Intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery, with an increased time to first analgesic request and a decreased need for postoperative analgesia.
P Pu ur rp po os se e: : To describe a modified approach to intravenous regional anesthesia (IVRA) for operations on the knee joint.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 52-yr-old male presenting for knee arthroscopy was anesthetized by IVRA using only 40 mL of lidocaine 0.5%. After performing IVRA in the routine way an additional below knee tourniquet was used and inflated after local anesthetic exsanguination towards the knee. Operation was performed without the need for further analgesic.C Co on nc cl lu us si io on n: : The technique allowed the use of a small anesthetic volume for IVRA on the lower limb, thus decreasing the potential risk of local anesthetic toxicity. NTRAVENOUS regional anesthesia (IVRA) is a reliable and efficient technique with a lower cost than general anesthesia and well adapted for limb surgery in the ambulatory patient. 1,2 The use of potentially unsafe large doses of local anesthetic made the technique unpopular for operations on the lower extremity. 3 We describe a case of knee arthroscopy that was performed successfully under IVRA using 40 mL of 0.5% lidocaine isolated between two tourniquets applied above and below the knee. ObjectifC Ca as se e r re ep po or rt t A man aged 52 yr weighing 78 kg presented for arthroscopy of the knee joint. He had pain and swelling of the left knee. Preoperative orthopedic examination showed mild genu vara, knee crepitation and synovial thickening. Knee x-ray showed advanced osteoarthritic changes more on the patello-femoral articulation and medial compartment of the knee joint.On the preanesthetic visit the patient requested a regional technique and gave no history of medical problems except previous multiple level lumbar disc surgery. The proposed IVRA technique, which had been approved by the departmental Ethical Committee, was fully explained to him and his consent was taken. The patient was given 10 mg diazepam orally 90 min before surgery.The patient was placed on the operating table. An iv access was secured in the right forearm and routine monitors were applied. A double cuffed tourniquet was arranged over a soft padding above the knee joint and an 18-G plastic cannula was inserted on the dorsum of the foot (Figure 1a). The lower limb was exsanguinated with a rubber bandage (Figure 1b).The tourniquet was then inflated to 270 mmHg which is 100 mmHg above the limb occlusive pressure (LOP) as determined by photoplethysmograpic pulse wave
Background:Transesophageal echocardiography (TEE) in the cardiac lab is usually performed in pediatric patients under general anesthesia with an endotracheal intubation (ET). This study was performed to investigate the safety and efficacy of using the laryngeal mask airway (LMA) as an alternative to ET to maintain pediatric airway during the general anesthesia for TEE.Materials and Methods:A total of 50 pediatric patients undergoing TEE in the cardiac lab were randomized to have their airway maintained during the procedure with either LMA (LMA group) or ET (ET group). Hemodynamic, respiratory parameters, time to extubation, recovery time, the incidence of complication and operator satisfaction were compared between the two groups.Results:There were no differences between both groups in hemodynamic and respiratory parameters. Laryngeal spasm was reported in one patient in the LMA group and two patients in the ET group. TEE operators were equally satisfied with the procedure in groups. The time to extubation was shorter in the LMA group (P < 0.01). The mean recovery time was also significantly shorter in the LMA than in the ET group (44 ± 8 min and 59 ± 11 min, respectively; P < 0.001).Conclusion:The LMA is safe and effective in securing the airway of children undergoing diagnostic TEE.
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