Difficult intubation has been a problem for anesthesiologist especially during maxillofacial surgeries with limited mouth opening.A technique of NASOPHARYNGEAL airway has been applied in 45 cases. This method has been completely successful in relieving upper airway obstruction and allowing normal ventilation. This technique is simple, quick and absolutely free from untoward reaction.

Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal TUBE and type of its cuff, inadequate airway humidification, trauma during intubations and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, etc. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and CUFFED Pharyngeal TUBE (CPT). From the patients, 120 ASA: PS-I cases, were selected, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. their operations were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used of one group and CPT for others. Immediately after Operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the TUBE, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P<0.001).

Background: UnCUFFED endotracheal TUBE (ETT) were considered for children less than 8 years. Meanwhile, aspiration around ETT in patients undergoing adenotonsillectomy is concerned. We compared CUFFED versus unCUFFED ETT regarding respiratory complications following adenotonsillectomy.Methods: 128 children aged 2-8 yr were divided to two groups of 64 each. UnCUFFED and CUFFED TUBEs were used respectively in the unCUFFED (UG) and CUFFED (CG) groups. Anesthesia was routinely performed in a identical pattern in all patients. The number of attempts to reach the appropriate TUBE size was recorded. After extubation, the patients observed for the occurrence of cough, hypoxemia, and stridor.Results: Less reintubation attempts were needed in the CG (p.value=0.002). In the UG, 31.3% and in the CG 10.9% had some respiratory complications (P.value=0.009). The change of the initial TUBE had significant effect on the occurrence of croup and stridor (P.value= 0.000).Conclusion: The use of CUFFED TUBE in 2-8 yr, could lower the incidence of respiratory complications following adenotonsillectomy. It also decreases the number of intubation attempts needed to reach the appropriate TUBE size.

Background: Nausea and vomiting are considered as two common clinical complications following anesthesia and surgery. The occurrence of such complications causes the patient to be kept in recovery room and hospital for longer periods of time and also leads to electrolyte disturbances, dehydration and hemorrhage from the site of sutures. Objective: To compare the incidence of post tubal ligation vomiting in patients following the application of two different anesthetic techniques (mask and combination of CUFFED pharyngeal TUBE and esophageal obtorator TUBE). Methods: This was a single blind, randomized clinical trial in which 122 cases as candidates for tubal ligation were studied at Qazvin Kosar hospital in 2001-2002. The subjects, all with ASA class I, were randomly divided into two groups as A and B. The anesthetic drug for induction and maintenance was similar in two groups. Ventilation of patients was carried out using masks in group A and a combination of CUFFED pharyngeal TUBE (Tashayod TUBE) and a tracheal TUBE inserted into esophagus in group B. Findings: There was no statically significant difference between the incidence of vomiting among both groups with values of 23.3% and 14.5% for groups A and B, respectively  When parameters such as mean age, weight and the duration  of  surgery were compared in two study groups, no significant difference was found, statistically. Conclusion: The incidence of post tubal ligation vomiting in study groups following the application of two different anesthetic techniques was similar.  

Background: CUFFED pharyngeal TUBE is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving. Materials and Methods: In our study CPT was compared with endotracheal TUBE (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, laryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia. Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (p<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (p<0.05). Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 Cm H2O.

