Comparative Evaluation of Direct Laryngoscopy Versus GlideScope for the Purpose of Laryngoscopy Management and Intubation in Candidates of Cesarean Delivery with General Anesthesia.

Background: The present study aimed at comparing the hemodynamic responses to laryngoscopy and initiation of intubation with either direct or video-assisted laryngoscopy. Materials and Methods: This double-blind clinical trial was performed on 90 pregnant women candidates for cesarean section under general anesthesia. The participants were divided into two groups. In the first group, intubation was performed using direct Macintosh laryngoscope (MCL group). The second group underwent intubation using the GlideScope video laryngoscope (GSL group). Then, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), the percentage of the saturation of peripheral oxygen (SpO2), the time-to-intubation (TTI), and the number of intubation attempts were recorded. Results: SBP, DBP, and MAP in the MCL group were significantly higher than GSL group 1, 3, and 5 min after laryngoscopy (P < 0.05). HR in the MCL group with the mean of 118.44 ± 15.53 bpm was significantly higher than that the GSL group with the mean of 110.11 ± 16.68 bpm only 3 min after laryngoscopy (P = 0.016). The TTI in the MCL group was significantly longer than that of the GSL group (12.80 ± 1.86 vs. 10.15 ± 2.61; P = 0.001). The frequency of the first intubation attempt in the GSL group with 91.1% was significantly higher than that the MCL group with 84.4% (P = 0.003). Conclusion: It seems that the GSL technique is a better choice to conduct laryngoscopy with more success in intubation and a higher stability of the patients' hemodynamic status.

A Comparative Study of the Effect of Low-Dose Epinephrine and Ketamine on Rapid-Sequence Endotracheal Intubation by the Priming Dose Method of Cisatracurium in Patients under General Anesthesia.

Background: Low-dose ephedrine and ketamine may accelerate the onset time of action of neuromuscular blocking agents. We studied the effect of ephedrine and ketamine and cisatracurium priming on endotracheal intubation conditions and the onset time of action of cisatracurium. Materials and Methods: The study was a double-blind clinical trial performed on American Society of Anesthesiologists (ASA) class 1 and 2 patients, who were candidates for general anesthesia. In total, 120 patients were entered into the study and were divided into 4 groups, E, K, E + K, and N. The first group was given 70 mcg/kg ephedrine (E group), the second group was given 0.5 ml/kg ketamine (K group), the third group was given the same amount of ketamine plus ephedrine (E + K group), and the fourth group was given the same volume of normal saline (control group); a single dose of 0.1 mg/kg cisatracurium was given, and intubating conditions were evaluated at 60 seconds after cisatracurium administration. Results: The mean Cooper score based on the response to laryngoscopy, the position of the vocal cords, and the movement of the diaphragm of patients in the control group with a mean of 2.53 ± 1.07 was significantly lower than in the three groups of E, K, and E + K with the means of 4.47. 1.17, 4.53 ± 1.14, and 7.63 ± 1.42, respectively (P value < 0.001). In the (E + K) group, it was significantly higher than in the two other drugs alone (P value < 0.001). The two groups of E and K alone were not significantly different from each other (P value = 0.997). The means of hemodynamic parameters were not significantly different in any of the groups (P value > 0.05). Conclusion: According to the results of the present study, the use of low-dose ephedrine and ketamine alone can improve intubation conditions. In addition, the combined use of these drugs not only had any Positive effect on patients' hemodynamic parameters but also greatly improved intubation conditions.

Comparative study of the effect of two different doses of remifentanil on bleeding control in lumbar fusion surgery: A randomized clinical trial.

