Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Using UNTEB via axial and the in-plane approach technique was performed in 42 segments of 25 patients who presented with lumbosacral radicular pain to lower extremities. The contrast medium was injected to evaluate the needle tip at the intervertebral foramen under fluoroscopic guidance. The numerical rating scale was used to assess pain before and after treatment. The success ratio of UNTEB in L3/L4 level was 100%, in L4/L5 was 95.4% and in L5/S1 was 100%. The numerical rating scale (NRS) for lumbosacral radicular pain improved from a mean from 7.8 to 2.8 1 day after procedure (p = 0.01) and from a mean from 7.8 to 2.4 1 week after UNTEB (p = 0.01). None of our subjects experienced any complications during and after the procedure. UNTEB with fluoroscopic validation is an accurate, effective, and safe method for short-term pain relief of the patients with unilateral lumbosacral radicular pain.

This study aimed to compare Miller and Macintosh laryngoscopes in zero to 4-year-old children. A total of 72 children with a score of I and II, according to the American Society of Anesthesiologists (ASA) physical status classification, who were candidates for elective surgery with general anesthesia and tracheal intubation were enrolled in the study. The children were divided into two equal groups (36 persons) according to used laryngoscope: Miller laryngoscope (group 1) and Macintosh laryngoscope (group 2). Observations and all laryngoscopies were performed by a single experienced anesthesiologist. Heart rate, systolic blood pressure, non-invasive arterial blood pressure, and hemoglobin saturation were measured and recorded. The number of endotracheal intubation attempts and complications were also recorded for both groups. In terms of gender, the first group consisted of 88.9% boys and 11.1% girls, and the second group consisted of 66.6% boys and 33.3% girls (p-value=0.05). The mean age was 16.7 months in the first group and 17.7 months in the second group (p-value=0.5). The mean weight of the children was 16988.5 g and 16300 g in the Miller and Macintosh groups, respectively (p-value=0.9). Regarding the Cormack-Lehane classification system, 5 patients were classified as grade 1 (13.9%), 14 patients as grade 2 (38.9%), 15 patients as grade 3 (41.7%), and 2 patients as grade 4 (5.6%) in the Macintosh group. In contrast, in the Miller group, 5 patients were classified as grade 1 (13.9%), 27 patients as grade 2 (75%), and 4 patients as grade 3 (11.1%) (p-value=0.004). These results can provide more data about the tracheal intubation method with the Macintosh and Miller laryngoscopes, the ease of intubation, and the best laryngoscopic view with each blade.

Background: Different drug regimens can be used for management of anxiety before endoscopy. This study aimed to compare the sedation effects of propofol+ketamine (PK) and sodium thiopental+fentanyl (TF) in children during upper gastrointestinal (UGI) endoscopy. Methods: A triple-blind clinical trial was conducted on 88 children aged 2-12 years who were candidate for UGI endoscopy at Children's Medical Centre, Tehran, Iran, during 2012-2013. It was administered propofol (2.1 mg/kg) + ketamine (1 mg/kg) and 100% oxygen in PK group, and thiopental (5 mg/kg) + fentanyl (1 mg/kg) in TF group. The haemodynamic status and degree of sedation by Ramsay's criteria were measured. Results: The mean age in PK and TF groups was 92.2±38.2 and 98.6±49.5 months, respectively. The systolic blood pressure and heart rate significantly increased and decreased in PK and TF groups during the procedure, respectively. The frequency of Ramsay's Sedation Scales of 5 and 6 were respectively 72.7% and 27.3% for PF, and 54.5% and 45.5% for TF group (p=0.076). Conclusion: Although both groups were similar in the degree of sedation, PK can be a more appropriate choice for sedation in children with special diseases undergoing endoscopy due to small changes in haemodynamic parameters and, consequently, their higher stability.

Introduction: Airway surgery and endoscopy in pediatric patients are always associated with challenges in anesthesia management. Deep anesthesia is required for preventing patient bucking during the procedure but patient breath should be maintained; in this regard, a combination of general and topical anesthesia can be beneficial. There is also evidence of the peripheral effects of opioids. The main objective of this study is to compare using lidocaine topically alone and combined with alfentanil opioids with respect to the central effects of opioids. Methods: In this study, 40 ASA class I and II children, aged 1–6 years, who were candidates for flexible diagnostic bronchoscopy were divided into two groups through block randomization using the random number table after obtaining parents' consent in complete health conditions. In this clinical trial, for collecting the data a special data collection form was used at the bedside of patients undergoing bronchoscopy at Pediatric Medical Center in 2017. Data including demographic information (age, weight, gender), duration of anesthesia, blood pressure before and after drug administration, duration of bronchoscopy, and recovery time were recorded in a form. Findings: In terms of demographic variables, there were not any significant differences between the two studied groups, indicating that the groups were matched and randomized appropriately. Although there were not any significant differences between the two groups of using lidocaine alone and in combination with alfentanil in other variables, in the recovery time a significant difference was observed between the two groups, with a mean of 13.05 min in the lidocaine group and 18.75 min in the lidocaine combined with alfentanil group. Conclusion: Topical administration of opioid with lidocaine through bronchoscopy had no impact on blood pressure, heart rate, anesthesia duration, and the frequency of perioperative complications.

Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery. Methods: A total of 80 hypertensive patients (systolic blood pressure> 200 mmHg or diastolic blood pressure>100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg. Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P<0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p<0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p<0.05). Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia.