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   2017| January-April  | Volume 11 | Issue 1  
    Online since July 24, 2017

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Use of dexemedetomidine–fentanyl versus midazolam–fentanyl for sedation during awake fiberoptic intubation: a randomized double-blind controlled study
Naser Fadel, Safinaz Hassan Osman, Mohamed Mahmoud, Mohamed Osman
January-April 2017, 11(1):13-19
Background and objective Sedation for awake fiberoptic intubation is considered a great challenge for anesthetist to maintain patient’s airway patent during sedation. The aim of this study is to compare the effect of dexmedetomidine–fentanyl versus midazolam–fentanyl combination on patient’s ventilation during sedation for awake fiberoptic intubation. Patients and methods A total of 60 patients, 20–60 years old, with American Society of Anaesthesiologists classification I and II, were enrolled in the study to be scheduled for awake nasal fiberoptic intubation for cervical spine surgery. Patients were divided into two groups. Group 1 received fentanyl 1 μg/kg, intravenously+midazolam, intravenously, 0.05 mg/kg followed by saline infusion (placebo) with additional doses of midazolam (0.05 mg/kg) to achieve a Ramsay Sedation Scale score of greater than or equal to 2. Group 2 received fentanyl 1 μg/kg, intravenously+dexmedetomidine, intravenously, 1 μg/kg infusion over 10 min, and then the infusion of dexmedetomidine 0.1 μg/kg/h and titrated to 0.7 μg/kg/h to achieve Ramsay Sedation Scale greater than or equal to 2. Measurements Vital signs (heart rate, systolic blood pressure, and oxygen saturation) as well as respiratory rate were recorded. Arterial blood gases sampling was done before and after the intubation. The Observer’s Assessment of Alertness/Sedation Scale was used to assess the level of sedation. The visual analog scale used to assess patients’ recall and discomfort, and finally, time to intubation in both groups was also recorded. Results There was significant decrease in heart rate, no difference in systolic blood pressure, and significant increases in SpO2 and PaO2, with preservation of patient’s ventilation in dexmedetomidine group. No difference was noted in visual analog scale score or time to intubation between both the groups. Conclusion Dexmedetomidine provided better intubating conditions, better patient tolerance, higher patient satisfaction, and good hemodynamic responses compared with midazolam, with preservation of arousability in addition to better ventilation properties.
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A comparison between the effect of ketamine versus dexmedetomidine infusion on the frequency of spells during Fallot repair: a randomized controlled trial
Mai A.F Madkour, Mohamed Elayashy, Mohamed Maher
January-April 2017, 11(1):1-7
Background Patients with tetralogy of Fallot experience changes in the dynamics of right ventricular outflow tract obstruction, or changes in systemic vascular resistance cause a decrease in the systemic arterial oxygen saturation. Dexmedetomidine use is not yet approved in pediatric patients, but its effects have been studied in pediatric patients during cardiac surgery, which showed a decrease in the incidence of arrhythmias after bypass. In this study, we postulate that dexmedetomidine may have potential benefits on the pulmonary vascular resistance, which may play a role in decreasing the incidence of tet spells during Fallot repair. Patients and methods This randomized controlled study was conducted in Cairo university pediatric hospitals, where patients were randomly allocated to two equal groups, 30 patients in each group between 6 months and 12 years of age. Patients were allocated to two groups to receive two different anesthesia maintenance regimens: group 1 (the ketamine group, n=30) received isoflurane 0–1% together with ketamine infusion 1 mg/kg/h, and group 2 (the dexmedetomidine group, n=30) received isoflurane 0–1% together with dexmedetomidine 0.25 μg/kg/h. Mean arterial pressure, heart rate, and oxygen saturation were recorded. Arterial blood gases, glucose and lactate levels, and number of tet spells, which is the primary outcome in our study, were evaluated. Results Our primary finding was the number of spells, which was 2 (range: 0–4) in the KET group compared with 0 (range: 0–2) in the DEX group (P<0.001). Intraoperative heart rate decreased more in the DEX group than in the KET group at all times of measurement but with a significant difference at T2 and T3. Mean arterial pressure also decreased in the DEX group with a significant difference between the two groups at T1, T2, and T3. Conclusion Dexmedetomidine infusion as an adjuvant to anesthesia decreased the number of spells in the prebypass period significantly better than ketamine infusion in children undergoing Fallot repair.
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Mac Doshi laryngoscope blade makes tracheal cuff protection easier during double-lumen tube placement
Om P Sanjeev, Prakash K Dubey, Chetana Shamshery, Amit Rastogi
January-April 2017, 11(1):8-12
Introduction Tracheal cuff rupture is a known complication during double-lumen tube (DLT) placement. Mac Doshi laryngoscope blade has an increased height of web. On account of its wider web, it provides a wider mouth opening and easier movement of the tongue to the left side. We hypothesized that this wider web should act as a guard and prevent brushing of tracheal cuff over teeth. Aims and objectives We designed this study to evaluate the usefulness of Mac Doshi laryngoscope blade for ease of tracheal cuff protection during DLT placement. Patients and methods After approval from the Institute Ethical Committee, 60 consenting patients of either sex with American Society of Anesthesiologists physical status II or III and scheduled for cardiac and thoracic procedures under general anaesthesia with DLT placement were recruited for this study. Patients were randomized with a computer-generated random number table and assigned to either of the two groups. In group 1, DLT placement was performed with Macintosh laryngoscope blade. In group 2, DLT placement was performed with Mac Doshi laryngoscope blade. Outcome parameters were incidence of tracheal cuff rupture and score given by physician for ease of tracheal cuff protection during DLT placement on Likert score for measure of agreement. Results The median score and interquartile range was 2 (2–4) in Macintosh versus 1.5 (1–2) in the Mac Doshi group. This difference was statistically significant (P=0.02). There was one case of tracheal cuff rupture in the Macintosh group and none in the Mac Doshi group. Conclusion Mac Doshi laryngoscope blade makes favourable condition for tracheal cuff protection during DLT placement.
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