Background Surgeries that require the patient to be in the prone position represent a challenge to the anesthesiologist in terms of securing the airway and additional time and personnel required for induction in the supine position and shifting to the prone position. Use of the classic laryngeal mask airway (LMA) in the prone position is a subject of controversy; the ProSeal LMA may be more suitable as it forms a better seal and provides access to the stomach. LMA Supreme is a newly introduced single-use supraglottic device that shares common features of both the LMA ProSeal and the intubating LMA. Aim of this study The aim of the study was to compare the use of LMA ProSeal and LMA Supreme after induction of anesthesia in the prone position. Patients and methods The study included 80 adult male patients for pilonidal sinus excision surgery. They were randomly divided into two equal groups: group P and group S. The ProSeal was used in group P and the Supreme was used in group S. Ease of insertion, ease of ventilation, leakage of inspiratory gases, SpO ₂ , EtCO ₂ , blood on the airway device after removal, and postoperative incidences of sore throat were recorded. Results There was no statistical difference between the two groups in terms of age, BMI, or duration of surgery. Both devices provided good air seal and good ventilation. Blood-stained saliva and postoperative sore throat were found more with ProSeal use than with Supreme. Conclusion Allowing the patients to take the prone position themselves and then inducing general anesthesia and securing the airway either with ProSeal or with Supreme is a safe practice.

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Background Levobupivacaine (chirocaine) is a long-acting amide local anesthetic that can be used in different applications like epidural, spinal, peripheral nerve, ocular block, topical application, and local infiltration. Clinical effects are comparable to those of bupivacaine or ropivacaine. Studies are needed on different adjuvants with levobupivacaine, such as dexamethasone and magnesium sulfate. Aim of this study The aim of the study was to compare the effect of adding either magnesium sulfate or dexamethasone to levobupivacaine in supraclavicular brachial plexus block. Materials and methods Sixty adult patients presented for upper-limb surgery under supraclavicular brachial plexus block using ultrasound. The patients were randomly arranged into two equal groups: magnesium sulfate was added to levobupivacaine in one group and dexamethasone was added in the other group. Duration of postoperative analgesia was recorded. Results There was no statistically significant difference in the duration of postoperative analgesia between the two groups. Conclusion There is no preferential difference in postoperative analgesia between dexamethasone and magnesium sulfate when added to levobupivacaine

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Background Elderly patients undergoing spinal anesthesia require restricted block with a low dose of a local anesthetic. Considering that the baricity of local anesthetic solutions is the primary determinant of the level of motor and sensory block in nonobstetric patients, the aim of this study was to evaluate the effect of baricity of bupivacaine on the quality of spinal block and on hemodynamics in elderly patients undergoing transurethral resection of the prostate (TURP). Materials and methods Ninety-nine patients undergoing TURP were randomized into three groups. Patients of the first group (33 patients) received intrathecal 10 mg hyperbaric bupivacaine 0.5%. The second group of patients (34 patients) received 5 mg isobaric bupivacaine added to 5 mg hyperbaric bupivacaine, resulting in what was called 'slightly hyperbaric solution'. The third group of patients (32 patients) received 10 mg isobaric bupivacaine 0.5%. All patients were injected below L2 level in the sitting position. Sensory and motor blockade was assessed, as well as the first request for analgesic, rescue analgesics, and the overall incidence of side effects. Results Onset of sensory block was comparable in the three studied groups, but motor block set earlier in the hyperbaric group and the 'slightly hyperbaric' group compared with the isobaric group. Higher sensory block was observed in the isobaric group. Recovery from sensory and motor block was earlier in the hyperbaric group. First need for analgesics was earlier in the hyperbaric group than in the 'slightly hyperbaric' and isobaric groups. Postoperative analgesia and tolerance to urinary catheter were prolonged in the isobaric and 'slightly hyperbaric' group as compared with the hyperbaric group. Conclusion Use of slightly hyperbaric bupivacaine (density = 1.013) than the traditional hyperbaric bupivacaine (density = 1.028) and the isobaric one (density = 1.007) results in good quality spinal block with fewer side effects in patients undergoing TURP.

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Background Airway management remains an important problem in the practice of anesthesia. The present study was carried out to compare intubating laryngeal mask airway (ILMA) and air-Q for blind tracheal intubation during surgical procedures under general anesthesia. Materials and methods This study was carried out on 70 adult patients scheduled for elective surgical procedures under general anesthesia with controlled ventilation such as gynecological, orthopedic, ophthalmic, or general surgery lasting up to 2 h. Data were collected on airway assessment, hemodynamic changes, insertion time of the device and the endotracheal tube, number of attempts of blind tracheal intubation, ease of insertion, and complications. Results Airway assessment parameters were similar in patients of both groups. The incidence of hemodynamic changes was significantly higher in the air-Q group than the fastrack group and the insertion time of the endotracheal tube as well as the percentage of ease of insertion in group I (fastrack) showed a statistically significantly higher value than group II (air-Q). However, there was no statistically significant difference between the two groups in the number of insertion attempts (a success rate of 88.57% for the fastrack vs. a success rate of 82.86% for the air-Q) and the complications. Conclusion Both the fastrack and the air-Q are suitable devices for blind tracheal intubation. The fastrack has a higher success rate in terms of blind tracheal intubation than the air-Q.

