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

To compare efficacy of hypnosis and intravenous sedation in controlling of important variables of vital signs and evaluate the patient anxiety before and after topical anesthesia in ophthalmic surgery

Background: Stress is one of the most important problems among preoperative patients. In order to reduce these signs and symptoms, some medications are used for patients. The aim of this study was to compare the efficacy of hypnosis to intravenous sedation on controlling the important variables of vital signs and to evaluate the patient anxiety before and after regional or topical anesthesia in ophthalmic surgery

Materials and Methods: this study was designed as a double-blind stratified randomized clinical trial. Hypnotism was administered to hypnotism group, and midazolam, fentanyl, and propofol were given intravenously to the IV sedation group. The patients were monitored and the baseline variables consisted of mean arterial pressure, pulse rate, respiratory rate, and O2 saturation were registered every 15 minutes during surgery. Patient anxiety was measured via Spielbeger`s State Anxiety Index [STAI] score before and after surgery

Results: 90 patients were participated in the study, with 50% [n=45] assigned to hypnosis group and 50% [N=45] assigned to IV sedation group. Patients characteristics, including age, gender, and body mass index [BMI] duration of surgery were similar among the groups [P>0.05]. Spielbeger`s State Anxiety Index [STAI] score before and after surgery were not significantly different in both groups [P>0.05]. Heart rate, respiratory rate, mean arterial pressure were lower among hypnosis group as well as this group had higher O[2] saturation during surgery [P<0.05]

Conclusion: hypnosis can be an effective means of controlling vital signs at different intervals of starting the ophthalmic surgery compared to intravenous sedation. In the hypnosis group anxiety was similar to IV sedation group, but O[2] saturation was more desirable

Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery

Acute normovolemic hemodilution [ANH] and preoperative autologous blood donation [PABD] have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances. In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery [35 in ANH, 35 in PABD] in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the infl uence of two transfusion methods on homeostatic function and hemodynamic balance. We compared 70 patients [38 male [54.3%] and 32 female [45.7%]] with mean age 54.8 years undergoing open heart surgery [CABG and valvular]. In ANH group, significant decrease was detected in Na [28.5%] K [2.5%], prothrombin time [PT] [88.57%], partial thromboplastin time [PTT] [94.28%], creatine phosphokinase [CPK] [11.4%], lactic dehydrogenase [LDH] [11.43%], albumin [Alb] [17.14%], globulin [91.43%] and total protein [80%]. Mean initial and post-operative hemoglobin was 14.12 +/- 1.06 versus 11.97 +/- 0.98, hematocrit 42.22 +/- 3.45 versus 35.40 +/- 2.88, systolic blood pressure 124.1 +/- 14.4 versus 110.88 +/- 15.6 [reduction 22.86%] diastolic blood pressure 76.02 +/- 10 versus 69.26 +/- 11 [reduction 3%] and pulse rate was 75.45 +/- 10 versus 84.45 +/- 12 [12%] in this case difference between two groups was strongly significant [P = 0.001]. In PABD group, significant decrease was detected in Na [20%], K [2.5%], PT [91.43%] PTT [80%], CPK [8.57%], LDH [5.72%], Alb [57.15%], globulin [71.43%] and total-protein [62.85%], the value of hemodynamic changes were in normal range. Though aut ologous blood transfusion [ANH and PABD] was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance