Retrograde Laryngeal Block: A New Technique for Awake Intubation Compared With Conventional Regional Airway Block

Introduction: Retrograde laryngeal block is a new technique that blocks complete supraglottic and glottic area by introducing catheter retrograde from trachea to these regions. Methods and Materials: This is a clinical trial conducted on two groups each containing 15 patients, who were candidate for awake intubation. The first group (A) underwent conventional method of airway block, by multiple injections of local anesthetic. The second group (B) underwent retrograde laryngeal block as a new method of regional airway anesthesia. In this method the catheter is inserted from cricothyriod membrane through a flexible guide wire, and then local anesthetic drug will be administered by direct vision of tip of the catheter by employing glide scope. The catheter has three separate orifices; each will stay on distinct area of either supraglottic and glottis area which can be adjusted at any level through this area that is considered to be blocked. Result: Both groups had hemodynamic stability during performing block. In group A we had two incidences of laryngospasm due to pain of multiple needle insertion; in group B we had no incidence of laryngospasm (P=0.1). In group A we had 5 patients with partial airway block which needed further intervention during awake intubation but in group B all the cases had complete and perfect airway block (P=0.001). Patients comfort was better in group B with single injection than group A with multiple injections (P=0.005). Discussion: The advantage of this method is single injection and high quality of block performance in comparison with the other technique. It can be conducted for the patients with neck pathologies that make conventional airway block impossible. Conclusion: This method can be applied in patients with neck pathologies that make conventional block impossible

Percutaneous Dilatational tracheostomy and surgical tracheostomy in Imam Khomeini Hospital: report of two cases (case report)

Background: percutaneous dilatational tracheostomy was invented by ciaglia in 1985. With advent of various instruments, various methods such as Fantoni, Grigges and etc, it became a widesepreadly used method of tracheostomy, especially in intensive care unit wards. In our country this was began in 2005, along with many work shops conducted by anesthesiology department of Tehran University of Medical sciences, with help of specialist from Turin University from ITALY. Case report: In this report two patients who underwent percutaneous dilatational tracheostomy are presented, and are compared with patients who had undergo surgical tracheostomy. Their long and short term complications such as bleeding, injury extents, and recovery was studied and presented. Conclusion: Tracheostomy is an opening in front of neck, in to the trachea, through which breathing is made possible. Percutaneous Dilatational Ttracheostomy (PDT) is a method of tracheostomy, in which the need for surgery and transfer of patient to operation room is alleviated. Dispite various benefits, PDT has a few short term and long term drawbacks, which are cartilage fracture, injury to vital structures, perforation of posterior wall, sever bleeding displacement of tube, tracheo-esophageal fistula and trache-oinnominate fistula. Incidence of these complications are lower than surgical tracheostomy. Global reports, especialllly from countries with large scale experiences present a different statistic regarding its success as an alternative method for patients with long surveillance and under mechanical ventilation

Comparison of Postoperative Pain between Infiltrative Local Anesthesia plus Paracetamol and Total Intravenous Anesthesia plus Paracetamol in Ambulatory Breast Surgery

Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia. Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA) underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA), the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU) stay was recorded for each patient. Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001). The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001). Patients in the LA group had longer PACU admission (P = 0.001). Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient

Evaluation of Serum Potassium Ion Content Fluctuation in the Kidney Transplant Recipient Patients in Shariati Hospital

Background: Chang in the serum K+ level may increase perioperative morbidity and mortality in kidney transplant recipients. Thus this research was done with the aim of evaluated of K+ change in kidney transplant recipients. Hence the following study was carried to evaluate the fluctuation of potassium ion in the kidney transplant recipient patients. Materials and Methods: In a simple randomized clinical trial the serum K+ level was assessed in 40 kidney transplant candidates as following interval, pretransplantation, during renal art, anastomosis, after diuresis and post transplantation period. After hydration with 5 ml/kg normal saline all patient were undergone general anesthesia identically. They were premedicated fentanyl (2µg/kg), induction was performed by thiopental sodium (5 mg/kg). Tracheal intubation was facifitated with atracurium (0.6 mg/kg). Anesthesia was maintained with N2O + O2 50%, halothane 0.1% and fentonyl 1 µg/kg every 30 min. Results: The least mean K+ level was during anastomosis (ie. 3.5±0.24 mmol/L) and showed a decrease in the serum K+ level compared to preoperative period (mean 4.4±0.48 mmol) (P< 0.001). The maximum serum K+ level detected preoperatively and postoperatively were 5 (mmol/ L) and 4.7 (mmol/L) respectively. Conclusion: Despite the above results we inferred that range of serum K+ level was maintained within normal. Therefore with suitable pereoprative assessment hyperkalemia is a rare occurrence in transplant recipients

