Evaluation of a new supraglottic airway device in ambulatory surgery: the I-gel[registered sign]

The I-gel[registered sign] is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion. The aim of our study is to state the efficiency and the place of I-gel[registered sign] in airway management in adult anaesthetic practice. One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel[registered sign], leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists. The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel[registered sign] was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9% of patients. The mean of the recorded peak airway pressure values was 18 cmH2O. After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice. This study showed that I-gel[registered sign] can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel[registered sign] has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series

[Effectiveness of intravenous magnesium on postoperative pain after abdominal surgery versus placebo: double blind randomized controlled trial]

The purpose of our trial is to evaluate the impact of the intravenous perfusion of magnesium on the morphin consumption and on the control of the stress neuro-endocrine and metabolic reaction in major digestive surgery. prospective, randomized, double blinded study versus placebo .Including 42 ASA I patients, scheduled for major digestive surgery, randomized into two groups: Magnesium, receiving a bolus of magnesium sulfate; 50 mg/kg, followed by a continuous perfusion; 10 mg/kg/h for the 24 postoperative hours. The control group received the same volume of an isotonic saline solution .Postoperative analgesia was assured by morphin PCA. The patients were evaluated by the pain visual analogic scale [Vas], the total dose of morphine consumed and the evolution of the biological markers of stress [glycemia, cortisol, ATH, prolactine and IL6] during the first 24 postoperative hours. Hemodynamic and respiratory parameters, side effects and patient satisfaction were recorded. the total dose of morphine consumed during the first 24 postoperative hours,was equivalent in the two groups [44.49 +/- 6.4 vs 45.26 +/- 9,1 mg; p= 0.59].the initial pain VAS means were equivalent [68mm +/- 15 vs 71mm +/- 14]. Ulterior pain VAS means,after morphin titration then with PCA were also equivalent and less to 40mm. the global amplitude and the evolution of the stress markers evaluated by the surface under curbs were comparable in the two groups, despite a magnesemia twice higher than the normal values in the magnesium group .the satisfaction and the incidence of side effects were similar. association of magnesium to morphin PCA does not help to reduce morphin consumption, and does not affect the control of the stress reaction in major digestive surgery

[Sternal clefit, a rare congenital anomaly. Report of the first Tunisian case]

Sternal cleft is an uncommon visually dramatic congenital anomaly of the chest wall. It is resulting of failure of the two lateral mesodermal sternal bars fusion by the eight weeks of gestation. Superior defects are the commonest forms, usually isolated. Clinical and surgical aspects of stemal cleft are presented. The advantages of early surgery in the neonatal period are developed. We report the first Tunisian case of a superior sternal cleft associated to haemangioma in a newborn boy. Scanning shows non-appearance of manubrium at the upper part of sternum. Sternal bars showing a U-shaped incomplete sternal cleft. Surgical repair consisted of reconstructing a new sternum from sternal bars and resection of haemangioma. The patient had good aesthetic and functional results. The appearance of a child with its heart bulging through its chest wall is very disturbing to parents. Early surgery is most easy and most comforting