Comparative study between Air-Q and Intubating Laryngeal Mask Airway when used as conduit for fiber-optic

This study compared Air-Q and Intubating LMA when used as a conduit for endotracheal intubation.MethodsOne hundred patients scheduled for surgical operations under general anesthesia were randomly allocated into two equal groups (n = 50). Group I: Air-Q and group II: Intubating Laryngeal Mask Airway (ILMA) in both groups intubation was done by Fiberoptic bronchoscope (FOB) through study device. After induction of anesthesia, patients were ventilated with Air-Q or ILMA. Then, endotracheal tube (ETT) was inserted through study device. Recorded measurements were as follows: number of attempts and duration of insertion of device, peak airway pressure and fiberoptic grading of laryngeal view. Also, we recorded number of attempts and duration of insertion of ETT and the incidence of blood stain on device and sore throat grading.ResultsDuration of insertion of Air-Q was 13.300 ± 3.471 s, whilst that of ILMA was 19.640 ± 4.737 s (p < 0.001). In group I, peak airway pressure was 26.400 ± 2.176 cmH₂O, whilst, in group II, it was 25.260 ± 1.468 cmH₂O (p < 0.01). Full view of vocal cords amounted to 78% and 26% of Groups I and II patients, respectively (p < 0.001). Time of insertion of ETT was 33.5 ± 6.795 s in group I, whilst in group II, it was 39.5 ± 6.566 s (p < 0.001). Blood stain was found on supraglottic device in 46% and 22% of cases in Groups I and II, respectively (p < 0.01).ConclusionAir-Q proved to be an excellent conduit for endotracheal intubation compared to the ILMA.     

Hemodynamic changes occurring with tracheal intubation by direct laryngoscopy compared with intubating laryngeal mask airway in adults: A randomized comparison trial

BackgroundHemodynamic changes are major problems due to general anesthesia. We designed a prospective randomized study to compare the hemodynamic responses due to direct laryngoscopy (DL) and intubating laryngeal mask airway (ILMA).MethodsSeventy adult ASA-I and ASA-II patients referred to anesthesia department were randomly divided into two groups: direct laryngoscopy (Macintosh laryngoscope) and ILMA. Systolic, diastolic and mean arterial blood pressure and heart rate were recorded at baseline, preintubation, 1, 3 and 5 min after intubation following intubation. Also some complications including sore throat, laryngospasm, hoarseness and cough were evaluated.ResultsMean age of studied patients in DL group (including 11 (31.4%) male) was 35.5 ± 12.2 and 35.5 ± 9 years old in ILMA group (including 16 (45.7%) male). There was no significant difference between two studied groups about measured hemodynamic indices (P < 0.05, CI = 95%). The results showed that the just difference between increment of diastolic blood pressure and mean arterial pressure after 5 min interval of two studied groups was significant (P = 0.04; P = 0.034). There was no significant difference between the number of patients with positive complications and those without them (P < 0.05).ConclusionLaryngoscoy through the intubating laryngeal mask airway was associated with lesser mean arterial pressure and diastolic blood pressure when compared to intubation by direct laryngoscope. Thus this technique seems to reduce hemodynamic response to tracheal intubation.     

Tips and tricks to increase the success rate of blind tracheal intubation through the Air-Q™ versus the intubating laryngeal mask airway Fastrach™

BackgroundThe Air-Q intubating laryngeal airway is a new supraglottic airway device which overcomes some of the limitations inherent to the intubating laryngeal mask airway (ILMA Fastrach^™) for tracheal intubation. Previous studies showed lower success rate of the Air-Q^™ versus ILMA Fastrach^™. This study was conducted to illustrate new maneuvers for increasing the success rate of Air-Q^™ versus ILMA Fastrach^™ and compare between both devices.MethodsOne-hundred and seventy adult patients, ASA I or II, aged >16 years old undergoing elective surgery under general anesthesia were divided randomly into 2 equal groups (85 each). Group A: using Air-Q ILA size 3.5 or size 4.5 Group B: using ILMA size 4 or size 5 according to the manufacturer’s recommendations for body weight in both groups. The time and the total success rate of blind intubation through them in 2 attempts only were recorded. In Group A, extension of the head with cricoid pressure was applied. The hemodynamic response to devices insertion and the complications related to both devices were compared.ResultsIn Group A, the total success rate in 2 attempts was 94.12%, while in Group B, it was 96.47%. However, this difference was not statistically significant. The first attempt success rate was 81.18% in Group A, while it was 82.35% in Group B. The total time to intubate the hemodynamic response to device insertion and the incidence of complications (sore throat, trauma and hoarseness of voice) showed no statistically significant difference between both groups.ConclusionThis study showed that extension of the head with cricoid pressure greatly increases the success rate of blind intubation through the Air-Q to 94.12% versus the ILMA Fastrach 96.47% with no statistically significant difference between both devices.     

Effect of fiberoptic intubation on myocardial ischemia and hormonal stress response in diabetics with ischemic heart disease

BackgroundDiabetic patients with ischemic heart disease can greatly benefit from decreasing the stress response to intubation with its metabolic sequelae. The use of fiberoptic bronchoscopy will eliminate the response to direct laryngoscopy while lubrication of ETT with lidocaine gel 2% will decrease the response to endotracheal intubation. This study was conducted to compare the stress response hormones (glucose, cortisol and c-peptide) and the hemodynamic responses to intubation between direct laryngoscopy and fiberoptic bronchoscopy in diabetic ischemic patients.Patients and methodsForty-four adult diabetic patients with ischemic heart disease, ASA II, with a blood glucose level between 120 and 180 mg/dL, requiring orotracheal intubation under general anesthesia were divided into 2 equal groups. The laryngoscopic group (n = 22) and the fiberoptic group (n = 22). Ovassapian airway was used to facilitate fiberoptic intubation with avoidance of jaw thrust maneuver. Blood glucose, cortisol and c-peptide were recorded before induction and 10 min after intubation and compared between both groups. The hemodynamic parameters were recorded and compared between both groups. Automated ST segment monitoring was used to detect ischemia.ResultsThere was statistically significant increase in HR, SBP and DBP in laryngoscopic group than in fiberoptic group. However, the incidence of ECG ST-segment changes was comparable with no statistically significant difference between groups. There were no statistically significant differences regarding glucose, cortisol and c-peptide levels between the study groups pre and post-induction. The intubation time in the fiberoptic group showed a statistically significant increase in comparison with the laryngoscope group (39 ± 12.04 vs. 29.3 ± 8.54 s; P < 0.05).ConclusionThe optimum use of fiberoptic bronchoscope with avoidance of jaw thrust maneuver attenuates the hemodynamic response to intubation which is beneficial in diabetic patients with ischemic heart disease. Stress response hormones showed no statistically significant difference between groups.     

Comparative study between LMA-Proseal™ and Air-Q® Blocker for ventilation in adult eye trauma patients

BackgroundThe disposable Air-Q® Blocker Masked Laryngeal Airway (MLA) is a new supraglottic device used for intubation, rescue ventilation, and for esophageal suctioning. Laryngeal Mask Airway-Proseal™ is a well known supraglottic device in clinical practice. The aim of the study was to compare Air-Q® Blocker against LMA-Proseal™ as supraglottic devices for ventilation.MethodsSixty adult healthy patients scheduled for eye trauma surgeries under general anesthesia were randomly allocated into 2 groups; Group A (n = 30), where Air-Q® Blocker is used, Group P (n = 30), where LMA-Proseal™ is used. The success rate and time of their insertion were measured. Laryngeal view grading was assessed by fiberoptic bronchoscope. Ease of gastric tube placement and any post-operative complications (airway edema, sore throat or hoarseness) were also measured. Stress response of device insertion was measured using the vital sign measurements.ResultsSuccess of insertion at 1st attempt was (90%) in Group A and (83.3%) in Group P. Insertion time was 18.37 ± 3.77 s in Group (A), while 23.43 ± 3.54 s in Group P, (p < 0.001). Airway seal pressure was comparable in both groups. Full view of vocal cords amounted to (76.7%) in Group A, and (56.7%) in Group P respectively. 1st Attempt Gastric Tube Insertion was (93.3%) in Group A, and (83.3%) in Group P. comparison of previous data in both groups showed no statistical significant differences between them. The incidence of postoperative complications and post insertion hemodynamic stress response was statistically nonsignificant when compared between the 2 groups.ConclusionThe Air-Q® Blocker demonstrated to be remarkably good as a ventilatory device, with adequate airway seal pressure, and improved facilitation of gastric tube insertion compared to LMA-Proseal™. Minimal pressor response was achieved after insertion with no statistical significance.     

