Influence of Different Doses of Ketamine on Intubating Conditions during a Rapid Sequence Induction and Intubation Model

OBJECTIVE: This prospective, randomized, double-blinded study aimed to compare the effects of three different doses of ketamine or lidocaine on intubating conditions and haemodynamics in a rapid-sequence induction model with 3 mg kg(−1) propofol and 0.6 mg kg(−1) rocuronium. METHODS: A total of 128 ASA I–III patients who were scheduled for elective surgery were randomized in the following five groups: Group 1 (n=24), 1 mg kg(−1) lidocaine+3 mg kg(−1) propofol+0.6 mg kg(−1) rocuronium; Group 2 (n=23), 0.1 mg kg(−1) ketamine+3 mg kg(−1) propofol+0.6 mg kg(−1) rocuronium; Group 3 (n=29), 0.3 mg kg(−1) ketamine+3 mg kg(−1) propofol+0.6 mg kg(−1) rocuronium; Group 4 (n=26), 0.5 mg kg(−1) ketamine+3 mg kg(−1) propofol+0.6 mg kg(−1) rocuronium and Group 5 (n=26), 3 mg kg(−1) propofol+0.6 mg kg(−1) rocuronium+saline as placebo. After preoxygenation, induction was performed with the assigned combination, and intubation was initiated after 60 s. The time to intubation, intubation score (Viby–Mogensen score) and haemodynamic data were recorded. Postoperative hoarseness, sore throat and hallucination incidences were followed up. RESULTS: Demographic, time to intubation and haemodynamic data were comparable among groups. Group 4 [13.5 (4–14)] revealed a higher intubation score then groups 1, 2 and 5 [12 (3–14), 11 (2–14) and 9.5 (0–13) and p=0.026, p=0.001 and p=0.000001, respectively]. Groups 3 [13 (4–14)] and 4 [13.5 (4–14)] had similar intubation scores. Side effects were comparable among all groups. CONCLUSION: The combination of 0.5 mg kg(−1) ketamine and 0.6 mg kg(−1) rocuronium along with propofol improves intubation conditions in a stimulated rapid-sequence induction model

Comparação de duas doses diferentes de morfina adicionadas à bupivacaína em raquianestesia para herniorrafia inguinal

ResumoJustificativa e objetivosComparar os efeitos de duas doses diferentes de morfina intratecal (MIT) sobre a analgesia no pós‐operatório, os tempos até a primeira mobilização e micção no pós‐operatório e a gravidade dos efeitos colaterais.MétodosApós a aprovação do Comitê de Ética Institucional, 48 pacientes com estado físico ASA I‐II foram incluídos neste estudo randômico e duplo‐cego. A raquianestesia foi feita com 0,1mg (Grupo I, n=22) ou 0,4mg (Grupo II, n=26) de MIT adicionados a 7,5mg de bupivacaína hiperbárica. Os tempos até a primeira necessidade de analgésico, mobilização e micção e os efeitos colaterais no pós‐operatório foram registrados. As análises estatísticas foram feitas com o programa SPSS 15.0 e p<0,05 foi considerado estatisticamente significativo. Os dados numéricos foram analisados com o teste t e expressos como média±DP. Os dados categóricos foram analisados com o teste do qui‐quadrado e expressos como número de pacientes e porcentagem.ResultadosOs dados demográficos foram semelhantes entre os grupos. Não houve diferenças em relação à dor, aos tempos até a primeira necessidade de analgésicos, à primeira mobilização e primeira micção. A única diferença entre os dois grupos foi a incidência vômito. No Grupo II, 23% (n=6) das pacientes apresentaram vômito durante as primeiras 24 horas de pós‐operatório, em comparação com 0% no Grupo I (p=0,025).ConclusãoPara herniorrafia inguinal, a dose de 0,1mg de MIT fornece analgesia comparável à dose de 0,4mg, com uma incidência de vômito significativamente menor quando combinada com uma dose baixa de bupivacaína hiperbárica.AbstractBackground and objectivesThe aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects.MethodsAfter Institutional Ethical Committee approval, 48 ASA I‐II patients were enrolled in this randomized double‐blinded study. Spinal anesthesia was performed with 0.1mg (Group I, n=22) or 0.4mg (Group II, n=26) ITM in addition to 7.5mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p<0.05 was considered as statistically significant. The numeric data were analyzed by the t‐test and presented as mean±SD. Categorical data were analyzed with the chi‐square test and expressed as number of patients and percentage.ResultsDemographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n=6) of the patients had vomiting during the first postoperative 24h compared to 0% in Group I (p=0.025).ConclusionFor inguinal hernia repairs, the dose of 0.1mg of ITM provides comparable postoperative analgesia with a dose of 0.4mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine

A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair

AbstractBackground and objectivesThe aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects.MethodsAfter Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1mg (Group I, n=22) or 0.4mg (Group II, n=26) ITM in addition to 7.5mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p<0.05 was considered as statistically significant. The numeric data were analyzed by the t-test and presented as mean±SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage.ResultsDemographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n=6) of the patients had vomiting during the first postoperative 24h compared to 0% in Group I (p=0.025).ConclusionFor inguinal hernia repairs, the dose of 0.1mg of ITM provides comparable postoperative analgesia with a dose of 0.4mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine

Preliminary report of laryngeal phonation during mechanical ventilation via a new cuffed tracheostomy tube

OBJECTIVE: To study the safety, efficacy, patient tolerance, and patient satisfaction of the Blom Tracheostomy Tube and Speech Cannula (Pulmodyne, Indianapolis, Indiana), a new device that allows the patient to speak while the tracheostomy tube cuff is fully inflated. METHODS: With 10 tracheostomized mechanically ventilated patients we recorded ventilator settings and physiologic variables at baseline with patient\u27s usual tracheostomy tube, then with the Blom Tracheostomy Tube and the Blom standard (non-speech) cannula, and then during three 30-min trials of the Blom Speech Cannula. During the Blom Speech Cannula trials we assessed the subjects\u27 success in phonation (eg, sentence length and volume). RESULTS: Nine of the 10 subjects achieved sustained audible phonation and were very satisfied with the device. CONCLUSIONS: The Blom Speech Cannula appears to be safe, effective, and well tolerated in tracheostomized mechanically ventilated patients while maintaining full cuff inflation. © 2010 Daedalus Enterprises

Existe correlação entre o volume ultrassonográfico da glândula tireóide e intubação difícil? Um estudo observacional

ResumoJustificativa e objetivosA avaliação ultrassonográfica pré‐operatória da glândula tireóide feita por cirurgiões pode prever desafios no manejo das vias aéreas. O objetivo deste estudo observacional foi avaliar os efeitos de parâmetros relacionados à tireóide investigados pré‐operatoriamente por cirurgiões mediante ultrassonografia e radiografia de tórax em condições de intubação.MétodosForam inscritos 50 pacientes submetidos à cirurgia de tireóide. Distância tireomentoniana (DTM), escore de Mallampati, circunferência do pescoço e amplitude de movimento do pescoço foram avaliados antes da operação. Volume da tireóide, sinais de invasão ou compressão e desvio da traqueia na radiografia de tórax também foram registrados. As condições de intubação foram avaliadas com o escore de Cormack e Lehane (CL) e a escala de intubação difícil (EID). Análises estatísticas foram feitas com o software SPSS 15.0.ResultadosA média do volume da tireóide dos pacientes foi de 26,38±14mL. A mediana da EID foi de 1 (0‐2). DTM (p=0,011; r=0,36, IC 95% 0,582‐0,088); escore de Mallampati (p=0,041; r=0,29, IC 95% 013‐0,526); sinais de compressão ou invasão (p=0,041; r=0,28; IC 95% 0,006‐0,521) e desvio da traqueia na radiografia de tórax (p=0,041; r=0,52, IC 95% 0,268‐0,702) foram correlacionados com a EID. Os pacientes foram classificados em dois grupos também relacionados à EID (Grupo I, n=19: EID=0; Grupo II, n=31: 1 < EID ≤ 5) e os preditivos de intubação difícil e os parâmetros da tireóide relacionados foram comparados. Apenas o escore de Mallampati foi significativamente diferente entre os grupos (p=0,025).ConclusãoO volume da tireóide não está associado à intubação difícil. Contudo, os parâmetros de avaliação clínica podem prever intubação difícil.AbstractBackground and objectivesPreoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid‐related parameters assessed preoperatively by surgeons via ultrasonography and chest X‐ray on intubation conditions.MethodsFifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X‐ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software.ResultsThe mean thyroid volume of the patients was 26.38±14mL. The median intubation difficulty scale was 1 (0‐2). Thyromental distance (p=0.011; r=0.36; 95% CI 0.582‐0.088), Mallampati score (p=0.041; r=0.29; 95% CI 0.013‐0.526), compression or invasion signs (p=0.041; r=0.28; 95% CI 0.006‐0.521) and tracheal deviation on chest X‐ray (p=0.041; r=0.52; 95% CI 0.268‐0.702) were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n=19: intubation difficulty scale=0; Group II, n=31: 1<intubation difficulty scale≤5) and difficult intubation predictors and thyroid‐related parameters were compared. Only Mallampati score was significantly different between groups (p=0.025).ConclusionThe thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation

¿Existe una correlación entre el volumen ecográfico de la glándula tiroides y la intubación difícil? Un estudio observacional

ResumenJustificación y objetivosLa evaluación ecográfica preoperatoria de la glándula tiroides hecha por los cirujanos puede prevenir los retos en el manejo de las vías aéreas. El objetivo de este estudio observacional fue evaluar los efectos de parámetros relacionados con la tiroides investigados por cirujanos antes de la operación, mediante ecografía y radiografía de tórax en condiciones de intubación.MétodosFueron inscritos 50 pacientes sometidos a cirugía de tiroides. La distancia tiromentoniana, puntuación de Mallampati, circunferencia del cuello y amplitud de movimiento del cuello fueron evaluados antes de la operación. También fueron registrados el volumen de la tiroides, signos de invasión o compresión, y desviación de la tráquea en la radiografía de tórax. Las condiciones de intubación se calcularon con la puntuación de Cormack y Lehane y la escala de intubación difícil (EID). Los análisis estadísticos fueron realizados con el software SPSS 15.0.ResultadosLa media del volumen de la tiroides de los pacientes fue de 26,38±14mL. La mediana de la EID fue 1 (0-2). Fueron correlacionados con la EID la distancia tiromentoniana (p=0,011; r=0,36; IC 95%: 0,582-0,088), puntuación de Mallampati (p=0,041; r=0,29; IC 95%: 013-0,526), signos de compresión o invasión (p=0,041; r=0,28; IC 95%: 0,006-0,521) y desviación de la tráquea en la radiografía de tórax (p=0,041; r=0,52; IC 95%: 0,268-0,702). Los pacientes fueron clasificados en 2 grupos también relacionados con la EID (grupo i, n=19: EID=0; grupo ii, n=31: 1<EID≤5), y los predictores de intubación difícil y los parámetros de la tiroides relacionados fueron comparados. Solamente la puntuación de Mallampati fue significativamente diferente entre los grupos (p=0,025).ConclusiónEl volumen de la tiroides no está asociado con la intubación difícil. Sin embargo, los parámetros de evaluación clínica pueden prever la intubación difícil.AbstractBackground and objectivesPreoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions.MethodsFifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale (IDS). Statistical analyses were done with SPSS 15.0 software.ResultsThe mean thyroid volume of the patients was 26.38±14mL. The median IDS 1 (0-2). Thyromental distance (P=.011; r=0.36; 95% CI 0.582-0.088), Mallampati score (P=.041; r=0.29; 95% CI 0.013-0.526), compression or invasion signs (P=0.041; r=0.28; 95% CI 0.006-0.521) and tracheal deviation on chest X-ray (P=0.041; r=0.52; 95% CI 0.268-0.702) were correlated with IDS. Also patients were classified into 2 groups related to their IDS (group I, n=19: IDS=0; group II, n=31: 1<IDS≤5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (P=.025).ConclusionThe thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation

Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

AbstractBackground and objectivesPreoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions.MethodsFifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software.ResultsThe mean thyroid volume of the patients was 26.38±14mL. The median intubation difficulty scale was 1 (0–2). Thyromental distance (p=0.011; r=0.36; 95% CI 0.582–0.088), Mallampati score (p=0.041; r=0.29; 95% CI 0.013–0.526), compression or invasion signs (p=0.041; r=0.28; 95% CI 0.006–0.521) and tracheal deviation on chest X-ray (p=0.041; r=0.52; 95% CI 0.268–0.702) were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n=19: intubation difficulty scale=0; Group II, n=31: 1<intubation difficulty scale≤5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p=0.025).ConclusionThe thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation