Feray Gürsoy

Positive pressure ventilation with the laryngeal mask airway in children.

We studied the safety of positive pressure ventilation (PPV) when using the size 2 laryngeal mask airway (LMA) in 46 ASA physical status I or II children (aged 38 +/-21 mo) undergoing elective surgery. The LMA cuff was inflated in incremental steps to achieve a cuff leak pressure >or=to 15 cm H2 O. Abdominal circumference was measured before and after PPV in study patients, as well as in a control group managed with tracheal intubation. Cuff leak pressure was 17 +/- 4 cm H2 O (range 12-34 cm H2 O). Forty-five patients successfully underwent PPV. Gas leak around the LMA cuff prevented PPV in one infant. The only respiratory variable that changed significantly was end-tidal CO2, which decreased from 40 +/- 6 to 34 +/- 5 mm Hg. Abdominal circumference increased in 28 patients but was not associated with any complications. Change in abdominal circumference in the study group was not significantly different from that observed in the control group. However, abdominal circumference increased 8 cm in one study patient, prompting insertion of an orogastric tube. The size 2 LMA provides an effective airway for PPV. Mild gastric distention often occurs. The risk of clinically significant gastric distention appears to be small, but it warrants close monitoring. We conclude that with certain precautions described in the text, the size 2 LMA provides a relatively safe airway for PPV in children. (Anesth Analg 1996;82:33-8)

The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia

We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 μg NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 ± 1.1 versus 4.5 ± 1.2 min; P = 0.01 and 3.3 ± 1.6 versus 5.2 ± 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 ± 1.6 versus 3.1 ± 1.2 min P < 0.0001 and 7.3 ± 1.3 versus 3.6 ± 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 ± 74 min versus 39 ± 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.

Ropivacaine versus lidocaine for deep‐topical, nerve‐block anaesthesia in cataract surgery: a double‐blind randomized clinical trial

Purpose:  To evaluate the safety and efficacy of ropivacaine versus lidocaine for deep‐topical, nerve‐block anaesthesia in cataract surgery.

A simple and inexpensive nasal cannula to prevent rebreathing for spontaneously breathing patients under surgical drapes.

IMPLICATIONS A new nasal cannula that provides oxygenation and suctioning simultaneously prevents rebreathing during surgery in spontaneously breathing patients under surgical drapes. When air is not suctioned, inspired CO(2) levels increase significantly, whereas suctioning prevents this increase. Expiratory CO(2), respiratory rate, heart rate, and arterial blood pressure remain stable regardless of suctioning.