Sitting position in neurosurgical procedure: king hussein medical center experience 2003-2004

The incidence of air embolism is still high with low mortality and morbidity if preventive measures and proper monitoring were taken. This will make management quick and effective. Forty patients underwent neurosurgical procedure in the sitting position for posterior fossa tumors, pineal tumor, foramen magnum decompression and cervical disc between January 2003 and January 2004. Gender and age distribution, venous air embolism, hypotension, postoperative ventilation and other complications were studied. Venous air embolism was found in 10% of patients who had a drop in their end tidal carbon dioxide by 5mmHg Hypotension with a 20% drop of the baseline blood pressure de/eloped in 5% of patients in the absence of hypovolemia. Patients who developed combined venous air embolism and severe hypotension were resuscitated by intravenous fluid and ventilated electively. Sitting position is safe if done with preventive measures and strict monitoring. Prompt management of complication is essential to reduce morbidity

Endotracheal tube cuff using air or saline to prevent postoperative hoarseness and sore throat: a randomized controlled trial

To compare the frequency and severity of sore throat and hoarseness following inflation of the endotracheal cuff using air or saline. A double-blined, randomized controlled trial in 63 intubated patients was conducted at Queen Alia Military Hospital in 1999. Patients were included if they were ASA 1-3, aged 18 years or older scheduled for operation below the neck which were expected to last longer than one hour. Following placement of the tracheal tube, the cuff was inflated slowly [using air or saline], until no leak was felt and was connected to a three-way stopcock, extension tubing and connection to a pressure transducer. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The frequency of significant sore throat and/or hoarseness overall was 15%. There were no statistically significant difference between the groups [air 15%, saline 14.5%]. In the air group mean, intra-cuff pressure increased significantly [start 14 mmHg, end 40 mmHg], while in the saline group there was no significant increase [start 12.7 mmHg, end 14.6 mmHg]. The substitution of saline reliably results in sustained low intra-cuff pressure but high tracheal pressure, but is not an immportant factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of the operations