Early clinical experience with a new video laryngoscope (SANYAR®) for tracheal intubation in adults: a comparison clinical study

Objective: SANYAR® video laryngoscope (S-VL) is a new video laryngoscope. We conducted a comparative clinical study to assess its ability to provide laryngeal exposure and facilitate endotrachetal intubation (ETI) in adult patients. Methods: This comparison clinical study was conducted on adult patients undergoing elective general anesthesia. The patients were randomly divided into two groups of direct laryngoscopy (DL) or S-VL. The primary outcome was the time required for performing ETI. The glottic view and successful ETI on the first attempt was also compared between the two groups. Results: Full and partial glottic visualization was achieved in 100% of the patients in the S-VL group, while the corresponding figure in the DL group was 90%. Cormack-Lehane III was observed in 5 patients of the DL group, and ETI was successfully carried out with S-VL. The first-pass success rate of ETI was significantly higher in S-VL group compared to the DL group (94% vs. 78%; P = 0.034). The mean times to ETI were 38.32±6.4 and 35.31±8.4 seconds in DL and S-VL groups, respectively (P = 0.650). Conclusions: During ETI for general anesthesia, SANYAR® video laryngoscope compared with direct laryngoscopy improved glottic visualization and first-pass ETI rate

The Efficacy of Intraoperative Ketamine-Haloperidol for Prevention of Catheter-related Bladder Discomfort After Lumbar Spinal Stenosis Surgery

Objectives: Catheterization of urinary bladder during surgery frequently leads to agitation of the patient in the recovery room, especially in those patients who remain catheterized after gaining consciousness. We hypothesized that administration of a combination of ketamine-haloperidol (KH) before urinary catheterization would reduce the incidence of catheter-related bladder discomfort (CRBD) while reducing some adverse effects of ketamine in the postoperative period. Methods: A total of 119 male patients who underwent lumbar spinal stenosis surgery were randomized into three groups. The KH group consisted of 39 patients who received KH just before urinary catheterization. The second arm of the study including 40 patients who received pethidine-haloperidol (PH). The control (C) group consisted of 40 patients who received normal saline as a placebo. We sought to determine the incidence and severity of CRBD at arrival in recovery and one, six, and 24 hours after. Results: The incidence of CRBD upon arrival in the recovery room was 17.9% in the KH group, and 52.5% and 55% in the PH and C groups, respectively. The incidence of CRBD was significantly lower in the KH group at arrival in the recovery room. The severity of CRBD was lower in the KH group at one and six hours of surgery (p < 0.007). There was no significant difference 24 hours after surgery. Conclusions: Intravenous administration of KH before urinary catheterization effectively decreases the incidence and severity of postoperative CRBD while reducing adverse effects attributed to ketamine

Medical Students’ Satisfaction with a Web-based Training Module of Clinical Reasoning

Background: There is a paucity of literature regarding the medical students’ perspectives on web-based training of clinical reasoning. Objectives: This study aimed to describe the implementation of a web-based training course of clinical reasoning for medical students and to evaluate their satisfaction with the program. Methods: This cross-sectional study was conducted at the Tehran University of Medical Sciences in 2018. Fifty internal medicine interns were consecutively enrolled. The study consisted of two phases. The first phase focused on the development of a web-based training module of clinical reasoning. The second focused on evaluating the trainee’s satisfaction with the virtual course. The educational content of the program was prepared by an expert panel and incorporated in a web-based educational tool designed for virtual training purposes. The students’ satisfaction with the virtual course was assessed using a questionnaire. Each item of the questionnaire was scored from 0 (0) to 1.5 (100). The content validity of the questionnaire determined by an expert panel, and its reliability was measured. Results: The mean score of each item of the questionnaire ranged from 77.3 to 85.3 which showed that the participants agreed with the items of the questionnaire. Also, Cronbach’s alpha coefficient was excellent in nine items of the questionnaire, good in four items, and acceptable in three items. The intraclass correlation coefficient was also estimated as 0.98. Conclusions: The participants were satisfied with the web-based training tool for clinical reasoning, used in the present study. The developed questionnaire also showed good validity and reliability for the assessment of trainees’ satisfaction with the web-based training module of clinical reasoning. Keywords: Logic, Distance Education, Assessment, Medical Studen

Platelet kinetics after slow versus standard transfusions: A pilot study

Background. Platelet transfusion is required in the acute phase of some thrombocytopenic disorders in order to prevent potentially dangerous hemorrhages. The purpose of this study was to assess the increase in platelet count following a slow platelet transfusion. Methods. Patients suffering from thrombocytopenia due to various underlying diseases were enrolled in the prospective pilot feasibility trial and were randomly divided into two groups. Standard platelet transfusion was administered in one group, while slow transfusion was used in the other. The platelet count was examined at 1 hour, 24 hours, and 1 week following the transfusions. Results. Although the platelet count was higher following 1 hour after transfusion via the standard method, the count tended to be higher 1 week after the transfusion in the slow transfusion group. This difference, however, only turned out to be statistically significant amongst females. Conclusion. A therapy of slow platelet transfusion might be more effective for the prevention of platelet loss. Further studies will be required to strengthen this hypothesis

A giant subclavian pseudoaneurysm following central venous catheterization

Inadvertent iatrogenic injury to an adjacent major artery is a rare but life-threatening complication of central venous cannulation. The present article reports the development of a large right subclavian artery pseudoaneurysm, presented as a rapidly growing mass at the site of injury, following attempted central venous catheterization

Helicopter emergency medical service in Tehran, Iran : a descriptive study

Objective: The study provides descriptive information regarding missions performed by Tehran helicopter emergency medical services (HEMS) during a 1-year period. Methods: All patients transferred by Tehran HEMS between March 2006 and March 2007 were enrolled in this descriptive study. Based on HEMS records, information was gathered on flight time, the number of patients transferred in each flight, and mission outcomes. Results: During the 1-year study, a total of 353 patients were transported via 138 helicopter flights to 4 medical care centers in Tehran. The mean flight time, the time from the initial call until the patient was delivered to a medical facility, was 36.56 +/- 18.44 minutes. Conclusion: Tehran HEMS is still far from attaining optimal values, particularly regarding flight time. More efforts are needed to improve the timing as a component of care and the quality of care provided by this system