Efficacy of laser acupuncture in attenuating hemodynamic response to orotracheal intubation and postoperative nausea and vomiting in children undergoing strabismus surgery

BackgroundLaser acupuncture may be offered to patients with needle phobia and children. This study aimed to investigate efficacy of the acupuncture point stimulation (Liv3 and P6) in preventing PONV and hemodynamic response to intubation in children.MethodsSixty children, ASA I or II aged 3–12 years, undergoing strabismus surgery were divided into 3 equal groups; 20 child each Group I (laser acupuncture group), Group II (ondansetron group) 0.15 mg/kg IV group and Group III (control group). Laser stimulation was performed bilaterally over 30 s, 15 min before induction of anesthesia and 15 min after arriving in the recovery room. Systolic, mean and diastolic BP and HR were measured in groups I and III before induction (times 1, 2), before intubation (time 3) and every minute after intubation for 5 min (times 4–8). 0–3 PONV scale was reported in all 3 groups I, II and III at 0–1 h, 1–6 h and 0–12 h postoperatively.ResultsMABP and HR were significantly less in the acupuncture group at T4, T5 (P values are < 0.05) as compared with the control group. Nausea, retching and vomiting in the control group were statistically significantly higher than both acupuncture and ondansetron groups at all intervals.ConclusionLaser stimulation of acupuncture points P6 and Liv3 decreases but does not prevent hemodynamic stress-response to endo-tracheal intubation in children, and effectively decreases postoperative nausea, retching, and vomiting in children undergoing strabismus surgery.     

Os efeitos do remifentanil sobre os marcadores do estresse oxidativo durante a cesariana,em correlação com a hemodinâmica materna e o desfecho neonatal: um estudo randômico controlado

Background and objectiveRemifentanil is used to attenuate maternal hemodynamic response to intubation and surgical stress during Induction–Delivery period of cesarean section. The goal was to compare the effects of two remifentanil dosing regimens on oxidative stress level, in correlation with its hemodynamic and neonatal effects.MethodsFifty‐one patients, 17 per group, enrolled for elective cesarean section were randomly divided by computer‐generated codes into three parallel groups: (A) patients received a 1 μg.kg⁻¹ remifentanil bolus immediately before induction, followed by 0.15 μg.kg⁻¹.min⁻¹ infusion, that was stopped after skin incision; (B) patients received a 1 μg.kg⁻¹ remifentanil bolus immediately before induction; (C) (control), patients did not receive remifentanil until delivery. Maternal venous blood samples were taken at basal time, at extraction and 30 minutes after the end of operation for spectrophotometrical determination of malondialdehyde and advanced oxidation protein products concentration. The same was conducted for umbilical venous sample.ResultsSystolic blood pressure and heart rate remained significantly lower in group A compared to B and C during entire Induction–Delivery period (p < 0.001, p = 0.02 after intubation; p = 0.006, p = 0.03 after skin incision; p = 0.029, p = 0.04 after extraction; respectively). Malondialdehyde concentration was lower at time of extraction in maternal blood in group A compared to B and C (p = 0.026). All neonatal Apgar scores were ≥ 8 and umbilical acid–base values within normal range.ConclusionsThe remifentanil dosing regimen applied in group A significantly attenuated lipid peroxidation and maternal hemodynamic response during entire I–D period, without compromising neonatal outcome.     

Comparative study between the trachlight and SensaScope intubation in normal patients scheduled for elective surgery

IntroductionAirway management is a core stone and remains a challenge of every anesthetist. Visual control may facilitate tracheal intubation. Rigid video-laryngoscopes are emerging among the devices suggested as alternatives to direct laryngoscopy. Among the many alternative devices to choose for tracheal intubation, semi-rigid fibrescopes and lighted stylets can alternate rigid laryngoscopy in endotracheal intubation.Aim of the workThe aim of the study was to clarify the efficacy and hemodynamic responses associated with tracheal intubation using trachlight technique (blind object) compared to SensaScope technique in patients subjected to elective surgery.Patients and methodsThirty patients were randomly allocated to either the trachlight (TL) or SensaScope (SS) group, (15 patients in each group). All endotracheal intubations were performed after induction of general anesthesia. Evaluation of technique, performance, duration of intubation, number of attempts at intubation, success rate of intubation with each device, hemodynamic changes [heart rate (HR), mean arterial blood pressure (MAP)] and oxygen saturation (SpO₂) were recorded.ResultsThe duration of the intubation procedures was shorter in the SS group (64.86 ± 54.166 s) than in the TL group (68.53 ± 50.89 s) but without statistical significance, while no significant difference in the numbers of intubation attempts between the two groups. HR and MAP showed transient increase without statistical significance between both groups.ConclusionThe endotracheal intubation was effectively using either trachlight or SensaScope, while the SensaScope (SS) group showed shorter time and attenuation of the hemodynamic changes produced by tracheal intubation without significant postoperative complications except 13% complaining of hoarseness of voice after extubation.     

Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury

BackgroundThe Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury.MethodsFifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2 mg iv and midazolam 1 mg iv that be repeated up to 0.05 mg/kg followed with a bolus dose of remifentanil 1.5 μg/kg then a continuous remifentanil infusion of 0.15 μg/kg/min for 3 min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO₂ < 90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded.ResultsIntubating time was significantly lower in G group compared with F group (26 ± 5 versus 72 ± 11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups.ConclusionThe GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation.     

Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

BackgroundObesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients.MethodsEighty patients with ASA physical status I‐III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m^‐2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited.ResultsThere was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1 s vs. 50.7 ± 21.2 s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1 s vs. 97.4 ± 42.7 s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05).ConclusionsAirtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.     

Macintosh laryngoscope versus Bonfils Intubation Endoscopes in endotracheal intubation: Hemodynamic,intra-ocular pressure and serum catecholamine responses

ObjectiveOne of the alternative methods in managing patients for endo-tracheal intubation is the Bonfils fiberscope. We studied the efficacy of Bonfils fiberscope in comparison to the classical laryngoscope with Macintosh blade inhemodynamic, serum catecholamine and intra-ocular pressure responses.MethodsIn a prospective, randomized trial 40 patients ASA I or II aged ?18 years scheduled for gynecological, urinary and lower abdominal procedures in supine position were randomly allocated to one of two groups; 20 patients each; according to intubating device by using either Macintosh laryngoscope (L) group or Bonfils Intubation Endoscopes (B) group. Pre-induction (baseline) and pre-insertion values of HR, MAP, IOP and blood samples for catecholamine level were recorded and repeated at 1, 3, and 5 min after intubation.ResultsThere was significant increase in HR, MAP, IOP and catecholamine level in L group at 1, 3, and 5 min after intubation.ConclusionBonfils laryngoscope had superiority over Macintosh as a method of intubation in situations where minimal changes in hemodynamic, catecholamine level and intraocular pressure are desirable.     

Comparative study between ephedrine infusion vs. CO/post loading of fluids for prevention of hypotension in emergency cesarean section under spinal anesthesia

IntroductionMaternal hypotension is the most common complication during cesarean section under spinal anesthesia. The aim of this study was to compare the effectiveness of CO/post loading of fluids versus immediate post spinal infusion of ephedrine in prevention of hypotension.MethodsNinety healthy pregnant patients ASA I with single term fetus arrived to the operating room with nonlife threatening cause for emergency cesarean section under spinal anesthesia. The patients were allocated randomly into 3 groups, Group R: started the CO/post loading at the time of spinal injection and continued after it with 0.5 ml/kg/min Lactated Ringer's solution until delivery of the fetus. Group V: started the CO/post loading with 0.5 ml/kg/min Voluven at the same period. Group E: started ephedrine infusion at 1 mg/min via the infusion pump immediately after spinal anesthesia until delivery of the fetus.ResultsThe systolic blood pressure changes were statistically significant but they failed to reach clinical significant values in the three groups. The total dose of ephedrine was significantly higher in Ephedrine group than the other two groups. Intraoperative heart rate increased in the first 30 min in Ephedrine group without any clinical significance. All fetal data were within normal range and comparable between groups. Apger score of the fetuses was not less than 8 in the three groups. The incidence of nausea and vomiting was higher in group R and group V compared to group E.ConclusionIntravenous infusion of ephedrine 1 mg/min immediately after spinal anesthesia for emergency cesarean sections, even if there is no enough time for proper prehydration, can control effectively the hypotension without episodes of hypertension or significant tachycardia, and it had no effect on fetal well-being. It could be as effective as CO/post loading of 0.5 ml/kg/min lactated Ringer or Voluven in controlling systolic blood pressure with fewer incidences of post operative complications.     

Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy

Background and aim of studyElectroconvulsive therapy (ECT) is one of the safest methods used for the treatment of patients with mental illness today. It is associated with surge in heart rate and blood pressure for a brief period of time. However, as an extreme complication, the hemodynamic response to ECT can produce myocardial ischaemia and even infarction, as well as transient neurological ischaemic deficits, intracerebral haemorrhages, and cortical blindness. This study is aimed towards finding a reliable drug that can prevent this untoward hemodynamic response in immediate post-ECT period.Place and duration of studyThe study was conducted at Combined Military Hospital Skardu after permission from the hospital ethics committee from January 2011 to December 2011.Study designOne thirty-four American society of Anaesthesiology (ASA) I & II patients of both genders were divided randomly in three groups named A, B and C. Patients were induced short general anaesthesia as per set protocol. Group A patients were given no additional drug, while group B patients had lignocaine 1 mg/kg and group C patients nitroglycerine (NTG) 3 μ/kg respectively just after induction. Heart rate (HR) and mean arterial pressure (MAP) were recorded 2 min after induction of anaesthesia just prior to ECT shock and then 1 min after ECT administration.Operation definitionsSignificant rise in heart rate was defined as an increase in heart rate of 10 or more beats per minute after administration of ECT shock from baseline.Significant rise in MAP was defined as the rise in MAP of 15 mm of Hg or more from the baseline after administration of ECT shock.ResultsThirty-three (75%) of 44 patients in group A showed significant rise in HR as compared to group B where no patient showed a significant increase in HR (p < .05). In terms of MAP 29 (65%) out of 44 patients showed a significant rise in group A and 22 (52%) out of 42 patients in group B showed similar results showing statically insignificant difference between the groups. When comparing patients of groups A and C, only 11 (22%) out of 48 patients showed significant rise in HR and 13 (27%) patients showed significant rise in MAP. The difference was statistically significant in both variables (p < .05).ConclusionNTG provided more hemodynamic stability in post-ECT period as compared to lignocaine which only prevented a surge in HR without any effect on MAP. We conclude that NTG can safely be instituted for anaesthesia in ECT patients for prevention of hemodynamic stress response.     

Quality of MRI pediatric sedation: Comparison between intramuscular and intravenous dexmedetomidine

ObjectiveThe study was designed to compare the efficacy of dexmedetomidine whether given intramuscular or intravenous for pediatric MRI sedation.Subjects and methodsNinety children between the ages of 2 and 8 years with ASA physical status I–II, scheduled for elective MRI, were enrolled in a double blind, comparative randomized study. Patients assigned into two equal groups. Group DV, sedation was performed using IV dexmedetomidine hydrochloride; a loading dose of 1 μg/kg administered over 10 min followed by a continuous infusion at 1 μg/kg/h. Group DM where the patient received IM dexmedetomidine 3 μg/kg. Primary endpoints included incidence of failed sedation and the requirement of midazolam supplementation. Secondary endpoints were time to sedation, duration of sedation, discharge time, and hemodynamic status.ResultsThe sedation failure rate was significantly higher in the DV group (40%) in comparison with the DM group (20%) (P = 0.04). Also, the use of rescue midazolam was significantly higher in the VD group (0.37 ± 0.47 mg) in comparison to the DM group (0.17 ± 0.35 mg) (P = 0.025). The onset of satisfactory sedation was significantly shorter in DV group in comparison to DM group (7.93 ± 0.884 vs. 16.87 ± 4.49). Also, the discharge time was significantly less in the DV group (32.27 ± 3.04 min) in comparison to DM group (41.87 ± 5.80 min). Patients in DV group had significantly lower MBP compared to patients in DM group after receiving dexmedetomidine (p < 0.05). Although the HR decreased in both groups during the MRI study, the decrease was statistically significant in the DV group compared to the DM group in the period extended from the 2nd to 35th min (p < 0.05).ConclusionIn pediatric MRI sedation, although IM dexmedetomidine does have a late sedation onset; it reduces the sedation failure rate, the need for supplement sedation and the incidence of hemodynamic instability associated with IV dexmedetomidine.     

