comparative analysis of the Baska Mask vs. proseal laryngeal mask for general anesthesia with IPPV

To compare the sealing pressure of the Baska Mask [BM] with Proseal laryngeal mask [PLM] in patients undergoing general anesthesia for a variety of elective non-head and neck surgical procedures.. Prospective, randomized, ethical issues committee approved interventional study. Setting: Operating rooms of Khoula Hospital, Muscat [Oman]. 52 consecutive adult patients of either sex requiring general anesthesia were included in the study. Patients with BMI >30, having known tendency to nausea/vomiting or pharyngeal pathology were excluded from the study. Following uniform induction with propofol 2-2.5 mg/kg, fentanyl 1.0-1.5 ug/kg, and relaxation with cisatracurium 0.1 mg/kg, either BM [n=30] or PLM [n= 22] was placed. Primary outcome measure was airway seal pressure while secondary outcome measures included device insertion time, number of attempts, leak fraction, duration of use, and laryngopharyngeal morbidity [sore throat, dysphagia, and dysphonia] at 1 hour and 4 hours postoperatively. Data collection was done by a staff member not involved with the study. The mean insertion time was significantly shorter in the BM group as compared to the PLM group [16.43 +/- 4.54 vs. 21.45 +/- 6.13] [P=0.001]. Mean sealing pressure was significantly higher in the BM group [29.98 +/- 8.51 vs. 24.50 + 6.19] [p= 0.013]. The leak fraction showed no difference between the devices and it ranged from 5.5-20% and 5-20% in the BM and PLM group respectively. All other studied parameters showed insignificant differences between the two devices. BM takes significantly shorter placement time and provides a better seal as compared to PLM

Fentanyl and midazolam induced respiratory arrest and neuromuscular paralysis during day care surgery: a case report

We report a 44 year-old, American Society of Anesthesiologist Class I [ASA I], female patient scheduled for elective excision of a small lipoma of the left thigh. She went into a 90 minute apnea and complete muscle paralysis as evidenced by the absence of all stimulatory responses by a peripheral nerve stimulator after receiving midazolam [1.0 mg] and fentanyl [100 micro g] intravenously for sedation and analgaesia. The patient made an uneventful recovery after 90 minutes. No cause and effect relationship could be established between the administered drugs and this unusual response

unnoticed broken sheathed metallic stylet in an endotracheal tube: a case report

We report a 58-years old patient, who underwent surgery for a fracture to the neck of the femur. Tracheal intubation was performed with the aid of a stylet; however, 15 minutes later, it was brought to the notice of the attending anesthesiologist that a broken piece of stylet had been left inside the lumen of the endotracheal tube. Prior to this, there was no evidence of a foreign body in the endotracheal tube or tracheobronchial tree. The broken piece of stylet was successfully retrieved with the help of a Kocher's forceps

CPAP with air and oxygen to non-ventilated lung improves oxygenation during one lung anesthesia

Ten adult patients undergoing one lung ventilation for elective thoracotomy were selected. All these patients failed to maintain oxygen saturation [SaO[2]] > 90% despite administration of 100% oxygen to the non-ventilated lung [NVL]. These patients were studied for the efficacy of continuous positive airway pressure [CPAP] of the NVL using air and oxygen combination [FiO20.5] employing a variable FiO2CPAP system. It was observed that application of CPAP [5-10 cm H2O] with a mixture of air and oxygen to the NVL increased the SaO2 > 90% in all these patients. This could be attributed to nitrogen in air which prevented absorption atelectasis in the NVL. This produced a better ventilation/perfusion ratio and hence the increased oxygen saturation

Clonidine premedication: a useful adjunct in producing induced hypotension with total intravenous anesthesia for middle ear microsurgery

Thirty adult patients were studied to evaluate the role of oral clonidine premedication on the dose requirement of intraoperative labetalol to produce induced hypotension during total intravenous anaesthesia [propofol I fentanyl] for middle ear microsurgery. Also studied was surgeon's satisfaction and quality of recovery. Patients with oral clonidine [4 micro g/kg] premedication [Group-II, n-15] demonstrated insignificant [p>0.05] pressor response to laryngoscopy intubation. Group II patients needed a mean of only 4.2 mg labetalol to keep the intraoperative mean arterial pressure between 60-75 mmHg as compared to 25.0 mg required in the unpremedicated group [Group I, n-15]. Surgeon's satisfaction with the operative field was similar in both the groups. However recovery time was significantly prolonged in patients receiving oral clonidine premedication