A rapidly enlarging neck mass: the role of the sitting position in fiberoptic bronchoscopy for difficult intubation.

Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances.

Duration of spinal anesthesia with bupivacaine in chronic opium abusers undergoing lower extremity orthopedic surgery.

BACKGROUND: It has been demonstrated that chronic opium abusers have lower thresholds for pain. Spinal anesthesia is a common procedure in anesthesia, which is performed through administration of drugs (usually local anesthetics) in the intrathecal space, to produce temporary pain relief. The aim of this study was to determine whether chronic opium abuse could have any possible effect on the duration of spinal block by bupivacaine. METHODS: In a case-control study, 50 opium abusers and 50 nonabusers undergoing lower extremity orthopedic operations were selected from the patients admitted in Taleghani Hospital in Tehran for elective surgery. The study parameters were assimilated as much as possible, including the method of anesthesia. RESULTS: No statistically significant difference was noted between the two groups regarding the age, sex, and duration of surgery; while, the duration of sensory block was much shorter in the opium abusers (86.6+/-15.7 minutes) compared with the nonabusers (162+/-22.1 minutes) (P<0.0001). CONCLUSION: The study suggests a shortened duration of spinal block with bupivacaine in opium abusers. The results can propose a number of possible mechanisms including cross-tolerance mechanisms between local anesthetics and opioid compounds at the level of spinal neurons. Further molecular studies at the level of spine are suggested.

Do the Concentration and Volume of Local Anesthetics Affect the Onset and Success of Infraclavicular Anesthesia?

BACKGROUND: Although local anesthesia is a suitable method for upper limb surgeries, there is debate regarding the effects of appropriate dosing. OBJECTIVES: In the current study, we investigated the effects of the concentration and volume of a local anesthetic on the beginning and quality of anesthesia during upper limb orthopedic surgeries. PATIENTS AND METHODS: This double-blinded, randomized, clinical trial was conducted on 60 patients aged between 18 and 85 years candidated for upper limb orthopedic operations. The patients were equally and randomly distributed into two groups (n = 30). Under ultrasound imaging guidance, the first group received 7 mL of 2% lidocaine and the second group 10 mL of 1.3% lidocaine into the brachial plexus cords. The onset of block and the level of sensory and motor block were documented for each nerve territory. RESULTS: The onset of sensory and motor block was significantly shorter in the 1.3% lidocaine group than in the 2% lidocaine group (P ≤ 0.05). The success rate of sensory and motor block was not different. The quality (completeness) of sensory block for the musculocutaneous nerve and that of motor block for the radial nerve were significantly better in the 1.3% lidocaine group than in the 2% lidocaine group. CONCLUSIONS: The volume of the injected anesthetic accelerated the onset of sensory and motor block without affecting the rate of success in our patients.

Effect of cryoanalgesia on post-thoracotomy pain.

We prepared this study to determine the effect of cryoanalgesia on post-thoracotomy pain. In this double-blinded randomized clinical trial, 60 patients who underwent thoracotomy were divided into two groups (control and cryoanalgesia). Visual Analogue Scale (VAS, 0-10) was used for the measurement of severity of post-thoracotomy pain. It was classified into three categories: 0-1 (mild), 2-3 (moderate), and 4-10 (severe). Pethidine (0.5-1 mg/kg) was administered in case of need for both groups. Patients were visited at the hospital a week later, and were contacted by phone at the first, second, and third months post-operatively. Intensity of pain in the control group was higher than the cryoanalgesia group in all visits the follow-up period. On the second day, the frequencies of severe pain (4-10) were 33.3% and 0 in the control and cryoanalgesia groups, respectively. The mild pain on the seventh day was 13.3% and 83.3% in the control and cryoanalgesia groups, respectively (P < 0.01). Pethidine consumption was 151.6 ± 27 mg in the control group and 87.5 ±48 mg in the cryoanalgesia group on the first day post-operation (P < 0.001). Cryoanalgesia is a useful technique with not serious side effects in order to alleviate post-thoracotomy pain and reduce the need for opiate consumption.

The role of paravertebral block in decreasing postoperative pain in elective breast surgeries.

BACKGROUND: Regional anesthesia is an alternative to general anesthesia in selected surgical settings. Paravertebral block as a regional anesthesia technique was compared with general anesthesia for elective breast surgeries regarding postoperative pain. MATERIAL/METHODS: Sixty patients scheduled for breast surgery were randomized to two groups of 30 patients each: general anesthesia (control group) and paravertebral block (study group). Postoperative pain, the primary outcome variable of the study, was assessed by a numeric rating scale at 1, 3, and 6 hours during the postoperative period. Total amount of morphine and hospital stay were also recorded. Student's t-test and ANOVA were used to compare results. A p value less than 0.05 was considered statistically significant. RESULTS: The paravertebral group was found to have better postoperative pain relief (p=0.0000), reduced need for morphine (p=0.0000), and a shorter hospital stay (p=0.0000) compared with the general anesthesia group. CONCLUSIONS: The study suggests paravertebral block as a suitable alternative to general anesthesia in selected breast surgical patients regarding postoperative pain reduction.