Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson&#x2019;s disease (PD). Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1&#x2009;&#x3BC;g&#x2009;kg&#x2212;1 and mean infusion rate was 0.26&#x2009;&#x3BC;g&#x2009;kg&#x2212;1&#x2009;h&#x2212;1 (0.21) [mean total dexmedetomidine dose: 154.68&#x2009;&#x3BC;g (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68&#x2009;mg&#x2009;kg (0.84) [mean total propofol dose: 117.72&#x2009;mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation). Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier <a target="_blank" href="http://clinicaltrials.gov/ct2/results?term=01789385">NCT01789385</a>.

Onur Ozlu

Sema Sanalbas

Dilek Yazicioglu

Gulten Utebey

Ilkay Baran

Sedation and Regional Anesthesia for Deep Brain Stimulation in Parkinson&#x2019;s Disease

Background. In this pilot study, we evaluated tip collisions against three commonly used measures of fibreoptic scope handling skills. Methods. Seventy-seven anaesthetists were recruited to perform a standardized task on an Oxford Box and a modified AirSim manikin. Collision count was correlated against time to scope placement, a global rating scale score, and up-to-date fibreoptic experience. Results. Strong and moderate correlations were found between collision count and task completion time for the Oxford Box (&#x3c1; = 0.730, P &#x3c; 0.0001) and AirSim manikin (&#x3c1; = 0.405, P &#x3c; 0.0001), respectively. Moderate correlation was found between collision count and global rating scale score for the Oxford Box (&#x3c1; = &#x2212;0.545, P &#x3c; 0.0001) and AirSim manikin (&#x3c1; = &#x2212;0.500, P &#x3c; 0.0001). Mild and moderate correlations were found between collision count and fibreoptic experience on the Oxford Box (&#x3c1; = &#x2212;0.240, P = 0.041) and AirSim manikin (&#x3c1; = &#x2212;0.423, P &#x3c; 0.0001), respectively. Conclusions. This study infers that collision count may be used as a measure of fibreoptic scope handling skills in simulation training. Using this outcome in addition to other measures of performance may improve accuracy and precision of fibreoptic scope placement.

Mari H. Roberts

Elizabeth K. Boucher

Michael Lim

Antony R. Wilkes

Iljaz Hodzovic

Evaluation of Tip Surface Collision Count as a Measure of Fibreoptic Scope Handling Skills: A Randomized, Cross-Over Manikin Study

Background. The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block. Method. Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs. Results. The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group. Conclusion. Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5&#x2009;mg/kg) as adjuvant to bupivacaine (0.25&#x25;) successfully decreased pain VAS and the need for analgesic drugs.

Ola T. Abdel Dayem

Mostafa M. Saeid

Olfat M. Ismail

Adel M. El Badrawy

Nevert A. Abdel Ghaffar

Ultrasound Guided Stellate Ganglion Block in Postmastectomy Pain Syndrome: A Comparison of Ketamine versus Morphine as Adjuvant to Bupivacaine

Objective. The ideal local anesthetic solution for intrathecal use has rapid onset and reliable duration, with less incidence of adverse events. This study was aiming to compare the onset of anesthesia and duration of action of isobaric and hyperbaric bupivacaine for subarachnoid block (SAB). Methods. Sixty patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups. Group I received 20&#x2009;mg of 0.5&#x25; isobaric bupivacaine, while Group H received 20&#x2009;mg of 0.5&#x25; hyperbaric bupivacaine. Injection was made intrattecally in midline position at L3-4 interspace in sitting position. 
Results. The onset of analgesia and motor blocks with isobaric was faster when compared to hyperbaric bupivacaine (4.8 &#xb1; 2.2 versus 7.5 &#xb1; 2.2 minutes and 4.1 &#xb1; 2.1 versus 6.4 &#xb1; 2.4 minutes, resp., <svg style="vertical-align:-0.30096pt;width:66.875px;" id="M1" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

		
	
</svg>). The duration of sensory and motor blocks was longer in isobaric when compared to hyperbaric bupivacaine (276 &#xb1; 30 versus 163 &#xb1; 22 minutes and 266 &#xb1; 32 versus 163 &#xb1; 24 minutes, <svg style="vertical-align:-0.30096pt;width:66.875px;" id="M2" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x31"/></g>

		
	
</svg>). In both groups, hemodynamic changes were not clinically relevant, and the adverse effects were comparable. Conclusion. Isobaric produced more rapid onset and longer duration when compared to hyperbaric bupivacaine.

Mochamat Helmi

Yusmein Uyun

Bambang S. Suwondo

Untung Widodo

Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery

Airway management is the foundation upon which anaesthesia is built, and fibreoptic intubation (FOI) is a key facet of this skill. Despite this, many trainee anaesthetists in the UK have been unable to perform sufficient FOIs to gain competence. We aimed to establish the incidence of FOI in adult patients, in a UK teaching hospital, in order to determine what FOI training opportunities actually exist. During the study period (from October 1st, 2008, to September 30th, 2009) an estimated 11&#x2009;712 general anaesthetics were undertaken that necessitated tracheal intubation. In 141 of these cases FOIs were performed giving an incidence of FOI of 1.2&#x25; (95&#x25; confidence interval 1&#x25;&#x2013;1.4&#x25;). Of these, 86 (61&#x25;) were in awake and 55 (39&#x25;) in anaesthetised patients. Only 16 (11&#x25;) of the FOIs were done solely for the purposes of training. We suggest that a greater number of FOIs should be undertaken to allow trainees to gain and consultants to maintain the FOI expertise necessary for the provision of safe anaesthesia.

M. D. Wiles

R. A. McCahon

J. A. M. Armstrong

An Audit of Fibreoptic Intubation Training Opportunities in a UK Teaching Hospital

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Journal of Anesthesiology