Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 58 62 Kadirehally Nalini Department of Anaesthesiology, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India. Anupama Gopal Department of Anaesthesiology, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India. Sadasivan Iyer Department of Anaesthesiology, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India. Nagaraj Mungasuvalli Department of Anaesthesiology, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India. 2020 12 29 2021 01 25 Background: Although several types of laryngoscope blades of different sizes and shapes are present, Miller (MIL) blade is the most preferable blade among paediatric population. However, there is dearth in the literature regarding the use of these blades in the adult population. This study aimed to compare the laryngoscopic view and ease of intubation using MIL and Macintosh (MAC) blade among adults. Methods: A total of 172 patients who were >18 years age, with ASA grades I and II, undergoing elective surgeries with general anaesthesia were included. Patients were distributed in two groups (MAC/MIL and MIL/MAC), where laryngoscopy was first done with MAC blade, followed by MIL blade in the MAC/MIL group and vice-versa in the MIL/MAC group. Grading of laryngoscopic views, number of attempts, ease of intubation and use of backward, upward, rightward pressure (BURP) were noted. R v 3.6.0 was used for statistical analysis and P values≤0.05 were considered as statistically significant. Results: MIL blade showed better laryngoscopic view compared to MAC blade (32.6% vs. 15.1%; P< 0.002). BURP application helped improve the laryngoscopic views with MAC blade. Intubation with MIL blade was easier with regards to ease of intubation and number of attempts 19 (P value<0.05). Conclusion: Glottis visualization is better with the MIL blade as compared to the MAC blade. Therefore, the MIL blade might be helpful in securing the airway among adult patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/324

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 87 95 Zahid Hussain Khan Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Fadhaa Al-fadhili Department of Anesthesiology and Intensive Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2021 02 13 Background: Sedation has a beneficial impact on patient’s tolerance to the endoscopic procedure. Conscious sedation is the anesthetic techniques of choice for endoscopic procedure. Conscious sedation for endoscopic procedure could be with one drug or a combination of drugs. There have been broad variations in sedation procedure between different countries, and even between different units within the same country. All drugs which depress the central nervous system have the ability to produce respiratory or cardiovascular complications. Endoscopy has a recorded mortality of 1 in 2000 and a morbidity rate of 1 in 200. These sedation techniques have their effects on patients. The main goal of this study is to describe the effects of conscious sedation on patients' outcome for endoscopic procedure. Methods: The design for this study was a review of literature in the medical databases of PubMed, Scopus, Embase, Cochrane and hand search journals from conferences in English. All studies that evaluated the use of CS for endoscopic procedure were included. Results: The results showed that the pain level of the patient (visual analogue scale) was substantially positive when conscious sedation was used. Conscious sedation, however is a lightly sedated patient who is conscious, amnesic, co-operative on demand and free from fear and anxiety. It is often used during endoscopic procedures to minimize discomfort and relax the patients. The intraoperative hypotension has also been extreme in some medications relative to others. Conclusion: The study revealed that CS is reliable and well tolerated anesthetic technique for endoscopic procedures, and is a better option for elective endoscopic procedures CS benefits for endoscopisit and patient outcome is superior to GA such as; short recovery times, less analgesia requirement, comfortable for patient which in turn, leads to faster induction, faster endoscopy, faster discharge, and faster turnaround time. Patients are usually willing to go home after a couple of hours. Rapid recovery is a benefit not only for patients, but also for hospital and day surgery departments. This increases the overall performance of the endoscopy unit. https://aacc.tums.ac.ir/index.php/aacc/article/view/338

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 103 105 Nkan Michael Paterne Mobio Department of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. Olama Enyegue epartment of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. Coulibaly Theodore Department of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. Abhe Bekoin epartment of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. Njomo Wilfried Department of Critical Care , University hospital Center of Angre, University of Abidjan Medical Sciences, Abidjan, Ivory Cost. Ouattara Abdoulaye Department of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. Tetchi Denis Department of Critical Care, University hospital Center of Cocody, University of Abidjan Medical Sciences, Abidjan , Ivory Cost. 2020 11 25 2021 01 02 Ischemic strokes have varying etiologies and multiple locations. Some locations are much rarer than others and just as difficult to diagnose. This is the case of the ischemic bi-thalamic stroke, attributable to the Percheron artery occlusion that we report in a 33-year-old woman with a history of taking estrogen-progestin. The lesion diagnosis could only be possible thanks to the performance of brain MRI, thus testifying to the diagnostic difficulties observed. Etiological research has shown dyslipidemia. The length of stay was 88 days. At the end of intensive care, the patient was conscious, not deficient and did not present memory disorders. https://aacc.tums.ac.ir/index.php/aacc/article/view/319

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 115 116 Masoud Tarbiat Clinical Research Development Unit of Farshchian Hospital, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Mohammad Hossein Bakhshaei Clinical Research Development Unit of Farshchian Hospital, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 01 10 2021 01 25 No Abstracts   No Abstracts   No Abstracts https://aacc.tums.ac.ir/index.php/aacc/article/view/327

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 63 68 Mohammad Hossein Bakhshaei Department of Anaesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Shahram Homayounfar Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Behzad Roozbahani Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Melika Malekpour Department of Anaesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Maryam Farhadian Department of Biostatics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 01 02 2021 01 18 Background: Myocardial infarction is considered to be the most common symptom of cardiovascular diseases. Regarding the limitation of access to Morphine sulphate as a special drug and complications followed, this study aims to compare the treatment effects of intravenous acetaminophen and morphine sulphate on the reduction of pain in MI patients and to improve the cardiac performance. Methods: The present study is a triple-blind randomized control trial in which 70 patients were divided into two separated groups and the pain was measured using Visual Analogue Scale. All analysis was done using SPSS Software at the significance level of 5 percent. Results: 42 patients were male (60%) of whom 20 were in case group and 22 in control group. There were no significant difference between intervention group and control group in terms of VAS score (p = 0.520). The index change of VAS over the time was statistically significant (p=0.001) in intervention and control groups (intra group change). The results of variance analysis with repeated measurements showed that mean differences of Ejection Fraction over time in both groups of intervention and control was not statistically significant (p=0.28). Conclusion: The findings of this study demonstrate that although Acetaminophen does not have an improved effect on pain control and cardiac performance than Morphine sulphate, it can be still an appropriate alternative for Morphine sulfate due to the lack of destructive effects and its availability. https://aacc.tums.ac.ir/index.php/aacc/article/view/325

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 96 102 EN Dheeraj Kapoor Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Pradeep Atter Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Amanat Kang Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Manpreet Singh Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. 2020 12 28 2021 01 16 The coronavirus disease 2019 (COVID -19) pandemic that has engulfed the world has put an immense strain on the existing healthcare systems. The rapid, insidious and often dramatic deterioration of the respiratory function of an infected patient, has led to an increased need for effective and rapid airway control. However, such airway control techniques put the healthcare workers to an increased risk of exposure to the virus. Therefore, interventions aimed at minimising such risks, while preventing the complications inherent to securing an airway are imperative to the management of a COVID-19 patient in acute respiratory failure (ARF). Personal protective equipment (PPE) is sine qua non to keep the intubator safe, however some barrier equipment’s have been employed with limited success. There are varied schools of thought on whether to intubate early or late, and the use of non-invasive methods for management of respiratory failure, however, most consensus statements reinforce the need for rapid sequence induction (RSI), which provides ideal intubating environment for an experienced intubator. Techniques, which decrease the number of required personnel as well as time, to secure the airway and increase the distance of the intubating physician from the patient, are recommended. Routine use of, videolaryngoscope, if available, is recommended. While intubation with an endotracheal tube is the gold standard airway technique, second generation supraglottic airway devices (SAD) are increasingly being recommended, particularly in cases of failure to intubate or in an unanticipated difficult airway. Awake intubation techniques are contraindicated due to increased risk of cough and subsequent aerosolization; however, few modifications were innovated when if it all required. In this review, we summarise the existing data with respect to the modifications and guidelines in severe COVID-19 patients who requires endotracheal intubation for invasive mechanical ventilatory support. https://aacc.tums.ac.ir/index.php/aacc/article/view/323

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 106 110 Mohammad Zeraati Department of Critical Care, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. Hojjat Torkmandi Department of Operating Room, Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran. Zahra Ghahramani Department of Radiology, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. Mohammad Abdi Department of Emergency and Critical Care, Zanjan University of Medical Sciences, Zanjan, Iran. & Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran. 2021 01 12 2021 01 18 Cerebral venous sinus thrombosis is a rare and infrequent condition in pregnant women. Hemorrhagic infarction can occur in early stages of cerebral venous thrombosis. This article reports a rare case of cerebral transverse sinus thrombosis presenting in pregnant women with unidentified secondary hypoparathyroidism, highlighting the difficulties in identifying this rare case from common diagnosis like preeclampsia. According to the differential diagnoses for this case, it can be a good exercise to strengthen clinical reasoning in students and medical teachers to improve the quality of clinical education. https://aacc.tums.ac.ir/index.php/aacc/article/view/328

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 117 119 Bhavna Gupta Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, India. Ajit Kumar Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, India. Vijay Adabala Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, India. 2021 01 19 2021 02 13   No Abstracts   No Abstracts   No Abstracts https://aacc.tums.ac.ir/index.php/aacc/article/view/330

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 69 74 Amirhossein Orandi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammad Mireskandari Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Shahram Samadi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Negar Eftekhar Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Mohammadi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Aminizadeh Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2021 01 05 2021 01 18 Background: Establishing and maintaining a secure airway using a cuffed endotracheal tube (ETT) is an important step in management of intubated patients. Out-of-range ETT cuff pressure is associated with various complications which could lengthen the hospital stay. The aim of this cross-sectional study was to evaluate ETT cuff pressure in intubated patients in the emergency department (ED), operating rooms (ORs), and Intensive Care Units (ICUs) of Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: The ETT cuff pressure of 153 patients was measured using a standard manometer. Demographic data and duration of intubation were recorded. The data were analysed using the SPSS software version 16. P values less than 0.05 were considered significant. Results: The ETT cuff pressure exceeded the recommended range in 125 out of 153 patients (81.7%). The mean cuff pressure (67.29 cmH2O) was significantly higher than the recommended range (p<0.001). The cuff pressure was higher in patients in the ORs compared to patients in the ED and ICU (OR=8.46, p<0.001). Conclusion: Intubation in the OR can be considered a risk factor for higher-than-normal ETT cuff pressure and subsequent complications. The ETT cuff pressure monitoring by means of a manometer is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/326

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 111 114 Houman Teymourian Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamidreza Azizi Faresani Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Arash Tafrishinejad Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamideh Ariannia Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sogol Asgari Department of Anaesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2021 01 19 2021 02 13 Achondroplasia is the result of a mutation in the gene encoding the type 3 receptor for a fibroblast growth factor. This abnormality results in malformation endochondral ossification. Achondroplasia is characterized by disproportionately short stature, lumbar lordosis, large head, midface hypoplasia, short hands, and normal cognitive development. Our report is about a 28-year-old patient with achondroplasia who underwent surgery for correction of kyphosis due to spinal canal stenosis. In this present case we study management anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/331

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 120 122 Debendra Kumar  Tripathy Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India. Sameer Sharma Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India. Mohammed Shafiq Shajahan Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India. Madhur Uniyal Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, India. 2021 01 16 2021 01 25 No Abstracts   No Abstracts   No Abstracts https://aacc.tums.ac.ir/index.php/aacc/article/view/329

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 75 81 Neha Panse Department of Anaesthesiology, SKNMCGH ,Pune,Maharashtra, India Kavita Adate Department of Anaesthesiology, SKNMCGH ,Pune,Maharashtra, India. Sachin Panchal Department of Anaesthesiology, SKNMCGH ,Pune,Maharashtra, India 2021 01 26 2021 03 13 Background: Pregabalin provides good postoperative analgesia in nociceptive stimuli. Various studies show that preemptive oral pregabalin reduces acute postoperative pain. We conducted a study to evaluate the efficacy of two different doses of pregabalin and its effect on onset and duration of spinal anesthesia and postoperative pain. Methods: In prospective, double-blind and randomized study, 60 patients posted for vaginal hysterectomy under spinal anesthesia were randomly allocated to two groups recieving cap. Pregabalin 75 mg (group 1) and cap pregabalin 150 mg (group 2) orally, 90 min prior to surgery. Onset and duration of motor and sensory blockade were observed. Postoperative pain was assessed by VAS for 24 hrs. Injection paracetamol 1 gm. was given intravenously as rescue analgesic. Time of first rescue analgesic and total dose of rescue analgesics was noted. Results: Group 2 patients had better postoperative analgesia in terms of prolonged sensory and motor blockade which correlated well with the time of first request for rescue analgesia (504±123.2 min) as compared to group 1 patients (304.9±37.6 min). Also the total dose of rescue analgesic (paracetamol) was significantly less with 150mg pregabalin (p = 0.0001). Conclusion: Pregabalin 150 mg prolongs the duration of spinal anesthesia and has better analgesic profile without significant side effects. Thus we conclude that 150 mg pregabalin given preemptively optimizes spinal anesthesia well in patients for vaginal hysterectomy. https://aacc.tums.ac.ir/index.php/aacc/article/view/334

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 2 2021 05 31 82 86 Mahshid Nikooseresht Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Pouran Hajian Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Mahshid Shafiian School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Abbas Moradi Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 02 02 2021 02 13 Background: Nausea, vomiting, and postoperative pain are common and undesirable complications after anesthesia and tonsillectomy surgery especially in children. This study was designed to evaluate the effects of high and normal dose lactated Ringer infusion on nausea, vomiting, and pain intensity after pediatric tonsillectomy. Methods: A total number of 100 tonsillectomy surgery candidates at the age range of 1-12 years were selected for this randomized clinical trial. The subjects were randomly assigned to the intervention or control group after signing of their informed consent. The intervention group received high-dose fluid therapy (lactated Ringer 30cc/kg) and the control group received the normal dose (lactated Ringer 10cc/kg) during the perioperative period. The amounts of consumed adjuvant antiemetic drugs, incidence of nausea and vomiting, and pain severity were evaluated in both groups in the recovery room, at 12 and 24 hours after tonsillectomy. Results: The incidence of nausea and vomiting and the use of rescue antiemetic drugs in the intervention group compared to the control group, were always lower in the recovery room, 12 and 24 hours after surgery; but only the difference in incidence of nausea and vomiting at 24 hours after surgery was statistically significant (P = 0.027). Conclusion: High-dose fluid therapy significantly reduces the late incidence (24 hours after surgery) of post- tonsillectomy nausea and vomiting in children https://aacc.tums.ac.ir/index.php/aacc/article/view/335