Comparison of intraoral mask and classic face mask in terms of ventilation success and practitioners' workload assessments: A randomised crossover study.

AIM: Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomised crossover study aimed to compare intraoral and classic face mask in terms of ventilation success of patients, practitioners' workload and anxiety assessments. Also we analysed potential risk factors of difficult mask ventilation for both masks. METHODS: In all, 24 anaesthesiology residents and 12 anaesthesiologists participated in the study. Each of the practitioners ventilated four patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analysed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-Bang score. RESULTS: Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of successful ventilation (P = .000) and tidal volume (P = .000). Leak volume in in intraoral mask ventilation was significantly lower than classic face mask (P = .000). Difficult mask ventilation risk factors for classic face mask were high weight (P = .011), neck circumference (95% CI, OR = 1.180, P = .002), Mallampati score (P = .029) and high risk of OSAS (P = .001). Difficult mask ventilation risk factors for intraoral mask were high body mass index (95% CI, OR 1.162 P = .006) and Mallampati score (P = .043). The anxiety ratings of practitioners were similar between two masks. The workload rating is higher with intraoral mask comparing to classic face mask. CONCLUSION: Intraoral mask may be an effective alternative device for bag-valve mask ventilation.

The effect of intraarticular levobupivacaine and bupivacaine injection on the postoperative pain management in total knee artroplastic surgery.

OBJECTIVE: Total knee arthroplasty (TKA) is associated with considerable postoperative pain. We compared the effects of intraoperative intraarticular levobupivacaine and bupivacaine on postoperative analgesia and analgesic consumption after total knee arthroplasty. METHODS: Sixty ASA (American Society of Anesthesiologists) physical status II-III, 18-75 years old patients scheduled for unilateral TKA were included in this study. For the operative procedure combined spinal epidural anesthesia was given by injecting 15mg levobupivacaine in subarachnoid space at L3-4/L4- 5 in sitting position for all patients. In Group L 20ml levobupivacaine(0.5%), in Group B 20ml bupivacaine (0.5%) was injected intraarticularly 10 minutes before opening of the tourniquet at the end of the surgery. For all patients postoperative analgesia was provided with PCEA (levobupivacaine+fentanyl) and oral 1gr paracetamol four times a day. Patients' intraoperative-postoperative hemodynamical data, postoperative sensorial-motor block characteristics, side effects, PCEA demand ratios and bolus volumes, total analgesic consumption, VAS values, first mobilization time, hospitalization time were recorded. Statistical analysis was performed with SPSS version 13.00 software. RESULTS: There was no intergroup difference in demographic data, hemodynamical data, PCEA demand ratios, total analgesic consumption, first mobilization time, hospitalization time and VAS values at 0,2,72 hour. Postoperative lower VAS values were determined at 4,8,12,24 hours in Group B and at 48(th) hour in Group L(p<0.05). CONCLUSIONS: Intraarticular local anesthetic administration in addition to PCEA for post operative pain relief provides good analgesia after TKA surgery.

Comparison of levobupivacaine alone and in combination with fentanyl and sufentanil in patients undergoing transurethral resection of the prostate.

BACKGROUND: It was aimed to compare the efficacy and adverse effects of levobupivacaine alone and in combination with fentanyl and sufentanil during transurethral resection of the prostate (TURP) under spinal anesthesia. MATERIALS AND METHODS: In this prospective, randomized, double-blind trial, 60 patients undergoing elective TURP under spinal anesthesia were randomized into three groups. Ten milligrams of 0.5% levobupivacaine in Group-I, 7.5 mg 0.5% levobupivacaine combined with 25 µg fentanyl in Group-II and 7.5 mg 0.5% levobupivacaine with 2.5 µg sufentanil in Group-III were administered intrathecally. RESULTS: The time for sensorial block to reach level T10 was 10.2 ± 2.0, 6.9 ± 1.7 and 7.0 ± 1.4 min in Group-I, II and III, respectively (P < 0.001). The maximum sensorial block level was T8 in all groups. The frequency of a complete motor block was higher in Group-I. The mean duration of motor block was shorter in Group-II and III than in Group-I (P < 0.001). There were no differences between groups regarding side effects (P > 0.05). The time for first analgesic request was shorter in Group-I than in the other two groups (P < 0.05). During the first postoperative 24-h period, 11 (58%) patients in Group-I, 9 (48%) patients in Group II and 9 (45%) patients in Group-III required an analgesic drug (P > 0.05). CONCLUSION: This study showed that combining lower dose levobupivacaine with fentanyl and sufentanil provides faster onset of sensorial block, lower frequency and shorter duration of motor block, and longer analgesia time in TURP under spinal anesthesia.

