A 72-year-old woman who was a candidate for percutaneous dilatational tracheostomy (PDT) using the Ciaglia Blue Rhino single dilator was examined. After dilation, a stoma was created on the guide wire, but the dilator could hardly pass through and pulled in the endotracheal tube with it. Bronchoscopy was therefore performed. The guide wire that was inside the Murphy eye of the endotracheal tube was then removed. So the dilator and guide wire was removed. The endotracheal tube was pulled back slightly and the tracheostomy tube was inserted once again. Fiberoptic bronchoscopy is recommended in cases of a problematic anatomy or when the PDT tube placement is suspicious.

Introduction: Esophageal cancer is among the most common malignancies. Hospital mortality in the past decade reduced; but its morbidity is still high. Pulmonary COMPLICATIONs are the most common COMPLICATIONs after esophageal resection. In this study we examined the effect of steroids administration during surgery to reduce postoperative morbidity with a focus on respiratory COMPLICATIONs. Material and Methods: Patients with esophageal cancer who underwent transhiatal esophagectomy, randomly divided into two groups to thirty patients: The intervention group (received 125mg methylprednisolone sodium succinate). After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th and patients discharged home on the day 8th or 9th. Postoperative COMPLICATIONs included anastomotic fistula, wound infection in the neck and abdomen and pulmonary COMPLICATIONs. We analyzed pulmonary COMPLICATIONs included pneumonia, Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occurred before the seventh day. The leukocyte counts and CRP levels measured on the 2nd and 7th days after surgery. Results: 60 patients enrolled in the study. Incidence of ARDS, ALI and pneumonia in the control group was 3, 5 and 2 and in steroid group 1, 1 and 1 respectively. CRP levels and blood leukocyte count was similar in two groups on the second day but seventh day values and difference between the two levels between the second and seventh days were significantly different between the two groups (p<0. 001). Conclusion: INTRAOPERATIVE single dose corticosteroids are effective in preventing pulmonary COMPLICATIONs after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery and decreased blood leukocyte count more in postoperative period.

Introduction: Awareness during anesthesia is a side effect associated with general anesthesia and refers to a condition in which brain awakens by a stimulus during a period of general anesthesia. The experiences are stored in explicit memory and patient might recall a few things after recovering from anesthesia. The experiences are sometimes in the form of pain perception, but the patient is not able to show a reaction due to the administration of muscle relaxants, the feeling of weakness and helplessness caused by INTRAOPERATIVE awareness might cause some patients to develop lasting and significant psychological issues. Given the importance of monitoring and maintaining the depth of anesthesia, this study aimed to determine the incidence of awareness and recall during general anesthesia. Materials and methods: A total of 400 patients who were referred to Besat Hospital and underwent various surgical procedures in 2016 were involved in this study. Data collection was performed using a questionnaire previously utilized by other researchers to study the same topic. Patients were visited 24 to 36 hours after recovery and interviewed about their experiences before, after and during operation. The data collected from each patient were then recorded in the patients questionnaire form. Results: data were obtained from patients indicates that out of 400 patients, 249 patients were men (62. 3%) and 151 patients were women (37. 7%). In order to induce, propofol was used in 71. 8%, thiopental sodium in 27. 3% and ketamine in 0. 9% of patients. Benzodiazepines were used as preanesthetic agents in 87. 8% of cases. Ten patients (2. 5%) had pointed to issues that suggested consciousness during anesthesia. The only significant connection in this study was found to be the lack of use of benzodiazepines and awakening during anesthesia. Conclusion: Given the increased risk of awakening during anesthesia without use of benzodiazepines as preanesthetic drugs, we suggest administration of these agents as far as possible in general anesthetics. Also, our findings indicate that the prevalence of consciousness during anesthesia is higher in our country compared to other countries.

Background: Most cardiac ischemic episodes tend to start at the end of surgery and during recovery from anesthesia. a2 adrenergic agonists are effective for this purpose. The aim of this study was to determine the efficacy of oral clonidine as premedication on cardiovascular stability during operation and to prevent cardiovascular COMPLICATIONs after surgery.Methods: Eighty eight patients enrolled in the study and randomly divided into two groups. The study group received 1mg oral clonidine and the control group received placebo, two hours before anesthesia. Systolic and diastolic blood pressures and heart rate measured and registered in 5 different times. Any change in ECG monitoring during operation and in the recovery room were registered. Also prevalence of postoperative cardiac COMPLICATIONs during the first postoperative day was recorded. All data were analyzed with suitable statistical tests. P<0.05 was significant considered.Findings: Comparison of mean systolic arterial blood pressures between the two groups were lower at all measured times in study group excepts on arrival to the operating room (P<0.05). Mean changes of heart rates in comparable with basic data were statistically higher in control group. Frequency distribution of ECG changes during operation and also frequency distribution of postoperative cardiac COMPLICATION during the first postoperative day were higher in control group Conclusion: Oral low dose clonidine as premedication before anesthesia in old patients can inhibit sympathetic over activity and ECG changes during operation. Also post. operative cardiac COMPLICATIONs were lower in study group.

Introduction: Intravesical explosions are a rarely documented COMPLICATION of transurethral resection of the prostate or bladder tumor. However an intrarenal explosion during ureteroscopic fulguration was documented in 1991. We reported 3 cases of an intravesical explosion resulting in an intrapritoneal bladder rupture during transurethral resection of prostate.

Introduction: Exchange transfusion (ET) is an effective mode of therapy in the treatment of hyperbilirubinemia, but is associated with some COMPLICATIONs in 5-10% of the patients, especially in preterm newborns. The most important COMPLICATIONs following exchange transfusion are: Acidosis, thrombocytopenia, hypocalcemia, hyponatremia, hypoglycemia and transmitting infectious agents. This study aims to determine some COMPLICATIONs of exchange transfusion in neonatal hyperbilirueinemia in NICU of 22 Bahman 22nd Hospital in order to promote its safety and efficacy.Materials and Methods: In this study neonates with undergone exchange transfusion due to hyperbilirubinemia were evaluated over a period of 36 months in NICU of 22 Bahman 22nd Hospital from July 2005 to July 2008 in Mashhad. The questionnaires were completed according to the by patients’ data. The data were then and analyzed for statistical results.Results : Of the 28 neonates who entered the study, 3 required more than one ET. COMPLICATION of ET occurred in 24 neonates (85.7%).The most common COMPLICATIONs were being metabolic acidosis (67.9%) and thrombocytopenia (50%).Conclusion: In order to avoid COMPLICATIONs following exchange transfusion, it should be emphasized to have laboratory tests done. For instance, tests of platelet count and arterial blood gases are needed so that in cases of COMPLICATIONs, the available information can facilitate the treatment. They can be treated on time.

Background: Septoplasty is one of the most commonly performed operations with several COMPLICATIONs.Purpose: To categorize and demonstrate the probability of the occurrence of septoplasty COMPLICATIONs.Methods: Three hundred and twelve patients who underwent septoplasty in Loghman Hakim general hospital, Tehran, Iran, were followed up for 6 months and evaluated for probable post-operative COMPLICATIONs.Results: The most common COMPLICATION was remained deviation, which was observed in 26.2% of patients followed by synechiae and perforations. There was no case of serious and life threatening COMPLICATIONs.Conclusion: Septoplasty has both aesthetic and functional COMPLICATION. However, meticulous and careful surgery can prevent most of them.