F. Semjen

Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management.

Background The intubating laryngeal mask airway (ILMA; Fastrach ™; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation. Methods One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation < 90%, bleeding) were recorded. Results The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05). Conclusion The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.

Clinical assessment of the laryngeal tube in pediatric anesthesia

Background :u2002The aim of this study was to evaluate a new device for airway management in children: the laryngeal tube (LTTM).

Postoperative Cystography and Endoscopic Treatment of Low-Grade Vesicoureteral Reflux

INTRODUCTIONnThe endoscopic subureteral injection of tissue-bulking agents has become an established alternative to long-term antibiotic prophylaxis and open surgery with a high success rate, especially for low-grade reflux (>90%). Though it is recognized that a routine postoperative voiding cystourethrography (VCUG) is unnecessary following a ureteroneocystostomy, most teams perform one after an endoscopic treatment.nnnMATERIALS AND METHODSnIn this paper, we report on our experience with the endoscopic correction of vesicoureteral reflux in 72 ureteral units, for whom no routine postoperative cystography was performed.nnnDISCUSSIONnTwo children presented with postoperative recurrent febrile urinary tract infections (UTIs), which were not correlated with cystography findings. Postoperative VCUGs after a ureteroneocystostomy are invasive and expose the child to radiation, they are associated with a substantial cost, and most of all, they do not allow the identification of those patients at risk of recurrent febrile UTIs. Further, the endoscopic subureteral injection of tissue-bulking agents have been used for several years, and numerous studies, set in various clinical settings, have since been published, confirming excellent long-term results for low-grade reflux.nnnCONCLUSIONSnWe feel that postoperative cystograms should be reserved for children who present with recurrent UTIs, new sonographic abnormalities, or who were treated for high-grade reflux.

Internal jugular venous line misplacement into the epidural space in a low birthweight premature child

function in two separate studies (7,8). Some anesthetic agents (halothane and enflurane) may cause much greater decrease of hepatic blood flow and oxygen supply than others (isoflurane and sevoflurane) (9). Isoflurane was preferred for this reason and titrated to hemodynamic parameters intraoperatively. Mivacurium was used as a muscle relaxant because its metabolism does not directly depend on the kidneys or liver (10). These patients may have a Vitamin K deficiency and liver dysfunction, resulting in prolonged PT and PTT. Splenomegaly and hypersplenism can result in thrombocytopenia. In this case, there was no clinical or laboratory evidence of bleeding abnormality. The anesthesia plan should be based on the careful preoperative assessment of the airway and neck mobility, attention to issues involving hepatobiliary, cardiac, neurodevelopmental, nutritional, hematological, ocular and facial abnormalities and adequate perioperative hydration. T U L A Y S. Y I L D I Z M D N U R C A N O. Y U M U K M D D U Y G U B A Y K A L M D M I N E S O L A K M D K A M I L T O K E R M D Department of Anaesthesiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey (email: tulaysahin00@yahoo.com, tsyildiz@yahoo.com)