Can ephedrine pretreatment be effective in alleviating rocuronium injection pain?

OBJECTIVE: The aim of this randomized, double-blind, placebo-controlled study was to evaluate the effect of ephedrine pretreatment on the intensity of rocuronium injection pain when rocuronium was applied by timing principle and also to compare this effect with lidocaine and placebo. SUBJECTS AND METHODS: 120 American Society of Anesthesiology risk score I-II patients scheduled for elective surgery under general anesthesia were randomized into three groups to receive either 70 µg/kg ephedrine (ephedrine group, n = 40) or 0.5 mg/kg lidocaine (lidocaine group, n = 40) or 5 ml NaCl 0.9% (placebo group, n = 40) as pretreatment. Thirty seconds after pretreatment drugs, rocuronium 0.6 mg/kg was administered by the timing principle and rocuronium injection pain scores were recorded. Twenty seconds after rocuronium administration, anesthesia was induced with thiopental and the patient's trachea was intubated. Hemodynamic parameters and adverse effects were recorded. RESULTS: The overall frequency of having pain was 82.5, 52.5 and 22.5% in placebo, ephedrine and lidocaine groups, respectively. Although the frequency of mild and moderate pain scores was higher in the ephedrine group than in the lidocaine group, this difference was not statistically significant (p = 0.032 and p = 0.001, respectively). CONCLUSION: Although not as effective as lidocaine 0.5 mg/kg, 70 µg/kg ephedrine pretreatment was able to alleviate rocuronium injection pain when rocuronium was applied by timing principle.

Comparison of bupivacaine alone and in combination with sufentanil in patients undergoing arthroscopic knee surgery.

PURPOSE: One disadvantage of spinal anesthesia using bupivacaine is the relatively short duration of action. Combining it with opioids can increase its analgesic effects. It was aimed to analyze the effectiveness and the side effects of bupivacaine alone and in combination with sufentanil in arthroscopic knee surgery during unilateral spinal anesthesia. METHODS: This is a prospective, randomized, double-blind trial. Fifty patients undergoing unilateral arthroscopic knee surgery were enrolled in this study. The patients were assigned into two groups to receive either 10 mg of 0.5% hyperbaric bupivacaine (Group I) or 5 mg of 0.5% hyperbaric bupivacaine combined with 2.5 µg sufentanil (Group II) to obtain unilateral spinal anesthesia. RESULTS: The time for sensorial block to reach level T10 was 6.3 ± 1.7 min in Group I and 4.8 ± 1.6 min in Group II (P < 0.05). Complete motor block was obtained at the 10th min in 16 patients in Group I (P < 0.005), and the duration of the motor block was lower in Group II (4.9 ± 2.2 h and 2.0 ± 1.1 h, P < 0.001). Bradycardia was encountered in 8 patients in Group I and in 1 patient in Group II (P < 0.05). No differences were encountered regarding other side effects. During the postoperative 24 h, 5 patients in Group I and 3 patients in Group II required analgesic drugs (n.s.). There was not any significant difference between groups with regard to first analgesic request time (8.3 ± 2.4 and 9.0 ± 2.3 h, n.s.). CONCLUSIONS: This study showed that combining lower dose bupivacaine with sufentanil provided faster onset of sensorial block and lower risk of motor block in unilateral spinal anesthesia for arthroscopic knee surgery.

