NON-STENTED HOLMIUM:YAG URETEROSCOPIC MANAGEMENT OF LOWER URETERAL CALCULI

Objective To evaluate the clinical outcome of non-stented ureteroscopic Holmium:YAG laser lithotripsy of distal lower ureteral calculi with respect to efficacy, safety, postoperative pain and hospital stay. Patients and Methods Thirty-five patients with distal lower ureteral calculi underwent ureteroscopy without prior ureteral dilatation followed by Holmium:YAG laser lithotripsy. No stenting was carried out at the end of the procedure. A second group of 35 age and sex matched patients who underwent the same procedure with placement of stents served as a control group. The patients were evaluated 24 and 48 hours, as well as 1 and 4 weeks postoperatively to determine postoperative pain and analgesic requirements. Radiological follow-up consisted of renal ultrasound and plain KUB film, while excretory urography was done 3 months postoperatively. Results Five patients (14.2%) of the study group showed a dilatation of the pelvicalyceal system and the upper ureter which improved completely by the seventh postoperative day. Patients with stents had statistically significantly more postoperative pain (

Optimizing surgical f

Background: The field of cochlear implantation has been expanding rapidly and it has been hailed as one of the greatest advances in otology. The technique of anesthesia plays a crucial role in success of cochlear implant surgery as the anesthesiologist has to produce conditions which facilitate surgery by inducing bloodless operative field. Study objective: To determine the efficacy of dexmedetomidine versus esmolol usage as an adjunct to induce controlled hypotension in children undergoing cochlear implant surgery. Design: Clinical trial study. Setting: Operating room in a university hospital. Patients: 70 children aged 2–4 years scheduled for cochlear implant surgery under general anesthesia. Patients were randomly allocated according to drugs used into two equal groups (35 patients in each group). Interventions: Group (D): The patients in this group received a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by continuous infusion 0.2–0.5 ug/kg/h after induction of anesthesia but before surgery. Group (E): The patients in this group received a bolus dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion 100–300 ug/kg/min after induction of anesthesia but before surgery. Measurements: Heart rate, Mean Arterial blood Pressure, Quality of surgical field, operative time, adverse events. Main results: The quality of surgical field was comparable between both groups in all times of measurements. The time to first analgesic request was statistically significant longer in group (D) than in group (E) and the total tramadol consumption was statistically significant less in group (D) than in group (E). Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients