Airway management for cervical spine injury

In this review, important factors related to initial management, diagnosis, airway, and anesthetic management of patients with cervical spine injury [CSI] are discussed. Early diagnostic and clinical evaluation is important in excluding CSI. In-line stabilization reduces movement of the cervical spine. Tracheal intubation under fiberscopic control, offers safety, and comfort to the patient. However, in cases of severe deterioration of vital functions, intubation must be performed without any delay at the site of the accident or in the emergency room. Early airway management and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique. The current opinion is that oral intubation after intravenous induction of anesthesia and muscle relaxation along with in-line stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI

Tramadol as an adjuvant to intravenous regional anesthesia with lignocaine

To assess the effect of different doses of tramadol when added to lignocaine during intravenous regional anesthesia [IVRA]. Sixty patients, scheduled for hand surgery under IVRA in King Fahd University Hospital, Al-Khobar, Saudi Arabia from January 2006 to January 2007 were randomly allocated into 3 groups [20 patients each] in a double blind controlled study. All patients received 0.5% lignocaine, 40ml plus 2ml of a study solution containing either isotonic saline control group, or tramadol 50mg [group T50] or tramadol 100 mg [group T100]. Hemodynamic changes, sensory and motor block onset and recovery times, tourniquet tolerance time, the quality of intraoperative anesthesia and the duration of postoperative analgesia were assessed. All patients, 20 in each group completed the study period. Patients who received tramadol had earlier onset of sensory block [5.2 +/= 1.2; 4.9 +/= 1.2 min in the T50; and T100 groups] compared with the control group [7.6 +/= 1.4 min]. Patients who received 100mg of tramadol had better tolerance of tourniquet [p=0.011], and less intraoperative fentanyl supplementation [p=0.042]. They had also a longer time to the first postoperative analgesic request [p=0.001] compared with the control group. Tramadol 100 mg is a beneficial additive to lignocaine for IVRA since it shortened the onset of sensory block, enhanced the tourniquet tolerance and improved the perioperative analgesia

effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

We hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of the Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 [8.2] in the placebo and 35.17.0mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group, p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine