In children, failed or difficult intubation is associated with complications, including desaturation and death. Whilst direct laryngoscopy is by far the most common technique used to guide endotracheal intubation, the associated incidence of failure is extremely high in children with difficult airways. Whilst videolaryngoscopy (VL) improves the view of the larynx during laryngoscopy; failure of endotracheal intubation with VL is well documented in children. However, the combination of a fibreoptic intubating videoendoscope (FIVE) with a VL eliminates the limitations of each individual device. The foresight, preparation, equipment and space required to implement this airway management strategy are usually prohibitive. However this approach can be streamlined. The C-MAC VL (with any blade) and either a 2.85 mm external diameter 11301 BDXK FIVE (Karl Storz, Germany) or 4.1 mm external diameter 11302 BDXK FIVE (Karl Storz, Germany), if connected to a dual input 8403 ZX Screen (Karl Storz, Germany) attached to the 8401 YA stand (Karl Storz, Germany) is compact and portable. The combination of the improved visualization of the airway provided by the VL with the ability to use the FIVE as an introducer with a controllable tip greatly increases the maneuverability of an endotracheal tube with the airway. This emerging technique could therefore redefine the management of difficult airways in children.
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Pain is one of the most common symptoms related with cancer and its treatment. Recent studies have shown that Pain is not adequately controlled in up to 31% of cases, and there are patients who do not respond well enough to the cures or experience significant side effects, or even intolerance to pain medications. One of the approaches to the management of unremitting unilateral malignant pain includes considering cordotomy as a treatment. Cordotomy involves creating a lesion of the lateral spinothalamic tract with a fluoroscopy percutaneous radiofrequency technique. We examined the case of a patient with lung cancer, bone metastasis suffering from associated severe pain on the left Chest wall. We propose cordotomy in selected patients with incident unilateral neoplasm-related pain.
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The Investigation of new agents with ability to produce long lasting analgesic period and minimal side effects are considered as crucial issues to drug researchers. The current study was conducted to compare the incidence of some common side effects including headache, pruritus, hypotension, nausea and respiratory depression under spinal anesthesia induced by lidocaine alone and in combination with sufentanil in caesarean section. This is a randomized, double-blind clinical trial and the samples were 100 healthy pregnant women referring to Tehran Javaheri hospital from April 2011 to April 2012. They were randomly divided into two groups. The first group was injected intrathecal 1/5 ml lidocaine 5% and the second one received 1 ml lidocaine 5% in combination with 1 ml sufentanil, (containing 5-µg sufentanil). Some common side effects such as headache, pruritus, hypotension, nausea and respiratory depression were recorded in the patients, during the surgery and 1, 3, 6, 24 hours after the operation. A checklist and a questionnaire were used for data collection. The data were analyzed by computer software SPSS, chi-square, and ANOVA tests. The side effects were more significant in the sufentanil group. It can be concluded that, the combination of lidocaine and sufentanil can induce more side effects than merely lidocaine.
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