Objectives: Spinal fusion surgery completely prevents movement or friction between the two vertebrae. Remifentanil, a selective drug agonist, suppresses and decreases the vasomotor system upon release of histamine. In this study, the efficacy of remifentanil infusion at doses of 0.1 and 0.3 µg/kg/min in the control of low blood pressure was compared. Methods: In this randomized clinical trial, 110 candidates for selective spinal fusion surgery were entered and randomized into 2 groups. The first group received 0.1 µg/kg/min and in the second group 0.3 µg/kg/min remifentanil. The systolic and diastolic blood pressure, pulse rate, SPO2, and surgeon's satisfaction were measured and compared between groups. Results: the systolic blood pressure was significantly lower in patients receiving 0.3 µg of remifentanil by the time 30, 45, 60, and 90 min during the surgeries (P < 0.05). No significant difference was observed in terms of PR (P = 0.19) and SPO2 (P = 0.41) between the two groups. We also observed significantly higher duration of surgeries (P = 0.002), duration of anesthesia (P = 0.009), significantly higher bleeding volume (P < 0.001), higher fluid intake (P = 0.01) and higher transfused blood (P = 0.01) in patients that received 0.1 µg remifentanil compared to other patients. Conclusion: Here we showed that administration of 0.3 µg/kg/min remifentanil was associated with significantly lower systolic blood pressure during the surgeries. On the other hand, patients that received 0.1 µg/kg/min remifentanil had significantly higher duration of surgeries, duration of anesthesia, significantly higher bleeding volume, higher fluid intake, and also higher transfused blood.

The effect of intranasal dexmedetomidine on hemodynamic disturbances caused by laryngoscopy and endotracheal intubation.

BACKGROUND: Induced stimulation while endotracheal intubating affects hemodynamic status. The present study compares the hemodynamic changes caused by endotracheal intubating after administering two doses of intranasal Dexmedetomidine. METHODS: In an experimental (before-after) trial, 88 patients undergoing general anesthesia enrolled in the study. The Iranian Register of Clinical Trial (IRCT) code of the study was IRCT20160307026950N15 (https://en.irct.ir/trial/39269). Patients were allocated to two intervention groups and one control group by random. Intranasal Dexmedetomidine and Normal saline 0.9% were administrated 30 minutes before induction of anesthesia. (1 µg/kg Dexmedetomidine in group 1, 2 µg/kg Dexmedetomidine in group 2 and 1 mg Normal saline 0.9% in group 3). Vital signs and hemodynamic parameters were measured and recorded in minutes 1, 3, 5, and 10th after induction. Data analysis was done by ANOVA and Chi-square tests. RESULTS: Heart rate, systolic and diastolic blood pressure, and mean arterial pressure were reduced in patients receiving dexmedetomidine (P<0.05), but there were no significant changes in the control group. In arterial oxygenation (P>0.05), there was no significant difference between the three groups in the arterial blood oxygen amount. CONCLUSION: Premedication of intranasal dexmedetomidine influences the hemodynamic changes due to anesthesia induction. The dose of 2 µg/kg is better than one µg/kg in improving the hemodynamic state following intubation.

Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy.

Background: Despite all of the benefits provided by laparoscopic cholecystectomy, such as rapid recovery and shorter hospital stay for patients, the incidence of postoperative nausea and vomiting (PONV) and postoperative pain (POP) still remains high. Objectives: This study was designed to compare the effects of intraperitoneal (IP) and intravenous (IV) dexamethasone on the reduction of PONV and POP. Methods: This prospective, randomized, double-blind clinical trial was conducted on a study population of 86 adult patients who were scheduled for laparoscopic cholecystectomy with the American Society of Anesthesiologists class I-II. The patients were randomized into three groups, namely IP dexamethasone (n = 29), IV dexamethasone (n = 29), and control (n = 28) groups. The patients were followed for clinical outcomes, including PONV, POP, and consumption of antiemetics, and their hemodynamic status during the first 24 hours after the surgery. Results: In the first 24 hours after the operation, no significant differences were observed in nausea (P = 0.41) and vomiting (P = 0.38) between the IP and IV dexamethasone groups. However, there was a lower severity of nausea in the IP group (P = 0.001). Additionally, the visual analog scale score representing POP was significantly reduced in the IP group (P = 0.02). No significant differences in the hemodynamic status were observed after the operation between all the three groups. Conclusions: The administration of 8 mg IP dexamethasone was associated with significantly reduced pain and severity of nausea, but not PONV, after laparoscopic cholecystectomy.

Evaluation of Plasma Fibrinogen Levels before and after Coronary Artery Bypass Graft Surgery and Its Association with the Need for Blood Products.

Background: The present study investigated the plasma level of fibrinogen before and after removing the pump in coronary artery bypass graft (CABG) surgery and its relationship with the need for blood products. Materials and Methods: The present study was performed on 60 patients who were candidates for CABG surgery. The fibrinogen level of these patients was assessed and recorded before surgery and immediately after removing the pump. In addition, their hemoglobin level was recorded before the operation and 2 h after. In addition, the number and type of blood products transfusion were recorded intraoperatively and postoperatively and also at the intensive care unit. Results: Patients' fibrinogen level after removing the pump with the mean of 130.53 ± 122.01 mg/dl decreased significantly compared to before surgery with the mean of mg/dl 224.95 ± 132.88 mg/dl (P < 0.001). In addition, the prognostic value of fibrinogen after removing the pump in determining the postoperative need of blood transfusion showed that the cut-off value of fibrinogen was < 196 mg/dl with a sensitivity of 16.82% and specificity of 80%, but it was not statistically significant (area under the curve [95% confidence interval]: 0.519 [0.350-0.689]; P = 0.825). Conclusion: According to the results of the present study, due to significant changes in fibrinogen levels after removing the pump compared to preoperation, it seems that this factor can play an important role in prognosis of the need to postoperative blood transfusion, although the prognostic value and the critical point mentioned in our study was not significant and it is required to do further studies.

Comparison of airway assessment tests for prediction of difficult intubation in obese patients: importance of thyromental height and upper lip bite test.

BACKGROUND: Prediction of difficult intubation (DI) has remained challenging for anesthesiologists and validity of airway assessment tests has not been fully investigated. This study aims to compare predictive values of these tests for prediction of DI in obese patients. METHODS: One hundred ninety-six patients with Body Mass Index (BMI) ≥30 kg/m2 were included in this prospective study. Variables including intubation Difficulty Scale (IDS), thyromental height (TMH), hyomental distance (HMD) in extent and neutral neck position, HMD ratio (HMDR), sternomental distance (SMD), thyromental distance (TMD), ratio of height to TMD (RHTMD), width of mouth opening (MO), mandibular length (ML), Cormack-lehane (C-L) grade, upper lip bite test (ULBT), history of snoring, and obstructive sleep apnea were collected. Multiple logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine independent predictors of DI (defined as IDS≥5) and their cut off points. RESULTS: DI and difficult laryngoscopy (defined as C-L grade ≥3) were observed in 23% and 24.5% of the study population, respectively. Multiple logistic regression identified TMH (Odds ratio (OR):0.28, 95% confidence interval (CI):0.14-0.58, P=0.001), BMI (OR:1.18, 95% CI: 1.11-1.26, P<0.001), HMDR (OR:0.45, 95% CI:0.36-0.56, P<0.001) and ULBT (OR: 3.91, 95% CI: 2.14-7.14, P<0.001) as independent predictors of DI. Sensitivity of TMH<4.8 cm, BMI>34.9 kg/m2, HMDR<1.4 and ULBT class ≥2 were determined as 75.1%, 73.3%,62.3% and 93.3% respectively. CONCLUSIONS: TMH and ULBT had the highest sensitivity for prediction of DI in obese patients in this study and it is recommended to be considered as part of airway assessment in this patient population.

The effect of caudal epidural block on the surgical complications of hypospadias repair in children aged 6 to 35 months: A randomized controlled trial.

