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

uses of melatonin in anesthesia and surgery

Melatonin is a hormone secreted by the pineal gland. It is available as a dietary supplement, taken primarily for the relief of insomnia. Increasing evidence from human and animal studies suggests that melatonin may be efficacious as a preoperative anxiolytic, a postoperative analgesic, and a preventative for postoperative delirium. It has also been reported to decrease intraocular pressure. Melatonin's high efficacy, wide safety profile in terms of dose, and virtual lack of toxicity make it of interest in anesthetic and surgical practice. This review examines clinical trial data describing the efficacy and safety of melatonin in the perioperative anesthetic and surgical settings. We shall, also, focus attention on animal and human experimental studies that concern these issues

Three decades of anesthesiology research at King Fahd Hospital of the university: bibliometric analysis of volume and visibility

Context: The quantity and quality of publications by an institution is an indicator of its contribution towards the development of science

Aims: to examine the volume and visibility of publications by the anesthesia department of King Fahd Hospital of the University [KFHU], Dammam, Saudi Arabia, in the last 30 years

Settings and Design: Publications by members of the anesthesia department in the last three decades were retrieved from the databases of PubMed and Scopus

Materials and Methods: For each article retrieved, the journal and time of publication, the type of the article and the authors were analyzed. The visibility of KFHU publications in leading anesthesia journals is related to the number of citations each article received. Since websites publish only citation reports for the years 1999 to 2011, we analyzed visibility for the years 1998 to 2008. The visibility was compared to the general Saudi anesthesia publications and those of some other Arab countries. It was also related to global indices

Statistical Analysis Used: Two visibility indices were used in the present study. The first relates the average citations per articles in the years following publication to the average global citations per anesthesia articles. The second relates the average citations per article in the 3 years following publication to the impact of the journal of publication. The h-index was used as a measure of both volume and visibility

Results: Anesthesiologists from KFHU published 151 documents in the years 1983-2013, with a marked increase in the last 6 years. The articles published from the year 1998-2008 received citations similar to the journals where it was published with visibility index of one. The average citations per article were 11.75 which are close to the global anesthesia citations per article [12.2]

Conclusions: KFHU anesthesia publications have increased recently. Its impact and visibility are similar to global indices

Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

Objective assessment of sedation depth is a valuable target. Spectral entropy is an anesthetic depth monitor based on the analysis of the electroencephalogram signal. To evaluate the performance of spectral entropy as an objective measure of sedation state in midazolam-premedicated patients and to correlate it with a clinically assessed sedation score. This prospective double-blind placebo-controlled study was performed in King Fahd Hospital of the university. Eighty adult ASA I-II patients were randomly assigned into 4 groups. Patients were premedicated using 0.02, 0.04, or 0.06 mg/kg midazolam or saline intramuscularly. The effect of these doses on the Observer's Assessment of Alertness and Sedation [OAA/S] scale, hemodynamic variables, response entropy [RE], and state entropy [SE], was evaluated at 10, 20, and 30 min after premedication. Spearman Rank-order correlation analysis to examine the relation between OAA/S and entropy. The ability of spectral entropy to predict the depth of sedation was evaluated using Smith prediction probability. Midazolam doses >/= 0.04 mg/kg produced significant decreases in RE, SE, and OAA/S scores. There was a strong correlation between midazolam dose and OAA/S scale, RE, and SE since Spearman Rank R values were 0.792, 0.822, and 0.745, respectively [P<0.001]. In addition, RE and SE were strong predictors of OAA/S level during midazolam sedation with no significant difference in prediction between the 2 entropy components. Spectral entropy is a reliable measure for the sedative premedication. It may be used to objectively assess the adequacy of midazolam premedication and to determine the dose requirement

Bibliometric analysis of the volume and visibility of Saudi publications in leading anesthesia journals

