Search

Purpose: The GlideScope (GS) video laryngoscope has been proven to be a suitable intubating device for a predicted difficult intubation. Patients with ankylosing spondylitis (AS) presented with particularly challenging airway management problems to the anesthesiologists. The benefits of using a GS in these patients have not been fully explored. The aim of this study was to evaluate the effectiveness of the GS, in comparison with the Macintosh laryngoscope, when performing nasotracheal intubation in patients with AS under general anesthesia., Methods: A total of 60 ASA I-II patients with AS were randomly assigned to undergo nasotracheal intubation using either the GS or the Macintosh laryngoscope. Preoperative airway assessments were performed in an attempt to predict the difficulty of tracheal intubation. Duration and number of intubation attempts, success rates, number of optimization maneuvers, Cormack and Lehane grades, Percentage of Glottic Opening (POGO) scores for each attempt, and difficulty of device use (VAS difficulty scores) were recorded. Complications associated with intubation were also recorded., Results: The rate of successful nasotracheal intubation was lower with the Macintosh laryngoscope (70%) compared with the GS (96.7%). In comparison with the Macintosh laryngoscope, the GS significantly reduced the intubation difficulty score, duration of tracheal intubation attempts, need for optimization maneuvers, and improved the Cormack and Lehane grade obtained during laryngoscopy., Conclusions: The GS reduced the difficulty of tracheal intubation and provided a better laryngoscopic view with higher overall success rates and shorter duration of intubation attempts than the Macintosh laryngoscope. In our study, the GS proved to be a better alternative in most cases, compared with the Macintosh laryngoscope, for intubating AS patients who preferred their airway management under general anesthesia.

Purpose: Ulinastatin, a urinary trypsin inhibitor, is widely used to treat acute systemic inflammatory disorders. However, its effects on early postoperative cognitive function have not been fully elucidated. The objective of this study was to investigate the effect of ulinastatin on serum IL-6, TNF-α, CRP and S100β protein concentration and early postoperative cognitive function in patients after abdominal surgery., Methods: Eighty ASAI-II patients older than 65 years, scheduled for elective abdominal surgery were randomly divided into 2 groups (n=40 each): ulinastatin and control. After induction of anesthesia, the ulinastatin group received 10,000units/kg of ulinastatin intravenously before surgical incision and 5000units/kg on post-op days 1-3. Cognitive function was assessed preoperatively and on post-op day 7 using a battery of nine neuropsychological tests. Serum IL-6, TNF-α, CRP and S100β protein levels were determined preoperatively, at the end of surgery and on post-op days 1-3., Results: There were significant decrements in each neuropsychological test, except for the Digit Span Backward Test between groups. Based on neuropsychological testing, the ulinastatin group had a lower incidence of postoperative cognitive dysfunction (POCD) than the control group (2.5% versus 27.5%, p<0.05). In the control group, serum S100β protein and IL-6 concentrations increased at the end of surgery and on post-op days 1 and 2. The ulinastatin group had lower serum S100β protein and IL-6 concentrations than those in the control group (p<0.05)., Conclusion: Ulinastatin may be effective in reducing the incidence of early postoperative cognitive dysfunction., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Both over- and undercorrection can occur in up to 10-15% of strabismus surgeries. Use of adjustable suture technique and an intraoperative awake test may decrease the incidence of over- or undercorrection. In this study, we investigated the ability to provide optimal conditions for intraoperative awake strabismus suture adjustment in children by means of target-controlled infusions (TCI) of propofol and remifentanil propofol compared with propofol and sufentanil., Methods: Forty-six ASA I-II patients undergoing strabismus surgery with intraoperative awakening were randomly assigned to anesthesia by TCI of propofol + sufentanil group (group SF) or propofol + remifentanil spontaneous breathing. Propofol was discontinued, and concentrations of the opioid TCIs were reduced to enable awake assessment of the mobility and position of the eye. Changes in intraocular pressure, respiratory function, hemodynamics, awakening time, and awaking quality were compared between the two groups. The degrees of sedation and analgesia were evaluated through the assessment of alertness and sedation scores (OAA/S) and visual analog scale scores (VAS)., Results: There was no significant difference in intraocular pressure at three sampling points between two groups (P > 0.05). The heart rate (HR) and mean arterial blood pressure (MAP) in group SF were significantly lower than group RF during laryngeal mask insertion (P < 0.05) as well as during the wake-up test (P < 0.05). Spontaneous breathing was maintained in all patients, and there was no significant difference in RR and Sp02 at T1-T11 between the groups (P > 0.05). There was no significant difference in the target effect-site concentration of propofol at T1-T10 between the groups (P > 0.05). The wake-up times in group SF were significantly longer than in group RF (P < 0.05). In contrast, the quality of wake-up test and the degree of consciousness after the patients were awakened were significantly better (19 good and 4 satisfactory vs 15 good, 2 satisfactory, and 6 poor) in SF group than RF group. The VAS was significantly lower at T6-T9 in SF group than in RF group (P < 0.05). The incidence of untoward events during and after surgery, such as respiratory depression and apnea, oculocardiac reflex, coughing, groan and nausea, and vomiting was not significantly different between the groups (P > 0.05)., Conclusion: Propofol combined with sufentanil or remifentanil can be suitable for planned intraoperative awakening for an adjustable suture technique in pediatric patients during strabismus surgery. Remifentanil has quicker wake-up time; however, sufentanil demonstrated an advantage in terms of better analgesia, more stable hemodynamics, and improved qualify of awakening., (© 2012 Blackwell Publishing Ltd.)