"Anesthesia mumps" after electroconvulsive therapy anesthesia.

Acute transient swelling of the parotid gland in association with anesthesia is known as "anesthesia mumps." We report an acute bilateral parotid swelling in a patient after electroconvulsive therapy anesthesia.

Comparison Between the Effects of Bupivacaine and Levobupivacaine for Spinal Anesthesia on QT Dispersion.

BACKGROUND: Bupivacaine and Levobupivacaine are frequently used local anesthetic drugs in spinal anesthesia practice. Both agents have arrhythmic effects on the heart. However, there is no clear information about which agent is more arrhythmogenic. OBJECTIVE: The aim of this article is to investigate the effects of bupivacaine and its S (-)-enantiomer, levobupivacaine, on cardiac arrhythmias in patients. METHODS: The study included 40 patients scheduled for inguinal hernia surgery. Patients were randomly divided into the following two groups using a sealed envelope method: Group I, the bupivacaine group (n = 20); and Group II, the levobupivacaine group (n = 20). The QT values were taken preoperatively and during the 10th of the spinal block, the 10th of the surgical incision, and the 10th postoperative minute. Additionally, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SO2), and heart rate (HR) values, in addition to motor block (Bromage scale) levels and durations, were recorded for each patient. RESULTS: HR values measured at 10 min after spinal block were significantly higher than the baseline values in the levobupivacaine group (p < 0.05). The corrected QT interval (QTc) values increased significantly at 10 minutes after spinal block and at 10 min postoperatively in the bupivacaine group (p < 0.05). QTd and QTcd measurements were taken at the 10th minute of spinal anesthesia, the 10th minute of the incision, and the 10th minute postoperatively. When compared to the levobupivacaine group, a statistically significant increase was found in the bupivacaine group (p < 0.05). CONCLUSION: Levobupivacaine allows greater hemodynamic stability, while bupivacaine affects QTc and QTd measurement times more. As such, we believe that levobupivacaine may be a better alternative to bupivacaine during clinical practice, particularly in patients with cardiac problems.

Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly.

Introduction and aim Postoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia. Material and methods This observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist's preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation. Results The postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018). Conclusion Early POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Comparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy.

PURPOSE: Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH. METHODS: Sixty patients were randomly assigned to receive either PVB or GA under standardized protocols (group PVB: at T9-L1 levels, 5 mL of 0.5% levobupivacaine for both procedures, and continuous propofol sedation; group GA: GA with 2 mg kg⁻¹ propofol induction and 2-4% desflurane maintenance via LMA, and routine antiemetic prophylaxis and multimodal analgesic treatment). Anesthesia-related, onset, recovery, and home discharge times, hemodynamic changes, pain, and incidence of adverse effects were compared. RESULTS: Anesthesia-related time and onset time were longer, but recovery and home discharge times were shorter in group PVB. Verbal rating scores (VRS) at 30, 60, 120, and 180 min and 6, and 12 h post-surgery were significantly lower in group PVB patients. VRS at 18, 24, and 48 h were comparable in both groups. No patient in group PVB and eight patients in group GA needed meperidine in the post-anesthesia care unit, and time to first analgesic and first rescue analgesic requirements were significantly longer in group PVB. CONCLUSION: In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.

Comparison of 0.25% levobupivacaine and 0.25% bupivacaine for posterior approach interscalene brachial plexus block.

