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Background and Objective Supreme laryngeal mask airway ( S- LMA) has been improved in recent years, but comparative studies with a sizeable number of paediatric patients are limited in number. In this study, oropharyngeal leak pressures ( OLPs) were compared between S- LMA and Pro Seal laryngeal mask airway ( P- LMA) in paediatric patients. Methods After obtaining approval from the ethics committee and written informed consent from the relatives of the patients, 60 patients, from 9 months to 5 years of age and 10-20 kg in weight, who were recommended for elective surgery were included in this prospective and randomised study. The patients were assigned to the S- LMA and P- LMA groups. OLP, insertion times, success rates, ease of airway device placement, fibre optical assessment, success rates and insertion times of an orogastric tube ( OGT) were compared. Results P- LMA was placed successfully in all the patients. One patient was intubated in the S- LMA group. The outcomes of a total of 59 patients were analysed. The insertion times of the airway devices were shorter in the S- LMA group than in the P- LMA group ( S- LMA; 12.2 ± 2.9, P- LMA; 15.4 ± 3.7 s) ( P = 0.001). The first insertion attempts of airway device placement were similar. The OLPs were similar ( P- LMA; 17.2 ± 2.3, S- LMA; 16.4 ± 1.7 cm H2O). The fibre-optically determined anatomic position was better in the P- LMA group ( P = 0.02). The insertion time of the OGT was shorter with S- LMA than with P- LMA ( P = 0.01). Conclusion Our findings suggest that S- LMA has OLPs similar to those of P- LMA in paediatric patients and that S- LMA provides successful positive pressure ventilation. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). Methods: In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a ‘U’-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in both groups. Sensory block was tested at 10 min intervals for 30 min. Successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Results: Block success rate was 94.5% in both groups. Block performance time was significantly shorter in the US than the NSUS group (157 ± 50 vs. 230 ± 104 s) ( P=0.000). Block onset time was similar in both groups (12.5 ± 4.8 in the US vs. 12.8 ± 5.4 min in the NSUS groups). There were two arterial punctures in the NSUS group. Conclusions: During LSIB performance US guidance alone produces block success rate identical to both US and NS guidance yet with a shorter block performance time. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effectiveness of the Airtraq® and CTrach™ in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 μg.kg−1 fentanyl, 3 mg.kg−1 propofol and 0.6 mg.kg−1 rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p < 0.001). The mean (SD) time taken for tracheal intubation was also shorter with the Airtraq than the CTrach (25.6 (13.5) and 66.3 (29.3)s, respectively; p < 0.001). There was less mucosal damage in the Airtraq group (p = 0.008). Our findings demonstrate that use of the Airtraq device shortened the tracheal intubation time and reduced the mucosal damage when compared with the CTrach in patients who require cervical spine immobilisation. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset. Methods: In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was injected following median, ulnar or radial nerves. A successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Sensory and motor blocks were tested at 5-min intervals for 30 min. Results: The block was successful in 27 patients in Group S and 28 patients in Group D. The time from starting the block until satisfactory anesthesia was significantly shorter in Group D than in Group S (19.3 vs. 23.2 min) ( P<0.05). Total sensory scores were significantly higher in the double stimulation group at 20 and 30 min after the block performance ( P<0.05). Conclusions: Although the block performance time was longer in the double stimulation group, block onset time and extent of anesthesia were more favorable in the double stimulation group. [ABSTRACT FROM AUTHOR]

Background and objective: The LMA-Supreme™ (S-LMA™) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Proseal™ (P-LMA™) and S-LMA™. Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMA™ ( n=30) or S-LMA™ ( n=30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H2O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMA™, n=1; S-LMA™, n=1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMA™, n=1) due to failed OGT placement. OLPs were similar (P-LMA™; 26.9±6.6 S-LMA™; 26.1±5.2). ICP increased significantly in the P-LMA™ at the 30 and 60 min during anesthesia (P-LMA™; 80.1±12.8, 92.9±14.4, S-LMA™; 68.3±10.9, 73.7±15.6). OGT placement was successful in all patients in the S-LMA™, but failed in five patients in the P-LMA™ ( P=0.02). Fiberoptically determined anatomic position was better with the P-LMA™ ( P=0.03). Conclusion: Our findings suggest that S-LMA™ had leak pressures similar to the P-LMA™, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation. [ABSTRACT FROM AUTHOR]

