Comparison of proseal laryngeal mask and endotracheal tube for airway safety in pediatric strabismus surgery

To compare proseal laryngeal mask airway [PLMA] with an endotracheal tube [ET] for airway safety, maintained ease of insertion, and hemodynamic stability in pediatric strabismus surgery [PSS]. This prospective-randomized clinical study was carried out in the Department of Anesthesiology, Faculty of Medicine, Gaziantep University, Turkey between April 2008 and July 2009. Eighty American Society of Anesthesiology [ASA] I-II children, weight 10-30 kg, aged between 1-12 years undergoing PSS were selected. The anesthesia was induced with 8% sevoflurane, 50% nitrous oxide/oxygen mixture, and a neuromuscular blockade with 0.5 mg/kg atracurium in both groups. After a sufficient dosage of anesthesia, the patients were randomized into 2 groups [Group P: PLMA, n= 40, Group T: ET, n=40] and an airway management device; either a PLMA or ET was inserted. The number of placement attempts, placement success or failure, success or failure of a gastric suction tube placement during the procedures and perioperative complications were assessed. Thirty-eight patients [95%] in the PLMA group, 39 [97.5%] patients in the ET group were successfully placed with a PLMA and ET on the first attempt [p>0.05]. There were no statistically significant differences in the hemodynamic parameters, end-tidal carbon dioxide, and complications. This study revealed that PLMA may offer an alternative airway to ET wherein positive pressure ventilation was the preferred choice for children undergoing PSS

Intravenous regional analgesia in a patient with Glanzmann thrombastenia

Glanzmann thirombastenia [GT] is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27 year old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia [IVRA]. The use of platelet transfusion and the recombinant factor VIIa, are stressed

Perimortem Cesarean Delivery Following Severe Maternal Penetrating Injury

The case of a severely traumatized pregnant patient, in whom a perimortem cesarean section, in the emergency department, led to the birth of a viable baby, with long-term survivor, is described. A postmortem cesarean section, resulting in fetal survival, performed after 45 minutes of maternal cardiopulmonary resuscitation is reported in a patient with multiple penetrating injuries. A 27-year-old primigravida suffered cardiopulmonary arrest at the 34th week of gestation following multiple knife injuries. Although extensive advanced cardiopulmonary resuscitation was performed for 45 minutes, her vital signs did not return to normal levels. A low segment cesarean delivery was performed, and a female baby was delivered. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation are important determinants of fetal survival. A perimortem cesarean section is advised in case of multiple penetrating injuries, even after 45 minutes of cardiopulmonary resuscitation, since it may result in fetal salvage.