Impact of Sitting or Semi-Setting Position of Patients During Breast Surgery on Hemodynamic Indexes

Background: Keeping the patient in a sitting or semi-sitting position for time-consuming oncoplastic breast surgery is a major challenge for anesthesiologists due to several considerations. This cohort study was conducted on two groups of patients undergoing breast surgery. Methods: Study participants were categorized into two groups: one group was composed of normotensive women (group A) and the other group comprised women with controlled hypertension (group B). After the induction of anesthesia in the supine position, the position was changed to sitting and the surgery was done in the sitting position. Hemodynamic monitoring included ECG, heart rate, non-invasive blood pressure (NIBP), invasive blood pressure (IBP), cardiac output (CO), arterial O2 saturation (SPO2), end-tidal CO2 (EtCO2), and bispectral index (BIS). The amount of administrated fluid and vasopressor was recorded for each patient. Any episode of hemodynamic instability was recorded, too. Results: Hemodynamic variation occurred in both groups, but the changes were more significant in group B and the amount of fluid and vasopressor administration was more prominent in group B. Changing the position caused no significant variation in BIS, SPO2, and EtCO2 in the two groups. Conclusions: The sitting position can be safe for time-consuming oncoplastic breast surgery using adequate hemodynamic monitoring. Hemodynamic changes are more significant in patients with controlled hypertension, and more medical interference is needed for these patients

Effect of Low-Dose Naloxone on Pain Severity and Side Effects of Opioids on Patients Undergoing Laparoscopic Cholecystectomy

Background: Previous studies have assessed effect of naloxone on pain severity and side effects of opioids however, their results are inconsistent. Our study was design to determine effect of low-dose naloxone on pain, nausea, vomiting, pruritus and urine retention on patients undergoing laparoscopic cholecystectomy. Materials & Methods: In this study 60 patients who need laparoscopic cholecystectomy participated and divided into two groups: naloxone (0.25 mg/kg/h naloxone plus 20 mg/kg/h morphine) and placebo (20 mg/kg/h morphine). Patients were evaluated 2, 4, 8 and 16 h after surgery and severity of pain and side effects including nausea, vomiting, pruritus and urine retention were recorded by a nurse. Results: Prevalence of nausea, vomiting, pruritus and urine retention in naloxone group was significantly lower than placebo 2, 4, 8 and 16 h after surgery. There was no significant difference on pain severity between two groups. Conclusion: Our results indicated that naloxone administration significantly decreased side effects of opioid including nausea, vomiting, pruritus and urine retention with no effect on pain severity

Quadriplegia due to lead-contaminated opium: a case report

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Lead poisoning could be associated with gastrointestinal renal, hematologic complications and neurologic deficit.&quot;n&quot;n Case report: The patient was an opium addict, forty one years old male, to hospital admitted with gastrointestinal signs, constipation, abdominal pain, severe weakness of upper and lower limbs without any sensory impairment and with anemia, leukocytosis, and slightly increased liver function tests. Serum level of lead was more than 200&amp;micro;g/dl. After treatment with dimercaprol (BAL), CaNa2EDTA for two five days sessions that followed with oral succimer for three days, signs and symptoms relieved, all laboratory tests became normal and blood level of lead reduced but the patient was discharged with quadriplegia. There was no fecal or urinary incontinence.&quot;n&quot;n Conclusions: Because of irreversibility and severity of lead related neuronal injury, we should suspect to lead poisoning in each patient with neuronal involvement and concurrent GI and hematologic signs.&quot;n&quot;n Keywords: Lead poisoning, motor palsy, opium, neuropathy, quadriplegia

The comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery

&quot;nBackground: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.&quot;n &quot;nMethods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.&quot;n &quot;nResults: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P&amp;lt;0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P&amp;lt;0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P&amp;lt;0.04) and the use of fluid was significantly larger in the sitting group (P&amp;lt;0.05).&quot;n &quot;nConclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb

Clinical Course Teaching in Transport of Critically Ill Patients: Small Group Methods

Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160) and other group the lecture base learning (n=160). In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005). The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003). The rate of adverse events was reduced significantly after clinical course teaching (P=0.041) Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients