Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications the most important is laryngo-tracheal injuries.
Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia.
Results: Fifty-seven patients (44 male mean age, 23.014.7 years) were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%). Head trauma was responsible for most cases of intubation (72.4%). The most common types of tracheal and laryngeal lesions were tracheal (56.9%) and subglottic (55.2%) stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001) but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS). Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%). No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS). Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS).
Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation period were greater in tracheal and subglottic lesions.
Background: The insertion of endotracheal tube is essential for most surgical operations, mechanically ventilated patient in ICU wards, During cardiopulmonary resuscitation and so for transport of patients. The aim of this study was determination of airway related distances in Iranian patients.
Methods: In a cross- sectional study during year 2007 in Imam Khomeini university Hospital a total of 75 ASA class I and II patients who were admitted to pulmonary ward evaluated for determination of incisor-vocal cord and incisor- carina distances. The nasal nare- vocal cord distance was determined too.
Results: A total of 71 patients, 45(63%) male and 26(36.6%) female were evaluated. The Incisor-vocal cord distance in males and females was 16.83±0.75mm against 15.04±1.12mm (P=0.03). The difference of nare-vocal cords and Incisor- vocal cord distances was 2-3Cm
Conclusions: There was direct association between height and tracheal length in the study patients. The tracheal length (suitable insertion depth) in our patients was different from the recommendations (23 & 21 Cm for men and women) for non- Iranian, 25.9 versus 22.6 for Iranian men and women respectively. The difference of nasal nare-vocal cord and upper incisor-vocal cord distances in our patients was 2-3 cm, the lower range of accepted or reported one. We offer to do another experience with larger study group to apply the data to Iranian population.
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MicrosoftInternetExplorer4
Background: The
insertion depth of tracheal tube differs based on sex, age, position of head
and neck, type of surgery, and anatomical consideration. The aim of this study
was to determine the airway related distances in Iranian patients with a
non-invasive, and accurate method, the computerized reconstruction of High
Resolution CT
(HRCT)
Virtual Bronchoscopy.
Methods: A total of 140 Iranian
patients who became candidate for sinus and chest tomography, were enrolled in
a cross- sectional study in Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2008. After
reconstruction of airway related distances, Incisor- Vocal cord (IVD), Vocal
cord- Carina (VCD) and
Incisor- Carinal (ICD) Distances were determined.
Results: A total of 140 patients
were evaluated, while 70(50%) were male. There was no statistically significant
difference between age groups, sex and BMI in study patients. The
measured IVD were 145.5±9.7 (males), 127.29±6.3 (females)
and 136.43±12.29mm (total).
For VCD, the
distances were 131±13.99 (males), 122.59±11.7 (females), and 127.09±13.65mm (total).
The measures for ICD in males, females, and total of patients were 277.17±16.63, 249.88±11.54, and 263.52±19.66mm
respectively.
Conclusion: The insertion depth for fixation of endotracheal tube
in Iranian adult patients is the same as that of anesthesia textbooks. There
were no statistically significant difference between our study data and
previously measured distances using invasive and less accurate methods. Virtual
bronchoscopy is a noninvasive and accurate method based on reconstruction of
computed tomographic images and the reconstructed images of tomography could be
useful in measuring and assessment of airway anatomy.
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MicrosoftInternetExplorer4
Background: Post-intubation tracheal stenosis is a
serious problem and surgical resection is the method of choice in long segment
tracheal stenosis treatment. The aim of
this study was to review the results of surgical treatment of long segment post
intubation tracheal stenosis and the role of bilateral hyoid bone cutting in
supra- hyoid release technique.
Methods: Between 2004 to 2008, 14 patients with
proximal long segment tracheal stenosis with resection of more than 40% of trachea length were
evaluated regarding surgical technique and post-operative results.
Results: The mean age of patients was 22.2±0.4 years. Etiology in
all patients were head trauma and prolonged intubation and all patients had
tracheostomy at the time of trearment. Average time between surgery and first
admission was 4.5±0.5 months. Average
length of stenosis and resected segment were 3.6±0.5 and 4.3±0.5cm respectively. Average increased length of
trachea after bilateral hyoid bone cutting was 1.1±0.3cm. Postoperative
complications occurred in one patient with wound infection, and 4 patients had
stenosis recurrence which was treated in 3 patients using multiple dilation. Quality of
life 2 years after surgery
in 71% of patients were classified
in good and excellent group. We didn't have any mortality.
Conclusion: Based on the fact that
surgery is the best method of treatment in long and multi segment tracheal
stenosis and tension in suture line is a serious problem, we recommend extended
releasing technique including bilateral hyoid cutting in surgical treatment of
these patients.
Background: Lung separation is the basis of thoracic anesthesia, which is performed by different instruments. Checking probable malpositioning of tracheal tube needs fiberoptic bronchoscopy. The aim of this study was to compare respirator suggested compliance with fiberoptic findings in detecting major tracheal tube malpositioning.
Methods: A total of 256 patients undergoing thoracic surgery with double-lumen tracheal tube insertion in Imam Khomeini Hospital, Tehran, Iran, during 2010-11 were divided into three groups (n=86). We used left-sided double-lumen tube (DLT) for left or right-sided surgeries (groups 1 and 2), and right-sided DLT for left-sided surgeries (group 3). The position of the tubes was evaluated and compared using bag compliance versus fiberoptic bronchoscopy.
