The most important complications after extubation are stridor and laryngospasm, and without correct management they can lead to hypoxia. This controled, study was designed to investigate the effects of topical beclomethasone on stridor and laryngospasm. A total of 200 children aged 1-10 years old and ASA physical status 1 were randomly divided into two groups. In the topical beclomethasone group 2 puff spray of beclomethasone was applied to subglottic, glottic and supraglottic areas before endotracheal intubation and then postoperative stridor and laryngospasm were recorded. The groups were well matched for their demographic data (sex, age, weight and tracheal tube size). The incidence of stridor in beclomethasone group was 8% and in the control group was 29%. On the other hand the incidence of laryngospasm in the beclomethasone group was 0% and in the control group was 5%. It is concluded that beclomethasone administered topically at the time of intubation helps to prevent postoperative stridor and laryngospasm.

Background: The induction characteristic of halothane in nitrous oxide and oxygen were compared with halothane in oxygen alone and intravenous induction with thiopentum and succinylcholine. Materials and Methods: A vital capacity technique was used for the gaseous induction groups using a mapleson F system and a 1-litre reservoir bag. four end points of anesthesia were recorded: time to cessation of hand grip, time to loss of eyelash reflex, time to jaw relaxation, and time to settled breathing after tracheal tube insertion we also recorded sequential blood pressure and pulse rate , the incidence of adverse airway events and the acceptability of the induction technique . Results: Induction with thiopentum and succinylcholine had a faster time to cessation of hand grip (p, 0.05) and jaw relaxation (p, 0.01). These differences disappeared with the final induction stage and halothane in nitrous oxide and oxygen had the faster time to regular settled breathing though this did not reach statistical significance. Cardiac stability was good and comparable in all groups. Conclusion These were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups.

Post extubation cough and larynogospasm and also bucking (straining) during emergence from anesthesia can be associated with hemodynamic changes in arterial oxygen saturation (SPa02). Recent studies have revealed that Lidocaine can diffuse across endotracheal cuff membrane and alkalinization and warming of Lidocaine can increase this capability.We decided to determine whether inflating the "SUPA" endotracheal tube's cuff with lidocaine could create a reservoir of local anesthetic, which might diffuse across the cuff membrane to anesthetize the mucosa thus attenuating stimulation during extubation.A total of 120 patients undergoing elective surgery were enrolled in a double blind randomized clinical trial, and occurrence of cough, bucking and laryngospasm noted were in four groups with endotracheal tube cuffs inflated with air, lidocaine 4%, alkalinized lidocaine 4%.Data were analyzed with SPSS windows with chi test and fisher test. There was no differece in study data between air and saline and so between lidocaine 4% and alkalinized lidocaine 4% group. Inflation of cuff with lidocaine was associated with significant decrease in occurrence of coughing and bucking compared to air and saline groups. There was no case of laryngospasm in lidocaine groups. Inflation of the "SUPA" Endotracheal tube cuff with lidocaine can significantly decrease occurence of coughing, straining and probably laryngospasm after extubation.

Background and aim: Laryngospasm, laryngitis and bleeding are the most serious complications after tonsillectomy. In this study, the frequency of these complications and their correlation with age, sex and application of lidocaine jelly has been assessed. Method: The sample consisted of 100 patients aged from 5 to15 years undergoing tonsillectomy in Resalat hospital of Shahrekord, during 6 months. The subjects were divided randomly into two groups. Case group intubated with 2% lidocaine gel via the endotracheal tube, and control group intubated without lidocaine gel. Laryngospasm, laryngitis and bleeding were recorded during the first postoperative day. Results: The incidence of laryngospasm and laryngitis was 8% and 17% respectively. There were no correlations between these problems and age or sex. The incidence of bleeding was 16% that was higher in older and female patients. The endotracheal tube lubrication with 2% lidocaine gel attenuated laryngospasm during recovery after tonsillectomy in children but it was not effective on laryngitis and bleeding.Conclusion: The application of lidocaine gelly after tonsillectomy for prevention of laryngospasm is recommended.

Negative pressure pumonary edema, is a well recognized phenomenon, and in the formation of pulmonary edema following an acute upper airway obstruction (UAO), an incidence of as high as 11%. The principal physiologic mechanism underlying the formation of edema in this setting involves the generation of markedly negative intrathoracic pressure leading to a net increase in the pulmonary vascular volume and the pulmonary capillary transmural pressure (Ptm). This is a report of a case of diffuse alveolar edema following an acute UAO. The pathophysiology and etiologes of NPPE is discussed.    

Non cardiac pulmonary edema which is known as pulmonary edema with negative pressure (NPPE) during airway anesthesia is caused by upper airway obstruction due to laryngospasm. This problem happened for a patient who was anesthtized for cataract surgery.A 60 y/o male who was candidate for cataract extraction, after induction of anesthesia was found to have an unpredictable difficult intubation because of anterior position of the larynx. At the end of operation, immediately after extraction of endotracheal tube, severe laryngospasm with copious amounts of pink foamy secretions was developed. Supportive measures including reintubation and mechanical ventilation were performed and the patient was admitted in the ICD and supportive ventilation was started. Successful weaning was done after two days and the patient was extubated.NPPE is non cardiogenic pulmonary edema which is caused by a negative intrathoracic pressure due to upper airway obstruction which causes shifting of fluid to the interstitial lung space. Signs and symptoms includs tachypnea, shortness of breath, production of copious amounts of pink, foamy secretions and decreased arterial oxygen saturation. Great degree of suspicious is very important for its diagnosis. Our patient undergone immediate supportive managements including establishment of airway, medical management, complete monitoring, and ventilatory support in intensive care unit. 2 days later weaning and extubation was done successfully