Is barbotage in central neuraxial blockade a ritual habit or an evidence-based technique?

Barbotage refers to the repeated aspiration and re-injection of CSF following injection of local anaesthetic into the intrathecal space, and its practice varies among anaesthetists. This article reviews the evidence for and against this practice to alter block dynamics following intrathecal injection reserved for spinal anaesthesia.

Laryngeal Changes After Septoplasty and Turbinectomy.

Studies found only a little amount of evidence about the impact of septoplasty on the mechanism of voice production, as well as vocal cord and laryngeal mucosal changes. Nasal obstruction is a common medical issue that is linked to changes in the quality of resonance of voice. To assess patients with deviated nasal septum and inferior turbinate hypertrophy's voice alterations using laryngeal stroboscope before and after septoplasty and turbinectomy. In this prospective case-control study, patients in group A had inferior turbinate hypertrophy and a nasal septal deviation, while participants in group B were healthy controls who were matched for age and gender. All of the included patients had their laryngeal stroboscope and acoustic voice characteristics evaluated both preoperatively and three months after surgery. Only the baseline evaluation of healthy controls was done. We included 30 patients with mean age 24.43 ± 7.81 years, and males accounted for two thirds of the included cases, speech testing showed that Amplitude perturbation significantly improved post septoplasty with p values < 0.05, while Fundamental frequency and NHR parameters didn't show statistically significant improvement compared to preoperative measurements and control groups. Paired comparison of laryngeal erythema, mucosal edema and mucosal waves showed significant improvement compared to preoperative laryngeal stroboscopic findings with p values < 0.001 each. Significant improvements were made to septal deviation following surgery nasal obstruction caused by nasal septal deviation and inferior turbinate hypertrophy is associated with amplitude perturbation, laryngeal erythema, mucosal edema, and mucosal waves in the patients.

What is the place of dural puncture epidural in labour analgesia?

Epidural analgesia is the gold standard for labour analgesia. Dural puncture epidural analgesia is a modification of the conventional technique, where the dura is intentionally perforated with a spinal needle but no intrathecal medication is given. This article reviews the evidence for and against the clinical use of dural puncture epidural.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery.

BACKGROUND: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. METHODS: In this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. RESULTS: The average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. CONCLUSION: The treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery / Ventajas del colgajo pericondrial-adipo-dérmico con base medial en la cirugía de remodelación del cartílago de oreja prominente

Background: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures.MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence.ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma.ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion. (AU)

Antecedentes: El recorte y la remodelación del cartílago son los dos tipos de técnicas en los procedimientos de otoplastia. Debido al riesgo considerable de hematoma, necrosis cutánea y deformidad de la oreja, las técnicas de recorte del cartílago han sido cuestionadas. Como resultado, los procedimientos de remodelación del cartílago basados en sutura, tales como las técnicas de Mustarde y de Furnas, han ganado popularidad. Sin embargo, dichas técnicas tienden a recidivar la deformidad debido a la memoria del cartílago y a la fatiga de la sutura, así como hay la posibilidad de extrusión y de la sensación de pinchazo en ellas.MétodosEn el presente estudio utilizamos un colgajo pericondrial-adipo-dérmico con base medial que se eleva desde el dorso auricular para cubrir y soportar la otoplastia de remodelación del cartílago, habiendo operado a 34 pacientes con esta técnica (14 mujeres y 20 varones). El colgajo pericondrial-adipo-dérmico con base medial se avanza anteriormente y se fija al borde helical inferior para cubrir el colgajo cutáneo distal. El objetivo de este procedimiento fue cubrir la línea de la sutura, impidiendo la extrusión de la misma, y soportar la reparación de la deformidad previniendo su recidiva.ResultadosEl tiempo quirúrgico medio fue de 80min, fluctuando de 65 a 110min, transcurriendo el periodo postoperatorio temprano de los pacientes con normalidad, excepto en dos pacientes: uno de ellos (2,9%) desarrolló hematoma y el otro desarrolló una zona pequeña de necrosis en el nuevo pliegue antihelical. En el periodo postoperatorio posterior un paciente desarrolló recidiva de la deformidad. Ningún paciente desarrolló extrusión de la sutura ni granuloma. (AU)

Should remifentanil patient-controlled analgesia be a routine choice for pain relief in labour?

Patient-controlled analgesia with remifentanil is usually reserved for patients for whom other forms of pain relief are contraindicated. However, remifentanil patient-controlled analgesia reduces the likelihood of needing an epidural and therefore the risk associated with it, provides good pain relief compared to other options, and the risks can be mitigated with appropriate management.

Routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia: is it worth it?

This article discusses the place of routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia. Benefits include reducing the probability of accidental awareness or excessive depth of anaesthesia, and creating training opportunities to improve familiarity with its use, but these must be weighed against the costs, as it may not be advantageous from a cost-benefit perspective.

Rapid sequence spinal anaesthesia: a technique reborn during the COVID-19 pandemic.

With the wish to reduce aerosol generation and the shorter time to anaesthetic readiness, this article discusses why rapid sequence spinal anaesthesia could be used in preference to general anaesthesia, for the benefit of both patients and staff during the COVID-19 pandemic.

Topical versus interlesional mitomycin C in auricular keloids.

BACKGROUND: The Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound. OBJECT: To compare between topical and intralesional mitomycin C in the treatment of auricular keloids. PATIENTS AND METHODS: Prospective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids. RESULTS: The two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group. CONCLUSION: Both topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.

Topical versus interlesional mitomycin C in auricular keloids

Background: The Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound.ObjectTo compare between topical and intralesional mitomycin C in the treatment of auricular keloids.Patients and methodsProspective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids.ResultsThe two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group.ConclusionBoth topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration. (AU)

Antecedentes: El queloide es una cicatriz fibrosa elevada que puede extenderse más allá de los límites de la herida original.Objetivo Comparar mitomicina C tópica frente a intralesional en el tratamiento de los queloides auriculares.Pacientes y métodosEstudio prospectivo aleatorio en el que se incluyó a 40 pacientes con queloides auriculares, que se dividieron en 2 grupos: el Grupo I incluyó 32 pacientes a quienes se aplicó mitomicina C tópica tras la resección quirúrgica de los queloides, y el Grupo II que incluyó 8 casos, a quienes se inyectó mitomicina C dentro de la lesión, tras la resección quirúrgica de los queloides auriculares.ResultadosLos 2 grupos no reflejaron diferencia significativa en cuanto a criterios de pacientes o lesión (p>0,05). La escala de Vancouver (VSS) disminuyó significativamente de 10,63 y 11 a 1,38 y 3 tras el tratamiento en los grupos de aplicación tópica e intra-lesional, respectivamente (p<0,001). Sin embargo, se detectaron una mejora y satisfacción más altas en el grupo de aplicación tópica.ConclusiónLas aplicaciones tópica e inyectada de mitomicina C son métodos efectivos para el tratamiento de queloides auriculares. Sin embargo, se reportaron mejores puntuaciones VSS y de satisfacción del paciente con la administración tópica. (AU)

Should positive end-expiratory pressure be used during elective general anaesthesia with supraglottic airway devices?

Anaesthetists' use of positive end-expiratory pressure during elective general anaesthesia via supraglottic airway devices varies. Positive end-expiratory pressure may help to maintain oxygenation and prevent atelectasis, but could worsen the risk of air leak, gastric insufflation and catastrophic aspiration.

Should lidocaine routinely be used to prevent pain on propofol injection during induction of general anaesthesia or sedation?

Anaesthetists commonly debate whether lidocaine should be added to propofol for anaesthetic induction. The benefits include pain relief and improved patient satisfaction, but disadvantages include the effect on the emulsion itself, the efficacy of propofol once it has been mixed, and the effect on growth of bacteria in the syringe.

What is the best choice for postoperative analgesia after major gynaecological oncology surgery?

Major gynaecological oncology surgery can be complex and extensive, with correspondingly high requirements for postoperative analgesia. Multiple options are available including intravenous, neuraxial and regional techniques. This article discusses the pros and cons of different anaesthetic modalities for postoperative analgesia.

Audiological assessment of neonatal hyperbilirubinemia.

OBJECT: To evaluate the hearing of infants with history of neonatal hyperbilirubinemia using ABR. METHODS: A prospective randomized study carried on 100 infants whose hearing was assessed by ABR. Infants were allocated into two groups; case group which involve 60 infants with history of neonatal hyperbilirubinemia (bilirubin more than17 mg/dl and less than 30 mg/dl) and control group involve 40 healthy infants. Each group was divided into 3 groups based on their age i.e. ≤ 6 months, > 6-9 months &> 9-12 months. The evaluated variables were latency time & inter peak latency time. RESULTS: The mean latencies of wave III&V of ABR were significantly higher in the case group compared with the controls (P < 0.001) while the mean latencies of wave I did not show a significant difference between the two study groups (P > 0.05). The mean inter wave latencies I-III, I-V& III-V of ABR were significantly higher in the case group compared with the controls. There was a negative correlation between age and the studied variables. CONCLUSION: Hyperbilirubinemia have an adverse effect on neonatal hearing which was reflected by ABR parameters of this study.

Adipose Tissue-Derived Mesenchymal Stem Cell Modulates the Immune Response of Allergic Rhinitis in a Rat Model.

This study was designed to investigate the potential effects and underlying mechanism of adipose tissue-derived mesenchymal stem cells (MSCs) on allergic inflammation compared to Montelukast as an antileukotriene drug in a rat model of allergic rhinitis (AR). The effect of MSCs was evaluated in albino rats that were randomly divided into four (control, AR, AR + Montelukast, and AR + MSCs) groups. Rats of AR group were sensitized by ovalbumin (OVA) and then challenged with daily nasal drops of OVA diluted in sterile physiological saline (50 µL/nostril, 100 mg/mL, 10% OVA) from day 15 to day 21 of treatment with/without Montelukast (1 h before each challenge) or MSCs I/P injection (1 × 106 MCSs; weekly for three constitutive weeks). Both Montelukast and MSCs treatment started from day 15 of the experiment. At the end of the 5th week, blood samples were collected from all rats for immunological assays, histological, and molecular biology examinations. Both oral Montelukast and intraperitoneal injection of MSCs significantly reduced allergic symptoms and OVA-specific immunoglobulin E (IgE), IgG1, IgG2a and histamine as well as increasing prostaglandin E2 (PGE2). Further analysis revealed that induction of nasal innate cytokines, such as interleukin (IL)-4 and TNF-α; and chemokines, such as CCL11 and vascular cell adhesion molecule-1 (VCAM-1), were suppressed; and transforming growth factor-ß (TGF-ß) was up-regulated in Montelukast and MSCs-treated groups with superior effect to MSCs, which explained their underlying mechanism. In addition, the adipose tissue-derived MSCs-treated group had more restoring effects on nasal mucosa structure demonstrated by electron microscopical examination.

Polysomnographic and pulmonary function changes in patients with sleep problems after septoplasty with turbinectomy.

OBJECT: To compare Polysomnography and Pulmonary function tests before and after Septoplasty with Turbinectomy in patients complaining of nasal obstruction and sleep problems due to deviated septum with hypertrophic inferior turbinate. METHODS: 90 patients underwent Septoplasty with Turbinectomy due to nasal obstruction and sleep problems involved in this study, their sleep quality evaluated by polysomnography before and after the surgery, their pulmonary functions assessed by spirometry before and after the operation. RESULTS: The postoperative pulmonary function values; FVC, FEV1, PEFR and postoperative polysomonographic values; AHI, Snoring index/hour, SpaO2 were higher than the preoperative values, and the results were statistically significant (p-values <0.001). CONCLUSION: Septoplasty with partial inferior turbinectomy might be a useful operation in the management of nasal obstruction and sleep problems that caused by a deviated nasal septum and hypertrophied inferior turbinate.

Bacterial cellulose graft versus fat graft in closure of tympanic membrane perforation.

OBJECT: To compare between results of bacterial cellulose graft myringoplasty and fat graft myingoplasty in patients had mild or moderate size safe perforation. METHODS: 120 patients undergoing myringoplasty due to mild or moderate size perforation were divided into 3 groups: group I: 40 patients undergoing myringoplasty with use of bacterial cellulose graft, group II: 40 patients undergoing myringoplasty with use of fat graft, group III: 40 patients undergoing usual myringoplasty with use of temporalis fascia graft (control group). RESULTS: Healing in 20 patients with small perforation and 17 patients with moderate perforation in Group I, Healing in 15 patients with small perforation and 10 patients with moderate perforation in Group II, Healing in 18 patients with small perforation and 12 patients with moderate perforation in Group III. CONCLUSION: Bacterial cellulose graft myringoplasty would be a good, simple, rapid and safe surgery that could be done under local anesthesia in outpatient clinic with shorter time of surgery than fat graft myringoplasty and temporalis fascia graft myringoplasty, with better hearing and healing. SUMMARY AT GLANCE: 120 patients undergoing myringoplasty were divided into 3 groups to compare between results of bacterial cellulose graft myringoplasty, fat graft myringoplasty and temporalis fascia graft myringoplasty.