Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol

A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery [FESS]. Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 microg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 microg/Kg/h infusion during maintenance [DEX group], or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance [E group] to maintain mean arterial blood pressure [MAP] between [55-65 mmHg]. General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables [MAP and HR]; arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia [Aldrete score >/= 9] were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded. Both DEX group and E group reached the desired MAP [55-65 mmHg] with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP [55-65 mmHg] were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score >/= 9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group. Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect

Validity of parentral nutrition after major neck surgeries

Assessment of parentral nutrition as a substitute therapy to enteral nutrition after major neck surgeries with primary pharyngeal repair. Forty patients were included in this study underwent various neck surgeries were prospectively randomized to receive either enteral nutrition [20] patients or parentral nutrition [20] patients. The patients were monitored for postoperative complications, wound healing, hospital stay, time to natural feeding and weight loss. The compared items were similar in both groups [mean duration of nutrition was 9.65, 9.9 days for TPN and NGT group respectively, mean hospital stay was 11.65, 11.9 days for TPN and NGT groups respectively, wound dehiscence and infection was in 15%, 20% in TPN and NGT respectively and also same result for pharyngocutaneous fistula, weight loss was 2.6 Kgm for TPN group and 2.39 Kgm for NGT group; p value was insignificant in all items. There were no major postoperative complications in both groups. The present study reveals that there was no significant statistical difference between parentral and enteral nutrition when used for postoperative nutrition after major neck surgeries

sensitivity and specificity of ultrasound-guided core-needle biopsy of neck masses

Neck masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine needle aspiration cytology includes a high rate of nondiagnostic samples. We performed a retrospective analysis on 166 ultrasound-guided core-needle biopsies form the necks of 68 patients. The target tissue was correctly sampled in 64 patients, and on revision biopsy it reached to 66 patients [97%]. We experienced 97% success in obtaining high quality histopathologic specimens [66 out of 68 cases]. In these 66 patients the sensitivity and specificity in differentiating benign from malignant lesions was 97.6%, and 100% respectively. We conclude that ultrasound-guided core-needle biopsy is a safe and reliable technique in the diagnosis of neck masses with high diagnostic yield and high tissue quality for histopathology that represents a sufficient alternative to open biopsy, even in diagnosis of lymphoma

Retropharyngeal abscess in children; changes in airway clinical presentation and management

Diagnosis of retropharyngeal abscess [RPA] in children is based on clinical suspicioun with supportive imaging studies RPA is frequently described as acute airway emergency. There is nowadays a change in the clinical presentation and management that has been explored in this study. The study included cases identified by a diagnosis of RPA including infectious and traumatic cases with confirmatory computed Tomography [CT] scan findings. Patients were treated with conservative antibiotics, CT-guided needle aspiration or open transoral drainage under general endotracheal anesthesia. Seventeen patients were identified. The mean age was 5.5 years. The symptoms were in the following order of frequency; posterolateral neck pain in 70.5%, odynophagia and drooling 47%, fever 29.4%, lateral neck mass 23.5%, and lastly respiratory distress in 1 patient [5.8%]. The commonest sign was limitation of neck movement 88.2%; of those, 10 patients [58.8%] had limitation of neck extension, 3 [17.6%] had torticollis, 2 [11.7%] had limitation on flexion. Following signs were, fever 53%, enlarged tender upper cervical lymph nodes 47%, tachypnea 35%, posterior pharyngeal bulge 11.7%, inspiratory stridor 5.8%, posterior pharyngeal wall congestion 5.8%. Conservative medical treatment with IV antibiotics alone was successful in 4 [23.5%], transoral incision drainage done for 5 patients [29.4%] patients, external neck drainage in 2 [11.7%] patients, transoral needle aspiration of pus plus IV antibiotics successful in 6 [35%]. Airway related side effects were self-limited and none of the patients needed tracheostomy. Children with RPA present with manifestations other than respiratory distress or stridor. CT scan is useful in confirming the diagnosis. IV antibiotics alone can be effective in clinically stable patients; transoral needle aspiration of pus covered by IV antibiotics be helpful while transpharyngeal incision drainage can be reserved for clinically unstable or difficult to aspirate patients

Stapes surgery: comparison between microdrill and footplate perforator

The study goal was to compare the effect of using footplate perforator and the microdrill on the postoperative hearing results and complications rate during stapes surgery. 70 ears with otosclerosis have been operated upon using microdrill to perforate the footplate in 34 ears and microperforator in 36 ears. All operations were operated upon at the Department of Otolaryngology, Mansoura University Hospitals from 2005 to 2007. The audiological results and complications rate of both groups were compared. There were statistically significant decrease of postoperative air and bone conduction in both groups. There was significant decrease in the mean post operative bone conduction in the microdrill group as compared to the perforator group. The mean postoperative air bone gap [500-4000Hz] was 7.8 dB and 9.3 dB for the microdrill group and the perforator group, respectively, which was statistically insignificant there was no significant SNHL in the microdrill group, while there was one ear [2.7%] had it in the perforator group. Stapedotomy using microdrill or footplate perforator provides good results, however, the use of microdrill may be useful as it is easy, safe and less traumatizing to the inner ear

Nodal level affection in elective neck dissection for squamous cell carcinoma of the larynx

The best prophylactic treatment for the NO neck is a subject of debate. Some authors propose lateral selective lymph node dissection [levels II-IV] for laryngeal squamous cell carcinoma [SCC] on the basis of probability of finding occult metastases in those lymph nodes. The necessity of routine dissection at level IV has been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent lateral neck dissection. We retrospectively evaluated 54 patients with N0 supraglottic and transglottic SCC who underwent total laryngectomy and selective [level II-IV] neck dissection. Twelve patients [22.2%] had occult neck metastases, 3 of them had also contralateral occult positive nodes. Level IV involvement occurred only in one patient [1.85%] ipsilaterally who had also other positive ipsilateral nodes at level II-III. Extracapsular spread [ECS] occurred in 23.8% of positive nodes. Elective dissection of level IV in clinically NO supraglottic and transglottic SCC may be unnecessary and reserved for cases with highly suspicious involvement of level II-III nodes to avoid occasional morbidity associated with its dissection