Randomized Study Comparing the “Sniffing Position” with Simple Head Extension for Laryngoscopic View in Elective Surgery Patients

2001 ◽  
Vol 95 (4) ◽  
pp. 836-841 ◽  
Author(s):  
Frédéric Adnet ◽  
Christophe Baillard ◽  
Stephen W. Borron ◽  
Christophe Denantes ◽  
Laurent Lefebvre ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Randomized Study ◽  
Orotracheal Intubation ◽  
Simple Extension ◽  
Laryngoscopic View ◽  
Head Extension ◽  
Group A ◽  
Group B ◽  
Neck Mobility

Background The "sniffing position" is recommended for optimization of glottic visualization under direct laryngoscopy. However, no study to date has confirmed its superiority over simple head extension. In a prospective, randomized study, the authors compared the sniffing position with simple head extension in orotracheal intubation. Methods The study included 456 consecutive patients. The sniffing position was obtained by placement of a 7-cm cushion under the head of the patient. The extension position was obtained by simple head extension. The anesthetic procedure included two Laryngoscopies without paralysis: the first was used for topical glottic anesthesia. During the second direct laryngoscopy, intubation of the trachea was performed. The head position was randomized as follows: group A was in the sniffing position during the first Laryngoscopy and the extension position during the second, group B was in the extension position during the first laryngoscopy and the sniffing position during the second. Glottic exposure was assessed by the Cormack scale. Results The sniffing position improved glottic exposure (decreased the Cormack grade) in 18% of patients and worsened it (increased the Cormack grade) in 11% of patients, in comparison with simple extension. The Cormack grade distribution was not significantly modified between the two groups. Multivariate analysis showed that reduced neck mobility and obesity were independently related to improvement in laryngoscopic view with application of the sniffing position. Conclusions Routine use of the sniffing position appears to provide no significant advantage over simple head extension for tracheal intubation in this setting. The sniffing position appears to be advantageous in obese and head extension-limited patients.

scholarly journals Comparative Evaluation of the Sniffing Position with Simple Head Extension for Laryngoscopic View and Intubation Difficulty in Adults Undergoing Elective Surgery

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Smita Prakash ◽  
Amy G. Rapsang ◽  
Saurabh Mahajan ◽  
Shameek Bhattacharjee ◽  
Rajvir Singh ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Randomized Study ◽  
Simple Extension ◽  
Upright Stance ◽  
Laryngoscopic View ◽  
Intubation Difficulty ◽  
Lifting Force ◽  
Head Extension ◽  
Extension Group ◽  
Position Group

The effect of patient position on mask ventilation, laryngoscopic view, intubation difficulty, and the stance adopted by the anesthesiologist during laryngoscopy and tracheal intubation was investigated in 546 anesthetized adults in this prospective, randomized study. Patients were randomly assigned to either the sniffing position group or the simple extension group. The distribution of Cormack grades was comparable between the two groups (P=0.144). The IDS score [median (IQR)] was 0 (0–2) in the sniffing group and 1 (0–2) in the simple extension group;P=0.002. There were significant differences between groups with regard to intensity of lifting force, external laryngeal manipulation, alternate techniques used, number of attempts, and the stance adopted by anesthesiologist. We conclude that the sniffing position is superior to simple head extension with regard to ease of intubation as assessed by IDS. An upright stance is adopted by more anesthesiologists performing intubation with patients in the sniffing position.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

2021 ◽  
pp. 112067212110053
Author(s):  
Moustafa Salamah ◽  
Ashraf Mahrous Eid ◽  
Hani Albialy ◽  
Sherif Sharaf EL Deen
Keyword(s):  
Randomized Study ◽  
Early Postoperative Period ◽  
Polyglactin 910 ◽  
Exclusion Criteria ◽  
Congenital Ptosis ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

scholarly journals The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2097
Author(s):  
Gennaro Nappo ◽  
Domenico Borzomati ◽  
Alessandro Zerbi ◽  
Paola Spaggiari ◽  
Ugo Boggi ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Randomized Study ◽  
Periampullary Cancer ◽  
Significant Prognostic Factor ◽  
Prognostic Role ◽  
R1 Resection ◽  
Group A ◽  
Group B

Background: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

scholarly journals Surgery without knife: an ideal treatment for lactational breast abscess

2017 ◽  
Vol 5 (1) ◽  
pp. 261
Author(s):  
Amandeep Saharan ◽  
Satish Dalal ◽  
Mahavir Singh ◽  
Chisel Bhatia ◽  
Tulit Chhabra
Keyword(s):  
Randomized Study ◽  
Needle Aspiration ◽  
Breast Abscess ◽  
Ultrasound Guided ◽  
Incision And Drainage ◽  
Skin Changes ◽  
Lactating Mothers ◽  
Group A ◽  
Group B ◽  
Early Healing

