Department of anesthesiology and reanimation, school of medicine, Marmara University, Istanbul, turkey

Objective: The aim of this prospective and randomized study was to compare the methods used for the assessment of the nasoduodenal tube position in critically ill patients according to the success rate, time spent on successful placement and cost effectivity. Methods: Sixty critically ill patients for whom enteral feeding with nasoduodenal tube (ND) was planned, were allocated randomly into 3 groups. The assessment of the location of the ND tube was done by auscultation of the loudest sound location over the right flank in group A, pH determination of the duodenal aspirate in group PH and fluoroscopic view in group F. The failure criteria was the placement of a ND tube in the stomach in all groups, the necessity of having more than two flat abdominal radiographs in group A and PH, the duration of fluoroscopy for more than 10 minutes in group F. The success rate, the time of successful placement and the total cost were determined and compared statistically by using analysis of variance and Fisher’s Exact Test. Results: The success rate was significantly higher in group F (95%). The time of successful placement was significantly shorter in group F (75.15 ± 5.32 min versus 147.95 ± 77.05 min in group A and 177.75 ± 154.84 min in group PH). There was no difference between groups regarding the total cost. A 25% false positive result was found in the PH group i.e. the tube was found to be in the stomach after the radiological evaluation although pH values were > 4. Conclusion: For critically ill patients in whom enteral feeding is planned with ND, fluoroscopy should be preferred whenever possible for the placement of the ND tube because the success rate is higher, the placement is quicker and it is more cost-effective than the conventional methods

The effect of propofol and alfentanil on the increase in intraocular pressure due to succinylcholine and intubation

PURPOSE. The aim of this study was to evaluate the effects of propofol and alfentanil on the increase in intraocular pressure (IOP) due to succinylcholine and intubation, in comparison with thiopental sodium and vecuronium bromide. METHODS. Forty patients aged 20-50 years, scheduled for elective surgery requiring endotracheal intubation, were assigned to four groups of ten. General anesthesia was induced with 2.5 mg/kg propofol in Group 1, 2.5 mg/kg propofol and 10 mu g/kg alfentanil in Group II and 5 mg/kg thiopental in Groups III and IV muscle relaxation was obtained with either 1.5 mg/kg succinylcholine (Group I, II and III) or 0.1 mg/kg vecuronium bromide (Group IV). In all patients mean arterial pressure, heart rate, oxygen saturation and IOP were recorded before (baseline) and after induction, after the muscle relaxant and after endotracheal intubation. RESULTS. Compared with their baseline values in Group I IOP decreased significantly after propofol (p<0.01) and increased significantly after intubation (p<0.01). In Group II IOP decreased significantly after propofol and alfentanyl (p<0.001), remained low after succinylcholine (p<0.01) and did not change after intubation. In Group III IOP decreased significantly after thiopental (p<0.001) and increased significantly after intubation (p<0.001). In Group IV ii decreased significantly after thiopental (p<0.001), remained low after vecuronium (p<0.001) and increased significantly after intubation (p<0.05). CONCLUSIONS. In all Groups, IOP did not increase significantly after succinylcholine, but only anesthesia induced with propofol and alfentanil prevented the increase in IOP due to intubation

Analgesia for adeno tonsillectomy in children: a comparison of morphine, ketamine and tramadol

Background: Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children. Methods: Sixty children (age 5-12 years) scheduled for adenotonsillectomy were randomized into four groups to receive intravenously (i.v) either 0.5 mg(.)kg(-1) ketamine hydrochloride (K), 0.1 mg(.)kg(-1) morphine hydrochloride (M), 1.5 mg(.)kg(-1) tramadol hydrochloride (T) or normal saline (S) in a volume of 4 ml during induction. After tracheal intubation 10 mug(.)kg(-1.)min(-1) ketamine hydrochloride in group K and 0.6 ml(.)kg(-1.)h(-1) saline i.v. in groups M, K and S were infused per-operatively. Postoperative analgesic requirements and side-effects were recorded. Pain was assessed by the Numeric Rating Scale (NRS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores. Results: Heart rate increased significantly peroperatively only in group K. NRS at first and fifth minute in group M and at first minute in group T and K and CHEOPS score at first, fifth, 15th and 60th min in group M were found to be significantly lower than in the control group. The time to first analgesic requirement was significantly longer in group M compared with ketamine and the control group. Six children in group M, nine in group T, 11 in group K and 15 in group S needed additional analgesics. Conclusions: Morphine hydrochloride 0.1 mg(.)kg(-1) i.v. administered during induction of anaesthesia provides efficient pain relief in children undergoing adenotonsillectomy

Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation

Background: It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video-assisted laryngoscope devices for the management of difficult pediatric airway. MethodsForty-five anesthesiology residents and nurse anesthetists participated in the study. Macintosh, Miller, Storz Miller, and McGrath Mac curved laryngoscopes were used for tracheal intubation of 3-6-month Airsim Pierre Robin manikin. We compared the duration of successful intubation, number of attempts, glottic view grades, severity of dental trauma, the use of optimization maneuvers, and the difficulty of use of the devices with straight and curved laryngoscope blades. ResultsSuccessful intubation duration was significantly lower in Storz Miller device, and the number of intubation attempts was significantly higher in the Macintosh laryngoscope (P<0.01). According to the Cormack and Lehane classification, Grades 1 and 2 glottic view was 20% for Macintosh and 40% for Miller laryngoscope, while it was 100% for Storz Miller and 80% for McGrath (P<0.001). Difficulty VAS scores of Storz Miller device were significantly lower than the scores of Macintosh, Miller, and McGrath laryngoscopes (15.714.89, 34.726.44, 31.5 +/- 26.74, 33.4 +/- 26.67mm, respectively; P<0.01). The severity of dental trauma was significantly lower in Storz Miller compared with Macintosh, Miller, and McGrath laryngoscopes (0.96 +/- 1.04, 1.67 +/- 1.15, 1.38 +/- 1.05, 1.42 +/- 1.27, respectively; P<0.01). ConclusionStorz Miller laryngoscope was found to have advantages over the other laryngoscopes in regard to glottic view, duration of successful intubation, number of attempts, dental trauma severity, need for additional maneuvers, and ease of use

Comparing the effects of general and spinal anesthesia on the postoperative pain intensity in patients undergoing emergent elective cesarean section

Objective: The aim of this study is to compare the effects of general and spinal anesthesia on postoperative pain intensity and analgesic agent requirements in patients scheduled for emergent or elective cesarean sections. Patients and Methods: This was a prospective, observational study conducted in patients who underwent emergent or elective cesarean delivery under spinal or general anesthesia. Postoperative pain intensity and analgesic agent requirements, postoperative complications and patients' satisfactions were evaluated during the first 48 h postoperatively. Results: A total of 212 parturients were enrolled; 104 (53 elective, 51 emergent) patients received general and 108 (54 elective, 54 emergent) patients received spinal anesthesia. Preoperatively, patients who underwent emergent cesarean section under spinal or general anesthesia had higher Numeric Rating Scale (NRS) scores than the patients who underwent elective cesarean delivery (p<0.001). In the first postoperative 48 h, NRS pain scores were similar in patients who underwent emergent or elective cesarean sections under spinal or general anesthesia. Postoperative analgesic agent requirements and patients' satisfactions were not statistically significant between groups. Conclusion: The effects of general and spinal anesthesia on postoperative pain were similar in emergent and elective cesarean sections. Therefore, postoperative analgesic effect should not be a determining factor in choosing the anesthesia method in cesarean sections

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

Objective: The aim was to compare the effects of low tidal volume (V-T) and moderate positive end-expiratory pressure (PEEP) with high V-T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V-T-PEEP and high V-T-ZEEP groups. The patients were ventilated with a V-T of 6 mL/kg and 8 cm H2O PEEP in the low V-T-PEEP group and a V-T of 10 mL/kg and 0 cm H2O PEEP in the high V-T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V-T-PEEP group than in the high V-T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V-T-PEEP group than in the high V-T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V-T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V-T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V-T of 6 mL/kg and 8 cm H2O PEEP than in patients ventilated with a V-T of 10 mL/kg and ZEEP. (C) 2017 The Author(s) Published by S. Karger AG, Base