Comparison of lidocaine vs lidocaine + ketorolac in intravenous regional anaesthesia [bier's block]

To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. An international quasi experimental study. This study was carried out in Nishtar Hospital Multan from 01/01/2006 to 30/06/2006 [6 Months]. Results: Patients were divided into two groups A and B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. We conclude that 30mg Ketorolac added to Lidocaine in IVRA increases degree of anaesthesia and also provide prolonged postop analgesia

Difficult ventilation in a patient after Endotracheal intubation: an unusual manufacturing defect in E.T.T. connecter

Airway resistance depends upon the diameter of endotracheal tube [E.T.T] and other respiratory organs. Actually resistance to flow through a tube increases up to sixteen times if diameter is reduced to half of the original size. Disposable E.T.T which are currently used in anaesthesia practice are made up of P.V.0 with a connecter which is fitted on proximal end of endotracheal tube and proximal end of connector is attached with breathing circuit. Usually the internal diameter of connector should be equal to internal diameter of endotracheal tube. In the market, tubes of different manufacturers and of different sizes are available for all age groups. In developing countries like Pakistan, hospital administration usually purchases the endotracheal tubes and other equipments which are relatively cheaper because of lack of funds. Here we present a case where there was a manufacturing defect in E.T.T connector with a very narrow internal diameter that was causing severe respiratory obstruction in a child undergoing laparotomy. We conclude that the anaesthetists must keep in their mind the possibility of E.T.T connector manufacturing defect if they face problem of increased airway resistance in an intubated patient after excluding other possibilities of high airway resistance