hemodynamic effects and complications of tracheal intubation with intubating laryngeal mask airway: a comparison with direct laryngoscopy

The intubating laryngeal mask airway [ILMA] is designed to facilitate blind tracheal intubation. Direct laryngoscopy, to facilitate tracheal intubation, produces a marked pressor response. This randomized, controlled study -was undertaken to compare the complications of insertion and hemodynamic effects following tracheal intubation through intubating laryngeal mask airway [ILMA] with that of conventional Macintosh laryngoscope. One hundred adult patients undergoing elective surgery were randomly allocated into two equal-sized groups. All patients received general anesthesia using a standard balanced anesthesia technique. Tracheal intubation was performed using either intubating laryngeal mask airway or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, the problems encountered during intubation, hemodynamic changes and postoperative pharyngolaryngeal complications were recorded. Time to intubation was comparatively longer in ILM.4 group than laryngoscopy group [58.6 +/- 8.2 sec. versus 29.2 +/- 5.6 sec. p <0.001]. The overall intubation success rate was comparable among the two study groups. The changes-in mean blood pressure were significantly less in ILMA group as compared to laryngoscope group [p <0.05]. The incidence of postoperative sore throat and hoarseness of voice was comparable among groups. Our results suggest that ILMA offers advantage over laryngoscope in minimizing the hemodynamic effects to intubation. Therefore, it can be used as a suitable alternative to laryngoscopy for tracheal intubation

Do antibiotic-coated central venous catheters reduce catheter-related bloodstream infection in intensive care patients?

Central venous catheters [CVCs] are a major cause of nosocomial bloodstream infections, which are difficult to control Catheters bonded with either antiseptics or antibiotics that constantly and slowly release antimicrobial substances are assumed to be beneficial in reducing rates of colonization and catheter-related infections. This prospective, randomized clinical trial was designed to evaluate the efficacy of catheters coated with either chlorhexidine and silver sulfadiazine [CHSS], or minocycline and rifampin [M/R] in reducing catheter-related colonization and bloodstream infections [CR-BSIs] in intensive care patients. 90 adult inpatients with CVCs, for 3 days or more, were conducted in this clinical trial [classified into three equal groups]. According to the type of the catheter, the patients were assigned to undergo insertion of triple lumen polyurethane CVCs either in standard version [unimpregnated] [Group I], or impregnated with either CHSS [on the extraluminal surface only] [Group II], or M/R [on the extraluminal and intraluminal surfaces] [Group III]. Microbiological evaluation was done for the insertion site before catheterization and at removal of the catheter, CVCs [tips and subcutaneous parts] and peripheral blood after removal of the catheter if accompanied by clinical signs of infection. 114 patients were assigned to undergo CVC insertion but dropouts with missing evaluation totalled 24 cases leaving 90 catheters with complete data and final microbiological evaluation. Clinical characteristics as well as clinical diagnoses of patients enrolled were similar in all study groups. Regarding colonization of the insertion site before catheterization, there were no significant differences between the three groups. Impregnated catheters showed a highly significant reduction in colonization of insertion site at removal of the catheter when compared to unimpregnated ones [P <0.001]. Impregnated catheters [groups II and III] were dramatically less likely to be colonized as unimpregnated version [group I] [4/30 [13.3%]; 2/30 [6.6%] vs. 10/30 [33.3%]]; respectively [P < 0.001]. Only one case of CR-BSIs [3.3%] was detected among catheters impregnated with CHSS vs. 4 cases [13.3%] among the unimpregnated ones. No cases of CR-BSIs [0%] were detected in the group of M/R-impregnated catheters. The use of CVCs coated with either M/R or CHSS is associated with a reduction in the rate of catheter colonization and catheter-related bloodstream infection compared to standard [uncoated] catheters in intensive care patients. In addition, the anti-infective efficacy of catheters impregnated with M/R was higher than that of catheters impregnated with CHSS