Background: A nerve stimulation-guided lateral sagittal infraclavicular block (LSIB) has been proven to be an effective block. The purpose of this study was to evaluate whether the use of ultrasound (US) guidance would further improve the block quality of LSIB. Methods: In a prospective manner, 80 adult patients scheduled for hand, wrist and forearm surgery were randomly allocated to US or nerve stimulation (NS) groups. A needle was inserted into a sagittal plane, 20° dorsally, until muscle twitches were observed in synchrony with the stimulation. In the US group, the block was performed using the same puncture site but under ultrasonic guidance. The final position of the needle was verified with the use of a nerve stimulator. A local anesthetic mixture of 20 ml of levobupivacaine, 5 mg/ml and 20 ml of lidocaine and 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups. Results: The block was successful in 37 patients in the NS group and 38 patients in the US group. Block efficacy was better in the US group than the group NS in radial nerve distribution at 20 min ( P<0.05). In the US group, there was a slight tendency toward better block density in other nerve areas also but these differences were not significant. Vascular puncture was noted in three patients in the NS group and none in the US group. Conclusions: The block success rate was high and comparable in both groups. There was a trend toward improved block quality in the US group, although not significant. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the clinical utility and block success rate of ‘lateral sagittal infraclavicular block (LSIB)’ in a large-scale clinical study. Methods: Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performed. In the LSIB technique the puncture site is immediately adjacent to the most medial point of the coracoid process and the anterior surface of the clavicula. The needle is inserted caudally in a sagittal plane, 20° dorsally (downwards), until muscle twitches are observed in synchrony with the stimulation. A Local anesthetic mixture of either 20 ml bupivacaine 5 mg/ml or 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 μg/ml epinephrine (total volume 40 ml) was administered following electrolocation of the median, radial or ulnar nerve. Results: Three-hundred and eighty patients were included into the study. Block was successful in 341 (89.7%) patients without any need for local anesthetic supplementation. We had complete failure in 17 (4.5%) patients and these patients received general anesthesia. Twenty-two (5.8%) patients needed either infiltration of local anesthetic at the site of skin incision or supplementation of the block at the axilla. No other complications other than vascular punctures − 25 patients (6.6%) – were observed. Conclusions: LSIB provided a clinically acceptable success rate and our results are in agreement with other studies assessing this approach. [ABSTRACT FROM AUTHOR]

Background: In this study, using a dose-ranging design, we examined the effects of clonidine with 0.125% bupivacaine on the duration of post-operative analgesia in caudal anaesthesia in children. Methods: We conducted a controlled, prospective study of clonidine in caudal anaesthesia in 60 children, aged 1–10 years, undergoing elective inguinal hernia repair. Induction and maintenance of anaesthesia were performed by inhalation of sevoflurane and nitrous oxide. The children were randomized in a double-blind fashion to four groups, and were given a caudal anaesthetic with either 0.125% plain isobaric bupivacaine (1 ml/kg) or bupivacaine plus 1, 1.5 or 2 µg/kg of clonidine. The blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated by the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) or a visual analogue scale (VAS). Paracetamol was given when the mCHEOPS score was greater than five or when the VAS score was greater than 30 mm. The monitoring of scores for pain, haemodynamic changes and post-operative nausea and vomiting was performed by nurses blind to the study allocation. Results: The duration of analgesia was found to be significantly longer in the group given bupivacaine plus 2 µg/kg of clonidine (median, 650 min; range, 300–900 min). Peri-operative hypotension and bradycardia, post-operative respiratory depression and motor block were not recorded in any patient. Conclusions: The addition of clonidine to 0.125% bupivacaine prolongs the duration of post-operative analgesia without any respiratory or haemodynamic side-effects. [ABSTRACT FROM AUTHOR]

