[ effects of the menstrual cycle on the hemodynamic response to laryngoscopy and trachea! Intubation]

Background: Hormonal, physical, and psychological fluctuations occur during the menstrual cycle. Previous studies have shown that hormonal changes during the normal menstrual cycle affect anesthesia and analgesia

The limitation of previous studies are that they did not measure luteal hormone [LH], Follicular stimulating hormone [FSH], estradiol, progesterone and cortisol levels. Our goal was to find more suitable conditions in menstrual periods for intubation of patient

Methods-. American Society of Anesthesiologists physical status I patients, 16 to 40 years, undergoing general anesthesia for elective surgery were enrolled in this study and conducted at Imam Khomeini Medical Center in 2013

The patients were assigned into two groups according to the phase of their menstrual cycle. Levels of sex hormones and hemodynamic variables were recorded for all the patients and statistical analysis performed

Results: In 77 patients, 38 women were in the luteal phase [49.4%] and 39 women were in the follicular phase [50.6%]

All tracheal intubations were successful on the first attempt with a mean duration of 2558+/-5.07 and 25.84+/-5.32 seconds in groups F and L, respectively [P=0.489]

None of the patients were excluded for long tracheal intubation time. Systolic blood pressure after intubation in the follicular phase [138.4+/-20 mm Hg] was significantly higher vs. the luteal phase [127.7+/-18 mm Hg] [P<0.01], as well as the women's heart rate after intubation in the luteal phase [90.7+/-12 beats per minute], was significantly higher than in the follicular phase [85.3+/-11 beats per minute] [P=0.05]

Heart rate was higher in the luteal group than the follicular group thus the women's heart rate after intubation in the luteal phase [90.7+/-12 bpm] was significantly greater than the follicular phase [85.3+/-11 bpm] [P=0.05]

Conclusion: Reviewing and comparing the results show that elective surgeries are better to be done in the luteal phase because of stable hemodynamic conditions

[ 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

[ prospective study comparing ligasure and open hemorrhoidectomy]

Hemorrhoid is among the most common anorectal diseases and patients with high-grade disease conditions need surgical treatment. Many surgical procedures are available to treat the disease. The aim of this study was to compare the operative time and outcomes, [post-operative pain and complications] of Ligasure hemorrhoidectomy with those of the open conventional method. This randomized single-blind clinical trial included 57 patients [28 in Ligasure and 29 in the open group]. The primary variable was the operative time for the excision of a single hemorrhoidal packet. The other variables were post-operative pain measured by morphine doses administered to control pain, scores of visual analogue scale [VAS] used to measure pain severity, pain during home stay measured by doses of oral ibuprofen and the mean daily VAS scores, early complications including bleeding and urinary retention, longer-term complications and time to return to work. The demographic data were comparatively the same between the two groups. The average time to excise a single packet of hemorrhoid was significantly shorter in the Ligasure group [8.91 min vs. 17.35 min, P<0.001]. Post-operative pain measurements [morphine doses and VAS scores] were lower in the Ligasure group, but the differences were not statistically significant [P=0.055 and 0.077, respectively]. Complications of the two procedures were also comparable. Neither of the groups returned to work in a shorter time. Ligasure hemorrhoidectomy seems to be a safe method and it can reduce the operative time significantly. It may also have a modest effect on post-operative pain

Succinylcholine-induced myalgia in obstetric patients scheduled for caesarean section-declofenac versus placebo patches-

Succinylcholine- induced myalgia is a minor but frequent complication. Its incidence and severity is different according to the studied population. The aim of this study was evaluation of the diclofenac patch effect on postoperative succinylcholine- related myalgia in cesarean section. The study was a prospective randomized double blind, placebo-controlled trial. One hundred twenty six participants undergoing elective cesarean section [previous cesarean section] were randomized in two equal groups [63 participants in each]: the diclofenac patch [containing 180 mg of diclofenac epolamine salt] and the placebo. Surgery was performed following rapid sequence induction of general anesthesia. All patients were paralyzed for intubation by succinylcholine [1.5 mg/kg]. Data on baseline characteristics, fasciculation, postoperative myalgia [at 12, 24 and 48 hours after operation], the need to analgesic agents, and adverse effects of diclofenac patch were collected. The basic characteristics were comparable between the two groups. The severity of fasciculation did not significantly vary between two groups. In diclofenac group, the incidences of myalgia at 12, 24 and 48 hours after operation were 23.8%, 19.1%, and 12.7% respectively versus incidences of 52.4%, 47.6%, and 44.4% respectively in placebo group. The incidence and severity of myalgia were significantly lower in patients receiving diclofenac through three evaluation periods [all p values less than 0.01]. No participants left the study because of the complications. Diclofenac patch is effective and safe in the prevention of postoperative succinylcholine induced myalgia after cesarean section