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Airway management in children with craniofacial anomalies can be complicated and may require multiple attempts with conventional direct laryngoscopy (DL). Videolaryngoscopes (VLs) have a well-established role in difficult airway management in adults; however, their role remains to be fully elucidated in paediatric age group. There is a relative paucity in the literature regarding the role of VLs in cases of syndromic children, and it is not clear whether they should be used as an initial option or as a rescue device. Herein, we report a series of cases of children with Pierre Robin sequence, Beckwith–Wiedemann syndrome, and Hurler’s syndrome wherein VLs proved beneficial after multiple failed DL attempts. Following initial failed attempts to intubate using DL, these children were subsequently intubated using VLs. Therefore, VLs should be used for initial intubation attempts in syndromic children with potential difficult airways.
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Objective: Flexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route.
Methods: Sixty children aged 6–12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded.
Results: The time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting.
Conclusion: Intubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6–12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.
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Objective: Pre-treatment with either fentanyl or midazolam has previously been used to prevent etomidate-induced myoclonus (EIM). The aim of the present study was to determine the effect of pre-treatment with a combination of midazolam and fentanyl in reducing the incidence and severity of EIM.
Methods: This prospective, randomised, double-blind study was conducted on 210 surgical patients allocated to three study groups. Group F patients received fentanyl 2 μg kg−1 and 5 mL saline. Group M patients received midazolam 0.03 mg kg−1 and 5 mL saline. Group FM patients received fentanyl 2 μg kg−1 plus midazolam 0.03 mg kg−1. The study drugs were administered intravenously over 30 s. Five minutes after study drug administration, etomidate 0.3 mg kg−1 was administered over 60 s. Patients were observed for 1 min for occurrence and severity of EIM.
Results: The incidence of EIM was 34/70 (48.6%), 55/70 (78.6%) and 11/70 (15.7%) in groups F, M and FM, respectively (p=0.001). Myoclonus of moderate or severe grade occurred in 23/70 (32.9%), 45/70 (64.3%) and 6/70 (8.6%) in groups F, M and FM, respectively (p=0.001). Patients who experienced myoclonus exhibited a significantly higher percentage change in post-induction heart rate (p=0.02), systolic blood pressure (p=0.001) and mean blood pressure (p=0.001) from pre-induction values than those who did not.
Conclusion: Pre-treatment with a combination of fentanyl and midazolam is more effective than that with fentanyl or midazolam alone in reducing the incidence and severity of EIM. Myoclonus is associated with a higher post-induction haemodynamic variation.
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Korgün ÖKMEN, Mustafa KÖPRÜCÜOĞLU
Korgün ÖKMEN, Mustafa KÖPRÜCÜOĞLU
Objective: Video-assisted thoracoscopic surgery (VATS) techniques are commonly used for surgical procedures within the thoracic cavity
with smaller incisions. There are very few regional anesthesia methods used to achieve this goal. This study aimed to investigate the effect
of two fascial plane block technique rhomboid intercostal block (RIB) and serratus anterior plane block (SAPB) administered on pain scores
after VATS.
Methods: A total of 90 patients who underwent VATS were included in this study. Patients were divided in three groups: Group R (intravenous patient-controlled analgesia (IV. PCA) +RİB with (25 mL 0.25% bupivacaine; n=30), Group S (IV. PCA + SAPB with (25 mL 0.25%
bupivacaine; n=30), and Group C (IV. PCA). The primary outcome was determined as a tramadol consumption amount (at hours 6, 12, and
24). Postoperative pain was evaluated using the VAS (at the 30th minute, 2nd, 6th, 12th, and 24th hours) scores. Secondary outcomes included the
side effect profile and additional analgesic use.
Results: VAS scores of the Group R were found to be statistically significantly lower to those of Group S and Group C (p<0.05). A comparison of Groups R and S with Group C in terms of tramadol consumption amounts, at all measurement time points, revealed statistically
significantly lower values (p<0.005).
Conclusion: As per the results of this study, we believe that RİB and SAPB administration for pain palliation after VATS is an effective
analgesia technique.
