Amylase content of tracheobronchial secretion as an indicator of silent aspiration under general anesthesia

The study was done on 50 adult women subjected to elective gynecological operation or emergency Caesarean section under conventional endotracheal anaesthesia. At the end of anaesthesia and before extubation, pH of oropharyngeal, pH and amylase content of tracheobronchial secretions were measured. Twelve percent of patients in the elective group and 24 percent of the emergency group had an amylase level of more than 5000 U/dl in their tracheobronchial secretion. Sixteen percent of elective group and 40 percent in the emergency one had a pH of 3.0 or less in their oropharyngeal secretion. There was a significant positive correlation between pH of oropharyngeal secretion and amylase level of the tracheobronchial secretion in both groups. Amylase content of the tracheobronchial secretion could be considered a specific indicator for the occurrence of silent aspiration

laryngeal mask airway: first clinical experience in Alexandria University hospital

The laryngeal mask airway consists of a tubular oropharyngeal airway to the distal end of which is sealed a silicon laryngeal mask with an inflatable rim which provides an airtight seal around the larynx. Anaesthetic techniques and drugs used were conventional and similar to those which would have been used for the same procedure if face mask or tracheal intubations had been employed. Blind insertion of the laryngeal mask airway size 4 was successful at the first attempt in 80 patients [out of 100], some manipulation was required in 16 patients, and correct insertion was impossible in 4 patients who required tracheal intubations. Laryngeal mask airway provided a clear airway in 96 out of 100 elective patients for a wide variety of surgical procedures, ranging from minor gynecological and urological procedures to major abdominal surgery with either spontaneous respiration or intermittent positive pressure ventilation. The LM airway does not require laryngoscopy or muscle relaxants for its insertion, it relieves the anaesthetist's hands from holding a face-mask during spontaneous respiration and facilitates positive pressure ventilation within the normal tidal volume and airway pressure. It has been used successfully in patients of difficult or failed intubation

effect of the priming principle on the intubation conditions with Atracurium

Administration of the initial dose of atracurium in two increments, .0.5-0.08 mg.kg[-1] "priming" dose followed 6 min. Later by a 0.45-0.42 mg.kg[-1] "intubating" dose decreased the onset time to 120.0 +/- 68.52 s, compared to 239.5 +/- 70.06 s in the non-primed group receiving a single 0.5 mg.kg [-1] dose of atracurium. The described technique provided excellent [75%] to good [25%] intubating conditions after 60 s, and a high intubation score [2.75 +/- 0.44] just a rapidly with atracurium as with succinylcholine chloride. In the non-primed group, intubating coditions were inadequate in 60% of cases, poor in 30% and good in only 10% of cases, the intubation score was only 0.5 +/- 0.69. A priming dose of 0.08 mg.kg[-1] gave a higher intubation score [3.0 +/- 0.0] compared to 2.5 +/- 0.53 with a smaller priming dose of 0.05 mg.kg[-1]. A comparative study between "Atracurium" of "Vecuronium" as regards the effect of the priming principle on the intubation conditions showed the same results of improvements of the intubation score and shortening of the onset time with priming

priming principle and vecuronium: could it be a replacement for suxamethonium?

The effect of the priming principle on some pharmacodynamic parameters of vecuronium was studied. Sixty adult patients were divided into three equal groups; one received vecuronium in two divided doses, the second received a single bolus dose, and in the third group suxamethonium was used for comparison. The priming dose [0.01 mg.kg[-1]], interval [6.0 min] and the injection-intubation time of the main dose of vecuronium [one minute], were all fixed. The Datex Relaxograph was used for neuromuscular monitoring, while a scoring system was applied for assessment of intubating conditions. There was neither significant depression in T[1] activity and/or TOF ratio after priming, nor any clinical side effect. The intubation score improved with priming [a mean of 2.6 +/- 0.7] relative to non-primed patients [1.6 +/- 1.0], but it did not reach the score of suxamethonium [3.0 +/- 0.0]. There was a significant decrease in onset time of vecuronium from 4.2 +/- 1.6 min. in group II to 2.4 +/- 0.8 min. in group I. There was a tendency to increase in clinical duration and recovery rate with priming, but insignificantly. The improved intubation score with priming could not only be explained on the bases of T[1] and TOF ratio depression. The priming principle proved to be a useful technique in facilitating endotracheal intubation, but needs further study regarding its mechanism of action and possible routine use