Effects of a head elevated ramped position during elective caesarean delivery after combined spinal-epidural anaesthesia

BackgroundElevating the torso in a Head Elevated Ramped Position during caesarean delivery benefits the mother by improving comfort and ventilation while reducing reflux symptoms and providing a better airway position. We hypothesised that using an elevation pillow for an elective caesarean delivery under combined spinal-epidural anaesthesia would not significantly increase the time to achieve a T4 block.MethodsFollowing ethical approval and informed consent, 60 women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomised to one of three groups: Control – horizontal with a small pillow under the head; Head Elevated Ramped Position – torso on an elevation pillow; and Head Elevated Ramped Position with initial position horizontal. Data collected were time to T4, block height at 30 and 120 min, adequate block at 12 min, need for epidural supplementation, maternal comfort and airway position assessment.ResultsTime to T4 among the three groups was not significantly different (P = 0.14). However, there was a significant difference in achievement of block height of T4 at 12 min and greater need for epidural supplementation in the intervention groups compared to the control group (P = 0.021). Non-inferiority analyses of time to T4 of both head elevated ramped positions were inconclusive about inferiority relative to the control. Head Elevated Ramped Position was significantly more comfortable than control (P = 0.007). Using the level of the external auditory meatus to the sternal notch as an indicator for ease of laryngoscopy, Head Elevated Ramped Position provided a significantly better position than control (P < 0.001).ConclusionElevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4; however, the need for epidural supplementation was greater in the intervention groups. Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required.     

Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy

ObjectiveTo assess the efficacy and safety of ketofol administration in controlling emergence agitation (EA) after sevoflurane-based anesthesia in children undergoing adenoidectomy or adenotonsillectomy.Subjects and methodsThis double-blinded randomized study involved 90 children (3–6 years) scheduled for elective adenotonsillectomy or adenoidectomy. They were randomly assigned to receive 10 ml of normal saline (control group, C) or, 1 mg/kg propofol in 10 ml saline (group P) or ketofol as 1 mg/kg propofol and 0.25 mg/kg ketamine in 10 ml saline (group K) 10 min before the end of surgery. In PACU, sedation, behavior, pain and severity of EA were assessed using modified Aldrete score, Aono’s scale, Objective Pain Score (OPS) and Pediatric Anesthesia Emergence Delirium (PAED) scale, respectively.ResultsIn ketofol group, OPS was significantly lower compared to propofol and control groups. Recovery criteria were in favor of ketofol and propofol groups including longer time to eye opening (p < 0.001) and time to Aldrete score ⩾ 9 (p = 0.001). Time to discharge from PACU was comparable in the three groups (p = 0.079). EA was significantly more frequent in the control group (p < 0.001), but comparable in ketofol and propofol groups. PAED score was significantly higher in control group compared to ketofol and propofol groups. Ketofol and propofol preserved hemodynamic stability.ConclusionKetofol provides a promising new option for controlling emergence agitation with adequate postoperative sedative and analgesic effect, good recovery criteria and hemodynamic stability compared to propofol and control groups in children undergoing adenoidectomy or adenotonsillectomy.     

Effect of tramadol gargle on postoperative sore throat: A double blinded randomized placebo controlled study

BackgroundPostoperative sore throat is an undesirable complaint after general anesthesia with laryngeal mask airway. Tramadol is a synthetic codeine analogue with NMDA receptor antagonist and local anesthetic effects. We compared tramadol gargle to placebo given 5 min before surgery on attenuating postoperative sore throat for 24 postoperative hours.MethodIn a prospective randomized double blind study, fifty patients of ASA I and II, undergoing elective moderate urological surgery under general anesthesia using laryngeal mask airway were allocated into two groups (25 patients each); all patients were asked to gargle for 1 min with 30 ml apple juice containing tramadol 2 mg/kg in group (T), and nothing in group (P) 5 min before surgery. The incidence and the severity of postoperative sore throat were graded at 2, 6, 12, and 24 h after surgery using a four-point scale.ResultIncidence and severity of postoperative sore throat were significantly less in tramadol treated group compared to placebo group at 2, 6, 12, and 24 h (p < 0.05).ConclusionPreoperative gargling with tramadol reduced the incidence and severity of POST compared to placebo group in patients undergoing elective moderate urological surgery, during general anesthesia with laryngeal mask airway for up to 24 h postoperatively.     

