Perfusion index as an objective alternative to the Alien test, with flow quantification and medico legal documentation

To evaluate the use of perfusion index for diagnosis of abnormal collateral hand circulation [CHC], in comparison with the modified Alien test and pulse oximetry using Doppler ultrasonography as a reference test. Forty two [84 hands] healthy volunteers were randomly selected for our study. Adequacy of the collateral hand circulation during occlusion of the radial artery was assessed in each hand using four tests by four expert investigators, one for each test: [I] Modified Alien test [2] Perfusion index [3] Pulse oximetry, and [4] Doppler ultrasonography being the standard test. The Doppler ultrasonography [the standard test] diagnosed abnormal CHC in 3 hands [3.5%]. The modified Alien test showed abnormal CHC in 16 hands [19%], with sensitivity 100%, specificity 78% and positive predictive value 18.7% when compared with the standard Doppler ultrasonography. Also pulse oximetry method indicated abnormal CHC in 4 hands [4.7%] with sensitivity 100% specificity 98% and 75% positive predictive value. ROC analysis showed that > 65.7% reduction in the perfusion index diagnosed abnormal CHC with 100% sensitivity, 98.8% specificity and 75.5% positive predictive value using Doppler ultrasonography as a reference test. Using Doppler ultrasonography as a reference test, perfusion index is a reliable objective test for diagnosis and prediction of abnormal CHC, with high sensitivity, specificity, and accepted positive predictive value

optimal effect-site concentration of sufentanil for laryngeal mask insertion during induction with target-controlled propofol infusion at 4.0 micro g/mL

The objective of this study is to determine the optimal effect-site concentration [Ce] of sufentanil for satisfactory insertion of laryngeal mask airway [LMA] when administered with a target-controlled infusion [TCI] of propofol at 4.0 microg/mL. A total of 25 adult patients scheduled for minor elective surgery were enrolled in this study. All patients received induction with a combination of propofol and sufentanil TCI. The TCI of sufentanil was started at a target Ce of 0.1 ng/mL. After equilibrium with the plasma concentration, the TCI of propofol was initiated, targeting a preset Ce of 4.0 microg/mL. After the loss of consciousness, LMA was inserted and assessed by an experienced Anesthesiologist. The Ce of sufentanil for the next patient was guided by modified Dixon's up-and-down method using 0.05 ng/mL as a step size. The Ce of sufentanil required for successful LMA insertion in 50% of adults [EC50] was determined by calculating the midpoint concentration of all independent pairs of patients after at least seven crossover points. The optimal Ce [EC50] of sufentanil for LMA insertion during propofol induction using target Ce of 4 microg/mL was 0.16 ng/mL [95% confidence interval [CI] = 0.12-0.20]. There was a significant reduction in propofol induced pain score P = 0.0275 and insignificant hemodynamic changes. Ce of sufentanil required for successful LMA insertion in 50% of patients [EC50] using propofol target Ce of 4.0 microg/mL was 0.16 ng/mL [95% CI = 0.12-0.20] with a significant reduction in the propofol induced pain and hemodynamic stability.

Does intra-cuff alkalinized lidocaine prevent tracheal tube induced emergence phenomena in children?

To study and investigate the efficacy of intra-cuff alkalinized lidocaine in the prevention of the endotracheal tube [ETT] induced emergence phenomena in children.Fifty children, ages 6-12 years, ASA physical status I-II, scheduled for elective dental surgery under N2O free general anesthesia with an expected duration of 120 min or more, were randomly assigned one of the two groups [25 patients each]; lidocaine group in which the cuff of ETT was inflated with a mixture of lidocaine 2% and sodium bicarbonate 8.4% and the saline group, in which tube cuff was inflated with 0.9% saline solution.There were significant reduction in the incidence and severity [p=0.005 and p= 0.014] of cough at extubation and in the PACU [P=0.048 and P=0.014]. The incidence and severity of postoperative sore throat was also reduced in the lidocaine group compared to the saline group [p=0.025 and 0.031 respectively]. Moreover, there was a significant prolongation of the time to spontaneous ventilation before extubation in the lidocaine compared to the control group [16.4 +/- 3.1 min and 9.4 +/- 1.7 min respectively] with p value < 0.0001. Intra-cuff alkalinized lidocaine reduces the incidence of cough, sore throat, improved ETT tolerance and inducing smooth extubation in paediatric patients, but prolongs time to spontaneous ventilation before extubation

sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: a comparative study

To compare the three common methods of endotracheal tube cuff inflation [sealing pressure, precise standard pressure or finger estimation] regarding the effective tracheal seal and the incidence of post-intubation airway complications. Seventy-five adult patients scheduled for N 2 O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group [n=25], the cuff was inflated to a pressure of 25 cm H 2 O; sealing group [n=25], the cuff was inflated to prevent air leaks at airway pressure of 20 cm H 2 O and finger group [n=25], the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested. Although cuff pressure was significantly low in the sealing group compared to the control group [P<0.001], the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group [P<0.001 and P=0.008]. The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff. In N 2 O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat

Lipomatosis of the parotid gland in children

Parotid lipomatosis is extremely rare in children. Only 4 cases have previously been reported in the English language medical literature. Surgical excision is frequently complicated by recurrence. We report, a fifth case, on a 5-month-old girl with rapidly progressive parotid lipomatosis. Emphasis is laid on the importance of preserving the unusually delicate tumor capsule to prevent tissue spillage and recurrence. The creation of an appropriate cleavage between the mass and the expanded skin with sparse subcutaneous fat, safeguarding the tumor capsule on one side and the skin blood supply on the other, represents a rewarding technical challenge