Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients

To compare two different supraglottic airway devices, the laryngeal mask airway [LMA] and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO[2], oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO[2], end-tidal CO[2], number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. No statistically significant difference was reported between both the groups, regarding heart rate, arterial BP, SPO[2] and end-tidal CO[2]. The mean duration of insertion attempts was 15.6 +/- 4.9 seconds in the I-gel group, while it was 26.2 +/- 17.7 seconds in the LMA group. The difference between both the groups regarding duration of insertion attempts was statistically significant [P=0.0023*], while the number of insertion attempts was statistically insignificant between both the study groups [P>0.05]. Leak pressure was [25.6 +/- 4.9 vs. 21.2 +/- 7.7 cm H 2 O] significantly higher among studied patients of the I-gel group [P=0.016*] and the incidence of gastric insufflation was significantly more with LMA group 9 [22.5%] vs. I-gel group [5%] [P=0.016]. Both LMA and I-gel do not cause any significant alteration in the hemodynamic status of the patients, end tidal CO[2], and SPO[2]. The postoperative complications were not significantly different except nusea and vomiting was statistically significant higher in LMA group [P=0.032]. among both LMA and I-gel patients. Insertion of I-gel was significantly easier and more rapid than insertion of LMA. Leak pressure was significantly higher with I-gel than LMA and thus incidence of gastric insufflation was significantly lower with I-gel

Rocuronium versus cisatracurium: onset of action, intubating conditions, efficacy, and safety

Neuromuscuiar blockers [NMB] are very important adjuvant to general anesthesia. Rocuronium bromide [ammosteroidal NMB] and cisatracunum besylate [benzyl isoquinolme NMB] are recently introduced non-depolarizing muscle relaxants In a prospective randomized study we had compared both drug at a dose 2x [ED95] as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects 40 female patients ASA l and ll. 20-50 year old underwent elective gynecological ambulatory surgery under general anesthesia [GA] were randomly assigned into 2 equal groups. ROC group, where 0.6mg/kg rocuronium was given and CIS group, where 0 1mg/kg cisatracurium was given. Neuromuscuiar monitoring was done by stimulating uinar nerve and recording the action potential of the first dorsal interosseous muscle using Date x Relaxogram. Standardized GA was given to all patients as follows, fentanyl 1.5mcg/kg. propofol 2mg/kg. 2x [ED95]/kg of the examined NMB. intubation was tried by the same anesthetist who was blind to the given NMB after 60 sec of injection, intubation was done if the intubating condition was acceptable [excellent or good], and it was re-attempted every 30 sec if it was poor or inadequate Anesthesia was maintained by 60% N2O in 02 and isoflurane to a total MAC 1.5. controlled ventilation was adjusted to normocarpia. Mean arterial blood pressure [MAP], heart rate, and intubating conditions were recorded interpretation of relaxogram for the onset of action, clinical duration, recovery index was done Clinically acceptable intubating conditions were achieved after 60 sec more frequently after rocuronium [80%] than after ctsatracurium[O%]. Rocuronium had a significant shorter onset time than cisatracunum [70.6 +/- 18.2 versus 160.4 +/- 14.3sec], Rocuronium had a significant shorter duration of action than cisatracurium [30.3 +/- 5.2 versus 45.7 +/- 7/5min], and the spontaneous recovery index was significantly shorter with rocuronium than cisatracurium [9.2 +/- 1.8 versus 13.6 +/- 2.4min]. There were no evidences of any significant clinical cardiovascular changes in both groups. There were no clinical signs of histamine release in both groups, but there was burning pain at the site of rocuronium injection in more than 50% of patients Conclusion: Rocuronium has a rapid onset of action with good intubating conditions, cisatracurium has an intermediate duration of action, both are potent and safe with excellent cardiovascular stability and without apparent histamine release

Prenatal Diagnosis of congenital diaphragmatic hernia improves the postoperative outcome: a local experience

To date, uniform standards for congenital diaphragmatic [CDH] management have not existed. This study was to compare infants with congenital diaphragmatic hernia [CHD] who had undergone a prenatal diagnosis to those who had not undergone such diagnosis. Sixteen infants with CDH who were admitted to the neonatal intensive care unit [NICU] of Suez canal university hospital from December 2000 to August 2004 were prospectively studied. They were classified into two groups; group I including 7 infants who were prenatally diagnosed as CDH by serial ultrasound scans. In group II: 9 infants were diagnosed as having CDH after birth with no prenatal diagnosis. Special care for respiration and resuscitation was performed for all patients in the two group according to a special resuscitation protocol. After stabilization and resuscitation, surgical intervention was done under special anesthetic care. The outcome of the morbidity and mortality in both groups were studied and statistically evaluated. The mean gestational age was 37. +/- 1.05 weeds in group I in contrast to 35.18 +/- 2.7 weeks in group II. [P=0.04] and the mean birth weight was 2.5 +/- 0.8 kg in group I in contrast to 2.1 +/- 1.3 in group II. All infants required mechanical ventilation. In group I, the mean gestational age at prenatal diagnosis was 26.5 weeks. The lung area head circumference ratio [LHR] ranged from 0.36 to 0.23. associated abnormalities in group I included ventricular septal defect, atrial septal defect, polyhydramnios, premature rupture of membrane and preterm labor. In group I, the overall survival rate was 4 patients out of 7 [57.1%] in group II, 2 infants out of 9 survived with a survival rate of 22.2% with a statistically significant difference. Prenatally diagnosed infants with CDH have a better survival rate and a less morbidity compared with those who have not undergone this diagnosis