PURPOSE: This study compares the onset time and quality of posterior approach interscalene brachial plexus block produced by 0.25% levobupivacaine and 0.25% bupivacaine. METHODS: Sixty adult patients undergoing open or closed shoulder surgery were enrolled in this double-blind, randomized study, and they were randomly allocated to receive 40 ml of 0.25% levobupivacaine (Group L, n = 30) or 0.25% bupivacaine (Group B, n = 30). The patients were assessed at 5 min intervals after local anesthetic injection in order to determine loss of shoulder abduction and loss of pinprick sensation in the C(5-6) dermatomes. The mean onset time of motor and sensory block and onset time of complete motor and sensory block were documented in both groups. RESULTS: In both groups, mean onset time of sensory block was <5 min and mean onset time of complete sensory block was <25 min. The onset times for sensory block and complete sensory block were not statistically different between the groups (P > 0.05). In both groups, mean onset time of motor block was <10 min but the mean onset time of complete motor block was <30 min. The onset times of motor block and complete motor block were not statistically different among the groups (P > 0.05). After the injection of the local anesthetic, 27% of Group L and 87% of Group B had complete motor block. Four patients in Group L had no motor block. CONCLUSION: We conclude that 0.25% levobupivacaine and 0.25% bupivacaine have similar motor and sensory block onset times and qualities when used in posterior approach interscalene brachial plexus block, and provide comfortable anesthesia and analgesia for shoulder surgery.

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting.

Introduction: Postoperative nausea and vomiting (PONV) are frequent in patients undergoing laparoscopic cholecystectomy. The aim of this study is to evaluate the effectiveness of intraoperative laser acupuncture stimulation of Pericardium 6 (PC6) and Large Intestine 4 (LI4) acupoints combined with antiemetic drug prophylaxis on PONV. Methods: A total of 88 patients, scheduled for laparoscopic cholecystectomy, were assigned into 2 groups. Group I received bilateral laser acupuncture on PC6 and LI4 acupoints after induction of anesthesia and also received antiemetic drug (metoclopramide) prophylaxis. Patients in Group II received only antiemetic drug prophylaxis. Nausea and vomiting frequencies and need for rescue antiemetic drug (ondansetron) were recorded after extubation, at 30th minute at recovery room and at 6th hour at ward. Results: The incidence of nausea and rescue antiemetic drug need was higher at postoperative 6th hour in Group II. Vomiting was not different in groups at any time. Conclusion: Intraoperative laser acupuncture stimulation of PC6 and LI4 acupoints combined with antiemetic drug prophylaxis decreases nausea and rescue antiemetic drug need in late postoperative period in patients undergoing laparoscopic cholecystectomy.

Brain Deaths and Donors in an Education and Research Hospital.

BACKGROUND: We aimed to define the causes of brain death (BD), criteria, and tests used for diagnosis, rates of family consent, and rates of organ donation in intensive care units (ICUs) of an education and research hospital. METHODS: The data of patients with BD diagnosis in 7 years in our hospital was collected from an electronic database and archives retrospectively consisting of the demographic data, the causes of BD, criteria, and the tests used for diagnosis, family consent, and organ donation rates. RESULTS: A total of 210 patients with BD diagnosis were enrolled in the study. There was a decline in number of patients with BD diagnosis between 2012 (54.76%) and 2018 (17.64%) in the neurology and neurosurgery ICU, while it increased from 35.71% in 2012 to 70.6% in 2018 in the general ICU. The most common cause of hospitalization for BD was spontaneous intracranial hemorrhage (43.8%). A total of 47.6% of brain-dead patients who did not qualify for organ donation were resuscitated unnecessarily after cardiac death. In 2012, diagnosis was always supported by ancillary tests, while in 2018, a total of 35.29% of the patients were diagnosed solely by clinical examination; 23.8% of patients' families had given consent for organ donation, and 19.53% of 210 patients became donors. CONCLUSION: Physicians should be aware that patients with poor neurologic outcome can be candidates of BD donation, and careful examination and rapid diagnosis is crucial. All segments of society and the health care professionals should be informed and updated about organ donation and BD regularly to raise the numbers of organ donation.

Red Cell Distribution Width in Diagnosis of Brain Death.

