Ratio of height to sternomental distance; A comparison of common upper airway tests for predicting difficult larygoscopy in elective surgery patients

Preoperative evaluation is important in predicting the risk of difficult airway management. Ratio of height to sternomental distance is a new test for predicting difficult laryngoscopy. Analytical cross - sectional study. Guilan University of Medical Sciences, Rash-lran. 1[st] Oct, 2009 to 30[th] Dec, 2010. 470 consecutive patients scheduled for elective surgery undergoing general anesthesia and requiring endotracheal intubation. The tests that were used to predict difficult laryngoscopy included: mouth opening range, body mass index [BMl], thyromental distance, sternomental distance, and neck movement range, ratio of height to thyromental distance, ratio of height to sternomental distance [RHSMD] and assessment of oropharyngeal view by modified Mallampati classification. After general anesthesia, glottic visualization was assessed during laryngoscopy using Cormack and Lehane classification. Multivariate analysis and 95 percent confidence interval with SPSS 14 statistical package were used to compare the results of study. Neck movement range /= 12.5 were valuable respectively. Odds ratio [95 percent confidence interval] of the neck movement range /= 12.5 and RHTIVID >/= 23.5 were 17.7[9.57 - 49.76], 12.28 [7.6 - 47.04], 12.22 [22.8-76.6], 9.35 [2.29 -10.52], 5.6 [0.08 - 0.89], 3.78 [0.022 - 0.595] respectively. RHSMD had the least false negative value. Cut off point of RHSMD >/= 12.5 and RHTMD >/= 23.5 was not different between men and women. RHSMD is a useful and valuable clinical screening test for predicting difficult laryngoscopy.

Difficult laryngoscopy; the predictive value of ratio of height to thyromental distance versus other common predictive tests of upper airway

Preoperative evaluation of anatomical landmarks and clinical factors helps to identify potentially difficult laryngoscopies; however, its predictive reliability is unclear. As the ratio of height to thyromental distance [RHTMD] is a newer upper airway predictive test for difficult laryngoscopy, the predictive value and odds ratios of RHTMD versus mouth opening, thyromental distance[TMD], neck movement, and oropharyngeal view [modified Mallampati] were evaluated. Data of 407 consecutive patients scheduled for elective surgery with general anesthesia requiring endotracheal intubation were collected and all five factors were assessed before surgery. Four senior anesthesiology residents, not aware of the recorded preoperative airway assessment, performed the laryngoscopy and grading [as in Cormack and Lehane's classification]. Difficult laryngoscopy [Grade 3 or 4] occurred in 94 patients [23.1%]. In the multivariate analysis, three criteria were found independent for difficult laryngoscopy [neck movement /= 24]. Neck movement [NM] /= 24 were valuable with lowest NPV. The multivariate analysis Odds ratio [95% confidence interval] of the NM, Mallampati class, IIG and RHTMD were 18.16 [9.634 - 34.265], 12.498 [6.744 - 23.16], 11.183 [6.571 - 19.03] and 3.123 [1.933 - 5.047] respectively.TMD

Control of post-surgical pain; comparison between tramadol and meperidine after emergency cesarean section

There are many complications for patients with post cesarean section relative pain. So it delays in discharging or increasing in hospital stay. The objective of this study was a comparison between Tramadol and Meperidine according to pain relief or other possible complications in post cesarean section pain control. This study was a double blind clinical trial. It arranged for 240 parturients who scheduled for emergency cesarean section with pain after surgery in spite of spinal anesthesia. All patients were in ASA class I. They were divided randomly in two groups. Meperidine [M] and Tramadol [T] groups with 120 patients in each group. After beginning of pain in post anesthesia care unit [VAS> or=4], in group [T] tramadol 1.5 mg/kg and in group [M] meperidine 0.5 mg/kg were injected intravenously. Apart from pain, other drug complications such as shivering, blood pressure changes, itching, nausea and vomiting, drowsiness were recorded one and two hours after injection. Data were analyzed by chi-square test, Relative frequency rate [RFR] of 50% decrease in pain score one hour after intravenous injection was 56.7% in group [T] and 69.2% in group [M] [P=0.054]. RFR for respiratory depression after one hour was 5.8% in [M] group and 0 in [T] group [P=0.007]. RFR for nausea after one hour was 39.2% in [T] group and 23.3% in [M] group [P=0.008]. RFR for vomiting after one hour was 23.3% in [T] group and 13.3% in [M] group [P=0.045]. RFR for drowsiness after one hour was 25% in [M] group and 3.3% in [T] group [P=0.007]. There was no statistically significant relationship after 2[nd] hour for pain relief, nausea, vomiting and drowsiness between two groups. There was no difference between two groups in RFR for shivering, blood pressure changes and itching in both two groups. This study illustrates both remedies Meperidine and Tramadol which were effective for pain relief and shivering after cesarean section. But according to high incidence of nausea and vomiting with Tramadol and more analgesic effects of Meperidine than Tramadol, administration of Meperidine is better than Tramadol after cesarean section for pain control

