Effect of local administration of Lidocaine with epinephrine on ETCO2 and hemodynamics in pediatric patients undergoing cleft palate surgery

Supplementation of local epinephrine with anesthetic has a number of advantages. it prolongs the effect of anesthetics, reduces its amount required and speeds surgery by decreased bleeding into operative field. However, epinephrine has significant side effects. Increased end-tidal carbon dioxide concentration [ETCO2] has been reported if epinephrine at a concentration of 1 in 200,000 is injected into the nasal mucosa of patients undergoing general anesthesia for nasal surgery. Two concentrations of epinephrine were compared to determine the concentration effect on homodynamic and ETCO2 in pediatric patients undergoing cleft palate surgery Design: Prospective, randomized, single-blind clinical trial. Participants: Twenty four pediatric patients, aged 1 to 4 years undergoing cleft palate repair with general anesthesia were included in the study. To determine the epinephrine concentration effect on ETCO2 and hemodynamics in patients who received injections, in the hard palate, 3-3 ml mL of 1% lidocaine containing two concentrations of epinephrine [1:200,000, or 1:400,000] determined by randomization. Following local infiltration injection as mean values between 62 and 71 mmHg were maintained consistently throughout surgery. ETCO2 was transiently increased in both groups at 5 and 15 min after surgical incision, with significant difference between the two groups, P < 0.05 only at 15 min after incision. Surgeons did not complain about increase bleeding in the operative field in both groups. Amount of blood loss in group 1 is 71.25 +/- 15.49 ml compared with 72.25 +/- 13.53 ml in group II [P

effect of prone position on respiratory mechanics during spinal surgery

To study the effect of prone position on respiratory mechanics during spine surgery. Prospective study. Elective spine surgery at a university hospital. 12 ASA physical I and II with no coexisting cardiorespiratory disease undergoing cervical or lumbar laminectomy under general anesthesia in prone position. Ten min after induction of general anesthesia and endotracheal intubation, while patients were in supine position, the following measurements were taken using anesthesia delivery unit [Datex Ohmeda type A_Elec, Promma, Sweden]: peak airway pressure [Ppeak], peak plataeu pressure [Pplat], peak mean pressure [Pmean] and dynamic lung compliance [DLC]. The same measurements were recorded 10 min after placing patients into prone position. At the end of surgery and 5 min after turning the patients supine and before tracheal extubation, the same measurements were again recorded. The results expressed as means +/- sd. One way ANOVA was used for analysis of differences in the data before, during prone position and after turning patients supine at the end of the procedure. For all comparisons p<0.05 was considered significant. During prone position there was significant reduction in DLC and significant increase in airway pressures. We conclude that turning the patients from supine to prone position during anesthesia for spine surgery caused significant decrease of DLC and significant increase of airway pressure

Non-stented holmium: YAG ureteroscopic management of lower uretral calculi

This study evaluated the clinical outcome of non-stented ureteroscopic laser lithotripsy of lower ureteral calculi with respect to efficacy, safety, postoperative pain and hospital stay. A total of 35 patients undergoing ureteroscopy without prior ureteral dilatation followed by holmium:YAG laser lithotripsy and the procedure were ended without stents. This randomized prospective study was compared to a control group of 35 age, sex and procedure matched patients who had undergone the same procedure with routine placement of stents in the same period of the study. Patients were contacted 24, 48 hours, 1 and 4 weeks postoperatively to determine postoperative pain and analgesic requirements. Radiological follow-up consisted of renal ultrasound and plain KUB film, while excretory urography was done at three months. Five patients [14.2%] of the study group demonstrated dilatation of pelvicalyceal system and upper ureter, which improved completely at the seventh postoperative day. Patients with stents had statistically significantly more postoperative overall pain and total analgesic use compared to the non-stented study group. Hospitalization was 1.8 +/- 1.6 and the time to return to normal activities was 7.3 +/- 1.2 and 9.7 +/- 1.3 days in both the non-stented and the stented group, respectively. None of 27 [77.1%] patients of the non-stented group, who had follow up excretory urography at three months had a newly identified ureteral stricture. Non-stented uncomplicated ureteroscopic holmium:YAG laser lithotripsy without ureteral dilatation is safe and offers numerous advantages over routine stent placement