Background: Proseal LMA (PLMA) has been used for airway maintenance during laparoscopic cholecystectomy. However, there is limited data regarding the effects of pneumoperitoneum, particularly on pulmonary mechanics. Objective of the present study was to evaluate and compare the use of PLMA with a CUFFED endotracheal TUBE (ETT) with regard to changes in pulmonary mechanics, haemodynamic variables, degree of gastric inflation, ease of device insertion and possible adverse events in patients undergoing laparoscopic cholecystectomy.Methods: After written informed consent and institutional ethics committee approval, we enrolled one hundred patients (ASA physical status1/2), 18-60 years of age who were scheduled to undergo laparoscopic cholecystectomy under general anesthesia (GA). Patients were randomly allocated to one of the two groups of 50 each. Group 1: CUFFED endotracheal TUBE and Group 2: ProSeal LMA. Patients as well as the surgeons were blinded to the airway device used. Insertion parameters, haemodynamic and ventilatory parameters (compliance, resistance and peak/plateau airway pressure) were measured at different time intervals before, during and after pneumoperitoneum.Results: Statistically significant (p< 0.05) but clinically insignificant difference was found in time taken for device insertion in the two groups (21.8 ± 5.9 s group I & 25.4 ± 5.7 s group II). Insertion of orogastric TUBE was easier and less number of attempts was required with PLMA. Hemodynamic parameters like heart rate, systolic, diastolic and mean blood pressures increased after the ETT insertion while there was a decrease/no change after PLMA insertion. There was a significant decline in the pulmonary compliance in Group 2, which was more pronounced after pneumoperitoneum. During pneumoperitoneum, higher peak and plateau airway pressures were noted in PLMA group than in ETT group. After desufflation these parameters returned to near pre-insufflation levels. There was no episode of arterial desaturation or end tidal carbon dioxide changes in either group.Conclusion: Our results indicate that in the PLMA group, the degree of changes in pulmonary mechanics caused by the pneumoperitoneum were significant however there was no incidence of arterial desaturation, or gastric regurgitation. Due to better hemodynamic stability with PLMA, it may even be better alternative than ETT in hypertensive/cardiac patients. Hence PLMA is a satisfactory airway device for laparoscopic cholecystectomy under GA, but further studies are required regarding its safety in patients with decreased pulmonary compliance like morbid obesity or obstructive pulmonary disease.

Background: There is some demand for nasogastric TUBE insertion in unconscious or ICU patients. Nasogastric TUBEs are generally made of flexible plastic materials, prone to twisting and deviation by the tracheal TUBE, when passing through the pharynx and esophageal opening, making it difficult to insert the NG-TUBE properly. We hypothesized that NG-TUBE insertion with help of guidewire can significantly increase a successful first-try insertion rate in contrast with the conventional "neck flexing" technique in unconscious intubated patients. Methods: One hundred adult intubated patients, in the emergency ward at Sina Hospital, Tehran University of Medical Sciences were enrolled in this prospective clinical trial study from February 2020 to July 2020. These patients were randomly divided into two groups, with and without use of the guidewire insertion technique. Parameters such as successful NG TUBE insertion average time, first and second try failure, total failure and occurrence of complications such as kinking, twisting, sticking, moderate hemorrhage and traumatic injuries to the nasopharynx pathway were studied. Results: One hundred patients were enrolled in this study. The median age of patients was 55. 4± 10. 8 years (12-75 yr). First-try insertion success was 98% in the guidewire group and 74% in the control group (P=0. 001). First, the try insertion failure percentage was 2% in the guidewire group and 26% in the control group (P=0. 001). The time needed for NG TUBE insertion was significantly lower in the guidewire group, as 38. 3± 4. 8 seconds in the guidewire group vs 61. 5± 6. 2 seconds in the control group (P=0. 001). A significantly lower number of complications like twisting, sticking, hemorrhage and traumatization were seen in the guidewire group. Remarkably, that no case of absolute insertion failure was seen in the guidewire group but there were three such cases in the control group. Conclusion: The incidence of a successful first-try NG TUBE insertion has been significantly improved by the use of Steel Wire rope against the conventional neck flexing technique, in unconscious intubated patients, and causes less traumatization and complications as well.

NASOPHARYNGEAL masses in young males, first of all presumes Juvenile NASOPHARYNGEAL Angiofibroma (JNA) in the mind, but other benign or malignant tumors should be considered for successful and adequate management of patients and also for minimizing morbidity from unnecessary interventions. We herein present a patient with NASOPHARYNGEAL carcinoma (NPC) mimicking JNA. The patient was presumed as JNA and underwent excessive surgical intervention and the final histopathology report was NPC. The aim of our case report is to highlight the importance of complete clinical examination and preoperative imaging in differentiating and ideal management of NASOPHARYNGEAL masses.