Impact of pillow height on double-lumen endotracheal tube intubation with McGRATH MAC: a prospective randomized clinical trial

Study objectiveThis study aimed to compare the impact of pillow height on double-lumen tracheal tube (DLT) intubation with McGRATH MAC (McG) in patients undergoing elective surgery.DesignRandomized clinical trial.SettingOperating room.PatientsFifty adult patients scheduled for elective surgery under 1-lung ventilation with an American Society of Anesthesiologists physical status of 1 to 3.InterventionsDLT intubation with McG was performed with a high pillow (HP group; 25 patients) or low pillow (LP group; 25 patients) by anesthesiologists.MeasurementsIntubation time, number of laryngoscopy, number of tracheal intubation attempts to successful intubation, percentage of glottic opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed.Main ResultsIntubation time was significantly shorter in the HP group compared with the LP group (HP: 32.1 ± 14.9 seconds vs LP: 49.4 ± 11.2 seconds, P < .001). The number of laryngoscopy were 1 (HP group, 22 patients; LP group, 17 patients), 2 (HP group, 3 patient; LP group, 7 patients), and 3 (HP group, 0 patient; LP group, 1 patient), with no significant difference between the 2 groups (P = .197). Although the percentage of glottic opening score did not significantly differ between HP and LP groups (HP: 95.6% ± 6.7% vs LP: 96.0% ± 12.3%, P = .08), the number of tracheal intubation attempts was significantly lower in the HP group compared with the LP group (P = .009). The visual analog scale score for laryngoscopy did not significantly differ between the 2 groups (P = .54). However, the visual analog scale for tube passage through the glottis was significantly higher in the LP group than in the HP group (P < .001).ConclusionsIntubation with an HP was associated with a better DLT intubation profile than with an LP with McG, possibly due to smoother tracheal tube progression through the glottis.     

Efeito de diferentes doses de esmolol sobre a resposta hemodinâmica,BIS e resposta de movimento durante a intubação orotraqueal: estudo prospectivo,randômico e duplo‐cego

ObjectiveA prospective, randomized and double‐blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.Materials and methods120 patients were randomly allocated to one of three groups in a double‐blind fashion. 2.5 mg kg⁻¹ propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6 mg kg⁻¹ rocuronium, a tourniquet was applied to one arm and inflated to 50 mm Hg greater than systolic pressure. The patients were divided into 3 groups; 1 mg kg⁻¹ h⁻¹ esmolol was given as the loading dose and in Group Es50 50 μg kg⁻¹ min⁻¹, in Group Es150 150 μg kg⁻¹ min⁻¹, and in Group Es250 250 μg kg⁻¹ min⁻¹ esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.ResultsIncidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1 st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p < 0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.ConclusionIn clinical practise we believe that after 1 mg kg⁻¹ loading dose, 150 μg kg⁻¹ min⁻¹ iv esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects.     

Intraocular pressure changes: the McGrath video laryngoscope vs the Macintosh laryngoscope; a randomized trial

Study ObjectiveTo determine the effects of the McGrath Series 5 video laryngoscope on intraocular pressure (IOP) during laryngoscopy.DesignProspective, randomized, double blind.SettingOperating room.PatientsEighty adult patients of American Society of Anesthesiologist physical status 1 scheduled for nonophthalmic elective surgery under general anesthesia.InterventionsThe endotracheal intubation was provided using McGrath series 5 video laryngoscope in MG group (n = 40) or Macintosh laryngoscope in M group (n = 40).MeasurementsThe IOP of the right and left eyes was measured before and after the laryngoscopic process.Main ResultsThe mean arterial blood pressure values just before laryngoscopy and intubation and after intubation were 77.38 ± 6.18 and 97.38 ± 12.77 in the McGrath video laryngoscope group and 75.85 ± 7.88 and 99.12 ± 14.30 in the Macintosh laryngoscope group, respectively. The IOP values of the left eye after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group were found to be significantly higher than those in the McGrath video laryngoscope group (P = .019, P = .019, and P = .007, respectively). In addition, the IOP values of the right eye were found to be higher after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group, compared to the McGrath video laryngoscope group (P = .009, P = .021, and P = .011, respectively). The mean IOP values for the left eye just before laryngoscopy and intubation and after intubation were 10.65 ± 2.52 and 15.57 ± 3.62 in the McGrath video laryngoscope group, and for the right eye, they were 10.60 ± 1.64 and 17.17 ± 2.38 in the Macintosh laryngoscope group, respectively.ConclusionThe McGrath Series 5 video laryngoscope may provide a lower IOP level compared to the Macintosh laryngoscope in an otherwise healthy, young patient population.