Comparison between tracheal intubation using the intubating laryngeal mask and conventional direct laryngoscopy regarding time, success rate and stress response during manual in-line stabilization of the neck

The aim of the study was to compare between the tracheal intubation through the intubating laryngeal mask [ILM] and by direct laryngoscopy during manual in-line stabilization [MILNS] of the head and neck as regard time, success of insertion and stress response to intubation and postoperative complications. The study was carried out on forty ASA I-II patients divided equally into two groups. The DL group where intubation was tried by direct laryngoscopy and ILM group where intubation was tried through the ILM during MILNS. We measured the time of insertion of ETT, the number of successful intubation, the number of intubation failure, the hemodynamic responses and hormonal stress response. The time of insertion of ETT was shorter in DL group than ILM group, the number of cases of intubation failure was larger in DL group than ILM group. The mean arterial pressure and heart rate increased at 2, 4 and 6 minutes after induction significantly in both groups and the increase was more in DL group than JLM group. The plasma concentration of norepinephrine increased significantly in both DL and ILM groups 10 minutes after tracheal intubation but the increase was more sigificant in DL group than ILM group. In conclusion, ILMA may be superior to direct laryngoscopy for Intubation in elective patients with cervical spine disorder with respect to reliability, safety and decreased stress response

Substitution of isoflurane by sevoflurane toward the end of long surgeries is cost effective

The lower solubility of sevoflurane allows a more rapid emergence from anesthesia than after anesthesia with more soluble but less expensive anesthetic isoflurane. Cost control in anesthesia is no longer an option: it is a necessity. We substitute sevoflurane for isoflurane toward the end of anesthesia lor operations longer than 3 hours in an attempt to combine the cost effectiveness of isoflurane with rapid emergence from sevoflurane. Sixty patients undergoing long abdominoplastic and ENT surgeries were randomly equally divided into three groups: group I [isoflurane group], group II [crossover group] where isoflurane was substituted by sevoflurane during the last 30 minutes of the operation and group III [sevoflurane group]. A fresh gas flow of 2 L/min as 60% N2O in 02 was used for maintenance of anesthesia. Consumption of volatile anesthetics was measured by weighing the vaporizers with a precision weighing machine and recovery variables were recorded. The times for spontaneous breathing, times to opening eyes, squeeze a finger on command, times for extubation, orientation, times to read Aidrete score >/= 9 and time to discharge from PACU: all these times were significantly longer in isoflurane group than the crossover and sevoflurane groups and no significant difference between crossover and isoflurane groups. Cost was significantly higher in sevoflurane group [1.242 EP per minute anesthesia]. The costs among the other two groups did not differ significantly [0.319 EP/min for isoflurane group and 0.344 EP/min for crossover group]. So sevoflurane based anesthesia was associated with the highest costs and faster recovery. In conclusion, by changing from isoflurane to sevoflurane toward the end of long anesthesia, we can accelerate recovery and decrease its expenditures without compromising the measured patient outcomes

approach to minimize perioperative hypothermia and its complications

During general anesthesia there is marked decrease in energy expenditure and heat generation, in addition, central thermoregulatory function is impaired Postoperatively, hypothermicpatients are uncomfortable and at risk of developing several hypothermic related complications such as shivering, ischemic cardiac events and decreased resistance to wound infections. We investigated the effect of I V infusion of a balanced mixture of ammo acids in prevention of perioperative hypothermia and its complications. Forty patients undergoing major abdominal surgery were randomly assigned to either an amino acid [a a] group or a control group. Patients in the a. a group received mixture of 19 amino acids I' V at a rate of 100 ml/h given 1h before induction and continuing for 3h after induction. The control group received Ringer's solution. During the perioperative period we recorded heart rate, arterial blood pressure, SO2, end tidal CO2 and rectsl core temperature Plasma norepinephrine was assayed before induction and after surgery On recovery the patients were observed for shivering and were asked about cold feeling. The mean duration of stay in PACU and hospital stay duration were recorded The surgical wounds were evaluated The mean core body temperature at the end of surgery and at the discharge from the PACU were significantly lower in the control group than the a a group The mean heart rate and arterial blood pressure were significantly higher in the control group. The incidence of postoperative shivering and cold feeling was higher in the control group than the a a group. The mean plasma concentration of norepinephrine was significantly higher in the control groupr. The mean duration of stay in the PACU and duration ofthe hospital stay were significantly longer in the control group than the a.a. group. In conclusion it was found that the infusion of amino acids to anesthetized patients will induce thermogenesis preventing perioperative hypothermia and significantly decreases the sympathetically mediated dynamic and hormonal response to hypothermia during recovery from anesthesia It decreases also significantly the postoperative shivering and cold feeling of the patient. Amino acid infusion enhances also recovery and shortens the hospital stay

