[Anesthesiologic and surgical problems in adenotonsillectomy in pediatric patients. Our current trend]. / Problematiche anestesiologiche e chirurgiche nell'adenotonsillectomia in pazienti pediatrici. Nostro attuale orientamento.

AIM: To verify, in dissection adenotonsillectomy (AT) performed in Rose position under general anaesthesia with oro-tracheal intubation, the following: 1) the ability of tramadol to produce an effective intra- and postoperative analgesia without any considerable side effects or interferences with the normal post-surgical course of the operation; 2) the possibility of obtaining, thanks to mivacurium, a myoresolution closer both to surgical times of the operation and to the necessity of a fast recovering of the pharyngo-laryngeal reflexes. EXPERIMENTAL DESIGN: A perspective and retrospective clinical study. SETTING: University clinic department (operating room and facility). PATIENTS: 110 patients submitted to adenotonsillectomy, aged 4-10, belonging to the I-II ASA categories and not taking any drug for at least 30 days. INTERVENTIONS: Intravenous pre-medication with tramadol 2 mg/kg; myoresolution with mivacurium 0.2 mg/kg; postoperative analgesia with tramadol 2 mg/kg i.m. one hour after the first administration and, with an equivalent oral dose of tramadol, six hours later. MEASUREMENTS: During surgery: ECG, HR, Sat HbO2, non-invasive arterial blood pressure; after surgery: clinical evaluation of pain, through a three-point scale, and of the surgical course. RESULTS: Good analgesical level both during and after surgery; myoresolution especially suitable to adenotonsillectomy duration and characteristics; no considerable complications. CONCLUSIONS: Tramadol intra- and postoperative analgesia and mivacurium myoresolution represents, in personal opinion, an efficient approach to dissection adenotonsillectomy performed in children under general anaesthesia.

[The treatment of benign laryngeal pathologies using CO2 laser in direct microlaryngoscopy with propofol-induced endovenous anesthesia in spontaneous respiration without intubation]. / Il trattamento delle lesioni benigne della laringe in micro-laringoscopia diretta con il laser CO2 mediante anestesia endovenosa con Propofol in respiro spontaneo senza intubazione orotracheale.

Direct microlaryngoscopy is an endoscopic technique with considerable diagnostic and surgical potentialities, which are increased when carbon-dioxide Laser is used, but often limited by the anaesthesiologic methods employed. In fact, the traditional anaesthesiologic technique, which uses small bore oral-tracheal tubes and provides good ventilation, has significant disadvantages: the tube often impedes surgical activity especially in the posterior regions of the larynx; stenoses of the larynx impede oral-thacheal intubation and thus require pre-operatory thacheotomy; administration of succinylcholine often induces diffused myalgia in the following 12-24 hours; administration of traditional narcotics always requires hospitalization. Jet-ventilation used by the Freach School as an alterative, while offering a more ample operatory space, is also accompanied by many disadvantages: vocal cords vibration; spray expulsion of smoke, blood, etc.; as with the traditional method, it cannot be employed in cases of laryngeal stenoses; succinylcholine often induces diffused myalgia; it cannot be used on out-patients. Introduction of Propofol, a new endovenous anaesthetic, the anaesthetologic pratice has permitted total endovenous anaesthesia to be achieved, in spontaneous respiration, without intubation. This method is indicated even in cases where the previously mentioned approaches are shown to be inadequate or impracticable. Narcosis with Propofol was used in 70 patients with benign laryngeal pathologies, belonging to the ASA risk classes I-II who underwent surgery via CO2 Laser during Microlaryngoscopy. The pharmacologic protocol of this narcosis require intravenous premedication with atropine and phentanyl, induction and continuation with Propofol and pharyngolaryngeal local anaesthesia with lidocaine spray. The advantages offered by this method are considerable: a completely free operative space; the possibility of being used in cases of laryngeal stenosis; a rapid return to consciousness; the absence of myalgia after surgery; the possibility of treating the disease on an out-patient basis. The absence of significant complications and the good results obtained lead us to propose this anaesthesiologic method as a valid alternative to anaesthesia by the traditional oral-tracheal intubation and to Jet ventilation.

Benzydamine for the prevention of pharyngo-laryngeal pathology following tracheal intubation.

A clinical study was carried out to assess the antiinflammatory effectiveness and related properties of this drug. It was performed double-blind in 40 adult patients (ASA I, and II) undergoing major otorhinolaryngological surgical procedures with tracheal intubation. The patients received benzydamine at random (n = 20), or a similar solution without the active substance (n = 20). The following parameters were considered: physical examination, sensations referred from patient, cytologic examination, glottographic examination, and spectrographic examination. The results suggest that benzydamine applied locally at a concentration of 0.3% has therapeutic efficacy without local or systemic side-effects.