The quantity and quality of publications by a country indicates its contribution towards scientific development. To examine the volume and impact of the Saudi anesthesia publications in leading anesthesia journals. Settings and Fifteen leading anesthesia journals were identified. Saudi publications in these journals from 1991 to 2011 were searched in the databases of Pubmed and Web of Knowledge. For each article, the journal and time of publication, the type of the article and the affiliation of the first author were analysed. The visibility of the publications was related to the number of citations and was analysed for the years 2000 to 2008. Data were compared with selected Arab countries. Statistical Two visibility indices were used. The first relates the average citations per Saudi articles in the years following publication to the average global citations. The second relates the average citations per Saudi article in the two years following publication to the impact factor of the journal of publication. The h-index was used as a measure of both volume and visibility. Anesthesiologists from Saudi affiliations published 173 documents in leading 15 anesthesia journals betweent the years 1991-2011, with a marked increase in the last 6 years. Anesthesia and Analgesia journal published 24% of Saudi articles. Saudi universities contributed to 55% of Saudi publications. The visibility of the Saudi articles was 0.7 of the international figures. Saudi anesthesia publications are increasing in recent years. Although the visibility of Saudi publications is below international figures, it compares favourably to Arab countries

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

effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

We hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of the Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 [8.2] in the placebo and 35.17.0mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group, p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine

Tramadol as an adjuvant to intravenous regional anesthesia with lignocaine

To assess the effect of different doses of tramadol when added to lignocaine during intravenous regional anesthesia [IVRA]. Sixty patients, scheduled for hand surgery under IVRA in King Fahd University Hospital, Al-Khobar, Saudi Arabia from January 2006 to January 2007 were randomly allocated into 3 groups [20 patients each] in a double blind controlled study. All patients received 0.5% lignocaine, 40ml plus 2ml of a study solution containing either isotonic saline control group, or tramadol 50mg [group T50] or tramadol 100 mg [group T100]. Hemodynamic changes, sensory and motor block onset and recovery times, tourniquet tolerance time, the quality of intraoperative anesthesia and the duration of postoperative analgesia were assessed. All patients, 20 in each group completed the study period. Patients who received tramadol had earlier onset of sensory block [5.2 +/= 1.2; 4.9 +/= 1.2 min in the T50; and T100 groups] compared with the control group [7.6 +/= 1.4 min]. Patients who received 100mg of tramadol had better tolerance of tourniquet [p=0.011], and less intraoperative fentanyl supplementation [p=0.042]. They had also a longer time to the first postoperative analgesic request [p=0.001] compared with the control group. Tramadol 100 mg is a beneficial additive to lignocaine for IVRA since it shortened the onset of sensory block, enhanced the tourniquet tolerance and improved the perioperative analgesia

Effect of preoperative ondansetron on postoperative patient controlled tramadol consumption

Tramadol is an atypical Opioid. It has a dual mechanism of action. The first mechanism is through its weak affinity to opioid receptors with some selectivity for mu-receptors and is produced mainly by its Ml- metabolite. The other mechanism relates to increased central synaptic levels of noradrenaline and serotonin, both are transmitters in the descending pathways that ensure analgesia. Both pharmacokinetic and pharmacodynamic interactions have been hypothsized between tramadol and the antiemetic Ondansetron. Ondansetron competes with tramadol for the Cytochrome P450-2D6 and therefore reduces its M1-metabolite. Ondansetron also blocks 5HT3 receptors, which partially contribute to tramadol analgesia. The aim of this study was to find out the clinical effect of preoperative prophylactic ondansetron administration on postoperative tramadol PCA demand. Sixty patients ASA I or II undergoing orthopedic surgery were studied. Patients were randomly allocated to receive either Ondansetron 4mg slowly IV at time of induction of anaesthesia or placebo. Intravenous Tramadol PCA was used for 24 hours postoperatively in both groups [Loading dose =1 mg/ kg., On-demand bolus = 20 mg. Lock-out interval = 10 minutes and total 4 hours dose limit =400 mg]. Tramadol consumption was recorded at I, 2, 4, 8, 12 and 24 hours following initiation of PCA. The incidence of postoperative nausea and vomiting was registered. The total 24 hours tramadol consumption in the ondansetron group was significantly higher than in the placebo group [612 +/- 72 versus 472 +/- 129.5 mg]. This higher consumption of tramadol occurred mainly during the first 4 hours, then the tramadol consumption was nearly similar in both groups after that. The overall incidence of nausea and vomiting was not significantly different between both groups [50% versus 40%]. A single prophylactic dose of ondansetron given at the time of induction of anaesthesia will increase the postoperative analgesic consumption of tramadol and does not reduce the incidence of PONV