INTRODUCTION: Red blood cell distribution (RDW) is a hematologic index automatically calculated by blood cell counters. Research about RDW in traumatic brain injury showed positive correlation between high RDW values and mortality, which inspired us to investigate whether RDW could be used as a supportive diagnostic biomarker for diagnosis of brain death. Our hypothesis is that RDW may be useful as a biomarker that supports the diagnosis of brain death. METHODS: After approval of the ethics committee, 209 patients who had been diagnosed with brain death between January 2012 and July 2018 were retrospectively reviewed. The RDW values of patients on the days of admission, brain death, and cardiac arrest were recorded. Data were collected from hospital database and patient charts. RESULTS: Statistical analysis revealed that the RDW values on the days of brain death and cardiac arrest were significantly higher than on the day of admission. In addition, the RDW values for the cardiac arrest day were significantly higher than on the day of brain death (P < .001). CONCLUSIONS: We can say that the increase in RDW, which is reported to be an indicator of mortality for many diseases, can be a supporting biomarker for brain death diagnosis when evaluated concomitantly with clinical diagnostic criteria.

Adding remifentanil to propofol and etomidate in cardioversion anesthesia.

OBJECTIVE: To compare their effects on cardiorespiratoy and recovery parameters and side effects. METHODS: This study was performed in The Ministry of Health Ankara Numune Research and Training Hospital, Ankara, Turkey, from January to May 2005. The 40 American Society of Anesthesiology II/III patients were randomized into 2 groups. All patients received remifentanil 0.75 microgram.kg(-1); and then received either etomidate 0.1 mg.kg(-1) (group E, n=20) or propofol 0.5 mg.kg(-1) (group P, n=20). Cardiorespiratory data, induction time, recovery parameters, pain scores, number of shocks (NS), total amount of energy used (TE), side effects, and patient/cardiologist satisfaction were recorded. RESULTS: Induction time and recovery parameters were shorter in group P. No differences were seen between the groups in NS and mean TE required. In group P, a statistically significant decrease in mean blood pressure occurred after induction and returned to its baseline levels in 6 minutes. After cardioversion over 2 minutes, the respiratory rates were decreased significantly more in group P when compared with group E. Two patients in group P became apneic and needed assisted ventilation. Pain scores, side effects and patient/cardiologist satisfaction were similar in both groups. No patients in either group had myoclonus. CONCLUSION: We can induce hypnosis with propofol 0.5 mg.kg(-1) or etomidate 0.1 mg.kg(-1) by adding remifentanil 0.75 microgram.kg-1 in cardioversion anesthesia. Although recovery parameters were longer in group E, and cardiorespiratory parameters were less stable in group P, their usage with remifentanil was both acceptable for cardioversion anesthesia.

Comparison of tramadol and lornoxicam in intravenous regional anesthesia: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n = 17) received 3mg/kg 0.5% prilocaine; group PT (n = 17) 3mg/kg 0.5% prilocaine + 2 mL (100mg) tramadol and group PL (n = 17) 3mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.

[Comparison of tramadol and lornoxicam in intravenous regional anesthesia: a randomized controlled trial]. / Comparação de tramadol e lornoxicam em anestesia regional por via intravenosa, um estudo randomizado e controlado.

BACKGROUND AND OBJECTIVES: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n=17) received 3mg/kg 0.5% prilocaine; group PT (n=17) 3mg/kg 0.5% prilocaine+2mL (100mg) tramadol and group PL (n=17) 3mg/kg 0.5% prilocaine+2mL (8mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.

Pressure support ventilation with the I-gel in intensive care unit: case report.

BACKGROUND AND OBJECTIVES: The I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation. CONTENTS AND CONCLUSIONS: In this case report we described the use of the I-gel supraglottic airway along 48h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed.

Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy.

OBJECTIVES: Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. OUTCOME MEASURES: The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. RESULTS: There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). CONCLUSION: Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy.

Endotracheal Tube Obstruction: A Manufacturing Defect.

Various manufacturing defects of endotracheal tubes are encountered in anaesthesia practice. One of the important defects of an endotracheal tube is that a partial or complete obstruction can be potentially life-threatening. Manufacturing defects may not be ascertainable by routine inspection. In this case report, we report a partial airway obstruction caused by a plastic membrane in the connector of an endotracheal tube as a manufacturing defect.