Results: The mean age of the study population was 44.7±13.4 (16-73) years, while 155 (59.9%) were male. The sensitivity, specificity, positive and negative predictive values, and the accuracy of bag compliance test for left-sided DLT in supine position were 40% (95% CI: 20-60%), 99% (95% CI: 96-99%), 84% (95% CI: 54-94%) 92% (95% CI: 88-95%) and 92% (95% CI: 87-95%), respectively. The above-mentioned variables for lateral decubitus position respectively were 27%, 98%, 76%, 89%, and 88%. Malpositioning was more prevalent in right-sided DLTs (P=0.02).
Conclusion: Based on the results of this study, and the high specificity, positive predictive value, and accuracy of bag compliance test, its use is encouraged as an alternative to fiberoptic bronchoscopy for checking DLT position, specially, in emergent surgeries or when fiberoptic bronchoscopy is unreachable due to lack of expertise or personnel.
Background: Nowadays, nanomaterials are used in daily life extensively. One of the most common of these materials is nano titanium dioxide (TiO2) which is used to purify the air and also sunscreens, shampoos and other hygienic products. Although nano-particles are useful, can also have potential hazards. The aim of this study is to evaluate the effects of TiO2 on lung tissue in rabbits.
Methods: We divided 18 male rabbits into three groups randomly. The first group recei-ved 50 µl of TiO2 with dose of 50 mg/kg by intratracheal instillation. The second group received 50 µl of TiO2 with dose of 100 mg/kg and the third group received 50 µl of nor-mal saline by the same route. Chest X-rays were taken from all rabbits before injection and on days of 10, 17 and 24 after injection. Twenty four days after injection, rabbits anesthetized and histopathological assays, blood samples and biochemical factors were evaluated.
Results: Radiographic assays showed a progressive pulmonary fibrosis in rabbits recei-ved TiO2 rather than the control group and this lesion developed to maximum at 24th day of the experiment. We also showed pulmonary emphysema and inflammation in histo-pathologycal study of groups treated with TiO2. Moreover, we observed a significant increase in the amount of liver enzymes, white blood cells and hematocrit in TiO2 treat-ed groups compared to control group (P≤0.05). There were no significant differences between plasma levels of creatinine in different groups (P>0.05).
Conclusion: Results showed that nanotitanium dioxide particles can lead to pulmonary fibrosis and inflammation and also increasing liver enzymes and inflammatory cells.
Results: Mean age, sex and weight were not significantly different between the two groups and were comparable. The mean duration of stay in recovery was higher in the case group than in the control group. The mean postoperative sore throat was significantly higher in the control group. Moreover, the mean incidence of delirium in the postoperative phase was higher in the case group. Besides, the rate of nurse satisfaction in the control group was higher than the case group. The incidence of bronchospasm, laryngospasm, and postoperative nausea and vomiting was not significantly different between the two groups.
Conclusion: Intratracheal ketamine can reduce postoperative sore throat and the need for postoperative analgesic medications. Postoperative complications were not increased with this strategy, but the length of recovery stay increased in these patients. |
Results: One hundred patients were enrolled in this study. The median age of patients was 55.4±10.8 years (12-75 yr). First-try insertion success was 98% in the guidewire group and 74% in the control group (P=0.001). First, the try insertion failure percentage was 2% in the guidewire group and 26% in the control group (P=0.001). The time needed for NG tube insertion was significantly lower in the guidewire group, as 38.3±4.8 seconds in the guidewire group vs 61.5±6.2 seconds in the control group (P=0.001). A significantly lower number of complications like twisting, sticking, hemorrhage and traumatization were seen in the guidewire group. Remarkably, that no case of absolute insertion failure was seen in the guidewire group but there were three such cases in the control group.
Conclusion: The incidence of a successful first-try NG tube insertion has been significantly improved by the use of Steel Wire rope against the conventional neck flexing technique, in unconscious intubated patients, and causes less traumatization and complications as well. |
Both lidocaine and ketamine effectively reduce hemodynamic changes during endotracheal intubation, but lidocaine potentially has greater benefits in terms of improving oxygenation and reducing heart rate variability, as well as reducing recovery time during anesthesia. No significant difference was detected between the two studied groups regarding diastolic blood pressure, systolic blood pressure, heart rate, mean arterial pressure changes, recovery stay, extubation time, and laryngoscopy grade. Conclusion: Based on the findings in this study, lidocaine offered more desirable hemodynamic stability than ketamine and resulted in fewer hemodynamic disturbances. Also, in the case of persistent hypertension or tachycardia. This was not observed in any of the groups. |
Results: The findings of our study showed that the average amount of sore throat 24 hours after surgery in the LMA and ETI groups was 2.13 and 2.2, respectively, and these values 14 days later were 1.17 and 1.07, respectively. The average level of hoarseness in the 24 hours after surgery in LMA and ETI groups was 2.66 and 3.13, respectively. The statistical comparison of the severity of side effects between the two groups showed that in the LMA method, the amount of sore throat and hoarseness is less than the ETI method, although this reduction does not have a significant difference.
Conclusion: The results of this study showed that the rate of complications of sore throat and hoarseness in the laryngeal mask group is reduced compared to the endotracheal intubation group, although this difference is not significant. |
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