Comparison of three methods in improving bag mask ventilation

Increasedlife expectancy in populations has brought along specific new scenarios in the fields of medicine for the elderly; prevalence of physical complications such as edentulism and patients with dentures is growing. Management of anesthesia and ventilation in this group of patients has turned into a great challenge. Some researchers suggest dentures to be left in place during bag-mask ventilation; yet, no unanimous agreement exists in this regard. In a single blind randomized clinical trial, we studied 300 patients with ASA class I, II [American Society of Anesthesiologists], Mallampati class [I, II] and aged over 55 years in three groups. After induction of anesthesia, in group G dentures were removed and in each buccal space an eight-layer 10x10 cm gauze and an oral airway were placed. In group D, the dentures and an oral airway were left in place. In group C [control], after removing dentures just an appropriate oral airway was placed. Then, each three group underwent bag-mask ventilation. Success of bag-mask ventilation [BMV] was considered as increase in end-tidal carbon dioxide to more than 20 mmHg and back to baseline with fresh gas flow of 3 L/min and adjustable pressure limiting valve pressure of 20 cm H[2]O. Success rates were evaluated between groups. Effective BMV was possible in 91 [91%], 64 [64%] and 41 [41%] patients in groups G, D and C respectively. The differences were statistically significant. Successful BMV rate was significantly higher in female patients in group G compared to group C; 43/44 versus 25/46 individuals, P = 0.0001, odds ratio = 0.03, 95% confidence interval [0.00, 0.22]. Leaving dentures in place in edentulous patients after inducing anesthesia improves bag-mask ventilation. However, placing folded compressed gauze in buccal space leads to more significant improvement in BMV compared to leaving dentures in place

Sensitivity of palm print, modified mallampati score and 3-3-2 rule in prediction of difficult intubation

This study evaluated the performance of modified Mallampati score, 3-3-2 rule and palm print in prediction of difficult intubation. In a prospective descriptive study, data from 500 patients scheduled for elective surgery under general anesthesia were collected. An anesthesiologist evaluated the airway using mentioned tests and another anesthesiologist evaluated difficult intubation. Laryngoscopic views were determined by Cormack and Lehane score. Grades 3 and 4 were defined as difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were determined for all tests. Difficult intubation was reported in 8.9% of the patients. There was a significant correlation between body mass index and difficult intubation [P: 0.004]; however, other demographic characteristics didn't have a significant correlation with difficult intubation. Among three tests, palm print was of highest specificity [96.46%] and modified Mallampati of highest sensitivity [98.40%]. In a combination of the tests, the highest specificity, sensitivity and Youden index were observed when using all three tests together. Palm print has a high specificity for prediction of difficult intubation, but the best way for prediction of difficult intubation is using all three tests together

Comparison of hemodynamic changes in administration of ondansetron and metoclopramide to preventing post-operative nausea and vomiting after strabism surgery

The aim of the present study was to compare the hemodynamic changes of intravenous ondansetron and metoclopramide for prevention of post-operative nausea and vomiting in patients undergoing strabism surgery under general anesthesia. This is a randomized double blind clinical trial performed on 96 patients with average age of 6-12y/o, ASA [American Society of Anesthesiologists] physical status I and 11 candidates for strabism surgery with general anesthesia between the years 2009 till July 2010. After the hospital's Ethic Committee approval, the study was conducted in Tabriz University of Medical Sciences, Tabriz, Iran. The patients were randomized into two groups, ondansetron [n=48] and metoclopramide [n =48]. In this study ondansetron 50pg/kg and metoclopramide 150pg/kg administered intravenously five minutes before induction of general anesthesia after routine monitoring. Systolic and diastolic blood pressure and heart rate were measured as hemodynamic variables in both groups. In recovery room Aldrete scoring system employed as the patients' discharge criteria. Incidence and severity of post-operative nausea and vomiting documented in recovery room and in different times in surgical ward by using a specified scoring system and getting information from patients and their caregivers. There were not significant differences between two groups in demographics, hemodynarnic parameters and anesthesia length. There was not also significant difference about the incidence and severity of nausea and vomiting between two groups. It is concluded that preoperative administration of both ondansetron and metoclopramide can decrease frequency and also intensity of post-operative nausea and vomiting without having significant difference and prominent complication