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PubMed2006

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint.

AIM: To determine in detail the complications associated with the use of mandibular repositioning splints (MRS) to treat sleep-related breathing disorders. METHOD: This prospective cross-sectional cohort study audits the management with mandibular repositioning splints of 121 patients suffering from sleep-related breathing disorders. Investigation of patients' and sleeping partners' perspectives on treatment was undertaken with the use of a questionnaire based study. RESULTS: Sixty-eight per cent of respondents reported that they were compliant with treatment; various side effects were reported of which excess salivation was the most common. Investigation of sleeping partners' perspectives revealed that 70% felt that their partners' snoring was improved and 47% felt that their partner's breathing pauses during sleep were reduced. Sixty-four per cent of the sleeping partners also reported that their own sleep pattern had improved since their partner's treatment. CONCLUSION: Mandibular repositioning splints used in the manner described by this paper are demonstrated to have a good compliance rate, provide successful treatment and exhibit only minor, reversible side effects.

Adult↗
PubMed2005

Randomized controlled trial of pilocarpine hydrochloride for the moderation of oral mucositis during autologous blood stem cell transplantation.

Pilocarpine hydrochloride has been reported to increase salivation and decrease oral mucositis in patients receiving head and neck radiotherapy, but there is only one report of its use in a cancer chemotherapy patient population. This prospective, double-blinded, randomized, placebo-controlled trial was undertaken to determine the efficacy of pilocarpine for the moderation of oral mucositis during autologous blood stem cell transplantation. Subjects were randomized to receive a 5 mg tablet of pilocarpine, or a placebo, during and following chemotherapy. Subjects were seen every other day and evaluated for gingival, oral, and oropharyngeal mucositis; nutrition; oral hygiene; eating; speaking; sleeping; pain at rest and/or with swallowing; and mouth dryness. We recorded the mean and highest scores and duration of problems, along with white blood cell counts and differentials, and the use of systemic narcotics for oral mucosal pain. We enrolled and randomized 36 subjects, and there were no statistically or clinically significant differences for the primary outcome of severity of mucositis and no clinically significant differences in any of the other outcome measures. Pilocarpine has no benefit for the moderation of the incidence, severity, or duration of mucositis in patients receiving autologous blood stem cell transplantation.

Adult↗
PubMedDate not supplied

Acute health effects of organophosphorus pesticides on Tanzanian small-scale coffee growers.

Acute health effects of organophosphorus (OP) pesticides on coffee farmworkers in 1991-1992 in Tanzania are reported to provide a basis for concern over farmworkers being overexposed during application. Workers exposed to OP pesticides (N=133) were drawn from a population of about 240,000 coffee farmers. They were interviewed on symptoms and personal protection, and their erythrocyte acetylcholinesterase (AChE) activity was determined during both spraying and nonspraying period. AChE activities during spraying and nonspraying period were comparable (mean 32.0, SD 7.8 vs. 33.0, SD 8.7 U/g HgB, P=0.26). The prevalence of cough, headache, abdominal pain, excessive sweating, nausea, excessive salivation, diarrhea, and vomiting did not differ significantly between spraying and nonspraying periods. There was no suggestion of decreased AChE in exposed subjects who complained of OP-related symptoms compared to symptomless exposed subjects. Use of gloves, long boots, head cover, face cover, and coverall was not significantly associated with AChE activity. No marked AChE depression was found during spraying season, which may explain the lack of association between symptoms and AChE. The fact that only moderately toxic OP pesticides were used may indicate that toxicity was not sufficiently high to cause depression. Experience, however, suggests that occupational poisoning remains a potential serious danger in coffee cultivation in Tanzania.

Abdominal Pain↗
PubMed1999

The use of atypical antipsychotics in the management of schizophrenia.

