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A revision of the Cormack and Lehane laryngoscopic grading system with special consideration to grade II laryngoscopic view
Hussain khan Z,Azarbakht Z
Tehran University Medical Journal , 2007,
Abstract: Background: The major responsibility of an anesthesiologist is to provide adequate respiration for the patient. The most vital element in providing functional respiration is the airway. No anesthetic is safe unless diligent efforts are devoted to maintaining an intact functional airway. Difficult intubation had been classified into four grades, according to the view obtainable at laryngoscopy by Cormack and Lehane in 1984. This grading system has been in use to evaluate and manage those patients with difficult airway by anesthesiologists. In clinical state, grades III and IV are quite rare, so the need for a modified Cormack and Lehane grading system was felt. The use of a modified Cormack-Lehane scoring system of laryngoscopic views during direct laryngoscopy, was previously examined in the Western population. Koh and his co-workers had examined this modified Cormack and Lehane grading system in Asian population in a study in Singapore General Hospital. The aim of this study was to investigate this scoring system in Iranian patients.Methods: In a cross sectional study, a modified version of the Cormack and Lehane grading system was evaluated in 300 patients requiring tracheal intubation. In the modified system, grade II (only part of the glottis is visible) was divided into IIa (part of the cords is visible) and IIb (only the arytenoids or the very posterior origin of the cords are visible). Difficult intubation was defined as requiring more than one laryngoscopy or the use of special equipments.Results: Sixty eight patients (22.7%) were scored as grade IIa and 32 (7.7%) as grade IIb. The prevalence of difficult intubation in grade IIb was significantly higher than patients in group IIa (47.8% vs. 2.9% respectively, Fisher's exact test, p= 0.001)Conclusion: The modified grading system provides more information than the original Cormack and Lehane system."n
Forward movement of the lower mandible in the prediction of difficult intubation: a prospective study
Hussain khan Z,Mirazimi F
Tehran University Medical Journal , 2007,
Abstract: Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. If the anesthetist can anticipate which patients may be more difficult to intubate, can reduce the risks of anesthesia greatly and be more prepared for any difficulties that may occur. The aim of this study was to investigate the inability of patients to protrude the lower jaw in predicting difficult intubation.Methods: In this prospective study, we enrolled 300 patients, above 16 years of age or older, who were scheduled for elective surgery. For all of the patients, before each operation, a single anesthesiologist measured the temporomandibular mobility, which was defined as the difference between the distances, from the lower incisors to the upper incisors in a neutral position and at maximum mandibular protrusion. At the time of intubation, another anesthesiologist, blinded to the preoperative airway assessment test, performed a laryngoscopy in which the laryngoscopic view of the larynx was determined according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.Results: Twenty-one patients were identified as having difficult intubation. Only one patient could not be intubated. The forward movement of the mandible was significantly greater in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, P<0.001). The use of a cut-off point of less than 5 mm for prediction of difficult intubation showed a sensitivity of 92.86% and a specificity of 70.43%.Conclusion: The forward movement of the mandible is significantly greater in patients with easy intubation compared those with difficult intubation Although infrequent difficulties may arise, most patients that do not have indicators of difficult intubation will be easy to intubate under anesthesia.
The effect of stress on prognosis and treatment response in 100 Rheumatoid Arthritis patients
Hussain khan Z,Mirazimi F
Tehran University Medical Journal , 2007,
Abstract: Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease with several factors that contribute to its manifestation and continuation. One of the factors that initiate RA is emotional stress, which is in direct relationship with the sufficiency or insufficiency of the neuro-endocrine axis. Therefore, any stress that is not resolved in the neuro-endocrine axis might lead to RA and, as the stress continues, it causes the continuation of the disease. The aim of this study is to determine the effect of stress on continuation of RA and to find curative methods and, ultimately, the best method for treatment.Methods: One hundred rheumatoid arthritic patients (80 females and 20 males), having a final diagnosis of RA based on the guidelines of the American College of Rheumatology and onset of disease within the last 12-36 months, were studied as case and control subjects. Data was collected using interviews and questionnaires that reflected their life events with stress as a serious factor in their disease. The patients were divided into two groups: group A with stable stress and group B with unstable stress. The same treatment method was given to both groups. The results of the treatment were evaluated and compared after two years of follow up.Results: There was significant improvement in the patients in group B with unstable stress over that of the patients in group A with stable stress (P<0.0001).Conclusion: The present study shows that a considerable number of RA patients suffer from serious stress that affects their clinical path and improvement, and is quite visible in the health indexes and continuity of the disease. The results further showed that stress can play an important role in the initiation and continuation of RA. Therefore, by identifying and making efforts to remove the stress factors using anti-anxiety drugs, the disease can be better controlled.
