ABSTRACT
Background@#Video laryngoscopes are approved equipment for difficult airway intubations. The borescope, which was introduced during the coronavirus disease 2019 (COVID-19) era, is placed over a direct laryngoscope blade to provide an economical video laryngoscope. In the current study, we investigated the use of an endotracheal tube mounted over a USB borescope versus a video laryngoscope in patients with suspected difficult airways. @*Methods@#After obtaining informed consent, 120 adult patients with suspected difficult airways undergoing elective surgery were included in this study. Patients were randomized into the USB borescope and video laryngoscope groups. The primary outcome was time to successful intubation. The secondary outcomes included hemodynamic changes, anesthetist’s satisfaction, and the incidence of complications. @*Results@#Intubation time was comparable between the two groups (video laryngoscope: 30.63 s and borescope: 28.35 s; P = 0.166). However, the view was clearer (P = 0.026) and the incidence of fogging was lower (P = 0.015) with the video laryngoscope compared to the borescope. Conversely, anesthetist’s satisfaction frequency was higher with the borescope than with the video laryngoscope (P < 0.001). @*Conclusions@#The video laryngoscope provided a better view and less fogging with an intubation time that was comparable to that of the borescope; however, the higher cost of the video laryngoscope limits its availability. Therefore, the borescope is a low-cost, readily available device that can be used for intubating patients with potentially difficult airways.
ABSTRACT
Major surgery may alert the systemic inflammatory response which may progress to severe postoperative complications. The present study investigated the effect of HES 130/0.4 compared to lactated ringer's solution on the postoperative systemic inflammatory response and pulmonary outcome during pediatric major abdominal surgery. Thirty children ASA I or II, aged [6 months- 36 months], scheduled for elective major abdominal surgery were randomized to receive either Hydroxyethyl Starch 130/0.4 solution in HES group or Lactated Ringer's solution in LR group for intraoperative fluid replacement. Volume of HES 130/0.4 or LR infused to replace blood loss was recorded. Serum level of IL6, IL8 and CRP were measured before induction and at 6, 12, 24; 48 hours postoperatively in pediatric intensive care unit. Hypoxia score [Po2/Fio2 ratio] was also assessed at the same time interval. HES group received 103.7 [12.6] ml of Hydroxyethyl Starch 130/0.4 solution. The mean volume of crystalloid infused was significantly higher in LR group 613.2 [47.1] ml versus 396.4 [29.1] ml in HES group [P <0.05]. Serum levels of IL-6, IL-8 and CRP were significantly increased from baseline in both groups during the study period [P<0.05]. This increase was significantly lower in the HES 130/0.4 treated patients compared to those in Lactated Ringer's group [P<0.05]. The peak value was reached at 12 hours for IL-6 and IL-8 and at 48h for CRP. The PO2/FiO2 significantly decreased relative to the baseline values throughout the study period in both groups. The decrease was significantly less in the HES group compared with the LR group at all postoperative time interval P <0.05. HES 130/0.4 is effective for intravascular volume replacement with the advantage of reducing the inflammatory response and improving pulmonary outcome in paediatric patients undergoing elective major abdominal surgery
Subject(s)
Humans , Postoperative Complications , Systemic Inflammatory Response Syndrome/therapy , Interleukin-6/blood , Interleukin-8/blood , C-Reactive Protein , Intensive Care Units, PediatricABSTRACT
This prospective, randomized study was performed to investigate and compare the effect of ultra operative sedatives dexmedetomidine, propofol, and ketamine, in patients undergoing urological procedures under spinal anesthesia with respect to sedation, hemodynamics, respiration, and side effects. The study included 60 adult male patients undergoing urological procedures [e.g. stone ureter and uretroscopy] under spinal anesthesia. Patients were randomized into 3 groups [n=20 in each group], all patients received spinal anesthesia followed by i.v. sedation with dexmedetomidine [bolus dose of 1 micro g/kg over 10 mm followed by iv. infusion of 0.2-0.5 micro g/kgm.], propofol [bolus dose of 0.5mg/kg followed by an intravenous infusion of 1-3mg/kg/h], or ketamine, after iv. administration of 0.01mg/kg midazolam, a continuous infusion of ketamine [0.5mg/kg/h] was started till the end of surgery. Hemodynamic data, oxygen saturation, and respiratory rate were monitored continuously and recorded at the beginning of the procedure and every 10min till the end of surgery and at 1 and 2h post operative. The sedation levels of the patients were assessed by the Ramsay sedation score and measured at 10-minute intervals; a score of 4 was targeted. Serum cortisol level was assessed before surgery [baseline], at 30 mm after skin incision, and 2h post operative. After surgery, the patients were observed in the recovery room until the motor block resolved. Time to the first analgesic demand [VAS 4-5] was recorded. The onset of sedation, and recovery time were also recorded. Side effects such as respiratory depression, hypotension, bradycardia, increased secretions, nausea, vomiting, and visual disturbances were recorded. Demographic and clinical data were comparable in all groups as regards age, sex, ASA physical status, body weight, and operative time. Hemodynamic parameters [SBP, DBP and HR] were comparable in the three groups at baseline. Significant reduction in SBP and DBP was recorded in the three groups after spinal anesthesia which responded well to fluid resuscitation. After 10min of starting sedative infusion SBP and DBP significantly reduced in dexmedetomidine and propofol groups [compared to group III] till the end of the study. HR mean values also showed significant reduction in the three study groups after spinal anesthesia [as compared to baseline]. HR was significantly lower in dexmedetomidine group after starting sedative infusion till end of the study. Serum cortisol level was significantly increased in the three groups compared to baseline reading at 30min and 2h of the study. Serum cortisol at 30min after skin incision in the three groups respectively [19.64 +/- 1.4 micro g/dL] - [23.31 +/- 2.4 micro g/dL] - [23.20 +/- 2.6 micro g/dL]. Serum cortisol at 2h post operative [19.90 +/- 1.3 micro g/dL] - [25.92 +/- 2.7 micro g/dL] - [24.14 +/- 3.1 micro g/dl] in the three groups respectively. Significant lower cortisol level was recorded in dexmedetomidine group compared to group II and III at 30min and 2h post operative. Respiratory rate was decreased significantly from baseline in all groups during sedation [p<0.05] with insignificant difference between groups before or during sedation. Spo2 did not fall below 93% in any patient in dexmedetomidine and ketamine groups during the study, but Spo2<93% was observed in two patients in propofol group. As regards complications, 2 patients in propofol group had respiratory depression. 2 patients in dexmedetomidine group had bradycardia [HR<50 beat/min]. Hypotension was recorded in 1 patient in dexmedetomidine group. Increased secretion was observed in 2 patients in ketamine group. There was no nausea, vomiting, visual disturbances, or hallucinations in the three groups in the postoperative period. In adult patients undergoing urological procedures under spinal anesthesia dexmedetomidine can be used safely. It can provide easily controllable analgesia and sedation without respiratory depression and good attenuating effect on stress response