Safety and efficacy of proseal laryngeal mask airway versus classic laryngeal mask airway and endo tracheal tube during elective surgery

The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway [PLMA], classic Laryngeal mask airway [LMA] and cuffed Endo Tracheal Tube [ETT] as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA[groupI],classic LMA [groupII]and ETT [group III] . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation – Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2 patients and grade 1 in no patient In conclusion :- PLMA and classic LMA could be better choices as ventilatory device in hypertensive and coronary artery disease patients

Early introduction of Oral fluids after laparotomy. controlled clinical trial

The early introduction of oral fluids after laparotomy permits an effective hydration and an earlier introduction of diet. Many surgeons restrict the oral intake after laparotomy as the postoperative hydration in these patients is dependent on the intravenous fluid replacement. This can be a source of complication for the patient. An effective postoperative hydration can be achieved by an oral fluid replacement in patients undergoing cholecystectomy with no increase in complications and with an early introduction of nutrition. These studies have been taken as steps further by comparing the patient tolerance of both restricted and unrestricted postoperative oral fluid regimens after laparotomy for most of the abdominal surgical procedures

Epidural anaesthesia in patients receiving prophylactic low molecular weight heparin [enoxaparin] during total hip replacement

This study was designed to determine the effect of LMWH as a prophylactic to reduce the prevalence of DVT after total hip replacement [THR] and to assess any haemorrhagic, soft tissue side effects or epidural haematoma after the use of LMWH. This study was carried out on 60 adult patients scheduled for total hip replacement under epidural anaesthesia. They were randomly classified into two groups: Group I [30 patients] received subcutaneous low molecular weight heparin [LMWH] enoxaparin 40 mg, 12 hour pre -operatively then after 12 h and 36 h postoperatively. Group II [30 patients] control group, did not receive enoxaparin. Haemorrhagic side effects were assessed by measurement of haemoglobine level, prothrombin time, partial thromboplastine time and platelets count, also we assessed blood loss and soft tissue complications as wound discharge and bruising of the leg. Both groups showed no significant difference in haemoglobin level and other blood laboratory tests in the pre -and postoperative period also there were no significant difference in haemorrhagic side effects or wound discharge but there was more bruising in the enoxaparin group, eight patients [13.3%] experienced minor neurologic complications or low back pain which was self limited and resolved with time. There were no manifestations of epidural haematoma leading to spinal cord compression. Proper patient selection, atraumatic technique, good monitoring, then administration of enoxaparin at least 12 hour before regional anaesthesia, removal of the catheter when the circulating LMWH is low after 10-12 hour from last injection and start the subsequent dose after 2 hours from removal of the catheter, should minimize the occurrence of epidural haematoma

Paravertebral and epidural blocks for post thoracotomy pain

Thoracic anesthesia offers particular challenge. Thoracic patients frequently have a painful wound after surgery. So analgesia after thoracic surgery is of particular significance. In the present study we assessed the efficacy of thoracic paravertebral and epidural blockade on post thoracotomy pain and pulmonary function. Thirty adult ASA I-III patients undergoing elective thoracic surgery were enrolled in this study. they were randomly divided into two groups: paravertebral and epidural group [15 patients each]. Both percutaneous paravertebral and epidural catheters were placed preoperatively. Before chest closure each patient received a bolus dose of bupivacaine [0.25 %] according to its height. This was followed by postoperative bupivacaine infusion [0.25 %] 0.1 ml kg-1h -1 in both groups. Also patients were encouraged to take supplementary doses of morphine from a patient controlled analgesia [PCA]. Subjective pain relief was assessed on a linear visual analogue scale and pulmonary function was measured by spirometry. Stress responses to noxious stimuli was assessed by plasma levels of cortisol and glucose. Respiratory variables were recorded throughout the study period. Also sensory level of analgesia and performance status were assessed in the two groups. Although we found significantly lower visual analogue pain scores at rest and on maximal coughing in the paravertebral compared to the epidural group, no significant difference in patient controlled morphine requirements was noted between the two groups. Pulmonary function [FVC, FEV1 and PEFR] was significantly better in the paravertebral group. Meanwhile no significant difference in respiratory variables was recorded between the two groups. Paravertebral block produced significantly diminished stress responses to noxious stimuli as manifested by less increase in plasma cortisol level than in epidural block. Sensory levels of analgesia and performance status was similar in both groups. Side effects as hypotension, urine retention, nausea and difficulty in breathing were troublesome in the epidural group. While nausea and difficulty in breathing were less in paravertebral group. Like epidural analgesia, paravertebral block deserves to be considered for post thoracotomy pain relief