Comparative study of ropivacaine and lidocaine for intravenous regional anaesthesia for hand and forearm surgeries

Intravenous regional anesthesia [IVRA] is a useful and reliable technique for limbs surgeries. Lidocaine, the most common used local anesthetic has a short duration of action. So searching for new longer acting and safe drug aiming at increasing popularity of IVRA. The aim of this study was to compare ropivacaine and lidocaine as regards the duration and quality of intra- and postoperative analgesia. This study was carried out on 20 patients. They were divided into 2 equal groups: group I received 40 ml of lidocaine 0.5% for IVRA, group II received 40 ml of Ropivacaine 0.2%. Assessments of intraoperative analgesia were obtained at 5 min. interval. The onset time of analgesia was recorded. Postoperative analgesia, decreased pin prick sensation, decreased grip strength times were recorded. The tolerance times for the proximal and distal tourniquets were recorded. Systemic side effects were rated. No significant difference was observed for onset of times of anesthesia, quality of intraoperative analgesia and tolerance time for the proximal tourniquet between the two groups. The tolerance time for the distal tourniquet was significantly longer in the Ropivacaine group [45 +/- 3 min] than lidocaine group [31 +/- 7 min]. Postoperative analgesia, decreased pin prick sensation and decreased grip strength times were significantly prolonged in the ropivacaine group. As regard CNS and other side effects, there was no significant difference between the two groups. Based on these finding. Ropivacaine offers advantages over lidocaine for IVRA. It provided good quality of intraoperative analgesia, prolonged distal tourniquet tolerance time and prolonged postoperative analgesia

Acomparison of the cuffed oropharyngeal airway [COPA] with the laryngeal mask airway [LMA] during manually controlled positive pressure ventilation for short surgical procedures

To examine cuffed oropharyngeal airway [COPA] during manually positive ventilation and to compare its reliability and efficacy with laryngeal mask airway [LMA] as regard to placement success rate, airway interventional requirements, airway stability in different head/neck positions, haemodynamic response and intra- and post-operative adverse events/symptoms. Sixty Patients were randomly assigned to be manually ventilated with COPA [n=30] or a LMA [n=30]. Our results showed that LMA group had more frequent success rate than COPA and shorter time to achieve an effective airway. As regard frequency and type of airway interventions it was significantly higher in COPA group. For haemodynamic changes after insertion of the device there was no significant difference between the two groups. The incidence of intraoperative adverse events was similar. As regard to post-operative adverse events incidence of sore throat was higher in LMA group while incidence of jaw and neck pain was greater in COPA group and blood was detected more often on the LMA group on removal. Conclusions: Although the COPA and LMA are equivalent devices in terms of physiologic alterations and overall clinical problems associated with their use. The use of LMA is associated with higher first time insertions rate and fewer manipulations suggesting that it is easier to use. The COPA is associated with less blood on the device and fewer sore throat, suggesting it may cause less pharyngeal trauma. Ultimately, both devices are similar in establishing a safe and effective airway for manually ventilated patients for short surgical procedures, but the COPA is more cheaper than LMA