Annals of Anesthesiology and Critical Care

Background: Postoperative sore throat, cough, nausea, apnea, and laryngospasm are common complications of intubation by
endotracheal tube (ETT) in pediatrics. The laryngeal mask airway (LMA) is a supraglottic device used as an alternative equipment
for ETT in order to decrease the complications.
Objectives: To compare the incidence of postoperative sore throat after LMA with ETT in pediatrics.
Methods: Seventy-six patients between the ages of 2 - 12 with ASA class I-II who underwent cochlear implant surgery were enrolled
and randomly divided into 2 groups including ETT or LMA for airway management. The incidence of complications including sore
throat, apnea, vomiting, laryngospasm, post operative cough, intra, and post operative arrhythmia and the influence of these equipment’s
on O2 saturation, end tidal CO2, airway pressure, and hemodynamic changes during operation were compared. Wong-Baker
facial grimace scale was used to evaluate the severity of pain.
Results: The rate of postoperative sore throat and laryngospasm in the ETT group was significantly higher than the LMA group (P =
0.002, 0.011; respectively). Apnea and vomiting were not significantly different. Rate of postoperative cough, incidence of intra, and
postoperative arrhythmia were not significantly different between the two groups. Mean arterial pressure, peak airway pressure,
end tidal CO2, and oxygen saturation during operation, which was measured continuously, had no significant differences between
the two groups.
Conclusions: LMA significantly decreases the rate of postoperative sore throat and laryngospasm in pediatrics. However, the rates
of apnea, oxygen saturation, and nausea were similar in both groups. Application of LMA as an alternative to ETT is appropriate in
pediatric patients.

Over the past two decades, the use of non-invasive positive
pressure ventilation (NIPPV) has increased in many
ICUs around the world (1). According to a study conducted
in French, the use of non-invasive ventilation during 1994
to 2001 increased from 20 to 90% (2). The result of serial
survey from more than 40 countries indicated that the
overall use of NIPPV increased from 4.4% in 1998 to 14% in
2010 (3, 4).
NIPPV is used in wide variety conditions. It is a wellrecognized
approach in the management of acute respiratory
failure, acute exacerbations of chronic obstructive
pulmonary disease (COPD), hypoxemic respiratory failure,
community-acquired pneumonia, cardiogenic pulmonary
edema, and after solid organ transplants (5). It is also considered
as the most effective treatment available for motor
neuron disease when respiratory symptoms appear (6).
Non-invasive ventilation is a well-known strategy to
avoid endotracheal intubation and its complications (7).
Endotracheal intubation in critically ill patients is accompaniedbyhigh
riskandlife threatening complications
such as severe hypoxemia and hypotension, even in intensive
care units (8). NIPPV reduces endotracheal intubation
rate, mortality, and length of stay in the intensive care unit
and it is a life-saving intervention (9-11).

---

Background: Rescuers with basic skills may have difficulties to perform efficient and safe mask ventilation. This study aimed at

determining the best head position for ventilation, while avoiding stomach inflation.

Methods: Forty healthy patients were mechanically ventilated with a face mask (7 mL.kg-1). The head was positioned either with n

= 20 or without a cushion support (n = 20), and in three different head extension positions.

Results: Head angles differed more with no cushion support at 12°; 95% CI 6 - 18°), 25° (95% CI 17 - 33°) and 32° (95% CI 27 - 37°); P <

0.05) when compared with cushion support at 5° (95% CI 3 - 7°), 16° (95% CI 13 - 20°), and 22° (95% CI 18 - 26°); P < 0.05. Without cushion

support, peak airway pressure in neutral position was higher (20 cmH2O, 95% CI 17 to 23 cmH2O) than in the anesthesiologist’s

favorite position (16 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000) or in extension (16 _ 7 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000).

Stomach inflation correlated with body mass index in the neutral position, and in the anesthesiologist’s preferred position without

cushion support.

Conclusions: Our data suggested that maximal head extension with no cushion support yields the lowest and thus safest peak

airway pressure during mask ventilation.

Trial Registration: ClinicalTrials.govNCT01909310, registered on July 24th, 2013

Introduction: Herein, we report our findings of the anesthetic management of a case of laryngocele to discuss the repercussions, which need to be considered in laryngocele management, and to determine the possible pressure effects on the airway.

Case Presentation: The patient was a 17-month-old girl with laryngocele, who was a candidate for surgery. Her symptoms had

initiated with wheezing and occasional dysphagia. On bronchoscopy, a tracheal mass was observed, accompanied by stenosis and tracheal deviation to the right side of the neck. The patient underwent anesthesia with sevoflurane via spontaneous breathing. Anesthesia was maintained with an intravenous infusion of propofol to keep spontaneous breathing. The mass was removed by a surgeon, and after ensuring the safety of the airway, atracurium and morphine were injected intravenously. At the end of the operation, she was transferred to the pediatric intensive care unit under intubation.

Conclusions: Maintenance of spontaneous ventilation during anesthesia induction is crucial in cases of laryngocele at very young age.

The effectiveness of psychological techniques such as patient education, cognitive and behavioral interventions, relaxation techniques, hypnosis, therapeutic suggestion interventions, and emotion-focused interventions has been assessed through the outcomes of postoperative pain, perioperative anxiety, quality of life, and recovery in adults. In this case presentation, we introduce using of hypnosis as an approach to pain control in hand surgery.