Anesthesia, essays and researches
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The i-gel is a novel supraglottic airway device with a soft and non-inflatable cuff. In our study we attempted to evaluate the performance of i-gel as a ventilatory device, as a conduit to blind tracheal intubation using conventional polyvinyl chloride tracheal tube and gastric tube insertion through it. ⋯ I-gel may be effectively used for ventilation, nasogastric tube insertion and as a conduit to blind endotracheal intubation with minimal complication and acceptable airway sealing pressures.
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There is an impelling need for accurate tests to predict difficult intubation, as failure to achieve endotracheal intubation causes significant morbidity and mortality in anesthetic practice. ⋯ Among individual test TMD and Calder are better predictive tests in terms of sensitivity. Combination of tests increases the chance of prediction of difficult intubation.
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The cardiotoxic effect of bupivacaine is a well-known fact that can lead to asystole, and most of the time it is refractory to resuscitative measures. We describe the case of a three-year-old child operated for anorectal malformation (ARM) by abdominal approach. Apart from congenital anomalies, preoperative evaluation was unremarkable. ⋯ Immediately after surgery when local infiltration block was given using 0.25% of bupivacaine (6 ml volume) around the abdominal incision for postoperative analgesia, the patient went into cardiac asystole. Cardiopulmonary resuscitation (CPR) was continued for 60 minutes but the patient could not be revived. At that time we had neither lipid emulsion nor the facility for cardiopulmonary bypass in our hospital setup.
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The purpose of this study was to evaluate the efficacy of transtracheal lidocaine injection to reduce the anesthetic requirements in patients who underwent brachial plexus surgery under general anesthesia. ⋯ The present study showed that the group of patients who received transtracheal block with lidocaine had a reduction in the requirement of the induction agent, propofol, and were more stable hemodynamically in the intraoperative period compared to those patients who did not receive transtracheal lidocaine. We conclude that transtracheal injection of lidocaine performed just prior to induction of general anesthesia is an effective alternative to intraoperative propofol infusion when long-acting muscle relaxants are to be avoided.
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During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. Dexmedetomidine attenuates the hemodynamic response to endotracheal intubation and reduces anesthetic requirement. ⋯ Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses during laryngoscopy, and reduced anesthetic requirements.