Airway management in a case of expanding neck hematoma after carotid endarterectomy

Background: Respiratory obstruction is a fatal complication following carotid endarterectomy, which caused direct compression of trachea secondary to venous and lymphatic congestion.Cases Report: In this study, we report a complicated case of carotid endarterectomy   that required emergency intubation in difficult circumstance due to progressing hematoma and soft tissue edema.Conclusion: we report a case of hematoma and edema causing compromised airway following carotid endarterectomy (CEA), in which quick action to decompress the hematoma and prepare a secure airway lead to successful outcome

Comparison of Analgesia in Subcutaneous Infiltration of Ropivacaine and Magnesium Sulfate for Postoperative Pain Control of Cholecystectomy

Background: The purpose of this study was to compare the effect of analgesia of Ropivacaine and magnesium sulfate as subcutaneous infiltration at the site of surgical cutaneous cholecystectomy in the postoperative period.Materials and Methods: To achieve the research goals, 80 patients referred to Shohada Tajrish Hospital in Tehran in 2016, which were randomly divided into two groups: Ropivacaine and magnesium sulfate. Patients in both groups had similar anesthetic procedures and all of them were monitored standard were recorded within 24 hours of operation. Overall morphine dose was also recorded for postoperative pain.Results: The findings showed that there was a significant difference between the two groups in the Ropivacaine group in the next hours despite the no significant difference in age, sex, BMI, duration of operation and pain scoring at first and third hours. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. The occurrence of PONV is also higher in the magnesium sulfate group, but this difference is not significant.Conclusion: Local injection of Ropivacaine reduced acute pain after open cholecystectomy surgery in comparison to local injection of magnesium sulfate. In addition, the use of Ropivacaine is associated with a significant reduction in the need for intravenous morphine for analgesia

YKL-40 Gene Expression and Plasma Levels of CD30 are not Affected by Isoflurane or Propofol: Pilot Study

Background: It has been hypothesized that the body's response to anesthesia techniques can increase risk of cancer recurrence and metastatic disease after surgery and also can modulate immune responses. Some acute inflammatory markers have been measured to survey the immunomodulatory effect of anesthesia, but in this research, we studied the plasma level of CD30 and YKL-40 gene expression which can present major changes of the immune system.Materials and Methods: Our study was a controlled before and after study. 34 women with biopsy-proven breast cancer were randomized to receive either propofol general anesthesia (n=17) or standard isoflurane general anesthesia (n=17). There were no significant differences between the two patient groups in age, body weight, and height, length of general anesthesia, operative time and group of surgery. The blood samples were collected in two different sets, before anesthesia and 72-h postoperatively. Soluble CD30 (sCD30) plasma level was measured by ELISA and YKL-40/CHI3L1 gene expression was evaluated by real-time-PCR.Results: The results showed that the anesthetics, propofol and isoflurane, have no effect on the expression of YKL-40. Despite increased in the expression of YKL-40 that was observed in patients receiving isoflurane, this increase was not statistically significant. There was no significant increase or decrease in plasma concentrations of sCD30.Conclusion: YKL-40 and sCD30 are not affected by isoflurane or propofol.  So, in immunological perspective, there is no preference in use of isoflurane or propofol in breast cancer patients

Dexmedetomidine is as effective as Ketamine in post operative sore throat a randomized double – blind study

Background: sore throat as one of the common postoperative challenges, with a prevalence of 65%, mandates more attention. Many therapeutic approaches have been tested; including ketamine gargle. This study compares the effect dexmedetomidine versus ketamine, both used as preoperative gargle, on the incidence and severity of postoperative sore throat in emergency surgical procedures. Materials and Methods: All patients undergoing emergency surgical procedures who referred to Shohadaye-Tajrish Hospital and needed anesthesia using succinylcholine for rapid sequence induction were considered as the target population and patients with ASA class 1-2, who aged 18-64 years, were enrolled. Inside the operating theatre, patients’ vital signs recorded and they were divided into ketamine and dexmedetomidine groups, each including 20 patients, receiving 0.5 mg/kg ketamine or 0.25µg/kg dexmedetomidine in 100cc water to gargle before induction of anesthesia. Standard similar anesthesia protocols were applied for all patients. In PACU sore throat was assessed using a visual analog scale (VAS) scoring. Results: in the ketamine group, 8 cases and in the dexmedetomidine group, 12 had dry throat (p= 0.150). The mean severity of the postoperative sore throat was 2.10± (minimum score of one and a maximum of 3) without significant difference between the two groups (p=0.344). mean diastolic pressure and SpO2 were significantly lower in the dexmedetomidine group compared with the ketamine group (p=0.047 and 0.001). Conclusion: both dexmedetomidine and ketamine gargle could be equally useful and effective in reducing postoperative sore throat

Unusual Airway Obstruction during General Anesthesia following Endotracheal Tube Cuff Herniation; A Case Report

Abstract Background: Airway management is always of great concern for anesthesiologists especially in the prone position. Utilizing an Armored endotracheal tube is considered to be safe in such patients. Cases Report: In this current case, we introduce a patient undergoing a wake-up test during spinal surgery who suffered from hypoventilation at the end of surgery. His condition improved only after extubation. After extubation, we confronted a herniated cuff that was not deflated, although we tried twice. We concluded that the patient's respiratory effort against obstructed airway produced a negative pressure, which made the cuff herniated, resulting in airway obstruction. Moreover, the patient biting the tube during the wake-up test damaged the tube and cuff deflation pathway. Conclusion: It is important to consider cuff herniation as a cause of obstruction when other possible etiologies are ruled out