Middle East Journal of Anesthesiology最新文献

Objective: To investigate the impact of Endotracheal tube (ETT) vs. Laryngeal Mask Airway (LMA) on postoperative nausea and vomiting (PONV) in patients undergoing surgery with general anesthesia.

Methods: Key words searching from databases such as Medline, Embase, and Cochrane library provided 14 studies focusing on the use of EET vs. LMA for general anesthesia. Pooled estimate of relative risk with 95% confidence interval using random effect model was conducted.

Results: 14 studies were selected for meta-analysis with a total of 1866 patients. 9 studies focused on the outcome of PONV in adult patients. It showed incidence of PONV with of LMA and ETT in adult of about 204/690 (30%) and 145/725 (20%) respectively with [Odds Ratio (OR) = 1.69, 95% CI, 0.76-3.75, P = 0.20]. Heterogeneity was high (I2 = 87%). Five studies focused on the outcome of PONV in pediatric patients with PONV in LMA and ETT group of 85/229 (37%) and 72/222 (32%) respectively with (OR = 1.30, 95% CI, 0.61-2.76, P = 0.50). Heterogeneity was moderate at (I2 = 53%). When all patients were combined heterogeneity was high at 81% with OR = 1.56, 95% CI, 0.87-2.79, P = 0.14.

Conclusion: Risk of PONV shows an increase trend toward the use of LMA. Larger randomized trials are needed to assess the impact of airway devices on PONV.

Airway management in pediatric patients presenting for tonsillectomy and adenoidectomy may prove challenging given the enlarged upper airway structures. Video Laryngoscopy (VL) can be very helpful but it does not come without risks. In this case report, we report an unfavorable outcome of VL in a pediatric patient with adenotonsillar hypertrophy.

Background: Postoperative cognitive dysfunction (POCD) is a well-recognized complication of cardiac and noncardiac surgery. However, contradictory results concerning postoperative mental function have been reported. The aim is to determine the effect of anesthetic techniques (general or spinal) on cognitive functions using more sensitive neuropsychological tests in patients undergoing urological surgery.

Material and methods: A total of thirty patients were enrolled in the study and assigned to receive either general (n = 15) or spinal (n = 15) anesthesia. A battery of neuropsychological tests including Wisconsin Card Sorting Test, Iowa Gambling Task, Stroop Color-Word Test, N-back Task and Continuous Performance Test was performed preoperatively and three days later.

Results: The two experimental groups were similar at baseline assessment of cognitive function. Although there were no statistically significant differences between general and spinal anesthetic groups with respect to Wisconsin Card Sorting Test and Iowa Gambling Task, a significant intergroup difference between pre-and postoperative N-back scores was detected in the general anesthesia group (p = 0.001 & p = 0.004). In addition, patients within this group had significantly higher error rates on the Stroop Color-Word (p = 0.019) and Continuous Performance Tests (p = 0.045). In contrast, patients receiving spinal anesthesia exhibited little change or marginal improvement on all subscales of the battery.

Conclusions: Our findings indicate significant decline in specific aspects of mental function among patients who were administered general anesthesia compared with the other technique. It seems that spinal anesthesia contributes to lower disturbance after surgery.

Background: Strabismus surgery in children is often associated with undesirable intraoperative and postoperative side effects including pain, postoperative nausea and vomiting (PONV), and occulocardiac reflex (OCR). Systemic analgesics have side effects and are contraindicated in some cases. We hypothesized that the preoperative subtenon injection of bupivacaine would reduce postoperative pain and the incidence of side effects adverse effects.

Methods: Sixty children (2 to 6 years of age, ASA status I to II) were randomized to receive either subtenon bupivacaine 0.5% or a saline injection before the beginning of surgery in a double-blind manner. Pain scores using the Face, Legs, Cry, Activity, and Consolability (FLACC) scale, incidence of OCR and PONV, requirement of additional systemic analgesia, and time to discharge from the recovery room were compared.

Results: The pain scores were significantly lower in the subtenon bupivacaine group at 0 min (p = 0.0056) and at 30 min (p = 0.013). There was no significant difference between the two groups at the other time intervals. There was a significant reduction in the incidence of occulocardiac reflex and the incidence of vomiting in the subtenon bupivacaine group. Eight of the 27 patients in the subtenon bupivacaine group required additional systemic analgesia compared to 19 of 29 controls. The time to discharge from recovery room was lower in the subtenon bupivacaine group.

Conclusion: These data provide some evidence that a preoperative subtenon block with bupivacaine combined with general anesthesia allows efficient control of postoperative pain as well as a reduction in the incidence of OCR and PONV in young children undergoing strabismus surgery.

