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.

Efficacy of plasmapheresis in neutropenic patients suffering from cytokine storm because of severe COVID-19 infection.

Background: With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication. However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. Methods: This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. Results: CRP(P<0.001), D-dimer (P<0.001), ferritin (P=0.039), and hemoglobin (P=0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P<0.001). However, plasmapheresis did not affect the length of hospital stay (P=0.076), which could have significantly increased survival rates (P<0.001). Conclusion: Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.

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.

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.

A randomized controlled trial for the effectiveness of intraarticular versus intravenous midazolam on pain after knee arthroscopy.

BACKGROUND: This double-blinded, randomized clinical trial was designed to evaluate the comparison of intravenous versus intraarticular (IA) administration of midazolam on postoperative pain after knee arthroscopy. MATERIALS AND METHODS: In this study, 75 patients randomized in three groups to receive 75 mc/kg IA injection of midazolam and 10 ml intravenous injection of isotonic saline (Group I), 75 mc/kg intravenous injection of midazolam and 10 cc IA injection of isotonic saline (Group II) or IA and intravenous injection of isotonic saline (Group III) at the end of knee arthroscopy. Pain scores, time until the first request for analgesics, cumulative analgesic consumption, satisfaction, sedation, and complications as studied outcomes were assessed. Patients were observed for 24-h. RESULTS: IA administration of midazolam significantly reduced pain scores in the early postoperative period compared with intravenous injection. Mean of time to first analgesic requirement in Group III (33.6 min) was significantly lower than Group II (288.8 min) and Group I (427.5 min). Cumulative analgesic consumption was increased in Groups II (35.5 mg), and III (70 mg) compared with Group I (16 mg), (P < 0.0001). Complications significantly occurred in 3 of 25 patients in Group I in contrast to 20 of 25 patients in Group III (P < 0.0001). At 2-, 4- and 8-h after arthroscopy pain score significantly decreased in Group I than other groups (P < 0.0001). Patients in Group I were significantly satisfy than other groups (P < 0.0001). CONCLUSION: Results show the greater analgesic effect after IA administration of midazolam than after intravenous injection and hence, IA administration may be is the method of choice for pain relief after knee arthroscopy.

Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial.

BACKGROUND: Either general or regional anesthesia can be used for lumbar disk surgery. The common anesthetic technique is general anesthesia (GA). The aim of this study was to compare the intra and postoperative outcomes of spinal anesthesia (SA) with GA in these patients. METHODS: Seventy-two patients were enrolled in the study. They were randomized into two groups with 37 patients in GA Group and 35 ones in SA Group. The heart rate (HR), mean arterial pressure (MAP), blood loss, surgeons satisfaction with the operating conditions, the severity of postoperative pain based on visual analogue scale (VAS) and analgesic use were recorded. RESULTS: The mean blood loss was significantly less in the SA Group compared to GA Group (p < 0.05). Intraoperative maximum blood pressure and heart rate changes were significantly less in SA Group (p < 0.05). The surgeons satisfaction was significantly more in the SA Group (p < 0.05). The number of patients who used postoperative analgesic as well as postoperative mean VAS was significantly less in SA Group in comparison with GA group (p < 0.05 for both). CONCLUSIONS: Our study showed that SA was superior to GA in providing postoperative analgesia and decreasing blood loss while maintained better perioperative hemodynamic stability without increasing adverse side effects.

Low dose intravenous midazolam for prevention of PONV, in lower abdominal surgery--preoperative vs intraoperative administration.

BACKGROUND: The aim of the present study was to compare anti-emetic efficacy of low dose midazolam premedication (35 microg/kg) 15 minutes before induction of anesthesia with midazolam (35 microg/kg) administered intravenously 30 min before conclusion of surgery, in patients undergoing lower abdominal surgery under general anesthesia. METHODS: Sixty patients were assigned to one of three equal groups: Group MP (n = 20), which received intravenous midazolam 35 microg/kg in a volume of 3 ml 15 minutes before induction of anesthesia and 3 ml normal saline 30 minutes before extubation. Group MI (n = 20), which received 3 ml normal saline 15 minutes before induction of anesthesia and intravenous midazolam 35 microg/kg in a volume of 3 ml 30 minutes before extubation. Group NS (n = 20), which received 3 ml normal saline 15 minutes before induction of anesthesia plus 3 ml normal saline 30 minutes before extubation. Assessments of the occurrence of postoperative nausea and vomiting (PONV) were made at regular intervals for the first 24 h. RESULTS: Incidence of PONV was significantly lower in Group MI compared with Group NS and Group MP at 6, 12, 18, and 24 hours after operation (P < 0.05). The time for the first episode of PONV was significantly higher in Group MI compared with Group NS and Group MP (P < 0.05). CONCLUSION: Our results indicated that midazolam 35 microg/kg (2 mg) given intravenously 30 minutes before the end of surgery was more effective in decreasing the incidence of PONV than midazolam premedication 35 microg/kg.

Pre-incisional infiltration of tonsils with dexamethasone dose not reduce posttonsillectomy vomiting and pain in children.

BACKGROUND AND OBJECTIVE: Recently, dexamethasone has been found to have a prophylactic effect on postoperative vomiting and pain in children undergoing tonsillectomy. However, few studies have examined the preemptive analgesic effects of dexamethasone after tonsillectomy. The aim of this study was to evaluate the effect of pre-incisional infiltration of tonsils with dexamethasone on the incidence and severity of postoperative pain and vomiting in children undergoing tonsillectomy under general anesthesia. MATERIALS AND METHODS: In a double blinded study, 62 patients were randomly allocated to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or an equivalent volume of saline at the peritonsillar region. All infiltrations were performed following the induction of general anesthesia and 5 minutes prior to the onset of surgery. Anesthetic agents, end-tidal carbon dioxide levels, and the administration of intravenous fluids were carefully regulated. Surgery was performed by one attending otolaryngologists using the same dissection and snare technique. The incidence of pain and vomiting, need for rescue antiemetics, and analgesic consumption were compared in both groups. Pain scores used included Children's Hospital Eastern Ontario Pain Scale, "faces", and a 0-10 visual analogue pain scale. RESULTS: Demographics of dexamethasone and placebo groups were similar. No statistically significant difference was found between the dexamethasone and placebo groups in pain score, nausea, vomiting, irritability, or analgesic requirement postoperatively. CONCLUSION: Preincisional infiltration of the tonsils with dexamethasone play a limited role in the recovery phase from tonsillectomy, but further prospective, randomized studies are needed to support it.

The preventative analgesic effect of preincisional peritonsillar infiltration of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy. A randomized, double-blind, placebo-controlled study.

BACKGROUND: In literature, the use of ketamine for the preventative analgesia in the management of postoperative pain is controversial. The purpose of the present study was the clinical assessment of the efficacy of preincisional peritonsillar infiltration of two doses of ketamine on postoperative pain relief compared with peritonsillar saline in children undergoing adenotonsillectomy. METHODS/MATERIALS: Seventy-five ASA physical status I and II patients, aged 3-12 years, scheduled for adenotonsillectomy were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into three groups of 25 each and received a local peritonsillar infiltration of 0.9% saline (group S), ketamine 0.5 mg x kg(-1) (group K1), or ketamine 1 mg x kg(-1) (group K2). All medications were 2 ml in volume which was applied 1 ml per tonsil 3 min prior to tonsillectomy. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale were used to evaluate pain levels and sedative conditions, respectively. RESULTS: Group S had significantly higher CHEOPS scores than group K1 and K2. Both K1 and K2 groups had comparable scores, which were not statistically significant (P > 0.05). During 24 h after surgery, 16 patients in group S and no patients in groups K1 or K2 needed analgesics (P < 0.001). CONCLUSIONS: A 0.5 or 1 mg.kg(-1) dose of ketamine given at approximately 3 min before surgery by peritonsillar infiltration provides efficient pain relief during 24 h after surgery without side-effects in children undergoing adenotonsillectomy.

M/F ratios of four different closing loops: 3D analysis using the finite element method (FEM).

BACKGROUND: It has been claimed that the opus loop is capable of delivering a constant and optimum M/F ratio without the need for gable bends. OBJECTIVE: To compare the forces, moments and moment/force (M/F) ratios of the opus loop, L-loop, T-loop and vertical helical closing loop (VHC loop) in a segmented arch with the finite element method (FEM). METHODS: The FEM was used to compare 3D models of closing loops in rectangular (0.016 x 0.022 inch) stainless steel wire. The L-, T- and VHC loops were designed with and without preactivation bends. The opus loop had no preactivation bends. The T-Loops were 10 mm in height and 10 mm in length. The horizontal and vertical forces, the moments and the M/F ratios at the alpha and beta ends were recorded at 0, 0. 1, 0.4, 0.7 and 1 mm intervals. RESULTS: The highest horizontal and vertical forces were produced by the L-loop (with and without preactivation bends) and in most cases the lowest forces were produced by the VHC loop. Loops with preactivation bends produced marked changes in the M/F ratio and loops without preactivation bends low, but relatively constant, M/F ratios over the full range of activation. Of the loops modelled without preactivation bends the opus and T-loop had the highest M/F ratios (7.20 - 7.67 mm at the anterior ends). CONCLUSION: Stainless steel opus and T-loops without preactivation bends had constant M/F ratios, but both loops failed to deliver the optimum M/F ratio of 10:1.