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Manish AGGARWAL, Rahul YADAV, Shalendra SİNGH, Deepali BANSAL
Manish AGGARWAL, Rahul YADAV, Shalendra SİNGH, Deepali BANSAL
Objectives: Both the Supreme Laryngeal Mask Airway (SLMA) and the I-gel (I-gel) are supraglottic airway devices (SADs) commonly
used for airway management in paediatric patients. This study aims to compare the efficacy in terms of insertion and ventilation profiles of size
2 SLMA and the I-gel in anaesthetised paediatric patients.
Methods: 100 children were prospectively allocated to two groups depending upon the device inserted as SLMA (n = 50) and I-gel (n = 50).
The primary outcomes were studied in terms of ease of insertion, haemodynamic changes, ventilation parameters, leak pressure and incidences
of complications during general anaesthesia.
Results: There were no failed attempts in the insertion of the airways in either group. The SLMA was more easily inserted in the majority of cases
compared to the I-gel group. The number of attempts for insertion and the time taken for insertion were comparable in the I-gel and the SLMA
group (13.84 6 2.38 vs. 14.02 6 1.7) (P .57, .66). Securing an effective airway took <30 seconds in both the groups with an overall median duration of 15 seconds. There was no difficulty in passing the gastric tube in either group (P < .30). There was a statistical difference between the oropharyngeal seal pressure (OSP), which was 25.18 6 1.59 and 22.10 6 1.36 cmH2O for SLMA and I-gel, respectively (P < .001). Haemodynamic
parameters after the insertion of the device were comparable, and there were no clinically important complications in the post-operative period.
Conclusions: Both the devices appeared to be simple and suitable for airway management during elective surgery in paediatric patients. However, the SLMA was easily inserted with less insertion time in the majority of patients. Also, it provides higher OSP during anaesthesia and is
better tolerated during emergence, with minimal risk of injury to the oropharynx.
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Alessandro SİMONİNİ, Etrusca BROGİ, Oscar MAZZEİ, Irene PARABOSCH, Girolamo MATTİOLİ, Giorgio CONTİ, Roberto D AGOSTİNO
Alessandro SİMONİNİ, Etrusca BROGİ, Oscar MAZZEİ, Irene PARABOSCH, Girolamo MATTİOLİ, Giorgio CONTİ,
... Devamını oku
Objectives: Fire in the operating theater is a potential source of important morbidity for the patient. Laser surgery of the head and neck district
presents a particularly high risk of fire due to the presence of all three elements of the ‘fire triad,’ necessary to cause combustive or explosive
events: an oxidiser, a fuel, and a heat source. The aim of the present study is to emphasise the need of new prevention tools and greater adherence to the recommendations available in the literature.
Methods: The sudden occurrence of combustion within the airway of an infant undergoing laryngeal laser surgery was presented along with his
management.
Results: An infant underwent CO2 laser surgery for the treatment of the laryngeal stenosis. Unfortunately, the endoscopic procedure was complicated by a fire of the tracheal tube. The tube was immediately removed, the saline was flushed down the trachea and the ventilation was maintained through a face mask. Subsequently, a fiberoscopy was performed and showed a vocal cord burn.
Conclusions: Since operating room fires are still an underreported occurrence, we believe that this present work might raise awareness about
this potential complication and give useful suggestions for the management of airway fires in paediatric anaesthesia.
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Masoud NASHİBİ, Farhad SAFARİ, Parisa SEZARİ, Ahamd NADERİ, Kamran MOTTAGHİ
Masoud NASHİBİ, Farhad SAFARİ, Parisa SEZARİ, Ahamd NADERİ, Kamran MOTTAGHİ
Nasogastric tubes are being used in clinical anaesthesia settings on a daily basis. Although rare, knotting could occur during insertion or removal.
Here, we report a knotted nasogastric tube which stocked in patient’s nasopharynx that was removed by using a pediatric bougie. Clinicians
must be aware of potential knotting of nasogastric tube. Pediatric bougie could be utile if knotted tube gets stocked in nasopharynx.
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Swapnil BARASKER, Sujeet GAUTAM, Anil AGARWAL, Afzal AZİM
Swapnil BARASKER, Sujeet GAUTAM, Anil AGARWAL, Afzal AZİM
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