cuffed oropharyngeal airway as an aid to fiberoptic intubation

The cuffed oropharyngeal airway [COPA] was evaluated as an aid to oral and nasal fibreoptic [FOP] tracheal intubation in 50 adult patients during general anesthesia. The patients were divided into two groups, 25 each, one group incubated with COPA + FOP and the other group with FOP only. In COPA + FOP group, the overall success rate was 96% and failure was 4% in comparison with 88% success and 12% failure in the other group. The side effects as hypoxia due to the more than one attempt for incubation and rescue use of muscle relaxant were less in the COPA + FOP group than the other FOP only group. It can be concluded that the COPA may be a useful aid to fibreoptic tracheal intubation allowing control and support of the airway during the procedure and using various anesthetic techniques in an acceptable amount of time. The ability to perform fibreoptic tracheal incubation while supporting effectively the airway using the COPA may be advantageous in managing the difficult airway and in trainee education

Evaluation of the intubating laryngeal mask as a primary airway device and with a fiberoptic guidance

This study was done using the intubating laryngeal mask airway [ILMA] and a portex tracheal tube to compare success rates, hemodynamic effects and postoperative morbidity with two methods of tracheal intubation. Ninety healthy ASA physical status I or II women with normal airways were enrolled in this randomized controlled study. All of the 90 patients were successfully ventilated. The results have shown that the success rates are equally high for tracheal intimation using ILMA-blind and ILMA-FOP techniques in women with normal airways. The intubating laryngeal mask airway [ILMA] can be used as a primary airway for oxygenation and ventilation

Non steriodal anti-inflammatory drugs [NSAIDS] and pruritus in patients receiving epidural fentanyl

In this study, pruritus and pain were evaluated in patients undergoing abdominal surgery during which epidural fentanyl was administered. All patients had an epidural catheter inserted at the time of surgery. Epidural fentanyl 100 pg was administered intraoperatively and infused at a concentration of 2 mug/ml for 24 hours postoperatively. All patients received a standard anesthetic and in addition, the study group had a 20 mg bolus of tenoxicam intravenously intraoperatively. Patients receiving tenoxicam demonstrated significantly lower pruritus and pain scores at 30 min and 2, 4, 8 and 24 hours postoperatively and reduced analgesic requirements for breakthrough pain in the first 24 hours. In conclusion, tenoxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus in patients who received perioperative epidural fentanyl. In addition, it significantly reduced pain and further analgesic requirements postoperatively

Concentration dependent effects of local anesthetics on reversibility of conduction block in intact cat sciatic nerve

Delivery of large doses of local anesthetics for spinal anesthesia by repeated injections or continuous infusion could expose the cauda equina to concentrations of drug that may be neurotoxic per se. This possible neurotoxic effect was studied by assessing recovery from conduction blockade of peripheral nerves after exposure to some of the local anesthetic solutions commonly used for spinal anesthesia. The reversibility of conduction blockade was studied in intact cat sciatic nerve by recording the compound action potentials [CAP] before and during exposure to local anesthetics and during drug washout. The nerves were exposed for 15 minutes to 5% or 2% lidocaine, 0.5% or 0.06% tetracaine, 0.5% bupivacaine or Ringer's solution [without local anesthetic] as control. After 15 minutes in the drug solution, the nerves were washed for 2-3 hours. Exposure of nerves to 5% lidocaine or 0.5% tetracaine resulted in irreversible total conduction blockade, whereas 2% lidocaine or 0.5% bupivacaine caused 25-50% residual block after 2-3 hours wash. Nerves exposed to Ringer's solution or 0.06% tetracaine had 0-10% residual block after 2-3 hours wash. However, the presence of verapamil [calcium-channel blocker] made the nerves more resistant to lidocaine and tetracaine, as these local anesthetics increase the intracellular calcium to a toxic level