Intracuff lidocaine improves endotracheal tube induced emergence phenomena in patients with hyperactive air way

Thirty adult patients of both sexes with hyperactive airway, scheduled for elective surgery more than one hour duration, were assigned to inflate the cuff of an endotracheal tube with 2.5 ml [50 mg] lidocaine hydrochloride to improve the endotracheal tube induced emergence phenomena. Patients were anaesthetized according to a standard protocol. There was insignificant change in heart rate and mean arterial blood pressure at extubation compared with that before induction. The incidence of coughing was 20% from 0-4 min. and 12% from 4-8 min., with no reported coughing at 25-60 min post extubation. There was no significant difference between the initial volume of air injected into the cuff and that removed from it. There was also, no lidocaine removed from the cuff. The mean extubation and spontaneous ventilation time were prolonged. The incidence of bucking and hoarsness at extubation were 5.7% and 6.7% respectively. Patients experienced neither restlessness before extubation nor dysphonia or postoperative nausea and vomiting after extubation. The visual analog scale for post operative sore throat showed significant reduction throughout the whole study periods. In conclusion, the use of intracuff lidocaine hydrochloride 2% is a relatively easy and safe practice with minimal stress response at extubation. It decreases coughing, bucking and sore throat, thus promoting smooth emergence from general anaesthesia in those patients in whom tracheal stimulation may be undesirable

effect of low dose dopamine on intraocular pressure

Fifty patients with postoperative impaired renal function evidenced by resistant oliguria were included in the study. All patients received dopamine infusion less than 5 micro.kg[-1] .min[-1]. After instilling benoxinate hydrochloride [Novesin 0.4%] eye drops, the Perkins tonometer was used to measure the intraocular pressure [IOP]. Patients were divided into two groups according to their ventilation. Group I: non-mechanically ventilated patients, and group II: mechanically ventilated patients. Twelve patients were excluded from the study, nine in group I and three in group II, due to stoppage of dopamine infusion, change-in the ventilatory status or due to the use of mannitol infusion. The two groups were comparable as regards age, weight and dopamine infusion dose. In the non-ventilated group, there was an insignificant difference as regards changes in the heart rate, mean arterial blood pressure [MABP], central venous pressure [CVP] and degree of sedation compared with control values at any time of measurement. A significant increase in IOP during dopamine infusion in both eyes compared with control values was detected [P<0.001]. In the ventilated group, there was an insignificant difference as regards changes in the heart rate, MABP, CVP, PaCO[2], positive end expiratory pressure [PEEP] and degree of sedation compared with control values at any time of measurement. However, there was a significant increase in IOP during the period of dopamine infusion in both eyes compared with control values [P<0.001]. The increase in IOP during the period of dopamine infusion was significantly higher in the ventilated compared to the non-ventilated group [P< 0.001]. The infusion of low dose of dopamine was associated with a significant increase in IOP in both eyes whether the patients were mechanically ventilated or not. Yet, the increase in IOP was greater in the mechanically ventilated group. Dopamine infusion should be cautiously given in patients with preexisting ocular hypertension or with traumatic eye injury. Monitoring of IOP during dopamine infusion is recommended in those patients especially during mechanical ventilation

Evaluation of the severity of organophosphous insecticide intoxication using poisoning severity scoring, laboratory and therapeutic parameters

Organophosphorus [OP] compounds are the most widely used insecticides that cause poisoning after accidental, occupational or suicidal exposure. Poisoning is particularly common in the developing countries where more potent agents are widely available for agricultural and household purposes. The aim of the study was to evaluate the role of poisoning severity score [PSS], different laboratory and therapeutic measures in assessment of severity of OP poisoning, and to determine the need for intensive care management in cases of OP intoxication. One hundred patients suffering from acute OP poisoning were interviewed and categorized clinically according to PSS into three grades. Routine laboratory tests were done including arterial blood gases, random blood sugar and serum potassium on admission. Specific tests were estimation of pseudo choline sterase activity on admission and serum amylase on admission and after six hours. The studied patients received different lines of treatment in the form of general measures plus atropine or atropine and pralidoxime with or without assisted mechanical ventilation.55% of patients had the mildest degree of OP intoxication [PSS1], 31% had PSS2 and 14% were graded as PSS3. Significant correlation was detected between the degree of poisoning assessed by PSS and different laboratory investigations as well as the lines of treatment used. Cases having the highest score of severity [PSS3] had the lowest psudocholinesterase activity with more pronounced hyperglycemia, hypoxia, metabolic acidosis and hypokalemia. Acute pancreatitis occurred specifically in them. They needed atropine and pralidoxime in addition to assisted mechanical ventilation with longer stay in hospital than other cases. Accordingly, all these parameters including clinical scoring[PSS], laboratory findings and lines of treatment needed can be used for determination of the severity of OP poisoning. They are recommended to be applied in all OP-intoxicated patients

Perioperative evaluation of the measurement of the arterio-jugular venous oxygen difference and the use of the free radical scavenger tirilazad mesylate in the management of the severely head injured patients

The aim of this study was to highlight the anesthetist role in dealing with the severely head injured patients, the assessment of the arteriojugular venous oxygen difference as an important parameter in the management of head injured patient and evaluation the role of the tirilazad mesylate in improving the outcome. This study was carried out on 80 adult patients with severe head injury. They were divided into 2 equal groups according to arterio-jugular venous difference in oxygen content [AVDO2]. Then each group was further subdivided into 2 subgroups A and B, subgroups I A and IIA receiving tirilazad mesylate while subgroups IB and IIB received placebo. The incidence of unfavorable outcomes in patients with wide AVDO2 [group I] was significantly higher than in those with normal or narrow AVDO2 [group II]. Unfavorable outcome occurred in 92.6% of the patients who had one or more episodes of hypertension compared with only 41.5% in those who did not. The outcome in patients who suffered a single or multiple episode of raised [ICP] above 20 mmHg was grave compared with those without intracranial hypertension. The present study showed no significant difference between the 4 subgroups as regard cerebral perfusion pressure [CPP]. The study showed that the patients who had hyperglycaemia above 150-mg/ dl had unfavorable outcome compared with those with normoglycaemia. In the present study tirilazed mesylate failed to demonstarte any neuroprotective efficacy in those who received this drug. Retrograde jugular cannulation is a simple technique that should be mastered and implemented by anesthesiologists for jugular oxygenation monitoring to detect the presence or absence of ischemia and hyperemia and consequently can modify his anesthetic plan according to the prevailing condition