LMA-proseal versus endotracheal intubation for elective laparosgopic cholecystectomy

The aim of this study was to evaluate the effectiveness of laryngeal mask airway -ProSeal as compared to endotracheal intubation during laparoscopic cholecystectomy as regards pulmonary ventilation and respiratory events at emergence. Forty patients aged 18 years or above, ASA 1 or 2 subjected to laparoscoeic cholecystectomy under general anesthesia were included. Patients with a history of hiatus hernia, gastroesophagcal reflux or diabetes mellitus were excluded Patients were randomized into two groups: Group 1 [LMA-PS] [Laryngeal mask airway ProSeal]: LMA-PS size 3 for female and size 4 for male patient were used. The cuff was inflated with air in 2-3ml increments until effective airway was obtained. Group 2[ETT][Endotracheal tube]: Cuffed ETT size 7mm for female and 8mm for male patient were used and inflated the cuff until no leak was audible. After preoxygenation with 100% oxygen for 3 minutes, anesthesia was induced with 20mg lidocaine, 2-2.5mg.kg[-1] propofol, 1-2micro g. Kg[1] fentanyl and vecuronium 0.05mg .kg[-1]. Positive pressure ventilation [PPV] was not used until after insertion of LMA-PS or ETT. Anesthesia was maintained with 50%nitrous oxide in oxygen, sevoflurare 1 -3%. We started with 6L.min[-1] fresh gasflow to be reduced to 3L.min[1] closed circuit. Incremental doses of vecuronium and fentanyl was given as required. Minute volume and Fio2 were adjusted to maintain SpO2 > 94% and PETCO2 < 45mmHg. If effective airway could not be maintained for 90 seconds or SpO2 /= 45mmHg at any time of the procedure, the LMA-PS will be shifted to ETT. Insufflation time, total anesthetic time, regurgitation [clear or bile stained fluid] and respiratory events at extubation cough, laryngeal spasm, the need for PPV, tracheal intubation] were recorded and compared in both groups. Our study showed that the incidence of respiratory events at extubation were significantly less in group 1 [LMA-PS] as compared to group 2. There was insignificant difference as regard ventilation parameters in both groups and was within normal physiological range. The use of Laryngeal mask airway ProSeal is associated with less incidence of respiratory events at recovery compared to endotra-cheal intubation and both were effective as regard pulmonary ventilation during laparoscopic cholecystectomy

Thoracic paravertebral block versus intrapleural analgesia following cancer breast surgery

The aim of this study was to evaluate the effeciveness of postoperative analgesia of thoracic paravertebral nerve block in comparison to intrapleural analgesia after cancer breast surgery. The study was carried out on thirty patients subjected to cancer breast surgery. General anesthesia was fixed for all patients as follow: peroxygenation by 100% oxygen for at least 3 minutes. Intravenous 2mg/kg propofol and 80ug/kg vecurounium. Intubation was done under complete muscle relaxation and anesthesia was maintained by a mixture of NO2/02[FiO2=40%] and isoflurane 1-1.5%. Top up dose of vecuronium was one fifth of the initial dose. At the end of surgery and before reversal of muscle relaxation and extubation patients were randomly assigned to one of two groups: GroupI patients received Thoracic paravertebral block[TPVB] at T4. GroupII patients received intrapleural analgesia[IPA]. A mixture of local anesthetic [0.3ml/kg ropivacaine0.5%] and 2mg morphine were injected before extubation of the patients to both groups. The duration of analgesia, verbal rating pain score[VRS] values, sedation score, vital sings and adverse effects were recorded. our study showed that TPVB was more effective in postoperative control of pain compared to IPA, has lower VRS scores, less analgesic requirements and longer duration of analgesia. Both techniques showed hemodynamic stability and significant decrease in PH but was within normal physiological range. TPVB has the upper hand in comparison to IPA in pain management, has lower VRS score, less additional analgesic requirements and longer duration of analgesia