Baby cuff as a reason for laryngeal mask airway cuff malfunction during airway management for anesthesia

Placement of laryngeal mask airway [LMA] is a blind procedure without requiring laryngoscopy. The reported success rate for LMA insertion at the first attempt is almost 95%; however, many functioning LMAs may not be in an ideal anatomic place. It seems that disposable LMAs have more stable cuff pressure compared to reusable LMAs; therefore, Anesthesiologists should bear in mind this fact when using reusable LMAs to achieve a proper sealing and safe airway management. In this report, we introduced a case with malfunction of LMA cuff during the airway management

medieval origins of the concept of hypertension

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni [?-983 AD]. This article has reviewed the chapter of "Fi al-Imtela" [About the Fullness] from the Hid?yat al-Muta'allimin fi al-Tibb [The Students' Handbook of Medicine] of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle [staying away from anger and sexual intercourse] and dietary program for patients [avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar]. Al-Akhawayni's description of "Imtela," despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension

Juvenile ischemic stroke secondary to cardiogenic embolism: a rare case report

Myxomas, the most common primary cardiac tumors, are known as a source of cardiogenic emboli. The possibility of their early detection has made them of great importance for emergency medicines. Detection of the disease is probable at early stages using echocardiography and associate complications such as syncope, cerebral embolic ischemic strokes, and sudden death. We report experience of a rare case of juvenile acute stroke in a patient with cardiac myxoma affecting all cardiac chambers presenting to the emergency department. In young stroke patients with signs and symptoms compatible with cardiovascular involvement, cardiogenic emboli should be taken into consideration; early echocardiographic studies are highly recommended. Prompt myxoma resection is required in both asymptomatic and stroke patients in whom intravenous thrombolysis course has not been implemented due to any limitations

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

Evaluation of cardiovascular diseases and their risk factors in hospitalized patients in east Azerbaijan province, northwest Iran: a review of 18323 cases

Coronary artery disease [CAD] is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. Data on 18.323 patients hospitalized due to cardiovascular diseases were collected to evaluate the diseases and their risk factors in 15 hospitals in the East Azerbaijan Province, northwest Iran. We assessed the main diagnosis of cardiovascular disease on admission in each hospital. Also, types of interventional and surgical procedures were assessed and all these variables were compared between men and women. The study population consisted of 56.6% male and 43.4% female patients. The median and range between quartile 1 and 3 [Q1-Q3] ages of the males and females were 59 [49-70] and 62 [51-71] years, respectively. Ischemic heart diseases were diagnosed in 68.4%, electrophysiological disorders in 6.5%, and valvular heart diseases in 4.5% of the patients. The frequencies of the studied risk factors were as follows: cigarette smoking [47.5%]; hypertension [66.95%]; diabetes mellitus [35.9%]; and history of cerebrovascular accident [16.4%] and renal disease [13.4%]. Medical therapy was performed in 79.23%, surgery in 6.28%, and cardiovascular interventional therapy in 13.99% of the patients. The in-hospital mortality rate was 1.57% [1.42% in the males and 1.76% in the females; p value = 0.009]. The most frequent known risk factors in the hospitalized patients were smoking, alcohol consumption, and diabetes. In the northwest of Iran, age at hospitalization due to cardiovascular diseases is slightly lower than that in the Western populations; however, sex distribution, diagnoses, and treatment modalities are not significantly different from those reported in Western countries

Propofol for laryngeal mask airway insertion in children: effect of two different doses

To compare two different doses of propofol for laryngeal mask airway [LMA] insertion in children undergoing out-patient surgeries. Insertion of LMA just after anesthesia induction is facilitated using propofol. However, the optimal dose of this drug not determined yet as heavy doses may lead to severe complications, whereas lower doses may not be quite as effective. In a double-blind randomized clinical trial, 120 children undergoing out-patient surgeries were recruited to receive intravenous propofol at a dose of either 2.5 mg/kg [group 1] or 3.5 mg/kg [group 2] for induction. Intravenous midazolam [0.03 mg/kg] and fentanyl [1 microg/kg] were used as pre-medication in all patients and anesthesia induction was initiated using lidocaine [1 mg/kg] prior to propofol administration. Hemodynamic changes, probable complications, quality of the established airway and number of attempts for LMA insertion were compared between two groups. There were no differences in systolic and diastolic blood pressure, heart rate, peripheral oxygen saturation and intraoperative complications between the groups [P>0.05]. LMA insertion was successful at the first attempt in 55 [93.2%] and 54 [91.5%] cases in group 1 and group 2, respectively [P>0.05]. The efficiency of the established airways was adequate in all the patients of both groups. It seems that propofol doses of 2.5 and 3.5 mg/kg are equally effective for LMA insertion following intravenous midazolam, fentanyl, and lidocaine

Modified cricothyroidotomy in skill laboratory

Unsuccessful tracheal intubation is considered the most common cause of anesthesia death or brain damage. This study delineates our experience recommending modifications in the cricothyroidotomy technique. Thirty emergency medicine residents of participated in a study performed on the human simulator moulage in Skill Laboratory of Tabriz University of Medical Science. The cricothyroid membrane was punctured using a 16-gauge cannula. Later, J guide wire was advanced into trachea and standard 16-gauge intravenous cannula with a removable needle stylet withdrawn after the puncture being dilated by a dilator. Consequently, a cuffed tracheal tube [ID= 6] was introduced from the foramen. From 30 residents, 18 residents performed cricothyroidotomy within 1 minute, 7 residents in 2 minutes and 5 residents failed to fulfill the procedure. Several studies using cadavers and human simulators have demonstrated the pre-hospital feasibility of this technique. However, descriptions of clinical pre-hospital experience with percutaneous cricothyroidotomy are limited. This study shows that skill lab may help residents to acquire techniques required in management of difficult airway.

Squamous cell carcinoma on the remaining sequel of tuberculosis, presented as pancoast tumor 8 years later

Herein a 46 year-old man is presented with intolerable severe pain of right shoulder radiating to right arm and fourth and fifth fingers. He had a history of right upper lobectomy due to complicated tuberculosis eight years ago. Based on the findings of clinical examination and computed tomography imaging, diagnosis of Pancoast tumor of the right chest apex was confirmed. However, Fine Needle Aspiration [FNA] under computed tomography [CT] guidance was not conclusive. By performing a limited thoracotomy, multiple biopsy specimens were obtained from the mass and destroyed ribs for histopathologic examination which consequently confirmed the diagnosis of squamous cell carcinoma. Eventually, the patient was referred to the radiotherapy ward for treatment of Pancoast tumor