ABSTRACT
The objective of this study is to evaluate the efficacy and safety of sealing pressure as an inflation technique of the Microcuff pediatric tracheal cuffed tube. A total of 60 children were enrolled in this study. After induction of anesthesia and intubation with Microcuff pediatric tracheal tube, patients were randomly assigned, to one of the three groups. Control group [n = 20] the cuff was inflated to a cuff pressure of 20 cm H 2 O; sealing group [n = 20] the cuff was inflated to prevent the air leak at peak airway pressure of 20 cm H 2 O and the finger group [n = 20] the cuff was inflated to a suitable pressure using the finger estimation. Tracheal leak, incidence and severity of post-extubation cough, stridor, sore throat and hoarseness were recorded. The cuff pressure as well as the volume of air to fill the cuff was significantly low in the sealing group when compared with the control group [P < 0.001]; however, their values were significantly high in the finger group compared with both the control and the sealing group [P < 0.001]. The incidence and severity of sore throat were significantly high in the finger group compared with both the control and the sealing group [P = 0.0009 and P = 0.0026]. Three patients in the control group developed air leak around the endotracheal tube cuff. The incidence and severity of other complications were similar in the three groups. In pediatric N 2 O, free general anesthesia using Microcuff pediatric tracheal tub, sealing cuff pressure is safer than finger palpation technique regarding post-extubation morbidities and more reliable than recommended safe pressure in prevention of the air leak
ABSTRACT
Labor is one of the most painful situations. Unrelieved labor pain can have adverse effects both on the mother as well as the baby. In this review article we summarized the clinical application of various methods used for painless labor and delivery, especially, the new development in epidural anesthesia and analgesia [EA] technique. We discuss the best time to introduce the epidural catheter and when to start the local anesthetic drug through epidural catheter. In the light of newer studies, we compared the mode of epidural drug delivery, continuous infusion or intermittent boluses and different adjuncts to local anesthetic used in modern practice for this purpose. In various recent research studies it was found that the volume of local anesthetic drug is more important in relieving the labor pain and providing satisfaction to patient than the drug concentration. In the end, we discuss the various complications and their prevention
ABSTRACT
Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Epidural analgesia by lidocaine [0.5%] and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration
ABSTRACT
The present study was conducted to compare the effect of pump injection versus manual injection on the venous pressure, during forearm intravenous regional anesthesia [IVRA] and the incidence and the magnitude of lidocaine leak,. A crossover randomized study of IVRA with a forearm tourniquet was conducted on 14 male healthy volunteers. This study was performed, once using manual injection of local anesthetic and once using automatic pump injection, on two separate sessions. In both techniques, 0.3 ml/kg lidocaine 0.5% was injected over 90 seconds. The occlusion pressure, continuous venous pressure and the serum lidocaine two minutes at end of injection, were recorded. The mean occlusion pressure 161.6 [17.2] mmHg was always higher than the mean initial arm systolic blood pressure 131.7[11]. The maximum venous pressure was significantly higher in the manual technique 176.7 [15.4] mmHg than in the pump technique 161.3 [12.3] mmHg [p = 0.04]. The incidence of lidocaine leak was significantly lower [35.71%] in the pump technique compared to [78.5%] in the manual technique [p = 0.02]. Moreover; the mean lidocaine plasma concentrations was significantly higher [0.86 [0.5] microg.ml[-1]] in the manual technique compared to [0.32 [0.4] microg.ml[-1]] the pump technique [p = 0.04]. The use of pump injection for forearm IVRA could significantly decrease the maximum venous pressure, and decrease the incidence and the magnitude of lidocaine leak past the tourniquet