The purpose of the study was to compare the effects of adding 50 μg of morphine, 25 μg of fentanyl or saline to 6 mg of hyperbaric bupivacaine on post-operative analgesia and time to urination in patients undergoing arthroscopic knee surgery under spinal anesthesia. In all groups satisfactory anesthesia was provided during the operation. There was a statistically significant difference between all the groups in times to voiding [Group BM 422 ± 161 min; Group BF 244 ± 163 min; Group BS 183 ± 54 min (mean ± SD)]. The incidence of pruritus was significantly greater in Group BM (80%) and BF (65%) in comparison with Group BS (no pruritus) (P < 0.05). The incidence of nausea was significantly increased in Group BM (35%) in comparison with Group BF (10%) and Group BS (P < 0.05). Analgesic consumption was significantly greater in Group BS in comparison with Groups BM and BF (P < 0.01). We conclude that during spinal anesthesia even mini-dose intrathecal morphine is not acceptable for outpatient surgery due to side-effects, especially severely prolonged time to urination. [ABSTRACT FROM AUTHOR]

Background: Administration of bupivacaine caudally has been used for postoperative analgesia after urogenital, rectal and lower abdominal surgery in children. Caudal opioids may offer analgesic advantages over bupivacaine alone but have been associated with side effects such as respiratory depression. Tramadol is an analgesic assumed to lack a respiratory depressant effect and has been shown to provide effective, long-lasting analgesia after epidural administration in adults and children. The aim of this study was to determine whether the addition of tramadol to bupivacaine caudally prolongs the duration of analgesia compared with bupivacaine alone, with respect to side effects, and whether caudal tramadol alone provides satisfactory analgesia.Methods: Sixty boys, aged 12-84 months, undergoing unilateral herniorrhaphy, were allocated randomly to three groups. Children in group B received 0.25% plain bupivacaine 1 ml kg(-1), group BT received an identical local anesthetic dose mixed with tramadol 1.5 mg kg(-1) and group T received caudal tramadol 1.5 mg kg(-1) in 0.9% sodium chloride in the same total volume (1 ml kg(-1)). Pain and demeanour assessments were made 1, 2, 3, 4, 6, 12 and 24 h after recovery from anesthesia with reference to a three-point scale.Results: Analgesia time (time between caudal injection and first administration of analgesic) in group BT (13.5+/-2.2 h) was significantly longer than in the other two groups (P<0.05). In group T, more patients required additional analgesia after surgery than in the other two groups (P<0.05). Pain scores in the three groups were similar up to 4 h after operation but the mean score in group T was higher than groups B and BT 4 and 6 h after operation (P<0.05). Significantly more patients who had received caudal bupivacaine alone or with tramadol had lower pain and demeanour scores during the first 24 h after operation compared with those in the tramadol group.Conclusion: Caudal administration of bupivacaine with the addition of tramadol resulted in superior analgesia with a longer period without demand for additional analgesics compared with caudal bupivacaine and tramadol alone without an increase of side effects. [ABSTRACT FROM AUTHOR]

Two edible wild mushrooms, namely Clitocybe alexandri (Gill.) Konr. ( Tricholomataceae) and Rhizopogon roseolus (Corda) T.M. Fries ( Rhizopogonaceae), collected from the southwest of Turkey, were tested for their antimicrobial activity by using the disc diffusion method. The ethanol, methanol, diethyl ether, water, ethylacetate and n-hexane extracts from the fruit bodies of mushrooms were assayed against 13 microorganisms. In comparison with the test antibiotics penicillin, novobiocin, nalidixic acid and ampicillin, the methanol extract obtained from the two mushrooms presented significant activity against E. coli, Bacillus subtilis and Enterobacter aerogenes. On the other hand, the ethylacetate extract from C. alexandri was found to be active against Candida albicans and Saccharomyces cerevisiae, whereas the ethanol extract of Rhizopogon roseolus was active against Saccharomyces cerevisiae. This research has shown that various extracts obtained from two macrofungi could be used in vitro to inhibit the growth of some important bacteria and fungi. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We report on a 17-year-old man who presented with unreported combination of right sided microtia and preauricular skin tag with conductive hearing loss, unilateral renal agenesis, partial syndactyly of forth and fifth metacarpals, multiple tarsal coalitions, absent toe, and hypoplastic tibia and fibula. Radiological and clinical findings did not match with the previously described syndromes with the type of anomalies seen in the case. We propose that this represents a new syndrome., (Copyright 2006 Wiley-Liss, Inc.)