Schwannoma of the cervical sympathetic chain; clinical and therapeutic considerations

Schwannomas are benign, slow-growing tumors that arise from Shwann cells of the nerve sheath. Those originating from the sympathetic cervical chain are extremely rare and usually presented as an asymptomatic neck mass. Here were reports a case of schwannoma of the cervical sympathetic chain in a 32-year-old man who had asymptomatic neck mass for 6 months. But it appeared pulsatile due to the anterior displacement of carotid sheath by the mass and thus mimics are carotid body tumor. As discussed in this report CT scan with contrast is enough for ruling out paraganglioma and imposing extra expense for MRI and angiography is unnecessary. The only rare complication encountered after surgery was Horner's syndrome, which required not treatment

Impact of bispectral index monitoring versus clinical judgment as a guide for conduction of anesthesia on serum cortisol level in coronary artery bypass graft surgery

Inadequate depth of anesthesia leads to release of stress hormones. Electroencephalographic monitoring by bispectral index is a guide to asses the depth of anesthesia. The aim of the present study was to measure the serum cortisol levels as an index of stress response in patients who are candidates for coronary artery bypass graft surgery in two groups of patients. Seventy-six patients who were scheduled for primary elective cardiopulmonary bypass were enrolled in a double- blind randomized study. The patients were divided into two groups. The infusion of anesthetic drugs was guided by bispectral index in group I [n=38], and by clinical judgment in group II [n=38]. For all the patients the blood cortisol level was measured four times during operation. Serum cortisol levels decreased during operation in both groups, reaching 67.8% of the baseline in group I and 63.2% of the baseline in group II. There were no significant differences in mean serum cortisol levels between the two groups [p<0.09]. Preoperatively, the mean blood cortisol level was 19.94 micro g/dl in group I and 16.89 micro g/dl in group II which reached to 10.48 micro g/dl in group I and 6.42 micro g/dl in group II postoperatively. There was no significant difference between two groups regarding bispectral index values. It seems that monitoring of the patients by clinical judgment or bispectral index has equal influences on serum cortisol levels during coronary artery bypass graft surgery

[ effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery]

Nausea and vomiting are common after general anesthesia. Nausea and vomiting are also common after tympanomastoid surgery that may endanger the results of middle ear reconstruction. Medications like dexamethasone have been used to prevent nausea and vomiting. In this study, the effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery has been evaluated. This study is a case control, double blinded, clinical trial that was performed in Dastgheib Hospital affiliated to the Shiraz University of Medical Sciences during 1381-1383. Eighty patients candidate for tympanomastoid surgery who were in physical status I [according to the classification of the American Anesthesiology Association] were selected randomly. These patients were divided into two control and study groups [each group consisting of 40 patients]. Just before induction of anesthesia, 2 ml normal saline was given intravenously to the patients in control group and 2 ml dexamethasone [8 mg] was given to the patients in the study group. The data were collected by a special form, and SPSS software and Chi Square test were used for statistical analysis. There was no significant difference between the study and control groups regarding the mean of age, male to female ratio, and length of anesthesia. Use of dexamethasone resulted in 32.5% decrease in post operative nausea [p=0.002] and 22.5% decrease in vomiting [p=0.04]. It seems that 8 mg intravenous dexamethasone is effective in reducing nausea and vomiting following tympanomastoid surgery and can be used routinely during tympanornastoid surgery

[Comparison of preoperative administration of rectal diclofenac and acetaminophen for reducing post operative pain in septorhinoplastic surgeries]

Post operative pain is usually treated by opioids, which is expensive and may induce various side effects. Non steroidal anti-inflammatory drugs have been considered recently for controlling pain due to their cheapness, fewer side effects and availability. This study compares the analgesic efficacy of preoperative administration of single dose of rectally diclofenac and acetaminophen for post operative analgesia in septorhinoplasty, one of the most common head and neck surgeries. Sixty adult patients with ASA =1 underwent septorhinoplasty were randomly divided into two equal groups. Thirty minutes before induction of anesthesia, 100 mg diclofenac suppository and 325 mg of rectal acetaminophen were given to group I and group II respectively. Induction and maintenance of anesthesia were similar in all patients. Then the severity of pain was graded 1, 2 and 4 hours after operation according to Visual Analogue Scale. Also the first time of analgesic request and: total administered dose of analgesics were assessed by another person in all patients. Results revealed that severity of pain in diclofenac group in all three defined times was significantly less than that in the other group [p<0.05]. Also the average of first time analgesic request in group 1 and 2 was 205 and 97 minutes respectively and the average dose of administered pehtidine was 12.25 mg in diclofenac and 37.15mg in acetaminophen group. The pre-operative administration of rectal diclofenac was more effective for post septorhioplasty analgesia than the rectal acetaminophen and thus it could be used and recommended as a safe, compensive and effective method for post operative pain relief in this common surgery

effect of local heat on incidence of sore throat and hoarseness after endotracheal intubation

Sore-throat and hoarseness are the most common complication after endotracheal intubation which take place 12-24 hr after operation. Different studies have reported the incidence of these complications between 24-90%. Increase of heat on the trachea will raise the blood pressure in the local capillaries and therefore induce better blood supplementation to the local tissues. This study aimed to evaluate the effect of local heat on the incidence of sore- throat and hoarseness after endotracheal intubations. One hundred and sixty patients aging 15 -50 years old, candidate for elective surgeries under general anesthesia, were randomly divided into two groups. Patients for head and neck surgeries were excluded from the study. Methods of intubation, type, size, cuff pressure of ETT, method of anesthesia and time of operation were the same for all patients. During the operation time, local heat was applied on the external surface of trachea [up to 40 [oc] by using electrical blanket for the patients in the study group. 24 hr after operation all the patients were visited by anesthesiologist for evaluating the sore- throat and hoarseness. The incidence of sore-throat in the control group was 65% versus 40% in the study group [p<0.05]. Moreover the incidence of hoarseness was 66.2% in the control group versus 10% in the case group. Application of local heat [40[oc] on the external surface of trachea can effectively decreases the incidence of postoperative sore - throat and hoarseness