A randomized comparative study of intraocular pressure and hemodynamic changes on insertion of proseal laryngeal mask airway and conventional tracheal intubation in pediatric patients

Objective: To assess the influence of proseal laryngeal mask airway (PLMA) insertion on intraocular pressure (IOP). Aim: We compared the effects of PLMA insertion and laryngoscopic intubation on IOP and hemodynamic response in pediatric patients. Background: Previous studies have shown that there is no hemodynamic response to PLMA insertion similar to classic LMA insertion, but there is no published report about the influence of PLMA insertion on IOP. Conventional laryngoscopic tracheal intubation evokes a rise in IOP and cardiovascular response and has been traditionally used to secure the airway in pediatric patients undergoing ophthalmic surgery. Materials and Methods: 59 patients, less than 14 years of age, scheduled for elective ophthalmic surgery were randomly divided into two groups, group P, in which the patient′s airway was secured with PLMA (using introducer tool technique), and group T, in which the airway was secured with laryngoscopy-guided endotracheal intubation. Heart rate, blood pressure, and IOP were measured just before insertion of the airway device and subsequently three times at intervals of 1 min after insertion of the airway device. Results: In group T, there was a significant rise in IOP as well as hemodynamic parameters recorded. In group P, there was no significant rise in hemodynamic parameters, but a significant rise in IOP was found though the rise was less than in group T. Conclusion: We conclude that the PLMA use is associated with lesser cardiovascular response and rise in IOP as compared to tracheal intubation

Recent advances in anesthetic management in repair of tracheoesophageal fistula repair

Thoracosopic repair of tracheoesophageal fistula and esophageal atresia (TREAT) is an advanced endoscopic procedure which requires a skilled approach in minimally invasive surgeries. TREAT is considered as a superior technique in achieving cosmesis and avoiding complications when compared to open thoracotomy. It requires a team of surgeons, anesthesiologists, and assistants and neonatal intensivists to look after the neonate in the perioperative period. Recent meta-analysis has shown no significant difference in outcome and functional evaluation in open thoracotomy and thoracoscopic approach to TEF repair. Anesthesiologists should be well versed with knowledge and ability to anticipate challenges in managing neonates under thoracoscopic TEF repair which plays an important role in the management and survival of these kids. We searched PubMed and Google Scholar databases with the following keywords anesthetic management, tracheoesophageal repair, surgical repair, non-intubated video-assisted thoracoscopic surgery, video-assisted thoracoscopic surgery, video-assisted thoracoscopic surgery, pediatric one-lung ventilation, and pediatric regional anesthesia. The last search was made on July 31, 2018

Anesthetic considerations for video-assisted thoracoscopic surgery in a child with Glenn shunt for thoracic duct ligation and pleurodesis

Glenn shunt is an anastomosis between superior vena cava and right pulmonary artery to palliate patients with single ventricle physiology of the heart. Chylothorax is a frequent and troublesome complication after the creation of this shunt, which if not controlled with medical management, might require pleurodesis, and thoracic duct ligation. Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain, earlier mobilization, lower overall morbidity, a shortened hospital stay with reduced cost, and a cosmetic incision. A comprehensive understanding of physiology of Glenn shunt and implications of the proposed surgical procedure (VATS) is necessary to plan the anesthetic agents, cardiovascular drugs, ventilation strategies, and other perioperative factors

Successful combined spinal–Epidural anesthesia for a case of scleroderma for amputation

This research has two objectives. The first objective is to explore the use of the modeling tool called "latent structural equations" (structural equations with latent variables) in the general field of travel behavior analysis and the more specific field of dynamic analysis of travel behavior. The second objective is to apply a latent structural equation model in order to determine the causal relationships between income, car ownership, and mobility.Many transportation researchers might be unfamiliar with latent structural equation modeling, which is also known as "latent structural analysis," "causal analysis," and "soft modeling." However, most researchers will be quite familiar with techniques that are special cases of latent structural equations: e.g., conventional multiple regression and simultaneous equations, path analysis, and (confirmatory) factor analysis. Furthermore, recent advances in estimation techniques have made it possible to incorporate discrete choice variables and other non-normal variables in structural equations models. Thus, probit choice models (binomial, ordered, and multinomial) can be incorporated within the general model framework.The empirical analysis reported here involves dynamic travel demand data from the Dutch National Mobility Panel for the three years 1984 through 1986. All variables in the model, with the exception of income level in the first year, are endogenous: income is treated as an ordinal (four category) variable; car ownership is treated as either an ordinal (ordered probit) or a categorical (multinomial probit) choice variable; and mobility, in terms of car trips and public transport trips, is treated as two censored (tobit) continuous variables. The model fits the data well, but only scratches the surface of the potential of latent structural equation modeling with panel data. Some possible extensions are outlined.The methodological discussion is not intended as a comprehensive overview of structural equation modeling with latent variables. Rather, the aim is to explore the technique in comparison to conventional methods of travel behavior analysis. Many extensive overviews are available, due to the popularity of the technique in the fields of sociology and psychology, and more recently in marketing research. The technique as described here has been in use since the early 1970s, but, because of recent rapid developments, current overviews are more relevant to transportation researchers. Such overviews are provided by Bentler (1980), Bentler and Weeks (1985), Fornell and Larcker (1981), Hayduk (1987), and Joreskog and Wold (1982), among others. In particular, Hayduk (1897) provides an extensive bibliography. Historical developments are reviewed in Bentler (1986) and Bielby and Hauser (1977).The author is aware of three computer programs for latent structural equation modeling: LISREL (Joreskog and Sorbom, 1984; 1987), EQS (Bentler, 1985), and LISCOMP (Muthen, 1987). Each program is based on a different approach to estimation and testing and each has its advantages and disadvantages. The three approaches are briefly reviewed in Section 6 on estimation methods. The application results presented here were obtained using the LISCOMP program. It is also possible to replicate the approaches of these programs by implementing several separate estimation procedures (e.g., maximum likelihood estimations of probit models and tobit models, and generalized least square and maximum likelihood estimations of siumultaneous equations) in sequential and recursive order, but this is inefficient in view of the available comprehensive packages