Comparison of three differnt techniques for management of difficult intubation

This study was carried out in Alexandria Main University Hospital to evaluate 3 different techniques for management of difficult air way Thirty adult patients with expected difficult airway were categorized into 3 groups [10 patients each]. Patients of group 1 were managed with blind nasotracheal intubation technique, patients of group II were managed with Mc Coy laryngescope, and patients of group III were managed with the intubating laryngeal mask airway [lLMA-Fastrach]. All patients received general anaesthesia before management of the airway with the chosen technique. The parameters recorded included number of intubation trials, incidence of failure and time to achieve satisfactory ventilation Also, haemadynamic and ventilatory parameters were recorded. Our results showed that group III [Fastrach] had the highest success rate for intubation together with the least changes in ventilatory parameters during the procedure. However, group I had the highest failure rate for intubation [30%] followed by McCoy laryngescope [20%]. Also blind nasotracheal intubation technique was accompanied by the highest incidence of changes in ventiiatory parameters and complications during the technique. In conclusion, the study showed that ILMA is a potential aid for management of difficult airway as it has the advantages of high incidence of success and the unique ability to maintain ventilation during trails of tracheal intubation. Also, blind nasal intubation and McCoy laryngoscope still have a considerable role for management of difficult airway

Analgesia for relie of circumcision pain in children: intramuscular ketamine versus topical lignocaine

Pain is the most common and often a very disturbing immediate sequelae of circumcision in children. Lignocaine, a local anesthetic, and ketamine, an intravenous anesthetic known for its analgesic effect were compared in this respect. This study was performed on thirty otherwise healthy infants undergoing day case circumcision. They were equally divided into two groups: lignocaine group, where induction and maintenance of anesthesia was inhalational with halothane [1.5- 2.5%] and nitrous oxide in oxygen, and analgesia provided intraoperatively with topical lignocaine 2% to a maximum of 10 ml applied with a syringe dripping onto the undersurface of the residual foreskin. In the second ketamine group, anesthesia was induced with intramuscular ketamine 4-8 mg/kg b.w. and maintained with halothane [0.5-1.5%] and nitrous oxide in oxygen. Low incremental doses of ketamine 0.5-1 mg/kg b.w. were given intravenously if needed. Postoperatively, rectal paracetamol [250 mg] was provided whenever the child complained of pain. Only 2 children [13.3%] in the ketamine group and 3 children in the lignocaine group [20%] required paracetamol. There were no statistically significant differences in the pain free periods nor the pain/discomfort scores between the two groups. In conclusion, both methods provided adequate analgesia with equally fast restoration to normal activities