Long-term drug treatment of schizophrenia with conventional antipsychotics has limitations: an estimated quarter to one third of patients are treatment-resistant; conventional antipsychotics have only a modest impact upon negative symptoms (poverty of thought, social withdrawal and loss of affect); and adverse effects, particularly extrapyramidal symptoms (EPS). Newer, so-called atypical, antipsychotics such as olanzapine, risperidone, sertindole and clozapine (an old drug which was re-introduced in 1990) are claimed to address these limitations. Atypical agents are, at a minimum, at least as effective as conventional drugs such as haloperidol. They also cause substantially fewer extrapyramidal symptoms. However, some other adverse effects are more common than with conventional drugs. For example, clozapine carries a significant risk of serious blood disorders, for which special monitoring is mandatory; it also causes troublesome drowsiness and increased salivation more often than conventional agents. Some atypical agents cause more weight gain or QT prolongation than older agents. The choice of therapy is, therefore, not straightforward. At present, atypical agents represent an advance for patients with severe or intolerable EPS. Most published evidence exists to support the use of clozapine, which has also been shown to be effective in schizophrenia refractory to conventional agents. However, the need for compliance with blood count monitoring and its sedative properties make careful patient selection important. The extent of any additional direct benefit offered by atypical agents on negative symptoms is not yet clear. The lack of a depot formulation for atypical drugs may pose a significant practical problem. To date, only two double-blind studies in which atypical agents were compared directly have been published. Neither provides compelling evidence for the choice of one agent over another. Atypical agents are many times more expensive than conventional drugs. Although drug treatment constitutes only a small proportion of the costs of managing schizophrenia, the additional annual cost of the use of atypical agents in, say, a quarter of the likely U.K. schizophrenic population would be about 56 M pound sterling. There is only limited evidence of cost-effectiveness. Atypical antipsychotics are not currently licensed for other conditions where conventional antipsychotics are commonly used, such as behaviour disturbance or dementia in the elderly. Their dose, and place in treatment in such cases have yet to be determined.

Antipsychotic Agents↗
PubMed2000

Analgesic, behavioural and cardiopulmonary effects of epidurally injected medetomidine (Domitor) in goats.

This study was carried out in order to evaluate the analgesic, sedative, immobilizing and cardiopulmonary effects of medetomidine in goats after lumbosacral epidural injection of three (10, 20 and 30 micrograms/kg body weight) doses. The volume of the injection for all three medetomidine doses was 5 ml in sterile water. Seventeen clinically healthy, Small East African goats of either sex and weighing between 12 and 22 kg (mean +/- SD; 14.8 +/- 2.5 kg body weight) were used. The animals were randomly assigned to two groups. Seven goats were used for evaluating analgesic, behavioural and cardiopulmonary effects while 10 were used for experimental surgery. The cardiopulmonary values and rectal temperature were determined and recorded at time 0 (preinjection) and at 5, 10, 15, 20 and 30 min, and thereafter at 15-min intervals up to 180 min after injection. Analgesia of the flank and perineum was determined at time 0 (preinjection) and at 5, 10, 15, 30, 60, 120 and 180 min using a scoring system. The spread of analgesia to the thorax, neck, forelimbs and head was also determined and recorded. The onset and duration of lateral recumbency was noted and recorded. Medetomidine at the given doses induced variable cardiopulmonary depression, which was not detrimental to the animals. All three doses (10, 20 and 30 micrograms/kg) of medetomidine induced adequate analgesia of the flank and perineum. Analgesia extended to the thorax, forelimbs, neck and head. The duration of lateral recumbency was 136 and 166 min for the 20 and 30 micrograms/kg medetomidine doses, respectively. The duration of lateral recumbency was not determined for the animal given 10 micrograms/kg medetomidine. Signs of sedation (lowering of the head, drooping of the lower lip, partial to complete closure of the eyes and salivation) were noted after administration of all three doses. It can be concluded from this study that all three doses induced adequate analgesia of the flank and perineum. Surgical analgesia of the flank of goats was achieved after lumbosacral epidural administration of 20 micrograms medetomidine/kg, diluted in 5 ml of sterile water. Surgery was not performed with the other doses (10 and 30 micrograms/kg) of medetomidine.

