Comparison of insertion characteristics of LMA ProSeal from the front and head-end of the patient: A randomized pilot study.

Background and Aims: LMA ProSeal (PLMA) is a commonly used airway maintenance device in elective procedures and is routinely inserted from the head-end of the patient. It is also used in pre-hospital emergencies where it may not always be possible to access the head-end. This study aims to compare the insertion characteristics of PLMA when inserted while standing, either at the head-end or from the front. Material and Methods: After institutional ethics committee approval, 60 consenting patients of either sex, between 18 and 60 years, ASA class I/II, and scheduled to undergo elective surgeries were randomly allocated to either group H (head-end insertion) or group F (front-end insertion). Patients with anticipated difficult airway, chronic respiratory disease, obesity, and who were pregnant were excluded. Insertion time, ease of insertion, fiber optic view, ease of drain tube insertion, number of attempts and success rate were noted. Normally distributed quantitative variables were compared using t-test, and qualitative variables were compared using Chi-squared test. A P < 0.05 was considered significant. Results: Insertion time in group H (23.76 ± 4.48 s) was lesser than in group F (30.53 ± 6.23s) (P = 0.027). Ease of insertion (P = 0.052), fiber optic view, ease of drain tube placement (P = 1.000), and number of attempts (P = 1.000) were comparable among the groups. Conclusion: Although the insertion time from the front is longer than from the head-end, the other insertion characteristics of PLMA including ease of its insertion, placement and success rate of placement are similar when it is inserted from the front or from the head-end. It is an appropriate airway device for securing the airway when the head-end is inaccessible.

Efficacy of fixed-dose phenylephrine bolus for treating post-spinal hypotension: Comparison between pre-eclamptics and normotensives.

Background and Aims: Pre-eclamptic parturients may have an exaggerated response to vasopressors. This study compares the efficacy of a 50 µg fixed bolus of phenylephrine for treatment of post-spinal hypotension in pre-eclamptic versus normotensive parturients. Material and Methods: After written informed consent and ethics committee approval, 30 normotensive and 30 pre-eclamptic parturients between 18 and 40 years with singleton term pregnancy about to undergo cesarean section (CS) under spinal anesthesia were included. Post-spinal hypotension was treated with a 50 µg fixed bolus of phenylephrine. The cumulative dose of phenylephrine, the number of boluses, and the median dose required to treat the first hypotensive episode, total number of hypotensive episodes, maternal side effects, neonatal appearance, pulse, grimace, activity, and respiration (APGAR) scores, and umbilical arterial cord blood pH were noted. Statistical analysis was done using Student's t-test, Mann-Whitney U-test, Chi-square test/Fisher's exact test as appropriate. A P <0.05 was considered significant. Results: The cumulative dose and number of boluses of phenylephrine required to treat post-spinal hypotension were comparable. The median dose required to treat the first episode of post-spinal hypotension was also similar (p = 0.792). The time to develop the first hypotensive episode was significantly earlier for group N (p = 0.002). The efficacy of a single fixed bolus of 50 µg phenylephrine was similar in both groups (p = 1.000). Neonatal median APGAR scores at 1 min after birth were significantly higher for group N (p = 0.016). Conclusion: A fixed-dose bolus of 50 µg phenylephrine is safe and effective in treating post-spinal hypotension in pre-eclampsia. The efficacy of phenylephrine is comparable in pre-eclamptic and normotensive parturients.

Subcutaneous emphysema: Unique presentation of a foreign body in the airway.

Foreign body airway (FBA) is a common problem among the children. Variable presentation makes it difficult to diagnose a case of FBA, particularly, when no definite history of aspiration is available. Subcutaneous emphysema (SCE) and pneumomediastinum are rare presentations. We report a case of FBA who presented with SCE without any history of aspiration. A 3-year-old female child was admitted with respiratory distress, fever and SCE over the right side of chest, neck and face. Initially, she was diagnosed as a case of pneumonitis with barotrauma. X-ray of the chest revealed SCE with pneumomediastinum without pneumothorax. Diagnostic bronchoscopy with rigid ventilating bronchoscope was done under general anesthesia. A plastic foreign body with sharp projections embedded in the mucosa was detected and retrieved from right main bronchus. Postoperatively SCE regressed gradually.

Is midazolam superior to triclofos and hydroxyzine as premedicant in children?

BACKGROUND: Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries. MATERIALS AND METHODS: Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed. RESULTS: The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed. CONCLUSION: Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.