Bedside percutanous forceps dilatational tracheostomy

ICU patients, mainly those who need prolonged ventilatory support, may require tracheostomy, which once was done in the operating room, nowadays is performed in the ICU, as percutaneous dilatational tracheostomy [PDT]. Forty two patients 18-72 yrs of age [mean 44 yrs], with varying indications for tracheostomy, had undergone PDT in the ICU under the standard protocol for this procedure. The mean time for completion of the procedure was 10 min. Advantages and complications are reviewed. The difficulties encountered were mainly the anatomical landmarks [10%], difficulties in dilatation [5%] and peristomal oozimg [1%]. It is concluded that percutaneous dilatational tracheostomy is an easy, cost effective, practical when done at bedside in the ICU, and spares transferring the patient to the operating theater

Anesthesia apparatus: cuff mate-2, endotracheal cuff inflator and pressure monitor

A digital endotracheal cuff inflator and pressure monitor were tested under clinical conditions on 150 patients in the intensive care Patients were either intubated with endotracheal tubes or had tracheostomies, and were spontaneously breathing or artificially ventilated. Patients were divided into three groups. Group A had the endotracheal tube or tracheostomy cuff inflated randomly by a syringe and tested later by the Cuff Mate. Group B had the cuffs inflated by a syringe till air leak just disappeared on a hand-bagged positive pressure inspiration. Group C had the cuff inflated by the Cuff Mate till air leak just disappeared on a hand bagged positive pressure inspiration. In all three groups, cuff pressure measurement and inflation were done using the Cuff Mate. Higher mean tracheal cuff pressures were recorded in Group A, in comparison with the other two groups, while smaller differences were observed between Group B and C. Using the Cuff Mate to inflate cuffs till no air leak, in addition to simultaneous monitoring of the cuff pressure to prevent excessive cuff pressure, decreases the ischemic damage that is caused by over inflated cuffs. Cuff pressures should be kept below that causing obstruction to the tracheal mucosal blood flow so as to avoid prolonged over inflated cuffs in intensive care patients

Reduction of pain following propofol injection using blood aspiration

A randomized, controlled, single-blinded study was carried out to see the effect of blood aspiration on reduction of propofol injection pain. Seventy-five patients were studied. They were divided into three categories, comparing the aspiration of 2ml of the patients' blood into the propofol syringe immediately before injection, and the addition of either normal saline 2ml, or lignocaine 20mg to the propofol before injection. The addition of blood was as effective as the addition of lignocaine in reducing the pain of injection, but significantly more effective than the addition of saline [P<0.001] in reducing propofol injection pain. Blood as well as lignocaine are more effective than saline in reducing pain of propofol injection

Analgesic effect of local bupivacaine infiltration in pediatric tonsillectomy

Forty children scheduled for elective tonsillectomy under general anaesthesia were divided randomly into two adjustable groups in a blind study, to receive peritonsillar infiltration with either 0.25% plain bupivacaine or 0.9% saline, in a dose of 0.4 ml/kg to a maximum of 10 ml i:e 5 ml around each tonsil, following induction of anaesthesia. Patients were assessed on awakening and then after 10 minutes, 30 minutes, 1 hour, 4 hours and 24 hours using pain scores of 1-5. Pain scores on awakening and after 10 minutes, 30 minutes and one hour were significantly lower in the bupivacaine group, but there was no difference between the two groups after 1 hour. In conclusion, peritonsillar infiltration with bupivacaine is a very useful analgesic for children having tonsillectomy for up to 1 hour postoperatively