Background Airway anesthesia is pivotal for successful awake intubation provided either topically or by nerve blocks. The widespread use of ultrasonography allows anesthesiologists to evaluate complex and varied anatomy before needle insertion. This study aims to evaluate the effect of ultrasound-guided technique for the block of the internal branch of the superior laryngeal nerve in difficult airway patients in comparison to blind anatomical technique. Sixty patients aged 18–60 years, of either sex, with the American Society of Anesthesiologists’ physical status (ASA) I–II were divided into two groups 30 patients of each. Group (L): using anatomical landmark technique to bilateral block internal branch of the superior laryngeal nerve (ibSLN) with 1 mL 2% Lidocaine and group (U): using ultrasound technique to bilateral block the ibSLN with 1 mL 2% Lidocaine. Assessment of the excellence of airway anesthesia during intubation by using the 5 points grading scale, time for intubation, effects on hemodynamic variables, and evaluation of patient awareness of pain and discomfort during fiber-optic intubation using numerical rating scale were compared. Results The duration of tracheal intubation was shorter in the ultrasound group as compared to the anatomical group; also, patient comfort was significantly better in the ultrasound group besides the effect of tracheal intubation on hemodynamics which was significant with a higher peak value during intubation and post-intubation in the anatomical group compared to the ultrasound group. Conclusions This study concludes that an ultrasound-guided block of ibSLN used as a part of the preparation of the airway for awake fiber-optic intubation enhances the quality of airway anesthesia and patient tolerance during the procedure.
Background Functional endoscopic sinus surgery (FESS) has been proposed as a selected treatment used in patients with chronic sinusitis that have not responded to medical therapy. Due to the nature of the location of endoscopic sinus surgery, even a small amount of bleeding can reduce the operative visibility. The aim of the work was to compare between dexmedetomidine and magnesium sulphate regarding their efficacy as a hypotensive agent in FESS in adult patients to obtain a bloodless surgical field. Patients and methods Sixty patients were randomly assigned into two groups, (D group) for dexmedetomidine (n = 30) and (M group) for magnesium sulphate (n = 30). In (D group), patients received 1 μg/kg dexmedetomidine in 100 ml saline solution as the loading dose 10 min before induction and 0.5–1 μg/kg/h infusion via syringe pump during surgery. In (M group), patients received 40 mg/kg magnesium sulphate in 100 ml saline solution over 10 min as the intravenous loading dose 10 min before induction, with a subsequent 10–15 mg/kg/h infusion. If there is an increase in the arterial blood pressure greater than the targeted MAP (55–65 mmHg), nitroglycerine infusion was started by 0.5 μg/kg/min. The surgeon estimated the quality of the surgical field and recorded it. The total blood loss was measured. In recovery, time to reach Aldrete score ≥ 9 was recorded to fulfill the discharge criteria. Pain score was assessed by the NRS numerical rating score. The time needed to first analgesia requirement was recorded. Sedation score was recorded using Ramsay sedation score. Results There was no statistically significant difference between both groups regarding MAP except at 30 min postoperatively as there was a statistically significant decrease in the MAP among the dexmedetomidine (D group) (p = 0.039). Nitroglycerine was required in eight cases in the magnesium sulphate (M group) to reach the targeted MAP which was statistically significant compared to the (D group). Patients in the (D group) had a statistically significant decrease in heart rate than in the (M group) during and after the operation (p = 0.35). The quality of the surgical field was significantly better among the (D group) (p < 0.05), and accordingly, the surgeon satisfaction was significantly higher in the (D group) (p = 0.001). Time to reach Aldrete score ≥ 9 and time for first analgesic requirement postoperatively were significantly longer in the (D group) (p = 0.023, p = 0.001 respectively). Regarding the Ramsay sedation score (RSS), it was higher in the (D group) which was statistically significant (p ≤ 0.001). Conclusion Dexmedetomidine was more effective than magnesium sulphate to achieve controlled hypotension in patients undergoing FESS. Compared with magnesium, dexmedetomidine offers the advantage of better clarity of the field, surgical satisfaction, less bleeding, and prolonged postoperative analgesia.
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