Comparison of RIVA and infraclavicular block in forearm and hand surgery.

OBJECTIVE: The aim of this study was to compare 2 techniques that are widely used in hand, wrist, and forearm: regional intravenous anesthesia (RIVA) and infraclavicular brachial block. METHODS: A total of 100 patients who were aged 18 to 85 years and who underwent hand, wrist, or forearm surgery of at least 30 minutes duration were included. RIVA was applied to Group 1 patients with administration of 40 mL of prilocaine (3 mg/kg). Ultrasonography-guided infraclavicular block was performed on Group 2 patients with 20 mL of 1% prilocaine. Several aspects of these 2 methods were compared, including length of time required to apply anesthesia, the analgesic effectiveness of the treatment during administration and in the peroperative and postoperative periods. RESULTS: The rate of mild and complete sensory loss was significantly higher in Group 2 at 10th and 15th minutes than in Group 1. The number scoring less than grade 2 using modified Bromage grading system in Group 2 was considerably greater than in Group 1. Processing time to apply the block was significantly longer in Group 1 compared with Group 2. CONCLUSION: It was determined that infraclavicular brachial block is superior to the RIVA method with respect to length of time required to administer and ease of application.

Rocuronium: automatic infusion versus manual administration with TOF monitorisation.

TOF (train-of-four) monitoring provides objective data in application of neuromuscular blocking agent. Thus, applicator-based differences are eliminated and optimum muscle relaxation is maintained during operation. In the present study, we aimed to compare the effects of target-controlled infusion system and standard TOF monitoring, on use of rocuronium. ASA I-II patients, who were aged between 18 and 75 years and scheduled for elective abdominal surgery at Haydarpasa Numune Training and Research Hospital, were enrolled in the study. In order to evaluate neuromuscular blockade, the patients in Group 1 were connected to the acceleromyography device of the target-controlled infusion pump (Veryark-CLMRIS-I-China) while the ones in Group 2 were connected to the routinely used acceleromyography device (TOF Watch SX). There was no significant difference between groups regarding patient characteristics, the durations of anaesthesia and surgery, quality of intubation, time to extubation and time to recovery (TOF ratio of 0.9). Intubation time was significantly longer in Group 1 (Automated group) as compared to Group 2 (Control group) (p < 0.05). The total rocuronium amount used in Group 1 was found to be significantly higher than the amount used in Group 2 (p < 0.05). There was no clinical evidence of residual neuromuscular blockage or reoccurrence of neuromuscular blockage in any patient in either group. Both methods can be used for administration of neuromuscular blocker agent during moderate time anesthesia. No advantage was noted when rocuronium was administered via automatical infusion pump during anaesthesia.

The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation.

OBJECTIVES: To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups. METHODS: Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpasa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded. RESULTS: The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar. CONCLUSION: Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.