SummaryPrevious studies of infiltration of local anaesthetics in children undergoing tonsillectomy resulted in conflicting results. The aim of this study was to evaluate the effect of the peritonsillar injection of bupivacaine and pethidine on postoperative pain in children undergoing snare-dissection tonsillectomy. In a double-blind study, 80 children (aged 7-15 years) were randomly divided into two groups receiving peritonsillar injection of either bupivacaine (1 mg.kg ) in adrenaline 1 : 200 000 (treatment group) or an equivalent volume of saline (placebo group) pre-operatively. The time needed for first demand of analgesia and analgesic consumption to reduce the visual analogue scale (VAS) for resting throat pain to £ 30, the VAS for pain on swallowing, drinking liquid and eating a soft diet, incidence of nausea and vomiting, and the need for rescue anti-emetics in the first 24 h after operation were compared in both groups. The combination of bupivacaine and pethidine could significantly decrease the consumption of analgesics for resting pain at 4,6,8,12, and 24 h after operation but did not reduce pain on swallowing, drinking liquid and eating a soft diet. The times to demand of first dose of analgesic and to first oral intake were not significantly different. The overall satisfaction of patients in relation to relief of postoperative pain was not significantly different between the two groups. Although peritonsillar injection of pethidine and bupivacaine in children reduces the analgesic consumption, it does not affect the dynamic pain state in the first 24 h after snare-dissection tonsillectomy.

Endotracheal tube (ETT) obstruction, either complete or partial, is a serious life threatening complication in intubated patients. Therefore, implementing a practical method to diagnose this condition is vital. Alteration in respiratory sound signals caused by ETT occlusion can be used for early detection of obstruction. This study is aimed to assess changes in respiratory sound signals after creation of different types of tubal obstruction in an animal model experiment. Artificial internal obstructions were created in three different sizes and three different locations by stitching pieces of smaller tubes in ETTs with internal diameter of 8 mm. A microphone was used to record respiratory sounds during both spontaneous breathing and mechanical ventilation in seven anesthetized dogs. The sound intensity levels produced by different grades and degrees of obstructions were measured and compared with those in non-obstructed tubes. During spontaneous breathing, significant decrease in sound intensity level was detected even with the lowest grades of obstruction (p = 0.003, 0.001, and 0.002, proximal, middle and distal obstructions, respectively). However, in mechanical ventilation, significant decrease in sound intensity was observed only in distal tubal obstruction (p = 0.037). The difference among levels of sound intensity produced by different obstruction locations of occlusion was not statistically significant (p ≥ 0.090). Data analysis revealed that sound intensity level decreased significantly when the degree of obstruction increased. In addition, this change in sound level was not related to the location of obstruction. The decrease in sound intensity changes can be used to detect ETT obstruction. However, further studies are needed for clinical application.

Context: Atorvastatin is considered as lipid reductive drugs with anti-inflammatory and pleotherapic effects in coronary artery bypass graph (CABG). Aim: This study is conducted to evaluate the effects of atorvastatin in CABG. Setting and Design: Patients with a coronary bypass graph procedure in Nemazee hospital in Shiraz were divided into two 50-groups receiving high-dose (80 mg) and low-dose (20 mg) atorvastatin. Materials and Methods: Troponin I, creatinine kinase-MB (CK-MB), atrial fibrillation (AF) after CABG, duration of mechanical ventilation, inotrope duration of consumption, blood sugar profile, liver and renal function, death during 30 days of CABG, MACE (major advance cardiac events) during admission in ICU, and 1 month follow up were surveyed. Statistical Analysis: Collected data were analyzed by independent and paired t-test and Chi square. Results: AST was increased, ALT, ALK-P after CABG were decreased, and urine volume in the second day of admission in ICU was increased in the high-dose group. There was an increase and following decrease in blood sugar of patients in the high-dose after CABG. An inflammatory marker after CABG was raised in both groups, ck-mb had an increase, and then followed by a reduction. Troporin had no significant differences between groups. Patients with high-dose atorvastatin had better glomerular filtration rate and renal performance. Along with decreasing AF in the case group, hemodynamics' disorder reduced and there was less bleeding. Conclusion: According to the above, it seems that a short-time prescription of high dose of atorvastatin in CABG can lead to better renal function, decreasing of arrhythmia and AF.