Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 483 487 EN Farhad Etezadi Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Leila Saeedinia Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Pejman Pourfakhr Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Khajavi Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Aylar Ahangari Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Shariat Moharari Department of Anesthesiology and critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2018 05 22 Background: Considering that a simple yet valid airway predictor is basically preferred to a multivariable test with the same level of validity, we designed a study to compare the validity indexes of the TMHT, as a single variable test, with that of Wilson, Arne, and Naguib tests. Methods: 270 consecutive ASA physical statues I and II patients aged ≥16 years, candidate to receive general anesthesia for elective surgeries, were enrolled in the study. All patients preoperatively were evaluated using four airway predictor tests including Wilson, Arne, Naguib, and Thyromental height test (TMHT). Cut-off points to predict a difficult laryngoscopy were extracted from previous published studies for each test. Based on each predictor, all patients were classified into either easy or difficult. Based on Cormack-lehane scoring system, as the gold standard, all patients during laryngoscopy were categorized into two groups of “easy, grades I, II” and “difficult, grades III, IV”. Finally, validity indexes for each test were calculated and compared to one another. Results: The incidence of difficult laryngoscopy according to Cormack-lehane grading was 17.4% (47/270). The predicted rates of difficult laryngoscopy were 47 (17.4%), 2 (0.7%), 10 (3.7%) and 61 (22.6%) for TMHT, Wilson, Arne and Naguib respectively. Based on Chi-square test, the TMHT as well as the Naguib could significantly predict difficult laryngoscopy. However, the highest rate of sensitivity, positive predictive value, negative predictive value, and accuracy belonged to TMHT. Conclusion: Both TMHT and Naguib are acceptable predictors of difficult laryngoscopy while the TMHT is a more accurate predictor of difficult laryngoscopy than the other multivariable models. https://aacc.tums.ac.ir/index.php/aacc/article/view/188 https://aacc.tums.ac.ir/index.php/aacc/article/download/188/329

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 488 491 EN Omid Aghadavoudi Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Behzad Nazemroayasedeh Assistant Professor, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran Mahboobe Shirali School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2018 05 26 2018 06 13 Background: Face mask ventilation has a distinct place in anesthesiology. One of the difficulties (obstacles, problems) with a mask, is laryngeal airway obstruction caused by the backward displacement of the tongue and soft tissue which is further exacerbated by obesity (body mass index over 25). Considering the fact that ventilation using a nasal mask appears to cause fewer problems especially in obese patients, we decided to compare the quality of ventilation after the induction of general anesthesia using ventilation through an anatomical face mask and anatomical nasal mask in patients with a body mass index (BMI) over 25 in this study. Methods: The study was a clinical trial, conducted on 70 patients between the ages of 18 and 70 years, with a BMI over 25, who were candidates for elective orthopedic surgery under general anesthesia at the Alzahra Hospital operating room. After evaluation of the inclusion criteria, the subjects were selected. Once placed on the operating table, the patients were administered 100% oxygen using a face mask held at proximity to the face for 3 minutes, after which anesthesia induction medication were administered to all patients. Subsequently, the patients were randomly divided into 2 groups. In the first group, ventilation was undertaken using the standard mask ventilation with 100 % oxygen for 3 minutes. In the second group, ventilation was performed through an anatomical nasal mask. The mean expiratory volume, mean SpO2, mean end tidal CO2 (Et CO2) and mean airway pressure were measured, recorded and compared in both groups. Results: From the ventilation parameters, maximum airway pressure during the 2nd minute after initiation of mask ventilation was significantly higher in the face mask group compared to the nasal mask group (4.6 +/- 1.6 and 12.5 +/- 1.7 respectively, p< 0.001) and the SpO2 at this time was higher in the nasal mask group compared to the face mask group (97.6 +/- 1.7 and 95.3 +/- 3 respectively, p< 0.001). Other parameters related to ventilation did not show any significant difference. Conclusion: According to the findings in this study, it can be concluded that ventilation with a nasal mask is more efficient than a face mask in patients with a BMI> 25 and is followed by a reduced amount of risk and complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/189 https://aacc.tums.ac.ir/index.php/aacc/article/download/189/330

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 492 496 EN Mehran Rezvani Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran Babak Alikiaii Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran Pooya Kiani Medical School, Isfahan University of Medical Sciences, Isfahan, Iran 2018 04 28 2018 05 13 Background: Daily use of Chlorhexidine mouthwash following endotracheal intubation is done routinely in intensive care units (ICU). Matrika (Chamomile extract) has shown antibiotic activities, and several articles report it has similar preventive effect as Chlorhexidine on ventilator associated pneumonia, and also on oral cavity hygiene. Our study aimed to compare rate of VAP occurrence in two groups of intubated patients receiving Chlorhexidine and Matrika in Alzahra hospital’s ICU. Methods: In this trial 90 ICU patients who were intubated endotracheally, were randomly divided into two groups who will receive one of Chlorhexidine (group A) or Matrika (group B) mouthwash every 8 hours. Occurrence of VAP was determined in the following 5 days after intubation, using the standard VAP diagnosis criterion. Results: 8 of 45 (17%) patients experienced VAP in the first five days after intubation in the Chlorhexidine group, and, 9 of 45 (20%) patients in the Matrika group experienced the same condition. VAP rate was not significantly lower in the Chlorhexidine group (p value= 0.73). Conclusion: The results show that VAP occurs in Chlorhexidine and Matrika group approximately at a similar rate. Our findings recommend further studies on Matrika as an alternative to Chlorhexidine. https://aacc.tums.ac.ir/index.php/aacc/article/view/184 https://aacc.tums.ac.ir/index.php/aacc/article/download/184/332

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 497 500 EN Hamidreza Shetabi Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran Amir Shafa Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran Mohamadmehdi Zare Department of Anesthesia, Al-Zahra Medical Center, Isfahan, Iran 2018 04 11 2018 05 12 Background: The combination of sedative and analgesic drugs has a favorable effect on pain management and sedation during painful procedures in pediatrics. Therefore, our aim was to compare the effect of sedation and analgesia of ketamine-sufentanil and ketamine-midazolam in painful procedures in children with blood malignancies. Methods: This double-blind, clinical trial was performed on 82 children with malignancy who had indication of painful diagnostic intervention; patients were randomly divided into two groups of ketamine-sufentanil (KS) and ketamine -midazolam (KM). In KS group, sufentanil 0.5mcg/ kg and ketamine 1mg/ kg and in the KM group, ketamine 1mg/ kg, and midazolam 0.1mg/ kg bolus were prescribed. In either group, hemodynamic indicators of sedation, side effects, duration of effectiveness were recorded. Data were analyzed using SPSS 20. Results: Sedation based on Ramsay sedation score was not significantly different between the two groups (p= 0.39). The average recovery time in the midazolam-ketamine group was higher (p-value= 0.076). Conclusion: The combination of ketamine-sufentanil and ketamine-midazolam was effective in sedation and analgesia in bone marrow aspiration and lumber puncture; side effects were however, lower in ketamine-midazolam group. https://aacc.tums.ac.ir/index.php/aacc/article/view/179 https://aacc.tums.ac.ir/index.php/aacc/article/download/179/333

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 501 504 EN Babak Alikiaii Assistant Professor Anesthesiology, Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran. Faezeh Khodabandeh School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Masoumeh Ghane Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. 2018 01 03 2018 05 27 Background: Selenium (Se), mainly through its incorporation into selenoproteins, plays an important role in in ammation and immunity. Evidence has emerged regarding roles for individual selenoproteins in regulating in ammation and immunity: The aim of the study was to evaluate of the effect of selenium administration on rapid shallow breathing index (RSBI) in ill patients. Methods: In this single blinded clinical trial study, 105 patients under mechanical ventilation were randomly divided into three groups, a received 1mg of Selenium, group B received 0/5 mg of selenium and group C received 2cc normal saline daily. Patients at the time of breathing spontaneously, and when receiving pressure support ventilation 8 and 5 cmH2o, and at the time of extubation were evaluated for Rapid Shallow Breathing Index and then compared between the groups. Results: There were no significant differences in the three groups in terms of distribution of age, sex, and cause of hospitalization and the mean of RSBI index at breathing spontaneously and when ventilator setting were reached to pressure support ventilation 8 cmH2o, however the difference was significant between the three groups from the pressure support ventilation 5 cmH2o until the extubation time. Conclusion: The results of the study showed a positive effect of selenium high dose (1mg) on the reduction of extubation time and RSBI, but due to the limitations of our study, further studies are recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/175 https://aacc.tums.ac.ir/index.php/aacc/article/download/175/334

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 505 508 EN Zahid Hussain Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Rahimi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Thaer Atabi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2017 08 03 2018 06 02 Stability of the airway is a fundamental element of acute care medical practice. While airway management is conceptually straightforward, the wide variety of clinical circumstances, patients, and tools can make the task of ensuring a stable, open airway under all clinical conditions extremely challenging. Care providers involved in airway management must therefore not only be technically skilled but also sufficiently flexible to adjust changing the conditions, risk/benefit balances, and goals. One aspect of airway management that requires particular attention is the airway that is difficult to secure or keep patent. For clinical or anatomic reasons, both bag mask ventilation and tracheal intubation in such a patient population may be difficult without specialized expertise or tools. Because adequate oxygen delivery through a patent airway is critical to life support and resuscitative efforts, the risks of inadequate airway management are high, adding to the challenge. One significant advance in difficult airway management is the development of algorithms to standardize the technical approach to successful endotracheal intubation in a patient with a difficult airway. Such algorithms are relatively recent (The American Society of Anesthesiologists difficult airway algorithm updated in 2015), and integrate clinical experience, evidence, and technical expertise into a stepwise approach to anticipated and unanticipated airway challenges. https://aacc.tums.ac.ir/index.php/aacc/article/view/143 https://aacc.tums.ac.ir/index.php/aacc/article/download/143/335

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 3 2018 06 30 509 512 EN Sara Payami Emergency Department of Imam Reza Hospital, Kermanshah, Iran. 2018 03 06 2018 04 09 Fentanyl is a strong opioid and it is widely used for pain relief. In this review, we evaluated the efficacy of fentanyl in pain management in the emergency department. For this review, we searched scientific search engines including google, google scholar, Cochrane library, Medline, and PubMed and collected original articles, including randomized controlled trials, comparative studies, cohort and case series related to fentanyl and its administration in the emergency department from 2010 to 2016. In this review, 8 articles and 44493 patients were evaluated. Four articles were retrospective and 4 articles were prospective of these four articles were randomized placebo controlled and double blinded. Among eight articles, six of them compared the efficacy and adverse events of fentanyl with other opioids. We found fentanyl significantly decreases pain intensity in patient with acute pain in the emergency department. Moreover, it is more effecti system by enhancing inhibitory and reducing excitatory neurotransmission. The major neurotransmitters, which are thought to play a role in anesthesia, are glutamate, serotonin, norepinephrine, dopamine, acetylcholine, and GABA. The knowledge of neurotransmitters and their receptors’ function is very important in perception of anesthesia in routines practice. The purpose of this review article is to give an overview of the different types of neurotransmitters in CNS, classification of neurotransmitters and mechanism of action of various types of neurotransmitters and their receptors. https://aacc.tums.ac.ir/index.php/aacc/article/view/126 https://aacc.tums.ac.ir/index.php/aacc/article/download/126/275

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 2 2017 04 23 334 336 EN Aboo Abdul Rahiman Ramzi Department of Anesthesiology, Kasturba Medical College, Manipal, Karnataka, India Malavica Kulkarni Department of Anesthesiology, Kasturba Medical College, Manipal, Karnataka, India 2017 03 02 2017 04 17 Intubating a patient with panfacial fractures is always a challenge to the anesthesiologist as both the anesthesiologist and the surgeon are essentially competing for the same space. The anesthetic management of a 19-year-old boy who presented with multiple maxillofacial injuries, pneumocephalus, and cerebral edema sustained during a road traffic accident has been described. He was posted for open reduction and internal fixation of the fractures, frontal sinus fracture elevation and basal repair which required access to scalp, mouth and the nose. As all the conventional modalities to secure airway seemed unsuitable, orotracheal intubation was done via submental route. Following intravenous induction the patient was intubated with a cuffed oral flexometallic tracheal tube. This was then modified to the submental route through a submental incision. The surgery proceeded uneventfully and the patient was extubated a day later in the ICU. He made a satisfactory recovery and the submental scar healed without complication or scarring. We briefly review the technique of submental intubation in adults which serves as an excellent alternative to tracheostomy. https://aacc.tums.ac.ir/index.php/aacc/article/view/112 https://aacc.tums.ac.ir/index.php/aacc/article/download/112/283

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 2 2017 02 19 103 103 EN Ali Shahriari Department of Anesthesiology and Critical Care, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran