Comparison of induction and recovery characteristics of halothane and sevoflurane among infants

The aim of this study was to compare the induction and recovery characteristics associated with Halothane and Sevoflurane anesthesia in infants undergoing herniotomy. A total number of 100 infants who underwent herniotomy at King Hussein Medical Center between July 2008 and February 2009, under general anesthesia were allocated to receive either Sevoflurane [n=50] or Halothane [n=50] anesthesia. Induction times, recovery times and induction and recovery complications were recorded. The time of induction was shorter with Sevoflurane than with Halothane. The incidence of excitement was higher in Sevoflurane group than in Halothane group during both induction and recovery. Recovery time was significantly shorter with Sevoflurane group than halothane group. Sevoflurane, when used for infants, has the advantage of faster speed of induction and more rapid recovery than Halothane, which may make it suitable alternative to the later

Hemodynamic response to tracheal intubation: a comparison between young, middle- aged and elderly orthopedic patients

Objective: To examine and compare the hemodynamic changes associated with laryngoscopy and tracheal intubation in the different age groups who underwent orthopedic surgical procedure

Methods: A total of 90 patients fulfilling the criteria of the American. Society of Anaesthesiology [ASA] class 1 and 2 who were admitted to the Royal Jordanian Rehabilitation Center between July 2001 to September 2002 and underwent orthopedic surgery [Back surgery, Total hip and knee replacement, knee arthroscopy] were divided equally into three groups of 30; young [18-25years], Middle aged [40-50 years] and elderly [65-80 years]. The hemodynamic response after tracheal intubation [systolic, diastolic blood pressure, mean blood pressure and heart rate were observed as a percentage change compared to the baseline]

Results: The greatest percentage change in the systolic arterial pressure after tracheal tube insertion was seen in the elderly group [15%]. The increase in systolic arterial pressure was significantly less in the young group compared with the two older groups at one, two, three and four minutes post-intubation. The greatest percentage increase in diastolic blood pressure compared to the baseline was seen in the middle- aged group [24%]. The elderly and young patients showed a significant difference in the diastolic blood pressure response only at one minute post-intubation. However the heart rate response was greatest in the middle-aged patients [40%] and least in the elderly [16%]

Conclusion: Elderly patients had the greatest systolic arterial blood pressure response but the least chronotropic response following tracheal intubation, whereas middle-aged patients had the greatest heart rate and diastolic arterial pressure response. This has clinical implications for choosing drugs for prevention of this response. Further studies are needed to discuss other hemodynamic variable

Epistaxis during nasotracheal intubation: risk factors and possible strategies to avoid it

This study aims to identify risk factors significantly associated with epistaxis during nasotracheal intubation. One hundred patients who underwent nasotracheal intubationn were included. Risk factors for epistaxis were analysed using the multiple logistic regression analysis with stepwise variable selection method. Epistaxis was most likely to occur if transit of the tube through the nasal passage was difficult [P = 0.0001, odds ratio 6.25, 95% confidence interval 3.14-14.26]. On the other hand, age and gender, obesity, smoking, tube size, repeated attempts at intubation, and intubation performed with aid of Magill forceps were not significantly related with risk of epistaxis. The presence of nasal anatomical abnormalities also did not correlate significantly with epistaxis. Strategies to ensure smooth transit of the tube through the nasal passageways are essential to reduce the incidence of epistaxis

Retrograde intubation of the trachea in a patient with ankylosing spondylitis. Case report

Successful intubation can be accomplished in the majority of patients via direct laryngoscopy. Infrequently a situation arises in which simple orotracheal intubation is contraindicated or impossible. We present a case in which retrograde intubation was of particular use in a male orthopedic patient. It was an efficient and simple method to establish an endotracheal airway

Traumatic laryngeal mask airway insertions cause. A severe pulmonary aspiration of blood - Case report and review of the literature

A patient who had an unusual and severe bleeding due to traumatic laryngeal mask airway insertion. In this case the bleeding caused a life - threatening complication.It demonstrates that the laryngeal mask airway [LMA] failed to protect the lower airway in the present case

Post-obstructive pulmonary oedema - a case series and review of the literature

Three case of post-extubation pulmonary oedema in healthy patients are reported. All were preceded by an episode of laryngospasm. Frank haemoptysis was a feature of two of the presentations. All were admitted to the intensive care unit [ICU]. One patient was reintubated and positive pressure ventilation was applied, one was treated with nasal prong oxygen supplement only and one was managed with continuous positive airway pressure [CPAP]. All cases resolved fully within 24 hours. In literature, the frequency of post-obstructive pulmonary oedema has been reported to be 0.05 to 0.1% of all anaesthetised patients, and is often unrecognisd or misdiagnosed. Most cases occur in the early postoperative period, so anaesthetists are well placed to witness, investigate and manage this interesting condition