Higher operating tables provide better laryngeal views for tracheal intubation.

BACKGROUND: The present study was conducted to investigate the influence of different operating table heights on the quality of laryngeal view and the discomfort of the anaesthetist during enodotracheal intubation. METHODS: Eight anaesthetists participated, to each of whom 20 patients were allocated. Before induction of anaesthesia, the height of the operating table was adjusted to place the patient's forehead at one of four landmarks on the anaesthetist's body (the order being determined by block randomization with eight blocks): umbilicus (Group U), lowest rib margin (Group R), xiphoid process (Group X), and nipple (Group N). Next, the anaesthetist began the laryngoscopy and evaluated the grade of laryngeal view. For this 'initial posture', the anaesthetist was not allowed to adjust his or her posture (flexion or extension of the neck, lower back, knee, and ankle). This laryngeal view was then re-graded after these constraints were relaxed. At each posture, the anaesthetist's joint movements and discomfort during mask ventilation or intubation were evaluated. RESULTS: The laryngeal view before postural changes was better in Group N than in Group U (P=0.003). The objective and subjective measurements of neck or lower back flexion during intubation were higher in Group U than in Groups X and N (P<0.01 for each). The improvement of laryngeal view resulting from postural changes correlated with the anaesthetist's discomfort score before the postural change (P<0.01). CONCLUSIONS: Higher operating tables (at the xiphoid process and nipple level of the anaesthetist) can provide better laryngeal views with less discomfort during tracheal intubation. TRIAL REGISTRY NUMBER: NCT01649973 (clinicaltrials.gov).

Effect of pre-emptive alveolar recruitment strategy before pneumoperitoneum on arterial oxygenation during laparoscopic hysterectomy.

In a randomised, controlled, single-blind trial, we examined the effect of a pre-emptive alveolar recruitment strategy on arterial oxygenation during subsequent pneumoperitoneum. After intubation, 50 patients were randomly allocated to receive either tidal volume 10 ml/kg with no positive end-expiratory pressure (group C) or alveolar recruitment strategy of 10 manual breaths with peak inspiratory pressure of 40 cmH2O plus positive end-expiratory pressure of 15 cmH2O before gas insufflation (group P). During pneumoperitoneum, group P was ventilated with the same setting as group C (FiO2,= 0.35, tidal volume 10 ml/kg). PaO2, measured during peumoperitoneum was higher in group P than in group C (166 +/- 32 mmHg vs 145 +/- 34 mmHg at 15 minutes, P = 0.028, 155 +/- 30 mmHg vs 136 +/- 32 mmHg at 30 minutes, P = 0.035). Alveolar-arterial oxygen gradient in group P increased less after gas insufflation (13 +/- 9 to 60 +/- 34 mmHg vs 10 +/- 9 to 37 +/- 31 mmHg, P = 0.013). We conclude that the alveolar recruitment strategy we applied before insufflation of the peritoneal cavity may improve oxygenation during laparoscopic hysterectomy

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block.

BACKGROUND: In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. METHODS: The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 microg/kg, followed by a continuous infusion of alfentanil 0.25 microg/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. RESULTS: VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1-4) vs. 3.5 (2-6), P=0.001], and the mean (+/- SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 +/- 2.7 min vs. 10.8 +/- 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). CONCLUSIONS: An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures.

Comparative study of fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for the detection of spinal bone marrow infiltration in untreated patients with multiple myeloma.

BACKGROUND: The presence and extent of osteolytic bone lesions in untreated patients with multiple myeloma are important factors in the staging of the disease, and the extent of bone lesions in multiple myeloma cases significantly influences decisions regarding therapy. Recently, fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) have been used to detect bone marrow involvement in patients with multiple myeloma. PURPOSE: To compare the efficacy of FDG-PET and MRI for the detection of bone marrow infiltration into the spine in untreated patients with multiple myeloma. MATERIAL AND METHODS: Twenty-two patients with multiple myeloma underwent both FDG-PET and spine MRI. The examined spinal regions by MRI included 21 thoracic and lumbar spines, one lumbar spine, and 12 cervical spines. The following imaging sequences were performed: T1-weighted spin-echo MRI with and without fat suppression, and T2-weighted spin-echo MRI in the sagittal plane. In the patients with bone marrow abnormalities, an additional contrast-enhanced T1-weighted spin-echo MR image and a fat-suppressed T1-weighted spin-echo MR image were obtained. Patients were divided into three groups on the basis of the criteria defined by Durie and Salmon: stage I (n=9), stage II (n=3), and stage III (n=10). The number and location of lesions detected in both FGD-PET and MRI were recorded, and the lesions were compared using the McNemar test. Bone marrow biopsy results, the patient's clinical examinations, and other imaging findings (MRI, FDG-PET, etc.) were used as references. RESULTS: In stages I and II (37 lesions in 12 patients), FDG-PET and MRI detected lesions in 78% (29 of 37 lesions) and 86% (32 of 37 lesions), respectively. However, the difference between the abilities of FDG-PET and MRI to detect lesions was not statistically significant (P=0.317). In stage III (101 lesions in 10 patients), FDG-PET and MRI detected lesions in 80% (81 of 101 lesions) and 92% (93 of 101 lesions), respectively. The difference between the abilities of FDG-PET and MRI to detect lesions was statistically significant (P=0.038). CONCLUSION: MRI is superior to FDG-PET in detecting bone marrow involvement in the spine of patients with advanced multiple myeloma.

Patient-controlled sedation vs. anaesthetic nurse-controlled sedation for cataract surgery in elderly patients.

BACKGROUND: Patient-controlled sedation (PCS) with propofol has been used successfully in various conditions, but controversies exist about its use in sedation of elderly patients for cataract surgery. This study evaluates the efficacy of anaesthetic nurse-controlled sedation (ACS) compared with PCS using the same device and the drug. METHODS: All of the 153 elderly patients (aged 51-88 years) undergoing cataract surgery with a sub-Tenon's infiltration were assigned to receive ACS (n = 51) or PCS (n = 51) with propofol or no intra-operative sedation (control, n = 51). Propofol was administered with a bolus dose of 10 mg and a lockout interval of 1 min. Cognitive function, sedation, pain, anxiety, side effects and satisfaction of patients were evaluated. RESULTS: The mean +/- SD doses of propofol administered were 34.9 +/- 8.8 mg and 30.1 +/- 30.4 mg in the groups ACS and PCS, respectively. The anxiety score was lower in both ACS and PCS groups compared with control group but was not different between the two groups. Patient's satisfaction was highest in PCS group, ACS group was the next, compared with non-sedated group. Other parameters were not different among the three groups. CONCLUSIONS: Both ACS and PCS using propofol provided reduced anxiety compared with control, but patient's satisfaction was higher in the PCS group compared with ACS group.

Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery.

BACKGROUND: The oculocardiac reflex (OCR) is frequently observed during strabismus surgery. This study was designed to evaluate and compare the effect of sevoflurane and desflurane on the incidence of OCR. METHODS: After obtaining Institutional Review Board approval and informed consent from parents, we enrolled 237 paediatric patients, aged 2-10 yr, undergoing strabismus surgery. No premedication was given. Anaesthesia was induced with thiopental and rocuronium. Patients were randomly allocated to one of the two anaesthetic regimens. Group S (n = 123) received sevoflurane and Group D (n = 114) received desflurane, both with 60% N2O/O2 for maintenance of anaesthesia. The OCR was defined as a > or = 20% decrease in heart rate (HR) from baseline values obtained immediately before muscle manipulation. If the HR did not increase after release of muscle tension, atropine 0.01 mg kg(-1) was administered. RESULTS: There were no significant differences between the two groups in age, sex, body weight, and the number of muscles operated upon. The mean values of baseline HR were 123 (16) min(-1) in Group S and 121 (18) in Group D (NS). The minimum HR was 106 (22) min(-1) in Group S and 103 (21) in Group D (NS). There was no difference in the incidence of OCR between sevoflurane (26.0%) and desflurane (28.0%) anaesthesia. CONCLUSIONS: Both agents can be used safely during strabismus surgery in paediatric patients.