[Pain control and ACTH changes in postoperative intravenous analgesia versus epidural analgesia in limb orthopedic surgery patients]

The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery. In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88, 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia [PCEA] or IV analgesia [PCIA]. Measurement of ACTH levels and Visual analogue scale [VAS] was performed in four relief phases including at the time of arrival to the operating room, immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded. The mean level of ACTH and VAS, 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score [RSS] in PCEA group at these intervals was more than PCIA cases. It seems that PCEA relieves pain more effectively than PCIA method. However, the proper method of anesthesia for each patient as well as patients' preferences should be considered in selecting the method of postoperative analgesia

[Fiberoptic intubation]

Airway management is the most important duty of an anesthetist, so more attention should be paid on different educational approaches in tackling difficult airway. Having problems in airway control leads to terrible consequences such as hypoxia and aspiration. Intubation with fiberoptic is a useful method for a safe airway management. When neck movement is not possible due to cervical spine injury or when direct laryngoscopy and vocal cord vision is not possible, awake oral or nasal fiberoptic intubation or under general anesthesia is very useful. This study's aim is to introduce a useful scopic device for intubation