Radial artery insertion is a common procedure in intensive care units. We describe a case of a critically-ill 73-year-old man in the neurocritical care unit with a subarachnoid hemorrhage whose radial arterial catheter tip was transected from the main line and was successfully managed with bedside retrieval of the catheter.

Esophageal rupture has been described following iatrogenic manipulation. In this report, we present an elderly lady admitted to the operative theater for laparoscopic cholecystectomy. Multiple intra-operative attempts to place a flexible orogastric tube were unsuccessful because of failure to advance. Post-operatively, the patient developed sepsis and a right pleural effusion. She was transferred to the Intensive Care Unit and she was treated with antibiotics. Radiologic evaluation confirmed an esophago-pleural fistula. Surgical repair was urgently performed for closure of fistula and lung decortication. The patient recovered and was discharged home.

Background: Video-laryngoscopes have gained popularity in the recent years and have shown definite advantages over the conventional Macintosh direct laryngoscopes. However, there is still insufficient evidence comparing the C-MAC with the Macintosh for patients during manual inline stabilization (MILS).

Methods: This prospective, randomized, single blind study was carried out to compare tracheal intubation using the C-MAC video-laryngoscope and Macintosh laryngoscope in patients during MILS. Ninety consented patients, without features of difficult airway, who required general anesthesia and tracheal intubation were recruited. Intubation was performed with either the C-MAC video-laryngoscope or the Macintosh laryngoscope by one single investigator experienced with both devices. Various parameters which included Cormack and Lehane score, time to intubate, intubation attempts, optimization maneuvers, complications and hemodynamic changes were recorded over the initial period of 5 minutes.

Results: C-MAC video-laryngoscope performed significantly better with lower Cormack and Lehane grades, shorter time to intubate of 32.7 ± 6.8 vs. 38.8 ± 8.9 seconds (p = 0.001) and needed less optimization maneuvers. There were no significant differences seen in the intubation attempts, complications or hemodynamic status of the patients with either device.

Conclusion: The C-MAC video-laryngoscope was superior to the Macintosh laryngoscope for patients requiring intubation when manual inline neck stabilization was applied.

Trigeminal neuralgia (TN) is characterized by unilateral, lancinating, paroxysmal pain in the dermatomal distribution area of trigeminal nerve. Percutaneous balloon compression (PBC) of Gasserian ganglion is an effective, comparatively cheaper and simple therapeutic modality for treatment of TN. Compression secondary to PBC selectively injures the large myelinated A-alfa (afferent) fibers that mediate light touch and does not affect A-delta and C-fibres, which carry pain sensation. Balloon compression reduces the sensory neuronal input, thus turning off the trigger to the neuropathic trigeminal pain. In this current case series, we are sharing our experience with PBC of Gasserian Ganglion for the treatment of idiopathic TN in our patients at an academic university-based medical institution in India. During the period of August 2012 to October 2013, a total of twelve PBCs of Gasserian Ganglion were performed in eleven patients suffering from idiopathic TN. There were nine female patients and two male patients with the age range of 35-70 years (median age: 54 years). In all patients cannulation of foramen ovale was done successfully in the first attempt. In eight out of eleven (72.7%) patients ideal 'Pear-shaped' balloon visualization could be achieved. In the remaining three patients (27.3%), inflated balloon was 'Bullet-shaped'. In one patient final placement of Fogarty balloon was not satisfactory and it ruptured during inflation. This case was deferred for one week when it was completed successfully with 'Pear-shaped' balloon inflation. During the follow up period of 1-13 months, there have been no recurrences of TN. Eight out of eleven patients (72.7%) are completely off medicines (carbamazepine and baclofen) and other two patients are stable on very low doses of carbamazepine. All patients have reported marked improvement in quality of life. This case series shows that percutaneous balloon compression is a useful minimally invasive intervention for the treatment of trigeminal neuralgia.

Background: Saphenous nerve neuropathy is one of the causes of chronic pain of the knee. Blockade of saphenous nerve under sonographich guide has been used for controlling pain in recent years. The goal of this study was to evaluate the effect of saphenous nerve block for controlling pain in patients with chronic knee pain.

Method: Thirty five patients with chronic knee pain referred to Amir Alam hospital during June 2012-June 2013 were enrolled in this study. Under sonographic approach, subsartorial blockade of saphenous nerve conducted and patients were followed up for 3 months after treatment. Demographic data, ASA (American Society of Anesthesiologists) category, weight, height, complications of intervention and pain scores were recorded.

Results: In 54%, the NRS was zero 30 minutes after intervention. In one patient (2.8%) all NRSs were 0 after intervention. We observed no sensory dysfunction in enrolled cases.

Conclusion: The result of current study showed that ultrasound guided subsartorial approach is moderately effective in blockade of saphenous nerve in cases with saphenous nerve entrapment in adductor canal for controlling chronic knee pain.