Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

effect of pregabalin and gabapentin on preoperative anxiety and sedation: a double blind study

Pregabalin and gabapentin are compounds, which have been alleged to possess anxiolytic, analgesic, and anticonvulsant properties. Both are amino acid derivatives of gamma amino butyric acid. Pregabalin has a similar pharmacological profile to that of gabapentin. It has an amino acid substitution at third position which allows better lipid solubility and diffusion across blood brain barrier, better pharmacokinetic properties and fewer drug interactions due to absence of hepatic metabolism. We hypothesized that premedication with oral pregabalin and gabapentin would produce dose-related reductions in acute [state] anxiety and increase in sedation [sleepiness] before induction of general anaesthesia. 90 women were randomly assigned to receive 300 mg pregabalin and 900 mg gabapentin and placebo 60 minutes prior to surgery. Anxiety and sedation was assessed before administration of drug and 1 hour later. A uniform anaesthetic technique was used in all groups. Parameters including sedation scores and various side effects were assessed. Demographic variables were comparable. The preinduction anxiety scores were statistically significant from the baseline values in group 1 and 11. The sedation scores were statistically significant 1 hour after the drug. There was statistically significant difference between group I and II [p=0.000], I and III [p=0.000] and II and III[p=0.015]. Analysis of sedation scores after surgery were comparable at all time intervals between group I and II. However statistically significant difference was noted between group I and III [p=0.000] and group II and III [p=0.000]. A higher percentage of patients in the pregabalin group complained of dizziness and somnolence than the gabapentin and control group. Preoperative pregabalin [300mg] and gabapentin [900mg] administration 1 hour before surgery led to significant reduction in preoperative anxiety and improves sedation without producing significant side effects

Massive subcutaneous emphysema secondary to rigid bronchoscopy in a child

Massive subcutaneous emphysema is a rare complication of interventional bronchoscopy. Complications reported include laryngeal and bronchial spasm, hematorrhea, arrhythmia, airway obstruction, tracheoesophageal fistula, and pneumothorax. Massive subcutaneous emphysema is a rare complication of rigid bronchoscopy. There has been no case report mentioned in the literature till date to the best of our knowledge. We report an eighteen months old female child who developed emphysema involving upper third of her chest, neck and face after rigid bronchoscopy, which increased progressively threatening closure of the airways but was successfully managed conservatively. The details of this case and the management are discussed

randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale [VAS] >/= 3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo

Subglottic foreign bodies - two case reports

Subglottic foreign bodies are not uncommon. Foreign bodies in respiratory tract have been major cause of morbidity The spectrum of presentation varies widely from sudden death due to complete respiratory obstruction to accidental finding during routine investigation. Two cases of unusual subglottic foreign bodies are reported, who required emergency tracheostomy. A common problem encountered in a case of laryngeal foreign body is delayed diagnosis; and special care has to be taken not to damage the surrounding laryngeal tissues during removal