use of laryngeal mask airway during transesophageal echocardiography in pediatric patients

Transesophageal echocardiography [TEE] in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation [ET]. This study was performed to investigate the safety and efficacy of using the laryngeal mask airway [LMA] as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA [LMA group] or ET [ET group]. Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group [P < 0.01]. The mean recovery time was also significantly shorter in the LMA than in the ET group [44 +/- 8 min and 59 +/- 11 min, respectively; P < 0.001]. The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE

effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

We hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of the Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 [8.2] in the placebo and 35.17.0mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group, p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine