Application of the upper lip catch test for airway evaluation in edentulous patients: an observational study

Application of upper lip catch test [ULCT] for airway evaluation in edentulous patients. This research is an evaluation of a clinical diagnostic test in edentulous patients prior to operation. Five hundred eighty eight edentulous patients in a referral university hospital, between March 2008 and June 2011 scheduled for elective surgery under general anesthesia were enrolled. Those unable to open the mouth and those with pharyngo-laryngeal pathology were excluded. ULCT was assessed and compared with Cormack-Lehane grading as a gold standard for airway evaluation. A high negative predictive value of 99.4% was a notable finding for the ULCT. The results also showed a high specificity [89.4%], high sensitivity [75.0%] and a high accuracy [89.3%] in a comparatively higher range for the ULCT. The ULCT proved to be a useful predictor for airway assessment in edentulous patients in this setting. Further studies are needed to reconfirm its validity in other ethnic groups

Safety of intramedullary autologous peripheral nerve grafts for post-rehabilitated complete motor spinal cord injuries: a phase I study

Many experimental studies have reported behavioral improvement after transplantation of peripheral nerve tissue into the contused spinal cord, even in large animals. The safety of this treatment in human remains unknown. In this translational phase 1 study, safety of peripheral nerve grafting for chronic spinal cord injuries and possible outcomes are being reported. Twelve complete motor spinal cord injury patients, who had finished their rehabilitation program, were enrolled. There were 4 thoracic and 8 cervical cases. Patients underwent sural nerve preconditioning in the calf, followed 1week later, by intramedullary transplantation of the harvested nerve fascicles. The patients were followed up for potential complications periodically, and final assessment by American Spinal Injury association [ASIA] and Spinal Cord Independence Measure [SCIM] III were reported after 2 years of follow-up. The median duration of the spinal cord injury was 31 months. At two years of follow up, out of 7 cases with ASIA Impairment Scale [AIS] A, 4 [57.1%] cases improved to AIS B and 1 [14.3%] case became AIS C. There were 1 patient with transient increased spasm, one case of transient cystitis, 3 patients with transient increased neuropathic pain and 1 case with transient episode of autonomic dysreflexia, all being managed medically. There was no case of donor site infection. The above complications were transient as they responded to temporary medical treatment. It may be deduced that after two years follow-up of patients that the procedure may be safe, however further controlled studies are needed to prove its efficacy

Comparative clinical trial between ciaglia and griggs techniques during tracheostomy performed in patients admitted to intensive care unit

Percutaneous dilatation tracheostomy [PDT] is one of the most frequent interventions in ventilator dependant ICU patients. Ciaglia and Griggs are two common PDT techniques. Few studies are available comparing these two methods, but there is no data available to compare these two techniques in Iranian population. The aim of this study was to compare Ciaglia and Griggs technique in our population in order to recognize advantages and disadvantages of each technique in order to identify the most beneficial one. This study is a comparative clinical trial conducted on 100 consecutive ICU admitted patients who needed prolonged intubation; half of them underwent PDT with Ciaglia method and other half with Griggs method. Procedural time and short term complications including bleeding, vital signs instability and technical errors were compared in both two methods. Both groups were comparable in demographic characteristics. Griggs method performed significantly faster than Ciaglia method [P=0.001]. Complications such as high grade bleeding [P=0.01] and cardiac dysrhythmias [P=0.07] were less in Ciaglia technique than Griggs. Skin incision smaller than required was reported more with Griggs method than Ciaglia [P=0.03]. We conclude that PDT with Ciaglia method is safer with less complications than the Griggs method. We suggest use of Ciaglia for less experienced operators.

[ comparison of mallampati test in supine and sitting position in traditional approach and during phonation for predicting of difficult laryngoscopy and intubation]

Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Overall, 28 [4.2%] patients had difficult laryngoscopy and 9 [1.4%] patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation. According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position

[ comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery]

Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009. In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups. The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups [P<0.05]. Except in the first and thirtieth minutes, the changes in heart rate [HR] were significantly different throughout the study between the two groups [P<0.04] and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position [P<0.04] and the use of fluid was significantly larger in the sitting group [P<0.05]. According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb

Bonfils fiberscope: intubating conditions and hemodynamic changes without neuromuscular blockade

To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs [NMBDs]. In this randomized controlled trial, 80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg[-1] was administered, followed by intravenous alfentanil 20 microg.kg[-1], lidocaine 1.0 mg.kg[-1], and propofol 2 mg.kg[-1] sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. Clinically acceptable intubating condition scores did not differ significantly between the groups [P=0.465]. Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group [P<0.001]. Although mean arterial blood pressure increased immediately after intubation in the Macintosh group [P=0.022], its post-intubation values were significantly less than baseline in both groups [P<0.001]. Intubation time took much longer in the Bonfils group [40 s] than the Macintosh group [11 s], P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time

Comparison of the effects of anesthesia with isoflurane and total intravenous anesthesia on the intensity of body temperature reduction during anesthesia and incidence of postoperative chills

