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Purpose: To compare the efficacy and safety of single-injection inferomedial (IM) and conventional inferotemporal (IT) peribulbar blockades. Patients and Methods: This prospective randomized study included 200 patients who were randomly allocated into two equal groups (n = 100 patients); in the first group, patients received IM peribulbar injection (IM group), while IT peribulbar injection was performed for the second group (IT group). The measurement data were patient characteristics, number of patients who required supplementations, total anesthetic volume injected, surgeon’s experience and any recordable complications. Results: The number of patients who required supplemental anesthetics due to inadequate block was significantly higher in the IT group (15 patients, 15%, vs. no patients, 0%, in the IM group). The total anesthetic volume injected was significantly lower in the IM group (5.6 ± 0.8 vs. 9.8 ± 0.7 ml in the IT group). Surgeon’s satisfaction was significantly higher in the IM group (100 vs. 22% in the IT group). The incidences of complications were not significantly different between the two groups. Conclusion: It is safe and effective to conduct single-injection IM peribulbar blockade using a small needle size and low anesthetic volume.

Background: The purpose of this study was to assess the effect of adding low dose rocuronium to local anesthetic solution on the quality of peribulbar blockade for vitreoretinal (VR) surgery. Methods: 80 consecutive adult patients scheduled for VR surgery were enrolled in this double-blind randomized clinical trial. Patients were categorized randomly into 2 equal groups: group C (control group) received local anesthetic mixture (4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and hyaluronidase ''30 U/ml") plus 0.5 ml normal saline, and group S (study group) received the same local anesthetic mixture plus 5 mg (0.5 ml) rocuronium. Globe and lid akinesia were assessed 15 min after injection, and supplemental peribulbar blockade was done in case of inadequate analgesia and or akinesia. Intraoperatively, supplementary sub-Tenon infiltration was performed in case of inadequate analgesia and/or akinesia. Measurement data included rate of supplementation, analgesic efficacy, time to first sub-Tenon infiltration, and total anesthetic volume. Major complications, and patient's and surgeon's satisfaction were also recorded. Results: The adequacy of peribulbar blockade 15 min after injection was comparable in both groups. Rate of supplementary sub-Tenon infiltration was lower in the rocuronium group which is statistically significant (15 injections versus 53 injections in the control group). Time to first sub-Tenon infiltration was significantly prolonged in the rocuronium group (90.4 + 11.8 versus 60.2 + 9.2 in the control group). The total anesthetic volume injected was significantly lower in the rocuronium group (13.2 + 0.6 versus 20.6 + 0.8 in the control group). There were no major systemic or local complications in both groups. Patient's and surgeon's satisfaction was significantly higher in the rocuronium group. Conclusion: Adding low dose rocuronium to local anesthetics prolongs duration of peribulbar anesthesia and offers an optimal surgical condition without serious adverse effects for patients undergoing VR surgery.

Background: Endotracheal intubation for cervically unstable patients remains a challenging procedure. We compared the utility of a relatively new promising airway tool ''GlideScope" (GL) with the routinely used McCoy laryngoscope in our critical care unit. Methods: Forty intubated patients with suspected or proved cervical spine injury who were scheduled for replacing a conventional endotracheal tube (ETT) by ETT with subglottic suction facility were enrolled in this randomized controlled trial. Patients were randomly intubated using either GL ''G group" or McCoy laryngoscope ''M group". The first attempt was performed by anesthetic residents inexperienced in using both scopes. In case of failure, a second attempt was done by a consultant anesthetist using these tools masterly. If these two attempts failed to intubate the trachea, a third one was attempted using a fiberoscope by the same consultant anesthetist. We compared the intubation profiles of both scopes. Results: There was a higher success rate of primary intubation attempts among the G group population (85% versus 55% in the M group ''P value 0.03"). Moreover, all secondary intubation attempts succeeded in intubating the trachea. The mean time for primary intubation attempts was statistically longer in the M group (27.6 ± 2.7 S versus 19.8 ± 5.2 S in the G group ''P value < 0.001"). However, there was no statistical difference as regards the mean time of intubation among the study population during the secondary intubation attempts. The Cormack and Lehane score and the percentage of required optimization maneuvers were significantly higher in the M group for both attempts. Conclusion: In critical care setting, GL is an excellent primary intubating tool for patients with potential cervical spine instability even if being performed by inexperienced users.