Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

Background: Intrathecal injection of chemotherapy drugs in leukemic children is a painful procedure that needs sedation and analgesia. Different combinations of ketamine and propofol (ketofol) are used for this purpose. In this study we compared two different concentrations of ketofol    (combination of 1/3 and 1/5 of ketamine and propofol). Methods: In this randomized double blinded controlled clinical trial, 80 Children were studied in two groups. Group 1 received a combination of 1/3 of ketamine and propofol and group 2 received a combination of 1/5 for procedure of Intrathecal injection of chemotherapy drugs. Hemodynamic parameters, recovery time, and drug side effects were compared between two groups.Results: In this study 80 children age 4-12 years old underwent Intrathecal injection of chemotherapy drugs were studied. There were no significant differences in age, weight between groups.  Recovery time was significantly shorter in group 2 (p = 0.001). Also heart rate was lower in group 2 significantly (p = 0.001), but mean arterial pressure was not different between two groups (p = 0.287). SPO2 was > 95% in all the children during the procedure (p = 0.74).Conclusions: Combination of 1/5 of ketamine and propofol (ketofol) for sedation in the children undergoing intrathecal injection of chemotherapy drugs is better than a combination of 1/3 because of shorter recovery time and lower heart rate.

Pneumocephalus after Tympanomastoidectomy: A Case Presentation

Introduction: Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.   Case Report: A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.   Conclusion: Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus

Prevalence of Malnutrition in Patients with Head and Neck Cancer in Yazd, Iran

Background: Head and neck cancers are accounted for 4.9% of all cancers worldwide. The aim of this study was to evaluate the prevalence of malnutrition in patients with head and neck cancers in Yazd, Iran.Methods: Eighty-nine patients with locally advanced head and neck cancers who referred to a training clinic or a hospital were included in this cross sectional study. All patients were assessed for nutritional status by Patient Generated Subjective Global Assessment (PG-SGA) questionnaire, and serum albumin and hemoglobin levels.Results: Bases on PG-SGA assessment, 49.4% of the patients had proper nutrition, 30.4% were at risk or suspected to malnutrition, and 20.2% had severe malnutrition. The prevalence of malnutrition was significantly related to gender of patients, type of treatment and the stage of the disease. There was no significant relationship between the prevalence of malnutrition and age, although the prevalence of severe malnutrition was higher at older ages.Conclusion: The prevalence of malnutrition among our patients was high. Nutritional evaluation is very important to detect patients at risk of malnutrition or with malnutrition and helps to choose the nutritional treatment

The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss

Introduction: In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL).   Materials and Methods: This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group.   Results: There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P0.05).   Conclusion: Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery

Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate

The Effect of Topical Tranexamic Acid on Bleeding Reduction during Functional Endoscopic Sinus Surgery

Introduction:Bleeding is a common concern during functional endoscopic sinus surgery (FESS) that can increase the risk of damage to adjacent vital elements by reducing the surgeon’s field of view. This study aimed to explore the efficacy of topical tranexamic acid in reducing intraoperative bleeding. Materials and Methods:This double-blind, randomized clinical trial was conducted in 60 patients with chronic rhinosinusitis with polyposis (CRSwP) who underwent FESS. Patients were randomly divided into two groups; tranexamic or salinetreatment. During surgery, normal saline (400 mL) or tranexamic acid (2 g) in normal saline with a total volume of 400 mL were used in the saline and tranexamic groups, respectively, for irrigation and suctioning. The surgeons’ assessment of field of view during surgery and intraoperative blood loss were recorded. Results:Mean blood loss was 254.13 mL in the saline group and 235.6 mL in the tranexamic group (P=0.31). No statistically significant differences between the two groups were found in terms of other investigated variables, such as surgical field quality based on Boezzart’s scale (P=0.30), surgeon satisfaction based on a Likert scale (P=0.54), or duration of surgery (P=0.22). Conclusion:Use of tranexamic acid (2 g in 400 mL normal saline) through washing of the nasal mucosa during FESS did not significantly reduce blood loss or improve the surgical field of view. Further studies with larger sample sizes and higher drug concentrations, and using other methods of administration, such as spraying or applying pledgets soaked in tranexamic acid, are recommended