use of laryngeal mask airway during transesophageal echocardiography in pediatric patients

Transesophageal echocardiography [TEE] in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation [ET]. This study was performed to investigate the safety and efficacy of using the laryngeal mask airway [LMA] as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE. A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA [LMA group] or ET [ET group]. Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups. There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group [P < 0.01]. The mean recovery time was also significantly shorter in the LMA than in the ET group [44 +/- 8 min and 59 +/- 11 min, respectively; P < 0.001]. The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE

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

Epidural analgesia during labor-0.5% lidocaine with fentanyl vs 0.08% ropivacaine with fentanyl

Although lidocaine is a cheap and globally available local anesthetic, yet it is not a popular drug for labor analgesia. This is claimed to its higher intensity of motor block, possibility of transient neurological symptoms [TNS] and its placental transfer with probable drawbacks on fetal well-being. However, these effects could be concentration dependent and, the evidence linking them to lidocaine is still lacking. This study was designed to evaluate the efficacy and safety of 0.5% epidural lidocaine plus fentanyl during labor. One hundred and twenty healthy full term nulliparous women in early labor with a single fetus presented by the vertex were enrolled in this randomized, double-blind clinical trial. Parturient were assigned to receive epidural analgesia either with lidocaine 0.5% plus fentanyl 2 micro g [-1mL] [LF], or ropivacaine 0.08% plus fentanyl 2 micro g[-1] ml [RF] when their cervix was dilated to 4 centimeters. Analgesia was provided with 20 ml bolus of the study solution and maintained at 10 ml[-1]h. Upper level of sensory loss to cold, Visual Analogue Pain Score [VAPS], motor block [modified Bromage score], the duration of the first and second stages of labor, numbers of instrumental vaginal and cesarean deliveries, the neonatal apgar score, patient satisfaction and side effects, were recorded. There were no significant differences in sensory level, pain scores, duration of the first and second stages of labor, numbers of instrumental and cesarean deliveries, the neonatal apgar scores, patient satisfaction or side effect between groups. Although motor block was significantly high in lidocaine group compared to ropivacaine group [p<0.05], all parturient were moving satisfactorily in bed. Dilute epidural lidocaine [0.5%] with fentanyl effectively and safely initiates epidural analgesia clinically indistinguishable from 0.08% epidural ropivacaine with fentanyl. Although it induces significant motor block compared to ropivacaine, it still preserves maternal ability to move satisfactorily in bed. Whether further reduction in lidocaine concentration could trim down the motor block, remains to be investigated