Soo Chang Son

Laryngeal mask airway guided fibreoptic tracheal intubation in a child with a lingual thyroglossal duct cyst

The establishment of a tracheal airway with direct laryngoscopy can either be difficult or impossible in children with airway pathology. Multiple direct laryngoscopic attempts cause oedema and/or bleeding with subsequent difficult ventilation. The techniques utilizing the laryngeal mask airway (LMATM) and the fibreoptic bronchoscope have been reported. The case of a child with lingual thyroglossal duct cyst in which the LMA was useful to secure the airway and as a conduit for fibreoptic tracheal intubation is reported.

Effects of sevoflurane and desflurane on respiratory mechanics after tracheal intubation in children

BACKGROUND Tracheal intubation causes a reflex tracheal constriction that leads to increased airway resistance. Inhalation anesthetics can prevent or minimize this response. Therefore, this study was conducted to evaluate the effect of 1 MAC sevoflurane or desflurane on respiratory mechanics in children after anesthetic induction using propofol and tracheal intubation. METHODS Sixty children undergoing elective surgery with tracheal intubation were assigned into two groups at random, a 1 MAC concentration of sevoflurane (n = 30) and a desflurane (n = 30) group. Anesthesia was induced using propofol (1.5 mg/kg) and tracheal intubation was facilitated using rocuronium (0.6 mg/kg). A respiratory profile monitor was used to measure the respiratory resistance, dynamic compliance and peak inspiratory airway pressure. The measurements were made at three time points, after three inspirations from the beginning of mechanical ventilation (baseline) and at 5 and 10 min after the administration of inhalation anesthetics. RESULTS Sevoflurane and desflurane led to a significant decrease in respiratory resistance and increased dynamic compliance at 5 and 10 min when compared to baseline. There were no significant differences in respiratory resistance and dynamic compliance between the two groups. CONCLUSIONS A 1 MAC concentration of sevoflurane and desflurane has a similar bronchodilatory effect after tracheal intubation in children.

The effect of intraoperative colloid solutions coadministered with 6% hydroxyethyl starch (130/0.4) on platelet function in patients undergoing total intravenous anesthesia

BACKGROUND Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. METHODS Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n = 15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n = 15). ADP- and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. RESULTS Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP- and collagen-induced platelet aggregation were recovered postoperatively in both groups. CONCLUSIONS The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia.