Effects of oral methylprednisolone and inhaled salbutamol in the decrease of wheezing in patients with asthma after tracheal intubation

Airway instrumentation in patients with bronchial hyperreactivity, may evoke life-threatening asthma attack and a good strategy for the prevention of bronchospasm has not been defined. In a randomized, prospective, placebo-controlled study, it was determined whether prophylaxis with either inhaled salbutamol-or combined inhaled salbutamol and oral methylprednisolone improves lung functions and prevents wheezing after intubation. Thirty one patients with partially reversible airway obstruction [airway resistance > 180%, forced expiratory volume in 1 second [FEV1] < 70% of predicted value, and FEV1 increase > 12% after two puffs of salbutamol] were randomized to receive daily either 3-2 puffs [0.2 mg] of salbutamol [n = 16] or 3-2 puffs [0.2 mg] of salbutamol and 40 mg of methylprednisolone [n = 15] orally for 5 days. In all patients lung function was evaluated daily and wheezing changes was assessed before and 5 minutes after tracheal intubation. Both salbutamol and combined inhaled salbutamol and oral methylprednisolone treatment significantly improved airway resistance and FEV1 to a steady state, with no difference between groups. When a single-dose of salbutamol pre-induction or prolonged salbutamol treatment was employed, most patients [8 of 10 and 7 of 9] experienced wheezing after intubation. In contrast, only one patient of those who received both salbutamol and methylprednisolone experienced wheezing [P = 0.0058]. Pretreatment with either salbutamol or combined inhaled salbutamol and oral methylprednisolone significantly improves lung function and decreases the incidence of wheezing after tracheal intubation. Methylprednisolone decreases incidence of wheezing more than salbutamol. Therefore, in patients with bronchial hyper reactivity, preoperative treatment with both methylprednisolone and salbutamol minimizes intubation-evoked broncho-constriction

Fogarty catheter for a difficult bronchial foreign body removal: [case report]

There are many methods for removal of tracheobronchial foreign bodies but there are many situations where removal of a foreign body seems impossible and may require a major surgical procedure. Familiarity with each method improves physician decision making. Case: A 17 months old baby with a history of foreign body aspiration suffered from long term pneumonia. There was a round shape foreign body in bronchoscopic view that could not be removed with standard methods, but was removed by application of Fogarty catheter. Conclusion: Removal of round, spherical foreign bodies may be performed by Fogarty Catheter preventing surgical intervention

Preemptive analgesia in elective cataract surgery [Phacoemulcification]

Preemptive analgesia is based on the idea that analgesia which initiates before a nociceptive even will be more effective than the analgesia commenced afterwards. This clinical trial compared postoperative analgesia and comfort in patients with general anesthesia combined with preoperative or postoperative local anesthesia. 90 patients who had been scheduled for phacoemulcification in Farabi Eye Hospital, 2002-3, were enrolled in the study. Sixty patients received general anesthesia: 15 received preoperative local anesthesia [GA+LA+OP], 15 received postoperative local anesthesia [GA+OP+LA], and 30 did not get local anesthesia [only GA]. Thirty patients only received local anesthesia [LA]. Subjective postoperative pain was determined by a visual analogue scale. Frequency of oculocardiac reflex, postoperative nausea and vomiting [PONV], and patient's comfort were assessed. Postoperative pain was less in local anesthesia [LA] compared to general anesthesia [GA] [p < 0.0001]. Additional preoperative application of local anesthesia [GA+LA+OP] resulted in less pain than additional postoperative application [GA+OP+LA] [p <0.05]. Additional postoperative peribulbar block did not differ from general anesthesia [Only GA]. The incidence of intraoperative oculocardiac reflex and postoperative nausea and vomiting was significantly less in patients with peribulbar block [P =.0001] and in GA+LA+OP group, as compared with others [P= 0.001]. We conclude that preoperative local anesthesia [Only LA] or in combination with general anesthesia provides the best comfort for the patient in eye surgery