Body Surface Area Is Not a Reliable Predictor of Tracheal Tube Size in Children

OBJECTIVES: The age-based Cole formula has been employed for the estimation of endotracheal tube (ETT) size due to its ease of use, but may not appropriately consider growth rates among children. Child growth is assessed by calculating the body surface area (BSA). The association between the outer diameter of an appropriate uncuffed-endotracheal-tube (ETT-OD) and the BSA values of patients at 24–96 months of age was our primary outcome. METHODS: Cole formula, BSA, age, height, weight and ultrasound measurement of subglottic-transverse-diameter were evaluated for correlations with correct uncuffed ETT-OD. The Cole formula, BSA, and ultrasound measurements were analyzed for estimation rates in all patients and age subgroups. The maximum allowed error for the estimation of ETT-OD was ≤0.3 mm. Patients' tracheas were intubated with tubes chosen by Cole formula and correct ETT-OD values were determined using leak test. ETT exchange rates were recorded. RESULTS: One-hundred twenty-seven patients were analyzed for the determination of estimation rates. Thirteen patients aged ≥72 months were intubated with cuffed ETT-OD of 8.4 mm and were accepted to need uncuffed ETT-OD >8.4 mm in order to be included in estimation rates, but excluded from correlations for size analysis. One-hundred fourteen patients were analyzed for correlations between correct ETT-OD (determined by the leak test) and outcome parameters. Cole formula, ultrasonography, and BSA had similar correct estimation rates. All three parameters had higher underestimation rates as age increased. CONCLUSION: The Cole formula, BSA, and ultrasonography had similar estimation rates in patients aged ≥24 to ≤96 months. BSA had a correct estimation rate of 40.2% and may not be reliable in clinical practice to predict uncuffed-ETT-size.

effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery

Renal insufficiency after cardiac surgery is associated with increased mortality, morbidity, and length of stay in the intensive care unit. We investigated the effect of isoflurane, halothane, sevoflurane and propofol anesthesia on perioperative renal function following elective coronary artery surgery. The medical records of 224 patients, in the Hacettepe University Medical Faculty Hospital who had undergone cardiac surgery in one year, were retrospectively reviewed. 65 [29%] patients received isoflurane, 68 [30%] patients received halothane, 64 [29%] patients received sevoflurane, and 27 [12%] patients received propofol infusion as part of maintenance anesthesia for coronary artery bypass surgery. Patient characteristics [age, sex, preoperative ejection fraction], operative data [duration of CPB, duration of operation, number of distal anastomoses, usage of diuretic, intraoperative crystalloid and blood transfusion], intraoperative urinary output, preoperative and postoperative [6th hours and 24th hours] BUN and plasma creatinine levels, were not statistically significant between and within groups. Intraoperative inotropic agent [dopamine] was used in 8 [12.3%] patients in the isoflurane group, in 10 [14.7%] patients in the halothane group, in 11 [17.2%] patients in sevoflurane group and in 9 [33.3%] patients in the propofol group. Postoperatively fluid and blood transfusion, postoperative drainage, urinary output, diuretic usage were smiliar between the four groups [p>0,05]. Inotropic agent was used in 8 [12.3%] patients in the isoflurane group, in 9 [13.2%] patients in the halothane group, in 16 [25%] patients in the sevoflurane group and in 7 [25.9%] patients in the propofol group. It is concluded that, halothane, isoflurane, sevoflurane and propofol infusion anesthesia as part of anesthesia maintenance for elective coronary artery bypass surgery does not affect early postoperative renal functions

Infusion and bolus administration of cisatracurium - effects on histamine release

The purpose of this study is to evaluate the usefulness of Cisatracurium Besilat [CB], and the method of its administration during laparotomies on adult patients, to determine whether CB caused cutaneous, systemic or chemical evidence of histamine release. This study was conducted as a randomized, double-blind clinical trial on 38 patients [ASA I-II]. After a standard anesthetic induction with fentanyl and propofol, patients received an i.v. bolus CB [0.15 mg/kg in Group A [n=20] or Group B [n=18]. In Group B, 0.18 mg/kg/h infusion was started. Following reaching stable muscle relaxations for intraabdominal operation and for recovery, Group A [Bolus group] and Group B [Infusion group] were compared. Train-of-four fade during recovery of block were recorded after administration of CB. The heart rate and arterial blood pressure were monitored noninvasively. There were no significant hemodynamic differences among the groups. 25%-75% spontaneous recoveries were [X +/- s] 12.75 +/- 4.52, 16.11 +/- 9.20 minutes for Group A, Group B. 70% TOF Ratios were [X +/- s] 1.07 +/- 0.13, 1.39 +/- 0.38 hours for the same groups. There was no consistent correlation between hemodynamic changes, cutaneous manifestations and histamine concentrations. - We conclude that CB does not cause systemic or cutaneous histamine release. The infusion method of cisatracurium has a stable level of curarization without side effect and there were no significant recovery time differences between the groups

effect of premedication on preoperative anxiety

The aim of this study was to evaluate the effect of premedication on anxiety, cortisol, residual gastric volume and gastric pH. Following the approval of the institutional Clinical Research Ethics Committee, 100 patients in ASA I-II scheduled for elective gynecologic surgery, were included into a double blind study. Patients were randomly allocated into two groups; the placebo and the premedicated. Oral 10 mg diazepam in the evening before surgery and 1.5 mg midazolam at least 15 min before surgery. The same anesthetic procedure was applied for both groups. Anxiety levels of patients were assessed by using Spiel Berger State- Trait Anxiety Inventory Scale [STAIs]. Blood samples for cortisol measurements were obtained at the preoperative visits, preanesthesia and intraoperative phases. Gastric contents were collected through an orally inserted gastric tube, acidity was measured by using Merck's pH paper. In placebo group, the pre anesthetic STAIs values were increased compared to the values obtained at preoperative visit [p<0.001]. The pre anesthetic STAIs values were decreased in premedicated group [p<0.001]. The changes of preanesthetic and preoperative visit values were statistically different [p<0.001]. The preanesthetic and intraoperative cortisol values were increased in both groups compared to values of preoperative visit. The augmentation was significantly higher in the placebo group [p<0.05]. Positive correlation was observed between basal state anxiety and basal cortisol values and preanesthetic STAIs and cortisol values in the placebo group [r=0.325, p<0.05]. These data support that preoperative sedation suppresses the preoperative anxiety and the cortisol augmentation resulting from surgery and stress