Adrenergic alpha-Agonists↗
PubMed2003

Sheep-associated malignant catarrhal fever involving 3-5-week-old calves in Saudi Arabia.

Between late December 1999 and late April 2000, three locally bred Friesian calves (ageing 25, 28 and 35 days) in a dairy farm, at Al-Ahsa locality of the eastern region of Saudi Arabia showed dullness and inappetence. Their rectal temperatures ranged between 41 and 41.5 degrees C. One to 2 days later and onwards, the calves showed lacrimation, nasal discharge, salivation, oedema of the head, conjunctivitis, exo-ophthalmia and corneal opacity. One calf showed diarrhoea. The superficial lymph nodes were oedematous and swollen. The calves died after 7, 5 and 8 days, respectively, following the onset of the disease. Calves and rabbits were experimentally infected with materials from the naturally infected calves. The rabbits showed fever, mild conjunctivitis and one rabbit showed wet faeces. The experimentally inoculated calves showed rise in temperature and mild symptoms but none of them died. The virus from the naturally infected calves and from the experimentally infected rabbits was identified as malignant catarrhal fever (MCF) virus using both the complement fixation test and the fluorescent antibody test, employing a reference anti-serum against the WC 11 strain of MCF virus. Serological survey for MCF antibodies in cattle, sheep and goats from the affected farm revealed that 54% of the examined animals were positive. The situation of MCF in Saudi Arabia was discussed in relation to sheep and wild game. This paper constitutes the first report of MCF in Saudi Arabia and the Gulf region.

Animals↗
PubMed2000

Effect of fentanyl on baroreflex control of circumflex coronary conductance.

1. Fentanyl, a synthetic mciro-opioid receptor agonist, is the preferred induction and maintenance anaesthetic agent in cardiac surgery. 2. Its actions on myocardial blood flow are poorly understood. There are reports of intra-operative myocardial ischaemia. Its reported actions on cardiorespiratory control vary widely, but do involve hypertension, bradycardia and peripheral vasoconstriction. 3. Accordingly, the postulate that fentanyl would cause coronary vasoconstriction and myocardial disadvantage was examined in awake dogs with a continuous wave Doppler flow probe mounted on the circumflex coronary artery. 4. Continuous intravenous infusion of fentanyl citrate (550 ng/kg per min) raised plasma concentrations of fentanyl to 3.37 ng/mL in a linear fashion at 20 min. There was a fall in core temperature of 0.7 degrees C and, although no apparent depression of ventilation or fall in arterial or coronary sinus PO2, there was a rise in PCO2 and H+ concentration. Some dogs salivated and panted transiently. Thus, fentanyl may reset temperature regulation in low doses but, at higher doses, is associated with metabolic acidosis. 5. In sinus rhythm, the arterial pressure of the dogs fell slightly, then rose to 115% of resting control. Circumflex flow and conductance rose early, then conductance steadily declined to 83%. Heart rate fell, then rose before returning to pre-infusion levels. The early circumflex coronary vasodilator effects, but not the later vasoconstrictor effects, were reduced in dogs with paced hearts. 6. In dogs with paced hearts, a dose-effect study using 138, 275, 550 and 1100 ng/kg per min fentanyl suggested that, at low plasma concentrations of 1-2 ng/mL, vasodilatation does occur in both coronary and systemic circulations; however, at higher doses, intense coronary and systemic vasoconstriction supervenes. 7. The dose-response effect of fentanyl on arterial baroreflex control of circumflex conductance was examined during the immediate 8 s circumflex vasodilator response to a step rise in aortic pressure caused by inflation of an intra-aortic balloon. At low plasma concentrations of fentanyl, baroreflex control of circumflex conductance appears to be enhanced but, with increasing plasma concentrations of fentanyl, appears to be depressed. 8. Therefore, the effects of fentanyl are dose dependent. At low plasma concentrations, left ventricular blood flow and its baroreflex control is enhanced but, at higher concentrations, it is depressed.

Analgesics, Opioid↗
PubMed2001

Ketamine sedation for children in the emergency department.

OBJECTIVE: To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department. METHOD: A medical literature search was performed along with a review of existing ketamine-use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty-eight children aged 1.5-12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3-4 mg/kg) or i.v. (dose 1.00-2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases. RESULTS: Onset of sedation was rapid (range 1-7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67-180 min) from time of drug administration. Side-effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1-3 days after the sedation, no delayed adverse events were reported. CONCLUSION: Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department.

Adjuvants, Anesthesia↗
PubMed2000

Role of corticotropin-releasing factor receptor-1 in opiate withdrawal.

Previous studies indicate that corticotropin-releasing factor (CRF) contributes to the anxiety-like and aversive states associated with drug-induced withdrawal. The present study extends this work by analyzing the CRF receptor subtype involved in withdrawal responses. First, the influence of a selective CRF receptor-1 (CRF-R1) antagonist, CP-154,526, on opiate withdrawal behavior was examined. Pretreatment with the CRF-R1 antagonist significantly attenuated several behavioral signs of naltrexone-induced morphine withdrawal, including writhing, chewing, weight loss, lacrimation, salivation, and irritability, measured during the first hour of withdrawal. Next the expression of CRF-R1 was determined as a second measure of the involvement of this receptor in opiate withdrawal. Naltrexone-induced morphine withdrawal resulted in down-regulation of CRF-R1 mRNA in several brain regions, including the frontal cortex, parietal cortex, striatum, nucleus accumbens, and amygdala, but not in the hypothalamus or periaqueductal gray. Expression of CRF-R2, the other major CRF receptor subtype, was not down-regulated significantly by withdrawal in any of the regions examined, although morphine alone significantly increased levels of this receptor subtype. Taken together, the behavioral and receptor regulation findings indicate that CRF-R1 is the primary mediator of the actions of the CRF system on opiate withdrawal, although it is possible that CRF-R2 contributes to the response.

Animals↗
PubMed2001

Extra-pyramidal parkinsonism complicating organophosphate insecticide poisoning.

We present a 1 7-year-old female with acute extra-pyramidal parkinsonism complicating a suicidal attempt with the organophosphate insecticide chlorpyrifos, who was initially suspected to have developed severe depression or psychosis. On admission she was stupurous, with diarrhoea and massive salivation lapsing into respiratory failure and coma. Following atropine and toxogonin treatment along with mechanical ventilation she developed overt extrapyramidal parkinsonism and encephalopathy, characterized by impaired sensorium and agitation, mask facies along with a muffled voice and swallowing impairment, a resting tremor with cogwheel rigidity switching to bradykinetic choreoathetotic movements. Once a parkinsonian syndrome was diagnosed, she was given amantadine therapy with complete recovery. The patient is presently maintained on amantadine therapy; there was mild worsening of her extrapyramidal signs following unplanned discontinuation of this medication, and on follow-up assessments after 9 months she is virtually asymptomatic. A parkinsonian extrapyramidal syndrome, complicating organophosphate intoxication, should therefore also be taken into account in any patient with organophosphate poisoning, presenting with marked behavioural alterations, rigidity or akinetic mutism, and beneficial response to amantadine.

Adolescent↗
PubMed2000

Hypoglycaemic brain lesions in a dog with insulinoma.

A 5-year-old female Collie dog showed excessive salivation, vomiting and neurological signs, including hind-limb weakness, mental dullness and subsequent recumbency with paddling movements of the limbs. Blood glucose and insulin concentrations were 35 mg/dl and 70.0 microU/ml, respectively. At necropsy, two masses, one at the caudal edge of the pancreas and the other in the omentum, were found and diagnosed as insulinoma. Histological examination of the brain showed early signs of acute neuronal necrosis exclusively in the superficial layers of the cerebral cortex, in addition to spongy changes in the dentate gyrus of the hippocampus. The light microscopical findings were identical in character and distribution with those of naturally occurring hypoglycaemia in humans and experimentally induced hypoglycaemia in animals.