This study compared the effects of anesthesia with isoflurane and TIVA [total intravenous anesthesia] on the intensity of body temperature reduction during anesthesia and incidence of chills after lumbar disc surgery. The study was done as a single blinded randomized clinical trial. From 60 patients who underwent lumbar disc surgery, 30 subjects were placed in isoflurane group and 30 in the TIVA group. Maintenance of anesthesia was done with isoflurane [MAC=0.8-1] and N2O 50% in isoflurane group and in TIVA group with propofol at the dose of 100-150 mg/kg body weight/minute and remifentanil at the dose of 2.0 mg/kg body weight/minute. Chills rate was recorded in recovery room. Changes in body temperature, body surface temperature, systolic blood pressure, diastolic blood pressure and heart rate showed no significant difference between the two groups before and after induction and at different times during the operation [P<0.05]. Chill rate was not significantly different between the two groups [P<0.05]. It seems that TIVA [remifentanil at the dose of 2.0 micro g/kg body weight/minute in combination with propofol at the dose of 100-150 micro g/kg body weight/minute] and 0.81 MAC isoflurane-N2O 50% can be used as a safe method of anesthesia in patients with good tolerance lumbar back disc surgery without hypothermia, chills and considerable hemodynamic changes

Preeclampsia/eclampsia: an insight into the dilemma of treatment by the anesthesiologist

A complicated and controversial subject in obstetrics i.e., toxemia of pregnancy is looked upon, both from an anesthesiological and obstetrical point of view. As pre-eclampsia and eclampsia involve immediate treatment and obstetric considerations, the choice between epidural and general anesthesia becomes necessary when cesarean section is contemplated. Apart from the pathophysiology of the vessel spasm as it is induced by preeclampsia, the therapeutic managements of fluid administration, the drugs of choice to treat hypertension as well as the technical aspects of anesthesia are reviewed

Upper lip bite test as a predictor of difficult mask ventilation: a prospective study

Oxygenation and ventilation by means of bag-mask and ambubag play a significant role in maintaining an optimal oxygen saturation of blood and hence the essence of life itself. Predicting difficulty in mask ventilation is again of paramount importance at the time of induction of anesthesia, and in emergency situations. In this study we aimed at evaluating factors that could help in predicting the difficulty of bag-mask ventilation. In a prospective study, 200 patients were allocated into two groups, 100 each. First group with a ULBT class I, and the other group with ULBT class II and III. Factors such as height, weight, gender, past history of snoring, neck circumference, Mallampati class, sternomental and thyromental distances were then evaluated in each of the patients in the two groups in order to arrive at their impact on the incidence of difficult mask ventilation. Data were analyzed using Chi-square, student t-test and Fisher's exact test depending upon the situation. A p<0.05 was considered to be statistically significant. The results revealed that negative predictive value [NPV] of ULBT class, history of snoring and neck circumference we 86%, 83%, 81%, respectively. A combination of these three predictors had an NPV of 95%. ULBT class alone was of value in predicting difficulty in mask ventilation, but a combination of the three tests significantly improved the predictive value

Pressure measurements during cardiac surgery-internal jugular vs central venous

Although central venous pressure [CVP] is a valuable guide and measurement during cardiac surgery anesthesia, there are many occasions however, when the time consumed in inserting a peripheral catheter, defeats the actual purpose. The purpose of this study was to compare central venous pressure and internal jugular veins pressure, and to see whether the jugular veins pressures were a reliable guide to central venous pressure monitoring. Simultaneous measurements of the internal jugular [both left and right side] and right atrial venous pressures were made in 70 patients undergoing cardiac surgery both at times when the chests were closed and when they were opened. After induction of anesthesia, a 16 gauge catheter was inserted into the internal jugular vein on each side of the neck, and another catheter was passed into the right atrium. Then the CVP and internal jugular veins were measured six times during anesthesia and postoperatively. A good correlation was found between pressures of right and left internal jugular veins with that of CVP both at times when the chests were closed and when they were opened. It is concluded that left and right internal jugular vein pressures are reliable guides to central venous pressures during anesthesia in cardiac surgery

Anesthetic management in a case of Klippel-Feil syndrome and literature review

Klippel-Feil syndrome is known by the classic triad of shortness of the neck, limitation of neck movements, and a low posterior hairline. There are often accompanying cervical spinal abnormalities such as kyphoscoliosis as well as urogenital and cardiac abnormalities. Presented here we have a 20 year old young man with hypoesthesia and decreased motor function in the right hand. The problem began one year back following a minor head trauma and had a progressive course involving the legs, especially the feet. Cervical magnetic resonance imaging was compatible with C3-C4 cord compression as well as blocked vertebrae. The patient was evaluated to be in Mallampati class II. Endotracheal intubation was performed employing gentle manual axial traction in both anterior and posterior operative approaches without any neurological sequela. It is recommended that in situations where fiberoptic or Bullard laryngoscopes are not available and Mallampati class is low, direct laryngoscopy associated with gentle axial traction may be a plausible substitute