Minerva anestesiologica最新文献

Background: Propofol, an intravenous (IV) anesthetic drug, is associated with injection pain if administered in its standard formulation without intervention. Pain transmission can be modulated or inhibited at the spinal cord dorsal horn cell level or at the supra-spinal levels. In this trial, rubbing and distraction were combined to evaluate their effects on propofol injection pain (PIP).

Methods: One hundred thirty-five patients were randomized equally into a lidocaine (L) group (received propofol mixed with 40 mg lidocaine before its IV injection), a rubbing distraction (RD) group (rubbing was applied starting from the IV injection site extending to the elbow, and distraction was done by asking the patients to watch a 10-second mobile video to answer a question related to this video), and a saline (S) group (received IV propofol mixed with 2 mL saline and not preceded by any drug). When patients received 0.5 mg/kg (1/4 of the total propofol dose) over five seconds, pain degree was evaluated using a 0-3 verbal rating scale (VRS) (0=no pain, 1=mild, 2=moderate, 3=severe pain]. The incidence and severity of PIP and the incidence of pain recall at 1h after surgery were recorded.

Results: PIP incidence was significantly lower in L and RD groups as compared to group S (P<0.001). Group L and group RD patients had significantly lower VRS pain scores compared with group S patients, P<0.001. Pain recall after surgery was significantly lower in RD group as compared to S group; P=0.003.

Conclusions: Rubbing and distraction could decrease the incidence and severity of PIP comparable to the IV lidocaine with a significantly lower incidence of postoperative recall.

Background: Despite recent advancements, ensuring the successful placement and safe ventilation of second-generation supraglottic airway devices (SAD) remains challenging, particularly in pediatric patients. This study aims to compare three LMA ProSeal insertion techniques to assess their impact on placement effectiveness in children, as measured by oropharyngeal leak pressure (OLP). This study hypothesized that different insertion techniques would have a statistically significant effect on OLP in pediatric patients.

Methods: This was a prospective, randomized, controlled trial conducted at a single-center university hospital from October 2023 to April 2024. A total of 150 children aged 1-10 years undergoing short surgical procedures (≤90 minutes) were enrolled. After inserting the LMA ProSeal via standard technique (SD group), direct laryngoscopy (DL group), or videolaryngoscopy (VL group), OLP was measured by detecting air leaks at the thyroid cartilage while closing the valve up to 30 cmH2O. A fiberoptic bronchoscope was used to evaluate the glottic view.

Results: Of the 159 screened patients, 150 were analyzed per protocol. OLP was significantly higher in the VL group (median [Q1-Q3], 26 [24.2-27] cmH2O) compared to the DL group (23 [21.2-24] cmH2O) and SD group (21 [20-22] cmH2O) (P<0.001). The DL group showed significantly higher OLP than the SD group (P=0.001). Fiberoptic imaging scores were higher in the VL group than in the other groups (P<0.001). The first-attempt success rate of SAD insertion was comparable between the VL and DL groups (94% each), but lower in the SD group (86%) (p=0.290). The SAD insertion time was significantly longer in the VL and DL groups compared to the SD group (median [Q1-Q3], 21 [19.2-22] s; 21 [19-22] s; 14 [13-16] s respectively, P<0.001), although there was no significant difference between VL and DL. The number of additional maneuvers during SAD placement was similar between the VL and DL groups but lower in the SD group (P=0.008).

Conclusions: Videolaryngoscopy resulted in the highest OLP and the best fiberoptic views, ensuring superior SAD placement. Direct laryngoscopy improved placement over the standard technique but was less effective than videolaryngoscopy.