The effects of dexmedetomidine on airway-related complications during emergence from general anesthesia in nasal and paranasal surgeries

Background: Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed by special technique or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine has sedative and analgesic effects, without affecting respiratory status. Objectives: To evaluate the effects of dexmedetomidine on airway-related complications during emergence from general anesthesia (GA) in nasal and paranasal surgeries. Patients and Methods: This prospective randomized clinical study was included 90 patients of both sexes, admitted for elective nasal and paranasal sinus surgery. They were randomly allocated into three groups 30 patients each, Group A: Standard awake extubation technique. Group B: fully awake "no stimulation extubation" technique. Group C: Dexmedetomidine­group, who received intravenous (I.V) dexmedetomidine 0.5-1 µg/kg bolus in 100 ml of normal saline over 10 minutes before the end of surgery by 10 minutes, The dexmedetomidine bolus was followed by 0.2 µg/kg/hr which was stopped immediately when extubation was done. Results: The following parameters were assessed between the three groups: hemodynamics, airway-related complications, extubation time. Group C: was associated with a significant increase in extubation quality compared with group A and group B regarding hemodynamics, airway-related complications, extubation time. Conclusion: This study showed that the dexmedetomidine group associated with minimal circulatory reflexes and airway-related complications further to the advantage of short extubation time compared with the "no stimulation" extubation technique

The feasibility of Determining the Position of an Endotracheal Tube in Neonates by using Bedside Ultrasonography Compared with Chest Radiographs

Background. Neonates in our neonatal intensive care unit (NICU) receive a large amount of radiation with X-rays (XRs) being done daily; even more often with reintubation; repositioning of endotracheal tubes (ETTs) and confirmation thereof; which has been our NICU policy for many years. Objective. To investigate the feasibility of determining the position of ETTs in neonates by using bedside ultrasonography (BUS); and to compare the results with those obtained from chest XR (CXR) findings. Methods. A prospective; cross-sectional study was done on intubated neonates in the NICU at Universitas Academic Hospital; Bloemfontein; to determine the position of ETTs by using BUS.Results. Thirty intubated patients included in this study had a median age of 13.5 days and a median weight of 1.6 kg. Ninety-three per cent of ETT placements were considered optimal when visualised by BUS; while 73.3 were considered to be placed optimally when CXR was viewed. When CXR and BUS findings were compared regarding optimal placing; the agreement was poor (?=0.10; 95 confidence interval -0.2 - 0.4). In four patients; the distance from the aortic arch to the tip of the ETT was outside the expected range of 1.5 - 2.2 cm: in two patients it was 1.5 cm (6.7) and in the other two 2.25 cm (6.7). BUS measurements were done mainly in extended head (53.3) or neutral (36.7) position. Conclusion. Although poor agreement between CXR and BUS findings was obtained; possibly because of handling of patients with secondary shifting of ETTs; BUS was found not to be comparable with CXR; but an alternative feasible method to determine the optimal position of ETTs in the trachea in neonates when using other reference points; with the added advantage of no radiation exposure