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Different methods have been described for lung isolation in patients for thoracic surgery with tracheotomies. It is important to consider whether it is a fresh stoma or a chronic tracheostomy. We would like to describe the use of endobronchial blocker directed fibreoptically in a fresh tracheostomy as a simple and safe technique for one-lung ventilation without causing any trauma to the fresh stoma site.

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Background For controlling post-thoracotomy pain, thoracic epidural (TE) analgesia is considered a gold standard technique. However, it may be associated with serious complications. Interpleural (IP) analgesia is thought to be a simpler technique. Therefore, the current study aimed to compare the efficacy of simple IP with TE bupivacaine in controlling post-thoracotomy pain in pediatrics. Patients and methods A total of 80 pediatric patients undergoing elective thoracotomy were randomly assigned to either the TE or the IP group. In the TE group, epidural catheter was threaded through the caudal space and the tip was placed at the fourth intercostal space. In the IP group, the surgeon inserted the IP catheter through the IP space under direct vision and directed its tip towards the fourth intercostal space on the paravertebral line. Bupivacaine 1.5 mg/kg in 25% concentration was administered through either TE or IP catheters as intermittent boluses every 6 h, starting from the beginning of skin closure, for 24 h postoperatively. Fentanyl 1 mg/kg intravenous bolus was administered as rescue analgesia to keep the pain score less than 0.4. Hemodynamic parameters and pain scores were recorded at 1, 6, 12, 18, and 24 h. In addition, interleukin-6 was measured at 1, 6, and 24 h beginning from the first injected local anesthetic dose. Total postoperative 24 h fentanyl requirements and time to first postoperative rescue analgesia were recorded. Results CRIES pain score showed no significant difference between the studied groups. Time to first rescue analgesia was significantly shorter in the IP group (2.75 ± 0.93) compared with the TE group (4.17 ± 1.07). Patients of the IP group required higher doses of intravenous fentanyl than did those in the TE group (12.83 ± 3.83 vs. 8.16 ± 3.4μg) (P<0.05). Conclusion For post-thoracotomy pain in pediatrics, equipotent analgesia can be achieved through TE blockade and the simpler IP technique, but with higher postoperative intravenous fentanyl supplementation to the latter technique.

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Background The use of continuous wound irrigation by local anesthetics has attracted considerable attention in many surgical specialties, including cardiac surgeries. The aim of this study was to evaluate the postoperative analgesic effect of local anesthetic infusion into the wound resulting from a standard median sternotomy using a catheter of surgical vacuum device of size 12 Fr in patients after coronary artery bypass graft operation in comparison with intravenous analgesia. Patients and methods This is a randomized clinical study conducted in Zagazig University Hospital. After obtaining approval and written consent, 40 patients who were enrolled for coronary artery bypass graft with standard median sternotomy incision were divided into two groups: in group 1 postoperative pain was managed according to the ordinary protocol of the cardiac ICU - that is, intravenous pethidine 50 mg/12 h and 1 g paracetamol/8 h with supplemental doses of 25 mg pethidine on patients' demand, with the total daily dose of pethidine not exceeding 400 mg. In group 2 postoperative pain was managed by continuous regional local anesthetic infusion of bupivacaine 0.25% at a rate of 4 ml/h for 48 h by means of a catheter inserted over the sternum. The following data were collected: the amount and time of analgesia given to the patients, data from pain assessment carried out after extubation and every 4 h until discharge from the ICU, heart rate, systolic blood pressure, forced vital capacity (FVC), forced expiratory volume in the first second (FEV ₁ ) and FEV ₁ /FVC ratio, time of weaning from the mechanical ventilator, and time of discharge from the ICU and discharge from hospital. Results There was significant statistical difference between the two groups regarding all of the collected data, except demographic data, FEV ₁ /FVC ratio, and length of stay in the ICU, which was 48 h for all patients in both groups. Conclusion Continuous local anesthetic infusion after standard median sternotomy resulted in lower pain scores, less need for narcotics, rapid weaning from the mechanical ventilation, better respiratory functions, and shorter hospital length of stay.

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Background β2-Adrenoceptor agonists accelerate the resolution of pulmonary edema in experimental and clinical studies. We tested the hypothesis that combining nebulized albuterol with lung recruitment maneuver (RM) during mechanical ventilation would improve oxygenation and accelerate the resolution of pulmonary edema more than would RM alone in patients with acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). Materials and methods In this randomized, controlled, single-blinded study, 60 patients admitted to the ICU of Qena University Hospitals and suffering from ALI and/or ARDS were recruited. All patients were subjected to the lung RM. They were assigned to two equal groups: the albuterol group (30 patients), in which patients were medicated with nebulized albuterol 1 mg diluted in 10 ml saline; and the control group (30 patients), in which patients were given 10 ml nebulized saline instead of albuterol. This regimen was repeated every 8 h for 3 days. Alveolar fluid samples were withdrawn before and 1 h after the lung recruitment for protein concentration measurement in the alveolar fluid. Results We found a significant difference between the two groups regarding PaO2 (P = 0.003) and PaO2/FiO2 (P = 0.023) before and after RM ± albuterol. No significant difference between the two groups was found regarding alveolar fluid clearance and alveolar protein concentration. Conclusion RM with nebulized albuterol improved oxygenation but the addition of albuterol was not beneficial regarding alveolar fluid clearance in terms of lowering alveolar protein concentration in ALI/ARDS patients. Trial registration The study was registered in the Australian Newzealand clinical trial registry (ANZCTR), with the number, ACTRN12613000836730, and website, http://www.ANZCTR.org.au/ACTRN12613000836730.aspx.

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