Propofol vs. thiopental NA; pregnancy outcome and postoperative nausea and vomiting [PONV] in art cycle

The aim of this study was to compare the side effects, fertilization rate and pregnancy rate [PR] and duration of recovery between Propofol and Thiopental Na after ICSI-vaginal retrieval of oocyte in ART cycle. This study was a prospective, randomized clinical trial. Ninety eight ASA [American Society of Anesthesiologist] physical status I and II women participating in an intracytoplasmic sperm injection [ICSI] program were assessed. All of the patients underwent general anesthesia induction with Propofol and Thiopental Na. The first group [49 cycles] received 2-2.5mg/kg of Propofol, and the second group [49 cycles] received 5mg/kg Thiopental during transvaginal oocyte retrieval. An informed consent form was obtained for each patient's treatment. Variables under study included: female age, cause and duration of infertility postoperative nausea and vomiting [PONV], heamodynamic changes, mean number of oocyte retrieved, oocyte metaphase II, embryo cleaved, embryo transferred, embryo quality and pregnancy rate [PR] and duration recovery. Statistical analysis was carried out by using SPSS. 10 software and statistical test of T-test and chi-square. The PR in Propofol group was 18 [36.7%] and in Thiopental Na group was 19 [38.8%] with no significant differences the mean duration of infertility and weight weren't statistically significant. The mean number of oocyte retrieved [metaphase II], embryo cleaved, embryo transferred and embryo quality weren't significant between the two groups. The incidence of nausea in Propofol group in comparison with Thiopental Na group was lower with significant differences. The incidence of vomiting between two groups was statistically significant [46.9% vs. 28.6% respectively] [p<0.05] between two groups Duration of recovery in Propofol group was 15 +/- 3 min and in Thiopental Na group was 25 +/- 5 min that was statistically significant [P<0.05]. Propofol offered lowerincidence of post operative nausea and vomiting and a quick recovery from anesthesia without any adverse effect on pregnancy outcome. These findings showed that Propofol was a good alternative for Thiopental Na in short time operation, like ICSI -vaginal retrieval of oocytes

Administration of NTG before embryo transfer does not increase pregnancy rate

Recent studies of uterine contractility in IVF-embryo transfer led us to consider an alternative, and possibly complementary, explanation for the high implantation rates of blastocysts. It has been demonstrated that myometrial contractile activity influences embryo implantation, possibly through mechanical displacement of embryos. The aim of this study was to examine the effect of nitroglycerine [NTG] treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs. This study was a prospective, randomized, double-blinded placebocontrolled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group [50 cycles] received an oral dose of 0.4 mg of NTG, and the control group [50 cycles] received a placebo, 15 minutes before fresh ET. An informed consent from was obtained from each patients. The main outcomes were implantation rate [IR] and pregnancy rate [PR]. The mean age of females in the control group and in the treatment group were 30.1 +/- 5.1 and 31 +/- 5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups [6.6 +/- 5.8 versus 7.8 +/- 5.1 years, respectively]. The mean number of oocyte retrieval [metaphase II], 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups [p>0.05]. Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn't statistically significant difference between two groups. [p>0.05] NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus