Tehran University Medical Journal

Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving.

Materials and Methods: In our study CPT was compared with endotracheal tube (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, Iaryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia.

Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (P<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (P<0.05).

Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 CmH2O.

Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

Background: Epidural injection of the drugs such as opioids has rather been a successful method in controlling post operative pain.

Materials and Methods: In a clinical trial study, 50 Female patients, in a range of 20-40 years old and ASA class I, who were scheduled for gynecologic operation were investigated. They were randomly divided in two groups. Before induction of general anesthesia, an epidural catheter was placed for each patient. Sixty minutes after the end of operation, a 15-ml solution containing 50-microgram clonidine was injected through the epidural catheter in the first group. In the second group, a similar volume solution containing 50- microgram fentanyl was injected. The catheter was removed after all the patients were followed for 4 hours and their pain was assessed by VAS (Visual Analogue Scale) method.

Results: Our findings revealed that the clonidine group had more intense pain however they had fewer complications than the opioid group.

Conclusion: We concluded that although clonidine might act as an analgesic drug, but epidural injection of a single dose of 50 microgram of the drug could not be effective enough for postoperative analgesia.