Animals↗
PubMed2002

Congenital cricopharyngeal achalasia: Diagnosis and surgical management.

BACKGROUND: Congenital cricopharyngeal achalasia is a rare condition in which a newborn presents with dysphagia, choking, nasal reflux, and salivation. Awareness of this condition is important because simple myotomy of the cricopharyngeus muscle often solves the problem. METHODS: The diagnosis and the surgical management of cricopharyngeal achalasia were reviewed based on 4 cases experienced over the last 13 years. RESULTS: The severity of the symptoms and the age of onset were dependent on the severity of achalasia. The cine-fluoroscopic swallow is an important diagnostic procedure. Surgery should be performed early enough for infants to learn how to swallow properly. The surgical procedure involves complete myotomy of cricopharyngeus, allowing the submucosa of the esophagus to bulge out in the posterior midline region. Postoperatively, nasopharyngeal reflux may resolve immediately or decrease over several months, depending on the timing of surgical intervention and the patient's ability to learn the act of swallowing. CONCLUSIONS: Early surgical intervention for this disease is recommended to achieve early recovery from dysphagia and to establish buccopharyngeal swallowing during the appropriate period of development.

Child↗
PubMed2002

Development of a clinical syndrome resembling haemorrhagic septicaemia in the buffalo following intravenous inoculation of Pasteurella multocida serotype B:2 endotoxin and the role of tumour necrosis factor-alpha.

Clinical changes and acute phase responses, including tumour necrosis factor-alpha (tnfalpha), in six buffalo calves were examined following intravenous inoculation of a bolus of endotoxin (1 microg kg(-1) bodyweight in 10 ml of phosphate-buffered saline [ pbs ]) extracted from Pasteurella multocida serotype B:2, the bacterium responsible for haemorrhagic septicaemia (hs) in Asia. Endotoxin injection caused a rapid onset of clinical signs characterised by dullness, sternal recumbency, elevated rectal temperatures, excessive salivation and dyspnoea that lasted for up to 12 hours post-inoculation (p.i.). Serum concentrations of tnfalpha rose within 1 hour p.i. to reach peak values ranging between 8 and 140 ng ml(-1) at 1-2 hours p.i. and then declined rapidly to baseline levels 3-5 hours p.i. Endotoxin injection induced other acute phase changes, including a rapid leucopenia and reductions in the serum concentrations of iron and zinc and a delayed but prolonged increase in haptoglobin from 12 hours p.i. that reached a plateau from about 60 hours p.i. Three control calves injected with 10 ml pbs showed no clinical or blood compositional changes. By reproducing key signs of hs the work confirms a pivotal role of endotoxin in the pathogenesis of hs and emphasises the exquisite sensitivity of the buffalo to P multocida endotoxin.

Animals↗
PubMed2002

A retrospective study of oesophageal endoscopy in cattle - oesophagoscopy for diagnosis of mucosal disease.

Oesophageal endoscopy in cattle has been rarely reported in the literature. It has, however, been used for many years as an aid to the diagnosis and treatment of illnesses of the upper gastrointestinal tract in small animals and horses. We have assessed the potential value of oesophagoscopy on 120 bovine patients presented at the 2nd Medical Clinic for Ruminants and Swine at the University of Veterinary Medicine, Vienna, over a period of three years. In the course of the study, cattle exhibiting symptoms such as salivation, regurgitation or swelling in the neck region were referred for endoscopic examination. The main indication was to confirm or exclude bovine virus diarrhoea virus infection in calves, in which typical erosions were visible endoscopically on the mucosa of the oesophagus in infected animals. In addition, endoscopy proved to be useful for the diagnosis of diverticula, ruptures and inflammation of the oesophagus. Oesophagoscopy can be considered to be a valuable supplementary aid to clinical examination and, in many cases, can facilitate diagnosis.

Animals↗
PubMed2004

Fertility study of the new pyrazolopyrimidinone derivative DA-8159 for erectile dysfunction in rats.

DA-8159 (5-[2-propyloxy-5-(1-methyl-2-pyrrolidinylethylamidosulfonyl)phenyl]-1-methyl-3-propyl-1,6-dihydro-7H-pyrazolo(4,3-d)pyrimidine-7-one, CAS 268203-93-6) is a new pyrazolopyrimidinone derivative for the treatment of erectile dysfunction. The test agent was administered by gavage at dose levels of 0, 17.5, 70, and 280 mg/kg to Sprague-Dawley male rats from 28 days before mating to the end of the mating period, and to females from 14 days before mating to day 6 of gestation. Effects of the test agent on general findings and reproductive performance of parent animals and on early embryonic development were examined. At 280 mg/kg, salivation and hair loss were observed at a high incidence in males and females, respectively. One female out of 24 died during the treatment period. A decrease in food consumption and a decrease in body weight were observed in both sexes. No treatment-related gross findings and histopathological findings were seen, except that the dead animal exhibited atrophy of the thymus. A decrease of prostate weight and an increase of liver, lung and spleen weights were seen. An increase in the period and irregularity of sexual cycle was observed. A decrease in fertility and pregnancy index was also seen. A decrease in the number of corpora lutea, implantations, and litter size was observed. There were no treatment-related changes in precoital time, mating index, sperm parameters, and serum testosterone concentration. At 17.5 mg/kg and 70 mg/kg, there were no adverse effects on all the parameters examined. Based on these results, DA-8159 induces suppressed body weight, decreased food consumption, irregularity in sexual cycle, reduced fertility, and decreased number of corpora lutea, implantations, and litter size at 280 mg/kg and no observed adverse effect levels (NOAELs) of DA-8159 are considered to be 70 mg/kg for general toxicity and reproductive capability of parent animals and for early embryonic development, respectively.

Abnormalities, Drug-Induced↗
PubMed2002

General pharmacological profile of the novel muscarinic receptor agonist SNI-2011, a drug for xerostomia in Sjögren's syndrome. 1st communication: effects on general behavior and central nervous system.

A novel muscarinic receptor agonist, SNI-2011 ((+/-)-cis-2-methylspiro[1,3-oxathiolane-5,3'-quinuclidine] monohydrochloride hemihydrate, cevimeline, CAS 153504-70-2), is a candidate therapeutic drug for xerostomia in Sjögren's syndrome. The general pharmacological properties of this drug on general behavior and the central nervous system were investigated in mice, rats and cats. 1. General behavior: When SNI-2011 was administered orally to mice at 100 mg/kg, mydriasis, a decrease of spontaneous motor activity, tremor, convulsions, salivation, abnormal posture, abnormal gait, reduced grip strength and reduced response against external stimulating were observed, and 2 out of 6 animals died. At 10 mg/kg or lower, no particular sign was observed except mydriasis, which appeared to be caused via the peripheral muscarinic acetylcholine receptors. 2. Central nervous system: SNI-2011 had no effect on the motor coordination in mice. Hypothermia was observed in rats and reduced spontaneous motor activity, analgesia and enhanced maximum electroshock-induced convulsions were observed in mice after oral administration of 30 mg/kg SNI-2011. Slight increase in the rate of theta-wave band in the hippocampal EEG of rats and spinal multisynaptic reflexes in cats were observed after intravenous injection of 10 mg/kg SNI-2011. At an oral dose of 10 mg/kg, prolongation of thiopental-induced sleeping time in mice was observed. The prolongation of sleeping time was inhibited by a peripheral muscarinic antagonist. These results suggest that SNI-2011 has muscarinic effects on general behavior and the central nervous system at the doses approximately 10-fold higher than the effective doses needed for saliva secretion.

Anesthetics, Intravenous↗
PubMed2004

[Otosialorrhoea - diagnostics and therapy of a salivary fistula of the external auditory canal].

