S. Ozgen

Ketamine gargle for attenuating postoperative sore throat

BACKGROUND Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. METHODS Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). RESULTS POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (P<0.05). CONCLUSIONS Ketamine gargle significantly reduced the incidence and severity of POST.

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

Background and objectives There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. Methods In all, 52 patients, ASA I–II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 &mgr;g kg−1 fentanyl (in 10 mL normal saline) and Group D received 1 &mgr;g kg−1 dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg−1 propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. Results More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). Conclusion Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Local Anesthesia for Extracorporeal Shock Wave Lithotripsy: A Double–Blind, Prospective, Randomized Study

Objective: The efficacy of local anesthesia in decreasing intravenous analgesic requirements during extracorporeal shock wave lithotripsy with a second–generation lithotriptor was studied. Methods: Subcutaneous infiltration was performed before the procedure. Sixty–nine patients (ASA I–II) were randomly allocated into four groups. Lidocaine 1% plus epinephrine (5 µg/ml) were infiltrated subcutaneously in a group of patients with ureteral stones (group UL), and a group with renal stones (group RL). The same amount of saline was administered to a group of patients with ureteral stones (group UC), and a group with renal stones (group RC). Results: Patients with ureteral stones needed higher doses of intravenous analgesic. Neither patients with renal stones nor patients with ureteral stones administered local anesthetic required less intravenous analgesic than patients given placebo. Conclusion: Local anesthesia did not decrease the requirement of intravenous doses of analgesics in patients treated with a second–generation lithotriptor (Dornier MPL 9000).

Anesthesia for congenital insensitivity to pain with anhidrosis

for further care and transferred to a normal baby room 3 days later. The follow-up chest X-ray showed full expansion of the left upper lung lobe without evidence of residual pneumatocele (Figure 2c). When anesthetizing infants with lung lesions, one of the most important questions is whether positive pressure ventilation will cause cardiopulmonary deterioration. For patients with pneumatoceles, spontaneous ventilation and single lung ventilation (SLV) should be considered (2). In the first case, we tried to keep spontaneous respiration before and after intubation and then move the tracheal tube for SLV without muscle relaxants. However, laryngospasm developed after two intubation attempts. In this situation, intermittent positive pressure ventilation could not be avoided to maintain the oxygen saturations and thereafter, tension pneumatoceles expanded with sudden cardiopulmonary collapse. In this case, multiple percutaneous decompressions effectively restored cardiac output. In the second case, we changed the plan of anesthesia. We used a muscle relaxant and applied low pressure ventilation (not higher then 10 cmH2O) so tracheal intubation was smooth. Intentional endobronchial intubation was performed and right side SLV was confirmed by auscultation then fiberoptic bronchoscopy. There was no untoward event during induction or surgery. Although a high frequency oscillator and 14G catheters were available for emergency use, they were not used. Single lung ventilation can be achieved with use of a balloon-tipped bronchial blocker, Univent tube or doublelumen tracheal tube in adults or children. However, a double-lumen tube for infants is usually unavailable (3). Pawar and Marraro (4) reported their experience with small-sized double-lumen tracheal tubes, but these tubes are not widely available. In the second case, SLV was achieved with the use of a normal tube. We deviated the tip to the right and gently pushed the tube into the airway until resistance was felt. In conclusion, anesthesia for infants with pneumatoceles remains a challenge with a risk of possible cardiopulmonary deterioration. Careful planning and successful airway management are keys to successful practice. Chih-Min Liu Chi-Hsiang Huang Hon-Ping Lau Huei-Ming Yeh Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan (email: mhyeh@ha.mc.ntu.edu.tw)

Anesthetic management of a 2‐year‐old male with propionic acidemia

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484 COMPARISON OF CAUDAL PRILOCAINE, BUPIVACAINE AND ROPIVACAINE FOR POSTOPERATIVE ANALGESIA IN CHILDREN

Background: Quantitative thermosensory testing (QST) is a highly sensitive method that quantifies activity of smaller sensory nerve fibres (Adand C-fibres) involved in thermosensation and pain. QST therefore has wide applications in testing nerve activity in health and patients with neuropathic pain. Aim: To compare thermosensation in control healthy subjects with patients suffering from burning mouth syndrome (BMS), lingual nerve injury (LNI), and inferior alveolar nerve injury (IANI). Methods: The self-calibrating Medoc TSA II Advanced Neurosensory Analyser was used to measure warm, cold, cool pain and warm pain thermal perception thresholds in healthy patients undergoing routine removal of lower third molars under local anaesthesia (n = 33), patients with BMS (n = 13; in accordance to IHS criteria), LNI (n = 20) and IANI (n = 19) patients attending secondary care clinics. Previously described methods were used) and involved testing the anterior two-thirds of the tongue or the vermillion of the lip. Results: Healthy controls showed no signs of hyperalgesia or dysaesthesia. Only two BMS patients demonstrated normal QST findings, with the majority (8/13) demonstrating hyperalgesia as cold, warm and/or mechanical allodynia; the remaining three showed dysaesthesia. LNI patients (11/20) showed hyperalgesia, with seven patients presenting dysaesthesia and two demonstrating a mixture of hyperalgesia (opposite side to injury) and dysaesthesia (injured side). IANI patients had similar results to the LNI patients with regard to a mixture of dysaesthesia and cold/warm allodynia. Conclusion: Thermosensation is altered in BMS, LNI and IANI patients, supporting the hypothesis that the underlying pathology of these conditions involves small-fibre neuropathies.