Annals of Anesthesiology and Critical Care

Background: Different techniques are proposed to improve glottis visualization during laryngoscopy, namely backward-upwardrightward pressure (BURP) and jawtrust; however, with controversial results. The current study aimed at comparing the maneuvers  to elicit their efficacy for better glottis visualization in videolaryngoscopy (VL).

Methods: In the current self-controlled, randomized, clinical trial, 104 patients candidate for elective surgery requiring endotracheal intubation were recruited. All participants underwent airway examination, thyromental distance (TMD), limitedmouthopening, and head extension were recorded. Laryngoscopy was performed by a single anesthetist using C-MAC® (KARL STORZ, Germany) and a Macintosh blade, size 4. A second anesthetist applied BURP and jaw thrust maneuvers. For each patient 3 images were provided with and without a maneuver in the optimal view. The images were randomly coded. An anesthesiologist blinded to the codes and assignments scored images based on the Cormack-Lehane scoring system.

Results: Both maneuvers significantly improved glottis visualization, but BURP rendered more promising effects. Gender-specific analyses yielded similar results. In subgroups of patients with limited head extension, TMD < 5 cm or limited mouth opening, the findings were significant.

Conclusions: Both BURP and jaw thrust maneuvers resulted in better glottis visualization. Nevertheless, BURP may provide better conditions during laryngoscopy irrespective of airway parameters and should be attempted first

Background: Low-pressure pneumoperitoneum during laparoscopic surgeries decreases some side effects related to inflate gas into abdominal cavity. The current study aimed at comparing the effects of standard- and low-pressure pneumoperitoneum on shoulder pain, nausea, and  vomiting after laparoscopic cholecystectomy.

Methods: In a randomized clinical trial, 202 ASA classes I and II patients, candidates for elective laparoscopic cholecystectomy, were randomly divided into the groups of standard- (12 to 14mmHg)and low- (6 to 7mmHg)pressure pneumoperitoneum. Postoperative shoulder pain, nausea, and vomiting were assessed between the 2 groups.

Results: Post-operative shoulder pain was statistically lower in low-pressure group in comparison with standard-pressure group (P = 0.001). Nausea and vomiting were not statistically different between the 2 groups (P = 0.54).

Conclusions: Low-pressure pneumoperitoneum during laparoscopic cholecystectomy was an efficient method to decrease postoperative shoulder pain

Background: Central venous catheterization is used for several goals in the emergency department. Common sites of insertion of central venous lines are the right and left jugular veins as well as the right and left subclavian veins. The aim of this study was to evaluate the tendency frequency of emergency medicine residents to choose central venous line insertion route and also to determine the post-procedure complications.

Methods: In this descriptive cross-sectional study, all patientswhounderwent central venous catheterization and were in the emergency ward of the Imam Reza hospital, Tabriz, Iran during March 21, 2015 to September 23, 2015 were included, preferences route of insertion and complications of both right and left jugular and subclavian veins were descriptively analyzed.

Results: Of all the 134 evaluated patients, 54.5% were catheterized in course of shock. 88.1% of patients underwent right jugular vein catheterization and only 4.5% experienced post-procedure complications. In 91.8% of cases, the decision-making was done by the physician and 75.4% of the catheterizations were fulfilled by second-year emergency medicine residents.

Conclusions: The most common route of catheterization was through the right jugular vein. Additionally, the most common complication was hematoma of the insertion site. In most of the cases, decision making was made by the physician and most of the catheterization procedures were fulfilled by second-year emergency medicine residents.

Background: Iatrogenic recurrent laryngeal nerve (RLN) injury is an uncommon but serious iatrogenic complication, especially after head and neck surgeries, and some thoracic procedures. Laryngoscopy can be an invasive and uncomfortable procedure; therefore, the use of ultrasonography (US) as a noninvasive method of screening patients for impaired vocal cord mobility is desirable. This study was conducted to compare the visibility of vocal cords in 2 suggested US views: suprathyroid and transthyroid approaches.

Methods: In this clinical trial, 144 patients of either sex, who were candidates for elective suchlike surgery, were enrolled. The participants underwent vocal cord US through transthyroid and suprathyroid windows in a transverse plane with and without water bath. The visibility of vocal cords in either view was graded from 1 (invisible) to 5 (clearly visible). Direct laryngoscopy was performed  after surgeries, with anticipated risk of vocal cord dysfunction, in patients with suspicious or invisible vocal cords in US.

Results: Symmetric movement of vocal cords was visible in 88.8% of the participants. The visibility of vocal cords in transthyroid view was better than the suprathyroid approach. The quality of sonographic views was better in females and in younger age groups. The application of water bath did not improve the overall visibility of vocal cords during US.

Conclusions: Transthyroid US seem to be a valuable screening modality for anticipated vocal cord dysfunction. Application of this method, particularly in nonelderly women, conveys more favorable results. Future improvements in the ultrasound machines in the hands of well-trained clinicians will improve its diagnostic accuracy.

Background: Currently, spinal anesthesia is an acceptable method for cesarean section (CS) throughout the world, since general anesthesia is associated with higher maternal morbidity and mortality rates. The current study was performed to survey different factors for maternal satisfaction of spinal anesthesia.

Methods: This cross sectional study was performed onwomenwhowere candidates for elective CS at Dr. Shariati hospital. Informed consents were obtained from all the patients, and the risks and side effects of both spinal and general anesthesia were explained preoperatively. The mothers were free to choose the anesthetic technique. One day after the operation, all mothers were examined with respect to the variables.

Results: A total of 84 women with the mean age of 30.7 _ 5.63 years and mean body mass index (BMI) of 31.2 _ 4.15 kg/m2 were anesthetized through the spinal method. Overall, 28.6% of the subjects were distressed about perioperative awareness, while 40.5%, 29.8%, and 46.4% reported postoperative pain at the injection site, headache, and lumbar pain, respectively. Maternal satisfaction of the spinal method and willingness to choose this method again in future surgeries were 83.8% and 78.5%, respectively.

Conclusions: Women undergoing CS are highly satisfied with spinal anesthesia, and the majority are likely to choose this method in the future. Factors decreasing satisfaction include inadequate preoperative explanations about the anesthesia method by the anesthesiologist, postoperative pain at the injection site, headache, and lumbar pain.