PATIENT: We report the case of a 49 year old female patient who suffered from frequent secretion of the left external canal of the ear after the treatment of a chronic mycotic otitis externa. The secretion was seen in connection with food intake. An operative revision in another hospital remained without success. The diagnostics covered the biochemical verification of saliva-amylase in the secretion, but also a high resolution MRI of the parotid gland. By this diagnostics it was easy to locate the salivary fistula during the operation. DISCUSSION: Salivary fistulas of the parotid gland to the external ear-canal are very rare. These fistulas develop after injury of the parenchyma or the gland ductus and also after surgery of the head- and neck-region. A otosialorrhoea rarely originates from a chronic inflammatory of the ear canal. These fistulas are assigned to the fissures of Santorini and the foramen of Huschke. The therapy of salivary fistulas to the external ear canal reaches from clossure of the fistula to total parotidectomy. But also a medicamental suppression of salivation, irradiation and a tympanic neurectomy are discussed in the literature.

Chronic Disease↗
PubMed2005

[The applicability of the ProSeal laryngeal mask airway for laparotomies].

OBJECTIVE: The ProSeal laryngeal mask airway (PLMA) has some design features, which in contrast to the classic LMA allow separation of the respiration from the gastrointestinal canal, a higher leak pressure and a better position assessment. It can be debated if these instrumental improvements justify the application of the PLMA for elective abdominal surgery in cases without aspiration risk. Insertion of airway instruments and gastric tube with regard to insertion time and difficulties and frequency of side effects were to be compared for the tracheal tube and the PLMA. The pharyngolaryngeal morbidity for both methods was also of interest. It was approached with direct and indirect postoperative interview techniques. METHODS: 65 patients were investigated both at the university hospital and at the hospital Neu-Bethlehem in Goettingen. The surgical intervention was a surgical or gynecological laparotomy. Anaesthesia was performed with a standardized application of propofol, alfentanil and rocuronium. Glycopyrroniumbromide was applied to minimize salivation. A total of 34 patients received the PLMA, 31 were intubated. All of them were provided with a gastric tube. RESULTS: The insertion of the PLMA took 70 seconds (21 - 234) on average, the intubation 57 seconds (35 - 145). Endotracheal intubation was accomplished in a shorter time period, but there was no significant difference in comparison with the PLMA-group (p = 0.1924). Insertion of the PLMA was significantly more difficult than oral intubation (p = 0.0006). The base of the tongue and the dorsal pharyngeal wall, but not the vocal cords or the epiglottis were visible in those cases, where the PLMA could not be positioned at all. Here the tip of the cuff was bended. The time period for positioning of the gastric tube was 38 seconds (15 - 75) in the PLMA- and 57 seconds (22 - 219) in the tracheal tube group. With these results the gastric tube positioning was accomplished in a significantly shorter time period in the PLMA-group (p = 0.0267), but not at a significantly higher level of difficulty for endotracheal intubation (p = 0,6247). In one case there was regurgitation through the drainage tube without aspiration before gastric tube placement. At the direct interview 16 patients in the PLMA-group and 23 of the tube group mentioned postoperative throat symptoms. The most frequent symptom was hoarseness (11 PLMA- and 18 intubated patients). There was no significant difference between PLMA- and tracheal tube application with regard to the total number of patients with pharyngolaryngeal morbidity and the frequency of single symptoms. The same is true for the degree of the symptoms. There was a tendency for a longer prevalence of throat symptoms after intubation, but no significant difference. CONCLUSION: In this investigation the PLMA could be successfully applied for elective laparotomies in cases without the risk of aspiration. Proper patient selection and a deep level of anaesthesia are important. The advantage for patients receiving the PLMA is a smooth recovery without cough, but not so much a reduced amount of pharyngolaryngeal morbidity. From this observation it might be concluded that the invasiveness of the surgical intervention might also influence the tolerance for the airway instrument. The disadvantage in this study was the more difficult insertion of the PLMA compared with the oral intubation. Further studies with a larger number of patients must show if these first results of the "Proseal"-LMA for lararotomies are to be confirmed.

Adolescent↗