use of bovine jugular vein in the fontan circulation

To report our experience n the use of bovine jugular vein [Contegra] in the completion of single ventricle repair. This is a prospective study on a selective group of single ventricle patients who underwent total cavopulmonary connection at Queen Alia Institute between July 2002 and April 2003. All patients had cardiac catheterization preoperatively. Pressure measurements were taken at different points before and after the procedure. All patients had an extracardiac connection on cardiopulmonary bypass without cross clamp and anticoagulated using heparin infection postoperatively for at least 5 days. Five patients were enrolled in the study [2-5 years of age], chest tubes drainage were minimal. Hospital stay was between 1-2 weeks. There were no evidence of conduit thrombosis, arrhythmias or mortality at three months of follow up. Contegra is a safe extracardiac conduit for the completion of single ventricle repair in selected group of patients. Its use is time sparing intraoperatively and decreases hospital stay and morbidity postoperatively. However, its use in a wider range of complex single ventricle patients needs to be evaluated

Hemodynamic response to tracheal intubation: a comparison between young, middle- aged and elderly orthopedic patients

Objective: To examine and compare the hemodynamic changes associated with laryngoscopy and tracheal intubation in the different age groups who underwent orthopedic surgical procedure

Methods: A total of 90 patients fulfilling the criteria of the American. Society of Anaesthesiology [ASA] class 1 and 2 who were admitted to the Royal Jordanian Rehabilitation Center between July 2001 to September 2002 and underwent orthopedic surgery [Back surgery, Total hip and knee replacement, knee arthroscopy] were divided equally into three groups of 30; young [18-25years], Middle aged [40-50 years] and elderly [65-80 years]. The hemodynamic response after tracheal intubation [systolic, diastolic blood pressure, mean blood pressure and heart rate were observed as a percentage change compared to the baseline]

Results: The greatest percentage change in the systolic arterial pressure after tracheal tube insertion was seen in the elderly group [15%]. The increase in systolic arterial pressure was significantly less in the young group compared with the two older groups at one, two, three and four minutes post-intubation. The greatest percentage increase in diastolic blood pressure compared to the baseline was seen in the middle- aged group [24%]. The elderly and young patients showed a significant difference in the diastolic blood pressure response only at one minute post-intubation. However the heart rate response was greatest in the middle-aged patients [40%] and least in the elderly [16%]

Conclusion: Elderly patients had the greatest systolic arterial blood pressure response but the least chronotropic response following tracheal intubation, whereas middle-aged patients had the greatest heart rate and diastolic arterial pressure response. This has clinical implications for choosing drugs for prevention of this response. Further studies are needed to discuss other hemodynamic variable

Epistaxis during nasotracheal intubation: risk factors and possible strategies to avoid it

This study aims to identify risk factors significantly associated with epistaxis during nasotracheal intubation. One hundred patients who underwent nasotracheal intubationn were included. Risk factors for epistaxis were analysed using the multiple logistic regression analysis with stepwise variable selection method. Epistaxis was most likely to occur if transit of the tube through the nasal passage was difficult [P = 0.0001, odds ratio 6.25, 95% confidence interval 3.14-14.26]. On the other hand, age and gender, obesity, smoking, tube size, repeated attempts at intubation, and intubation performed with aid of Magill forceps were not significantly related with risk of epistaxis. The presence of nasal anatomical abnormalities also did not correlate significantly with epistaxis. Strategies to ensure smooth transit of the tube through the nasal passageways are essential to reduce the incidence of epistaxis

Reduction of pain following propofol injection using blood aspiration

A randomized, controlled, single-blinded study was carried out to see the effect of blood aspiration on reduction of propofol injection pain. Seventy-five patients were studied. They were divided into three categories, comparing the aspiration of 2ml of the patients' blood into the propofol syringe immediately before injection, and the addition of either normal saline 2ml, or lignocaine 20mg to the propofol before injection. The addition of blood was as effective as the addition of lignocaine in reducing the pain of injection, but significantly more effective than the addition of saline [P<0.001] in reducing propofol injection pain. Blood as well as lignocaine are more effective than saline in reducing pain of propofol injection