Comparative study between the use of Macintosh laryngoscope and Airtraq in patients with cervical spine immobilization

Airway management is a major responsibility for anesthetist. This study was carried out to evaluate and compare the efficacy of Airtraq [AL] and Macintosh Laryngoscopes [ML] in intubating patients with cervical spine immobilization using manual inline axial stabilization technique [MIAS]. This randomized controlled study was carried out in Alexandria Main University Hospital on 40 adult ASA I and II patients after written informed consent and approval of the ethical committee, randomly categorized into two equal groups. All patients were subjected to same anesthetic protocol. Group I patients were intubated using AL and group II patients were intubated using ML. Hemodynamic measurements and oxygen saturation were recorded. Intubation criteria for both groups including [duration of intubation procedure, number of attempts, number of optimization maneuvers, Cormack and Lehane grade at laryngoscopy, Intubation Difficulty Scale score [IDS], rate of successful placement of endotracheal tube, neck mobility during laryngoscopy and intubation complications were recorded. Data statistically analyzed using SPSS[R] software using [t and x[2] tests] and P < 0.05 considered significant. There was statistically significant increase in both heart rate and mean arterial blood pressure values following intubation in ML group than AL, oxygen saturation showed no significant difference between the two groups. Duration of intubation was statistically significant longer in ML group and needed more optimization maneuvers than the AL group, while for the number of intubation attempts; there was no statistically significant difference between the two groups. Both the Cormack and Lehane grading and IDS score values have shown statistically significant higher values in ML group. The Airtraq Laryngoscope offers a new approach for the management of difficult airway like patients with potential cervical spine injury, it is fast, easy to use, gets an easy view of the larynx without moving the cervical spines or causing hemodynamic stimulation

Retrobulbar versus peribulbar analgesia in ophthalmic surgery

The aim of the present study was the comparison of peribulbar injection as an alternative method to retrobulbar injection. This study was carried out on sixty patients admitted to the Ophthalmology Department of Alexandria University Hospital for ophthalmic surgery under regional analgesia. Thirty patients received retrobulbar analgesia and the other thirty received peribulbar analgesia. The analgesic fluid used was a mixture of bupivacaine 0.5% and lidocaine 2.0%, 50: 50 without epinephrine. In the present study, comparison between retrobulbar and peribulbar techniques was done as regard the effect on heart rate, mean arterial blood pressure and respiratory rate. No significant changes were observed in any of the above parameters. There were no significant differnces between both groups. Comparison of analgesic effect of both groups including lid akinesia, globe akinesia and analgesia by grading assessment from scores 4 to 1 [4 was the best, 1 was the worst] was done. Onset time was shorter in retrobulbar than peribulbar analgesia while duration of analgesia was significantly longer with peribulbar than with retrobulbar block. Lid akinesia was better with peribulbar block. In both groups there was no change in pupillary size or intraocular pressure. No complications were observed in both groups

effects of metoclopramide and clonidine hydrochloride premedication on intraocular pressure

Thirty adult patients classified into three equal groups were studied to evaluate the effect of premedication on intraocular pressure [IOP]. In group I [control group], atropine premedication was not accompanied by significant changes in IOP. In group II [metoclopramide group] where metoclopramide was given in addition to atropine, premedication was accompanied by significant increase in IOP, while in the third group [clonidine group] where clonidine CHL was given in addition to atropine, there was a significant decrease in IOP after premedication. Following intravenous induction with thiopentone sodium, there was a significant IOP reduction in the three groups. The reduction was significantly less in metoclopramide group than in control and clonidine groups. No significant changes in IOP was observed in the three studied groups after administration of vecuronium. In the three studied groups, laryngoscopy and endotracheal intubation were accompanied by a significant increase in IOP after one and two minutes. This rise was significantly less in clonidine groups than in control and metoclopramide groups. By the fifth minute following laryngoscopy and intubation, the three groups showed significant IOP reduction

Changes in amino-acids and ammonia associated with transurethral resection of the prostate [TURP]

The plasma levels of some amino-acids and ammonia were determined pre and postoperatively in 15 old male patients underwent transurethral prostatic resection [TURP] under subarachnoid block. Glycine 1.5% was used as the irrigant solution. TURP was associated with a significant rise in plasma levels of glycine and serine, a significant drop in alanine, glutamic acid and proline levels. There were no significant changes in threonine and aspartic acid. Following TURP, plasma ammonia showed a significant increase. This increase was within the physiological range and was not associated with toxic manifestations

Evaluation of the use of pethidine HCl as a local analgesic agent in tooth extraction

This study was carried out to evaluate the use of pethidine HCl as a local analgesic agent in tooth extraction. Two groups of patients [25 patients each] were included in this study. The first group underwent upper tooth extraction. Injection of pethidine was done by local infiltration. The second group underwent lower tooth extraction, where pethidine was given by the nerve block technique. Pethidine HCl was proved to be effective, giving sufficient analgesia for tooth extraction with reasonable mean time of onset of action which was 3.26 +/- 0.58 min. in group I and 4.28 +/- 1.12 min. in group II. The mean duration of analgesic action in group I was 32.0 +/- 3.65 min. and in group II, it was 39.42 +/- 3.96 min, which was sufficient for completion of extraction. Analgesia was associated with mild systemic sedative effect. Pulse rate, mean blood pressure and respiratory rate did not change significantly throughout the procedure. Side effects of the technique were minimal and were comparable with those observed during the use of other local analgesics

Comparison between diazepam and midazolam as a sedative during colonoscopy

In the present study, intravenous diazepam 10 mg and midazolam 5 mg were compared in two groups each of 15 patients undergoing colonoscopic examination. Midazolam was found to be more potent than diazepam. Its onset of action was faster than diazepam. It provided a greater degree of sedation, more intense amnesia, better endoscopic conditions and no pain on injection. The cardiovascular, respiratory blood gas and hepatic effects of both drugs caused no significant changes. Recovery time was more prolonged after midazolam than diazepam