BACKGROUND: Caudal epidural block (CEB) in hypospadias surgery has the benefit of reducing post-operative pain and possibly intra-operative bleeding. Some studies, however, have suggested that this technique may increase the rate of post-operative complications. Considering the uncertainty about the effect of CEB on surgical complications of hypospadias repair, the current study was performed. OBJECTIVE: The aim of this randomized clinical trial was to compare the complication rates between patients who receive CEB after hypospadias surgery and those who did not. STUDY DESIGN: This double-blind randomized controlled trial was conducted on boys aged 6-35 months, who underwent hypospadias repair surgery in a university hospital from March 2018 to March 2019. Sixty patients were randomly divided into two groups (group A: 31 and group B: 29). In group B, CEB was performed, using 0.5 mg/kg of 0.125% bupivacaine (Marcaine). Postoperative complications including fistula, meatal stenosis, dehiscence, and occurrence of bleeding were assessed during six months after surgery. RESULTS: The patients were assessed for possible complications at 24 h, one week, one, three and six months after surgery. No remarkable differences were observed between the patients in the two groups in terms of the frequency of dehiscence, fistula, and meatal stenosis (P > 0.05). Moreover, the difference in complication rates between the patients with proximal and distal hypospadias did not reach statistical significance (P = 0.549). DISCUSSION: Assessment of complications showed no significant difference between the two study groups in terms of dehiscence, fistula, and meatal stenosis (Clavien type III). In addition, complication rate was not significantly different according to severity of hypospadias between the two groups. Our study had limitations such as short follow up and small sample size, which resulted in insignificant difference in complication rate between proximal and distal hypospadias. These limitations request large studies with long term follow up. CONCLUSION: The current study showed that the use of caudal block anesthesia in comparison with general anesthesia did not increase surgical complications, which approved CEB protocol as a safe method in hypospadias repair.

A Comparative Study of Valsalva Maneuver, Lidocaine, and Valsalva Maneuvers with Administration of Lidocaine to Reduce the Pain Associated with Administration of Etomidate During General Anesthesia.

OBJECTIVES: The purpose of this study is a comparison of Valsalva, lidocaine, and Valsalva with administration of lidocaine to reduce the pain associated with administration of etomidate. METHODS: The present study is a clinical trial study. The number of samples in each group was 30 and a total of 90 people were selected. This study was a clinical trial and the subjects were randomly divided into three groups: Group 1: Valsalva, 2: Lidocaine, 3: Valsalva and Lidocaine. Pain due to etomidate was rated on a VAS from 1 (painless) to 3 (worst imaginable pain) and their information was recorded. The collected information was entered into SPSS 22 and analyzed with appropriate statistical tests. RESULTS: A total of 90 subjects participated in the present study and were divided into 3 groups: Valsalva, lidocaine, and Valsalva with lidocaine. No significant difference was observed between demographic variables in the study groups. There was a significant relationship between severity of pain in the three groups. According to the results, the highest pain intensity was in the Valsalva group and the lowest pain intensity was in the Valsalva with lidocaine group. CONCLUSIONS: Valsalva with lidocaine reduces the severity of pain caused by etomidate to a greater extent than other groups.

Comparison Prophylactic Effects of Gargling Different Doses of Ketamine on Attenuating Postoperative Sore Throat: A Single-Blind Randomized Controlled Trial.

CONTEXT: Postoperative sore throat (POST) is a common annoying problem following endotracheal (ET) intubation. AIMS: Comparing the impact of low and high doses of ketamine gargle on lowering POST incidence and severity. SETTINGS AND DESIGN: 96 patients selected for septoplasty surgery under general anesthesia were investigated through a single-blind randomized controlled trial. METHODS: This study was performed on three equal groups. Group K and G gargled 50 and 100 mg ketamine, respectively, solved in normal saline and group C gargled pure normal saline for 30 s at 5 min before tracheal intubation. POST severity measured immediately after the entrance to the postanesthetic care unit (PACU) and then 2 h, 4 h, 8 h, and 24 h after operation. STATISTICAL ANALYSIS USED: Collected data were analyzed by the Chi-square test, Mann-Whitney test, Kruskal-Wallis test, one-way analysis of variance (ANOVA) and Friedman test using SPSS version 20. RESULTS: POST incidence and severity in group C were significantly higher than both K and G groups at all times. Although significant differences between low and high doses of ketamine were acknowledged at 8 h post-operation, 100 mg ketamine could attenuate POST severity further than 50 mg at all times. CONCLUSIONS: It seems that 100 mg outperformed 50 mg ketamine without rising complications and dissatisfaction for subjects. So, it gives us a powerful reason to suggest gargling 100 mg ketamine for lessening POST incidence and severity.

Comparison of hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in electroconvulsive therapy.

BACKGROUND: Electroconvulsive therapy (ECT) is nowadays used commonly as one the most effective treatment methods in psychiatric disorders. In patients undergoing ECT, succinylcholine is usually used. In addition, cisatracurium is occasionally used on a case report basis globally. In this study, we compared the hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in ECT. MATERIALS AND METHODS: The current crossover clinical trial was performed on 45 patients who were candidates for ECT between 2017 and 2018. The patients were given succinylcholine or cisatracurium randomly on two separate occasions of ECT. The independent t-test and Chi square Test were used to compare the data. RESULTS: Comparison of mean systolic blood pressure (P = 0.14), diastolic blood pressure (P = 0.33), and mean arterial pressure (P = 0.23) did not show any significant difference between the two groups. The induced seizure duration (P = 0.002), return of spontaneous respiratory from seizure ending (P = 0.001), and apnea duration (P = 0.01) were significantly higher in the cisatracurium group compared to the succinylcholine group. However, the frequency of tachycardia in cisatracurium group was lower than the succinylcholine group (P < 0.001). In addition, the serum potassium level had a significant difference (P < 0.001) between the two groups. CONCLUSION: Using cisatracurium can be an alternative to succinylcholine during ECT since it causes less elevation in serum potassium and creates a longer duration of induced seizure, more rapid re emergence of spontaneous breathing at the end of seizure (P = 0.001), and a lower prevalence of tachycardia compared to succinylcholine (P < 0.001).

How to Predict Difficult Tracheal Intubation: The Application of Acromio-axillo-suprasternal Notch Index.

BACKGROUND: The incidence of difficult laryngoscopy or tracheal intubation is high, which needs a method to predict the difficulty of tracheal intubation to decrease the rate of complications. Therefore, the aim of this study was to evaluate acromio-axillo-suprasternal notch index (AASI) method for predicting difficult tracheal intubation and difficult laryngoscopy. MATERIALS AND METHODS: This cross-sectional and diagnostic value study was performed on 108 patients who had indication for endotracheal intubation in the emergency department. Before endotracheal intubation, AASI was evaluated in all patients. The sensitivity, specificity, and total accuracy for predicting the power of AASI for the difficulty of tracheal intubation were measured. RESULTS: Based on Cormack and Lehane grading system, 54 patients had easy endotracheal intubation (33.3% Grade I and 66.6% Grade II) and 52 patients had difficult endotracheal intubation (57.7% Grade III and 32.7% Grade IV). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AASI in cutoff point 0.515 for predicting difficulty of endotracheal intubation with 0.857 area under the receiver operating characteristic curve were 84.6%, 77.7%, 78.5%, 84%, and 81.13%, respectively. CONCLUSIONS: Our results showed that predicting difficulty of endotracheal intubation by AASI is accurate and with high sensitivity and specificity values, therefore, training this method to emergency physicians should be considered in our country or other countries. Further studies are required to confirm our findings.

Anaesthetic Management of a Known Case of Werner Syndrome by Peripheral Nerve Block in the Orthopaedic Surgery of Forearm.

Werner syndrome (WS) is a rare hereditary disease, characterised by the clinical signs and symptoms of premature ageing. Patients with WS usually have difficult airway due to anatomic malformation of the oral cavity. General anaesthesia with endotracheal intubation poses a high risk for these patients. On the other hand, the risk associated with the peripheral nerve block is minimal. Here we report the successful management of a known case of WS by using a peripheral nerve block (axillary brachial plexus block) without any significant complications. The patient was a 39-year-old man, a known case of WS, admitted to the hospital with chief complaint of non-healing ulcers on his wrist and elbow due to the compression effect of the abnormal ulna bone on the overlying soft tissue. To the best of our knowledge, this is the first case report of using peripheral nerve block in the anaesthesia of a patient with WS.

Comparing the prophylactic effects of oral gabapentin, pregabalin, and celecoxib on postoperative pain management in orthopedic surgery of the lower extremity: A double-blind randomized controlled trial.

BACKGROUND: Lower extremity pain after orthopedic surgery is so frequent that has led to many treatment modalities. This study aims to compare the prophylactic effects of oral gabapentin, pregabalin, and celecoxib on reducing postsurgical pain of the lower extremity orthopedic surgery. MATERIALS AND METHODS: In a double-blind randomized controlled trial, 120 patients were randomly divided into four groups using block design randomization. 1 h before spinal anesthesia, the studied groups received 300 mg oral gabapentin; 75 mg oral pregabalin; 200 mg oral celecoxib; and starch as placebo. The severity of postoperative pain (using visual analog scale), mean arterial pressure, heart rate, opioid consumption dose, and drug side effects were recorded for six times (each 60 min up to two times and then every 6 h for the next four times). Chi-square, one-way analysis of variance (ANOVA), and ANOVA repeated measure tests were used for statistical analysis. RESULTS: Significant reduction of pain severity was observed only at the first time measurement between pregabalin and placebo groups (P: 0.014). Patients in the pregabalin group required lower dose of opioid compared to placebo group during admission in surgical ward. There were no significant differences concerning pain reduction, opioid administration, and side effects between pregabalin, gabapentin, and celecoxib groups. CONCLUSION: Taking 75 mg oral pregabalin before lower extremity orthopedic surgery can attenuate postoperative pain, especially during the 1st h postoperation as well as less opioid consumption and much more patients' satisfaction.

The Predicting Ability of Serum Phosphorus to Assess the Duration of Mechanical Ventilation in Critically Ill Patients.

BACKGROUND: No previous study exists to evaluate serum phosphorus (Ph) level as a predictor of the need to mechanical ventilation (MV). This study was designed to determine the predictive ability of admission serum Ph level on MV in patients admitted in Intensive Care Unit (ICU). MATERIALS AND METHODS: This prospective study was conducted on 100 patients (>16 years old), admitted to our ICU over 1-year. Patients were classified into two groups according to the days of the need to MV. Group A: Patients who required equal or <5 days MV, and Group B: Patients who required more than 5 days of MV. We measured total serum Ph concentrations at the times of ICU admission, connecting to the ventilator and weaning from the ventilator. RESULTS: There were significant differences between serum Ph concentration on admission to ICU (Group A: 3.39 ± 0.39 mg/dl, Group B: 2.89 ± 0.31 mg/dl, P < 0.001), at the time of connecting to ventilator (Group A: 2.49 ± 0.38 mg/dl, Group B: 2.25 ± 0.26 mg/dl, P = 0.004) and weaning from ventilator (Group A: 3.42 ± 0.33 mg/dl, Group B: 2.98 ± 0.34 mg/dl, P < 0.001) between two groups. Duration of ICU stay in Group A was 6.08 ± 1.48 days and in Group B was 15.35 ± 6.45, this difference was significant (P < 0.001). We found the best cut-off point of 3.07 for serum Ph concentration to predict the longer duration of MV. CONCLUSION: According to the results of our study, hypophosphatemia may increase the need to MV. Therefore, monitoring serum Ph level is a good prognostic factor to predict the need to ventilation.

The evaluation of effects two different doses of hydrocortisone on the intensity of perioperative shivering in elective surgery under spinal anesthesia: A double-blind randomized controlled trial study.

BACKGROUND: Post- and intra-operative shivering is one of the most complications of spinal anesthesia so recommend a suitable drug with at least complications for prevention and control of postoperative shivering. This current study aimed to compare the preventive effect of hydrocortisone on intra- and post-operative shivering in patients undergoing surgery with spinal anesthesia. MATERIALS AND METHODS: In a clinical trial study, ninety patients who candidate for surgery with spinal anesthesia were selected and randomly divided into three groups. The first and second groups were received 1 mg/kg and 2 mg/kg hydrocortisone, respectively, and the third group was received normal saline, and postoperative shivering was compared between the three groups. RESULTS: The investigation of the incidence of inter- and post-operative shivering in patients in the three groups revealed that within the study period, 31 patients suffered from shivering among which 9, 5, and 17 cases were in 1 mg/kg hydrocortisone group, 2 mg/kg hydrocortisone group, and placebo group, respectively, and according to the Chi-square test, the difference among the three groups was significant (P = 0.004). CONCLUSION: According to the obtained results, the overall conclusion of the study is that using hydrocortisone at least with the dose of 1 mg/kg as a preventive drug reduced the incidence of intra- and post-operative shivering with spinal anesthesia.

The effects of propofol, ketamine and combination of them in prevention of coughing and laryngospasm in patients awakening from general anesthesia: A randomized, placebo-controlled, double blind clinical trial.

BACKGROUND: Coughing and laryngospasm are undesirable outcomes occurring during emergence from general anesthesia. We compared the effect of small doses of propofol, ketamine and a combination of them on the occurrence and severity of coughing and laryngospasm in patients awakening from general anesthesia. MATERIALS AND METHODS: 160 patients who were scheduled to undergo operations under general anesthesia were randomly assigned to one of the following groups, 40 in each group: propofol group (0.25 mg/kg intravenous (IV) propofol), ketamine group (0.25 mg/kg IV ketamine), combination group (0.25 mg/kg IV propofol, and 0.25 mg/kg IV ketamine) and control (0.1 ml/kg IV saline). Drugs were administered before extubation at previously defined time. Presence and severity of coughing and laryngospasm were recorded within twominutes after extubation. RESULTS: The presence of coughing in the combination group (27.5%) was less than that in other groups; also it was less frequent in the propofol group (57.5%) than the control (82.5%) (all P < 0.05). But the incidence did not differ between the propofol and the ketamine (70%) group; nor did it differ between the ketamine and control groups (P = 0.356 and P = 0.121, respectively). The cases with severe coughing (grade 3) in the combination group (none) were significantly less than in the propofol (four) and the control groups (seven) (P = 0.040 and P = 0.006 respectively). There was no significant difference between the groups in frequency of laryngospasm. CONCLUSION: Administration of propofol or combination of propofol and ketamine decreases the incidence of post extubation coughing. This combination can also decrease severe cases.

The correlation between anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation.

BACKGROUND: Cardiovascular hemodynamic changes after laryngoscopy and endotracheal intubations can cause serious complications. This study was carried out to evaluate the correlation between the anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation (EI). MATERIALS AND METHODS: This descriptive-analytical pilot study was carried out in 2012, in the Kashani Hospital, Isfahan, Iran. After obtaining written informed consent from 130 patients who fulfilled the inclusion criteria, they were enrolled in the study. The recorded data included were, age, weight, height, neck circumference (NC), waist-to-hip ratio (W/H ratio) and body mass index (BMI). The heart rate (HR), systolic blood pressure (SAP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded at baseline (before injection of the anesthetic drugs), just before laryngoscopy, and one, three, five, and ten minutes after EI. RESULTS: The best cut-off points for BMI, NC, and W/H ratio, for prediction of significant cardiovascular changes after EI were, 26.56 kg/m(2), 38 cm, and 0.82, respectively. There was a significant correlation between BMI and HR changes in the first and fifth minutes and also in MAP in the third and fifth minutes after EI (P < 0.05). Moreover, there was a significant correlation between NC and MAP in the fifth minute (P < 0.05). The W/H ratio was significantly related to the DBP in the tenth minute and MAP in the fifth and tenth minutes (P < 0.05). CONCLUSIONS: Based on the results of this study, among the anthropometric indices, the BMI, NC, and W/H ratio were significantly correlated with cardiovascular changes after laryngoscopy and tracheal intubation.