Adding a conduit to glidescope blade facilitates tracheal intubation. prospective randomized study

To determine the effect of modifying the GlideScope [GVL] blade on the intubation time. This prospective study was conducted at the Department of Anesthesia, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2011 and October 2011. Sixty patients requiring endotracheal tube [ETT] intubation for elective surgery in whom airway was anticipated normal were randomly allocated to one of 2 groups. Group M [n=30]: intubated via a modified GVL blade in which a tube conduit along the side of the GVL blade was created to allow the passage of ETT through the cords. Group C [n=30]: intubated with the conventional GVL blade and rigid intubating stylet. Time to successful tracheal intubation [TTI] was 39.6 +/- 2.1 seconds in Group M versus 66.4 +/- 8.3 seconds in Group C [p=0.0001], tracheal intubation was deemed more easily in Group M than in Group C [VAS2 +/- 1 versus 6 +/- 1, p=0.0001], and all patients in Group M were successfully intubated on the first attempt when compared with 90% in Group C [p=0.009]. The addition of a conduit to the GVL blade made the passage of the ETT easier and TTI shorter without increasing adverse events or intubation failure.

Effects of local low-dose rocuronium on the quality of peribulbar anesthesia for cataract surgery

Peribulbar anesthesia is associated with delayed and/or incomplete orbital akinesia compared with retrobulbar anesthesia. This study examined the effects of adding rocuronium 5 mg to two different concentrations of lidocaine-bupivacaine mixture on onset time of orbital and eyelid akinesia in patients undergoing cataract surgery. In a double-blind study, 90 patients were equally randomized to receive a mixture of 0.5 ml normal saline, 4 ml lidocaine 2%, and 4 ml bupivacaine 0.5% [group I], a mixture of rocuronium 0.5 ml [5 mg], 4 ml lidocaine 2%, and 4 ml bupivacaine 0.5% [group II], or a mixture of rocuronium 0.5 ml [5 mg], 4 ml lidocaine 1%, and 4 ml bupivacaine 0.25% [group III]. Orbital akinesia was assessed on a 0-8 score [0 = no movement, 8 = normal] at 2 min intervals for 10 min. Time to adequate anesthesia was also recorded. Results are presented as mean +/- SD. Ocular movement score decreased during the assessment period in all groups. However, at 2 min after block administration, the score decreased to 4 +/- 2 [95% CI 3,5] in groups II and III compared with 5 +/- 2 [95% CI 4,6] in group I [P<0.01]. Time to adequate condition to begin surgery was 9.8 +/- 2.9 vs. 6.9 +/- 4.1 vs. 7.9 +/- 3.9 min for groups I, II, and III, respectively [P=0.01]. The addition of rocuronium 5 mg to a mixture of lidocaine 2% and bupivacaine 0.5% shortened the onset time of peribulbar anesthesia in patients undergoing cataract surgery without causing adverse effects

Broncho-pleuropericardial fistula complicating staphylococcal sepsis

This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis