Airtraq[TM] versus Macintoch laryngoscope in intubation performance in the pediatric population

Airtraq[TM] is an optical laryngoscope that allows viewing of the vocal cords without a direct line of sight. The main objective of this prospective, randomized, controlled trial was to evaluate Airtraq intubation characteristics, mainly intubation time and cardiovascular changes in the pediatric patients. Fifty children of American Society of Anesthesiologists class I, 2-10 years of age were divided into 2 groups using sealed envelope technique. Children were premedicated with midazolam. Anesthesia was induced with sevoflurane, fentanyl, and atracurium. Patients were randomly allocated to be intubated with either Airtraq [Airtraq group] or Macintosh laryngoscope [Macintosh group]. Intubation time, number of intubation attempts, optimization maneuvers, and ease of intubation were recorded. Hemodynamic variables were recorded before and after anesthetic induction, 1, 3, and 5 min after tracheal intubation. The mean age of children was 6.1 years. Compared with Macintosh group, the use of Airtraq was associated with shorter intubation time [51.6 +/- 26.7 s vs 22.8 +/- 6.1 s, respectively, P=0.001], less median number of intubation attempts 2 [1-2] versus 1 [1-1], P=0.001], more ease of intubation [2 [1-3] versus 1 [1-1], P=0.001] and less increase in the heart rate 5 min after intubation [P=0.007]. No optimization maneuvers required for Airtraq laryngoscope [P=0.001]. Airtraq decreases intubation time, number of attempts, and optimization maneuvers, less heart rate changes during intubation compared with Macintosh laryngoscope

Anesthesiologists work-related exhaustion: a comparison study with other hospital employees

Anesthesia is a demanding occupation due to long working hours, sustained vigilance, unpredictability of stressful situation, fear of litigation, competence, and production pressure. Work-related exhaustion can lead to several physical and psychological symptoms and delay decision making. The aim of this study was to evaluate how different work conditions affect personnel exhaustion by studying a sample of anesthesiologists comparing them with ophthalmologists and ancillary hospital staff One hundred fifty persons divided into three equal groups [50 each] were invited to participate in this study. Subjects were asked to answer two self report questionnaires: The Multidimensional Fatigue Inventory [MFI-20] and General Health Questionnaire [GHQ-12] which used to assess work related exhaustion and mental health, respectively. Multidimensional Fatigue Inventory scale [MFI 20] and General Health Questionnaire [GHQ 12] were significantly higher in anesthesiologists than in other groups [P=0.001]. Different aspects of work-related exhaustion showed that general, physical and mental fatigue were significantly higher in anesthesiologists [P=0.002 and 0.001, respectively]. Reduced activity and reduced motivation were also higher in anesthesiologists compare to the other groups [P=0.005 and 0.001, respectively]. Work-related exhaustion under the current study is more obvious among anesthesiologists. Ophthalmologist and ancillary hospital employees felt that they had less stress at their work

occupational fatigue in anesthesiologists: illusion or real?

Fatigue is usually reported after lack of sleep or excessive physical or mental effort. Endocrine disorders are also associated with the symptoms of fatigue. Symptoms of fatigue were reported 20% of working population. Anesthesiologists are more exposed to stress at work because of long working hours and high demand of the job. The aim of this study was to evaluate fatigue at work from anesthesiologist' own perspectives and to identify the possible risk factors associated with fatigue. Two hundred and ten persons, were participated in this survey, they were 50 anesthesiologists, 60 diabetic patients and 100 employees. Participants were asked to answer two self report Questionnaires: The Multidimensional Fatigue Inventory [MFI-20] and General Health Questionnaire [GHQ-12] which used to assess the degree of fatigue and mental health respectively. Total fatigue score was significant in anesthesiologists compared to both patients [P value = 0.047] and employees [P value < 0.001]. All sub-items of fatigue score were higher in anesthesiologists compared to those of employees [P value < 0.001], however only general and mental fatigue were higher in comparison to patients [P value = 0.02]. The GHQ score of the anesthesiologists was significantly higher when compared to those of the employees [P value < 0.001] but no difference with patients [P value = 0.090]. Physical, mental and total score of fatigue were higher in female anesthesiologist. Fatigue and psychological distress are common among anesthesiologists in comparison to patients and ordinary hospital employees. Female anesthesiologists were affected more by fatigue

Low molecular weight hydroxyethyl starch 130/0.4 versus albumin 5% in pediatrics undergoing abdominal tumor excision

Hydroxyethyl starchs [HES] have the advantage of a higher plasma-expanding effect and an infrequent incidence of allergic reactions, but they have more pronounced effects on emostasis. A new HES with a lower in vivo molecular weight [HES 130/0.4] has been introduced

The aim of this study was to compare the effect of hypervolemic haemodilution of the ecently available low molecular weight hydroxyethyl starch 130/04 and albumin 5% on the hemostatic function, renal function and blood loss during laparotomy for abdominal tumor excision Forty six children with age range between 3 and 5 years were enrolled in the study. Patients were randomly allocated after induction into two groups ; Group I patients received either 6% HES 130/0.4 as a hypervolemic hemodilution with a dose of 25 ml/kg over one hour oreoperativly. Group II [control group] patients received Albumin 500 as a hypervolemic hemodilution with a dose of 25 ml/kg

Measurements: hemoglobin and hematocrit, PT, partial thromboplastin time [PTT], platelet count, serum creatinine, urine out put were measured. Blood losses at the end of surgery were calculated using the equations developed by Mercuriali and lnghilIeri, considering sex, preoperative body weight and hemotocrit and volume of blood transfusion

Results: The mean intra-operative blood loss in group I was 362.8 +/- 4.5 ml, whereas it was 374.1 +/- 3.2 ml in group II, there was no statistically significant differences in the mean blood loss in both groups .There was no statistically significant difference in all other measurements in both groups

Conclusion: The new low molecular weight hydroxyethyl starch 130/0.4 up to 25 ml/kg hypervolemic hemodilution have similar blood loss without effect on hemostatsis and renal function similar to albumin 5% during laparotomy for abdominal tumor Excision in Pediatrics abdominal tumor excision in pediatrics

Perioperative anesthetic management of liver transplantation: a retrospective analysis of King Faisal Hospital experience

Background: Liver transplantation is the accepted standard of care for patients with End Stage Liver Disease [ESLD]. Since the liver transplant programme restarted in King Faisal Specialist Hospital and Research centre in 2001 and results have been improving. We review the overall results of liver transplantation over the last 6 years

Patients and Methods: Characteristic of patient population: Data retrospectively reviewed between April 2001 to January 2007 years, our center performed 122 liver transplantations, 77 from deceased donors [DDL T], and 45 from living donors [LDLT], in 118 patients 4 cases were retransplanted. Perioperative Management: All patients were evaluated preoperatively according to the institute protocol. All patients received general anesthesia according to our protocol. Swan Ganz‘catheterization and Rapid Infusion System [RIS] only used when clinically indicated most of the patients were assisted by mechanical ventilation in Medical Surgical Intensive Care Unit [MSICU] postoperatively. Fluid therapy and vasoactive agents were managed according to haemodynamic parameters

Results: The patients were 68 male and 54 female. Their median age was 43 years, ranging from 2 to 63 years. 111 patients were adult and 11 patients were pediatrics. In DDLT the median operating and anesthesia time were 8 hours [range 4-19], and 9 hours [range 5-20] respectively, median MSICU discharge time 15 hours [range 9-85] and hospital stay was 13 days [range, 6-183]. After a median fol/ow-up period of 760 days [range, 2-2085], the overall patient and graft survival rates was 86%. Deaths were due to primary non-function in 4 patients, central pontine myelinolysis in one patient, chronic rejection in one patient, recurrent malignancy in 2 patients, and recurrent HCV infection in 3 patients. In the LDLT group; median operating and Anesthesia time were 11 hours [range, 7-17] and 12 [range 818] respectively. Median MSICU discharge time was 16 hours [range 4-76] and median hospital stay was 15 days [range, 7-127]. After follow-up period of 685 days [range, 26-1540], the overall patient and graft survival rates were 90% and 80% respectively. Graft failure and deaths were due to hepatic an‘ery thrombosis in 2 cases, biliaIy complication in one patient, uncontrollable bleeding in one patient, portal vein thrombosis in 2 cases, and smalI-for-size-syndrome in 3 patients. Four patients were successfully retransplanted using cadaveric organs. The median intraoperative packed red blood cells [PRBCs] transfused was 6 units [range 0-40] and 4 units [range 0-65] in DDLT and LDLT groups respectively

Conclusions: Both DDLT and LDLT are being successfully performed at KFSH and RC with good outcomes. Our early experience indicates higher rate of biliary and vascular complications in the LDLT group. Intraoperative Packed Red cells, blood products, fluid replacement and estimated blood loss in both groups were matching the international centers results

Preoperative nebulization of dexamethazone, racemic epinephrine and lidocaine in adults undergoing minor laryngeal surgery

Background and Objectives: The main objectives of anesthesia for laryngeal surgery are to provide the surgeon with immobile field with enough space for the rigid Iaryngoscope. Secured airway and ventilation, together with haemodynamic stability. It is equally important to promote rapid awakening and return of protective airway reflexes and to prevent possible respiratory complications such as cough, stridor, and laryngospasm. The aim of this study was to compare the effects of three different drugs given by nebulizing techniques administered in the immediate preoperative period. We compared dexamethazone, racemic epinephrine and lidocaine effects on postoperative respiratory complications and recovery after short-term laryngeal surgery in adults

Materials and Methods: Eighty ASA I-II patients aged 18-55 years of either sex scheduled for minor laryngeal surgery were included in this prospective, placebo-controiied, randomized, and double-blinded study. Patients were randomly allocated into four even groups according to the nebulized drug given, 20 patients each: Group I: 0.9% Normal Saline [control group], Group II: Dexamethazone 0.5 mg/kg, Group III; Racemic Epinephrine 2.25 % 0.01 ml/kg and Group IV; Lidocaine 1.5 mg/kg. All the drugs were prepared in 5 ml solution and given over 10 min periods by nenulizer in the holding area before shifting the patient to the OR. Recovery time has been recorded. Postoperative respiratory complications were assessed using Postoperative Respiratory System Evaluation Scoring [PRSES] at 1, 5, 10 minutes after removal of the rigid Iaryngoscope

Results: The occurrence of PRSES-1 [indicates no respiratory complications] was Significantly more frequent in group III [R-epinephrine] and group IV [lidocaine] in Comparison to both group I [control] and group II [dexamethazone] at the 1st, 5th, and 10th min after recovery. However, the frequency of PRSES-1 in group IV was significantly higher than group III, at all evaluation times. Dexamethazone group recorded significant prolonged recovery time compared to R-epinephrine group III. However it was insignificantly prolonged compared to both groups I and IV. Therefore, Patients of lidocaine group showed better recover criteria and lower incidence of respiratory complications compared to the other study groups

Conclusions: Nebulization of Lidocaine in the immediate preoperative period is very effective in reducing postoperative respiratory complications after short-term laryngeal surgery by way of rigid Iaryngoscope

Relation of papillary muscle traction to autonomic nervous system dysfunction as evaluated by head-up-tilt-test in mitral valve prolapse

Mitral valve prolapse [MVP] is one of the commonest valvular abnormalities and is characterized by systolic superior leaflet displacement. This results in abnormal tension on the papillary muscles which may lead to, or is associated with alteration in the autonomic functions. The aim of this work is to detect and assess papillary muscle traction [PMT] in patients with idiopathic MVP in a trial to correlate it with any autonomic dysfunction as evaluated by head-up-tilt test [HUTT]. Thirty symptomatic MVP patients and a control group of 15 persons [cardiologically free], aged 15-35 years, were enrolled in the study. They were all thoroughly evaluated clinically, radiologically, electrocardiographically and by ECHO-Doppler. Patients with secondary causes for MVP were excluded. PMT was measured by 2-dimentional ECHO in all patients and controls who were subsequently subjected to HUTT. The obtained results showed both groups to be comparable. The MVP patients showed mitral regurgitation [MR] in 13 cases [43.3%]. Seventeen patients [56.7%] had MVP with no MR. PMT was greater in patients than in controls [5.7+/-3 versus 0.85+/-0.7mm], p value <0.001. Leaflet displacement as well as PMT index were also significantly higher in patients than in controls [p<0.001]. HUTT was positive [provoking syncope or presyncope associated with hypotension, bradycardia, or both] in six MVP patients [20%] and in none of the controls. HUTT appeared to be predictable by four of the studied parameters, namely, leaflet displacement, PMT, traction index and MR. Ten patients had PMT >/=6mm and 20 patients had it <6mm as shown by ECHO. Six out of the 10 patients who had PMT of >/=6mm had abnormal response to HUTT, while none of the 20 patients with PMT <6mm, and none of the controls had an abnormal response to HUTT. A statistically derived predictor value of >/=6mm PMT should be considered as an indicator to perform HUTT to MVP patients in a trial to detect asymptomatic patients prone to syncope. We recommend that PMT be a part of routine ECHO examination of MVP patients. Those with MR or PMT of 6 mm or more should be evaluated by HUTT for the occurrence of syncope or other manifestations of autonomic dysfunction aiming at avoidance or decrease of morbidity in this group of patients