Background: Incidence of breast abscess is 0.4 to 11% of all lactating mothers. Traditionally the treatment of breast abscess has been incision and drainage. Recently aspiration under ultrasound guidance is emerging as another treatment option and rapidly replace incision and drainageMethods: Authors carried out a prospective, randomized study involving 50 lactating women with breast abscess. In group A - 25 patients were managed by ultrasound guided needle aspiration and in group B - 25 patients were managed by incision and drainage.Results: In patients of group A, most breast abscesses resolved with one or two aspirations only, with early healing and lesser number of hospital visits as compared to patients in group B. There was no surgical scar and early resumption of breastfeeding was seen in group A.Conclusions: Ultrasound guided percutaneous aspiration is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for smaller and unilocular breast abscesses while incision and drainage should be reserved for larger and multilocular abscesses with imminent skin changes.

scholarly journals Penile nerve block at the base of penis in combination with intravenous ketamin plus midazolam versus general anaesthesia(GA) in children undergoing circumcision for post operative pain management in the Eastern Nepal

2014 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
NR Sharma ◽  
P Timalsena ◽  
U Rai
Keyword(s):  
Pain Management ◽  
General Anaesthesia ◽  
Nerve Block ◽  
Randomized Study ◽  
Pain Scale ◽  
Single Shot ◽  
Post Operative Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B

Adequate post operative analgesia in children provides satisfactory psychological objective of this study was to compare the post operative analgesia requirement and child satisfaction between two groups, general anaesthesia(GA) alone and GA in combination with penile nerve block. This prospective randomized study was conducted in 50 children aged 6 to 14 years, who underwent circumcision. The boys were randomly allocated into two groups. Group A (n = 25) received GA with Single shot ketamin 2mg/kg IV plus midazolam 0.1 mg/kg and dorsal penile nerve block at the base of penis prior to circumcision with and Group B (n = 25) received GA with ketamine 2mg/kg IV plus midazolam 0.1 mg/kg plus halothane by laryngeal mask. Severity of pain was assessed quantitatively by children’s hospital eastern Ontario pain scale (CHEOPS). The pain intensity was assessed at one hour A1 in group A and B1 for group B and at two hour A2 for group A and B2 for group B during postoperatively period for two hours. Statistical analysis was done by SPSS method. The post operative analgesia was satisfactory with CHEOPS score 6 or <6 in group A 1. In group A 2 twenty two out of twenty five cases had CHEOPS score <6.Where as in group B1 and B2 it was > 6 .Which was statistically 100% significant. In conclu­sion, combined penile nerve block in combination with intravenous ketamine plus midazolam is the satisfactory method of Post operative pain management in children undergoing circumcision. DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10846 Journal of Chitwan Medical College 2014; 4(1): 33-36

scholarly journals Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring

2018 ◽  
Vol 179 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Jessica Pepe ◽  
Cristiana Cipriani ◽  
Mario Curione ◽  
Federica Biamonte ◽  
Luciano Colangelo ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Mineral Metabolism ◽  
Randomized Study ◽  
Density Measurement ◽  
Mean Value ◽  
Ecg Monitoring ◽  
Mineral Density ◽  
Group A ◽  
Group B ◽  
The Impact

ObjectiveHypercalcemia may induce arrhythmias. There are no data on the prevalence of arrhythmias in primary hyperparathyroidism (PHPT) in daily life. Aim of the study was to investigate both the prevalence of arrhythmias in patients with PHPT compared to controls and the impact of parathyroidectomy, evaluated by 24-h electrocardiogram (ECG) monitoring.DesignThis is a randomized study.MethodsTwenty-six postmenopausal women with PHPT and 26 controls were enrolled. PHPT patients were randomized to two groups: 13 underwent parathyroidectomy (Group A) and 13 were followed up conservatively (Group B). After 6 months, patients were studied again. Each patient underwent mineral metabolism biochemical evaluation, bone mineral density measurement, standard ECG and 24-h ECG monitoring.ResultsPHPT patients showed higher calcium and parathyroid hormone compared to controls and a higher prevalence of both supraventricular (SVBPs) and ventricular premature beats (VPBs) during 24-h ECG monitoring. Groups A and B showed no differences in mean baseline biochemical values and ECG parameters. Mean value of QTc in PHPT groups was in the normal range at baseline, but significantly shorter than controls. A negative correlation was found between QTc and ionized calcium levels (r = −0.48,P < 0.05). After parathyroidectomy, Group A had a significant reduction in SVPBs and VPBs compared to baseline and restored normal QTc. Group B showed no significant changes after a 6-month period.ConclusionsThe increased prevalence of SVPBs and VPBs is significantly reduced by parathyroidectomy, and it is mainly related to the short QTc caused by hypercalcemia.

scholarly journals Is Local Anesthetic Infiltration Prior to Intravenous Cannulation Beneficial to Patients?

2013 ◽  
Vol 8 (1) ◽  
pp. 10-13
Author(s):  
Babu Raja Shrestha ◽  
U Shrestha ◽  
A Shrestha ◽  
A Rana
Keyword(s):  
Heart Rate ◽  
Local Anesthetic ◽  
Randomized Study ◽  
Cardiovascular Responses ◽  
Control Group ◽  
Venous Cannulation ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Local Anesthetic Infiltration

Aims: Intravenous cannulation causes pain, anxiety and frustration in patients along with changes in hemodynamic parameters. Infiltration of local anesthetic lessens the pain of intravenous cannulation. This study was performed to compare cardiovascular responses and verbal rating pain scores in two groups with and without local anesthetic infiltration prior to venous cannulation. Methods: This was a randomized study conducted in 100 elective surgical patients, divided into two study groups with 50 patients in each: group A (Control) and group B (local anesthetic infiltration). Prior to venous cannulation in group B, 0.5 ml of 1% lidocaine was infiltrated at the procedure site at dorsum of the wrist. Patients in group A were cannulated directly without local anesthetic infiltration. The hemodynamic changes pre and post cannulation and verbal pain rating scores were recorded by blind observers in all patients. Results: Demographic values in two groups were similar. Increase in heart rate from baseline value was significant in control group (p < 0.05). Post cannulation heart rate, systolic and diastolic blood pressure were significantly higher in group A compared to group B for the first three minutes (p < 0.05). Amongst higher number of patients in group A, verbal rating pain score was significantly higher. Ninety-four percent of the patients in group B were pain free, comfortable and satisfied with the procedure. Conclusions: Intravenous cannulation can be made pain free with patient satisfaction and hemodynamic stability if carried out with prior local anesthetic infiltration. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 10-13 DOI: http://dx.doi.org/10.3126/njog.v8i1.8853

Chemotherapy of Brain Metastases from Lung Carcinoma: A Controlled Randomized Study

Neurosurgery ◽  
1991 ◽  
Vol 28 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Yukitaka Ushio ◽  
Norio Arita ◽  
Toru Hayakawa ◽  
Heitaro Mogami ◽  
Hiroshi Hasegawa ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Lung Carcinoma ◽  
Tumor Regression ◽  
Randomized Study ◽  
Multidisciplinary Treatment ◽  
Group A ◽  
Radiotherapy Alone ◽  
The Difference ◽  
Group B

Abstract A controlled randomized study was carried out to evaluate the effects of chemotherapy in patients with brain metastases from lung carcinoma. One hundred patients were randomly divided into three groups at the time of diagnosis or after surgery for metastases. Group A received radiotherapy alone; Group B received radiotherapy and chloroethylnitrosoureas (methyl-CCNU, 100-120 mg/m2, or ACNU 80-100 mg/m2, every 6-8 weeks), and Group C received radiotherapy and a combination of chloroethylnitrosoureas and tegafur (300 mg/m2. daily). Of the 100 patients, 88 could be evaluated. The reduction rates of the tumors of the patients in whom tumor was not surgically removed or not totally removed were compared. Complete resolution of the tumor was noted in 29, 69, and 63% of the patients in Groups A, B, and C, respectively, Tumor regression of ⩾50% was seen in 36, 69. and 74% of the patients in Groups A, B, and C, respectively. The difference in the response rates of Groups A and C was statistically signficiant (P&lt;0.05). Median survival after the start of treatment for brain metastasis was 27, 30.5, and 29 weeks in Groups A, B, and C, respectively. There was 1 long-term survivor (more than 5 years) in Group A, 3 in Group B, and 1 in Group C. The main cause of death was deterioration attributable to the primary lesion or systemic metastasis, and no statistical difference was noted in survival time among the groups. Our results indicate that combination chemotherapy with chloroethylnitrosoureas and tegafur has an additive effect on radiotherapy in reducing or eliminating brain metastases from lung carcinoma, and that brain metastasis is well controlled by multidisciplinary treatment including chemotherapy.

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