Airway changes in pregnant women before and after delivery.

AIM: High incidence of difficult or failed intubation in obstetric patients is still a major problem to challenge anaesthesiologists. Although the probability of difficult intubation is impossible to predict preoperatively, some simple, practical bedside tests may help. This study used five simple tests in an attempt to better evaluate airway changes in pregnant women before and after delivery. MATERIALS AND METHODS: Pregnant women from the ASA I-II group who were planning to undergo a normal vaginal delivery were evaluated as to the possibility of experiencing difficult intubation. Mallampati scores, thyromental distance, sternomental distance, mouth opening, and the degree of neck extension were recorded just before delivery and 24 h after delivery. RESULTS: Significant differences were seen in the pre- and post-delivery measurements (p < 0.05). Before delivery, Mallampati scores I, II, III, IV were 35, 24, 2, 0, respectively, and 24 h after delivery became 46, 15, 0, 0, respectively. CONCLUSIONS: Within 24 h after delivery, Mallampati scores changed in one-third (n 21, 36.6%) of the patients. Significant differences between the two measurements of thyromental and sternomental distances, mouth opening, and the degree of neck extension confirm difficult airway management in pregnant women.

The effects of Valsalva maneuver on venipuncture pain in children: comparison to EMLA(®) (lidocaine-prilocaine cream).

BACKGROUND: Venipuncture is one of the most painful events for children in hospitals. Valsalva maneuver (VM) decreases the incidence and severity of pain on venipuncture pain in adults. This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic (EMLA(®)) cream for venipuncture pain in children. METHOD: In this study, we evaluated the effect of VM on venipuncture pain in children. 60 patients scheduled for elective surgery were randomly divided into three groups. In Group V, children were punctured during VM. In Group E, EMLA(®) 5 % cream and in Group C (control group) vaseline was applied on the non-dominant hand 60 min before the venipuncture. Patients made a pain assessment using visual analog score (VAS). Mean arterial pressure (MAP), heart rate (HR), and SpO2 measurements were obtained during the venous cannulation. RESULTS: Respectively, the VAS was 2.15 ± 1.95 for Group V and 1.00 ± 0.79 for Group E and 2.55 ± 2.74 for Group C. A significant reduction in the severity of pain was observed in Group E. The difference being statistically significant (p < 0.05), the VAS of Group V was higher than Group E but lower than Group C (p > 0.05). CONCLUSIONS: On the basis of data from this study, the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA(®).