findings of Presence of pericholecystic fluid and the duration of operation (P>0.05). Conclusion: Overall, the findings of this study showed that preoperative ultrasound is able to provide valuable data in predicting the duration of laparoscopic cholecystectomy.