"Is it essential to write complete first names of authors in Bio-medical journals? "
"Hussain Khan Z,Kashfi A "
Acta Medica Iranica , 2001,
Abstract: NO ABSTRACT
PSYCHOGENIC ABRUPT ASYSTOLE DURING SPINAL ANESTHESIA: REPORT OF A CASE
K. Ghazi-saidi,Z. Hussain khan
Acta Medica Iranica , 1999,
Abstract: Psychogenic abrupt asystole during spinal anesthesia is an uncommon occurence. A case is presented with literature review.
The Comparison of Mallampati Test in Supine and Sitting Position in Traditional Approach and During Phonation for Predicting of Difficult Laryngoscopy and Intubation
Z Hussain Khan,SH Eskandari,M Rahimi,J Makarem
Tehran University Medical Journal , 2012,
Abstract: Background: Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. Methods: In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated.Results: Overall, 28 (4.2%) patients had difficult laryngoscopy and 9 (1.4%) patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.Conclusion: According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.
The comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery
Mohajer MR,Karvandian K,Hussain Khan Z,Jafarzadeh A
Tehran University Medical Journal , 2011,
Abstract: "nBackground: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009."n "nMethods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups."n "nResults: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05)."n "nConclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.
Evaluation of Perioperative Blood Glucose Changes During Elective Eye Surgeries Under General Anesthesia, With Two Methods: Glucometer and Lab Assay
H. Zahedi,V. Akhyani,Z. Hussain Khan,M. Yunesian
Tehran University Medical Journal , 2006,
Abstract: Background: Hyperglycemia is a metabolic response to surgical stress. In this study, patients’ blood glucose changes were measured before, during and after elective eye surgeries under general anesthesia, with two methods: glucometer and glucose oxidase enzyme lab assay. Probable influencing factors and the correlation rate of these two methods were evaluated. Methods: This analytic cross – sectional original study was performed on 230 American Society of Anesthesiologists (ASA) Class 1or 2 non–diabetic patients. All the patients underwent a similar general anesthesia and their blood glucose levels were measured simultaneously with two cited methods on three occasions. Results: In all cases, post-surgery blood glucose in comparison to pre-surgery levels increased significantly in both methods irrespective of independent variables of the study. Considering these independent variables, increase in blood glucose levels was significant in most of the patients. The mean increase in blood glucose post-surgery in comparison to pre–surgery, measured with lab assay, had significant statistical correlation with the type of eye surgery but not with other variables like age, gender and duration of surgery. Correlation of the two methods were also partially significant statistically. Conclusion: Considering the results of this study and the fact that blood glucose changes under general anesthesia is usually unrecognized clinically, we recommend blood glucose measurement in non–diabetic patients during long surgeries. It is advantageous to use Accu–chek (Sensor model) glucometer for this purpose.
"A FATAL GAS EMBOLISM FOLLOWING THE USE OF INTRAOPERATIVE HYDROGEN PEROXIDE AS AN IRRIGATION FLUID"
Z. Hussain-Khan1,A. A. Soleimani M. Farzan
Acta Medica Iranica , 2004,
Abstract: Hydrogen peroxide, an oxidizing agent used in surgery for its antiseptic properties, has been associated with life-threatening complications. We report a case of suspected gas embolism following irrigation of a tibial bone cyst with hydrogen peroxide in a five year-old boy under general anesthesia, who died despite resuscitative measures and a long stay in the intensive care unit.
Nocardial cerebellar abscess in a case of systemic Lupus erythematosus receiving long term corticotherapy
Saberi H,Fakhr Tabatabai SA,Hussain Khan Z
Acta Medica Iranica , 2001,
Abstract: Central nervous system ranks among the favorite sites to get involved by Nocardia astroides. This opportunistic organism complicates many disorders characterized by cellular or humoral immunity disturbances.A 36-year-old woman is being presented, known to have systemic lupus erythematosus (SLE) and having received a two year course of corticosteroid treatment. Cerebellar abscess was found on diagnostic imagings performed because of heddaches and dysequilibrium of two weeks duration.Craniectomy was performed and the abscess excised. Nocardia astroides grew in the pus culture. On switching the empirical therapy to a combination of trimethoprimsulfamethoxazole and vancomycin, the patient exhibited dramatic improvement in symptoms later on and postoperative imaging showed an absence of the lesion. We recommend a high index of clinical suspicion for nocardia abscess in patients suffering from SLE and presenting with neurological treatment presents the only plausible option
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