Anesthesiology and pain medicine
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Laryngoscopy and tracheal intubation lead to the alteration of hemodynamic parameters, including blood pressure and heart rate, in traumatic patients who sustain rapid sequence intubation (RSI). Various drugs such as fentanyl, alfentanil and sufentanil have been used to modify these hemodynamic responses. ⋯ Alfentanil, fentanyl and sufentanil can be used safely as premedication drugs for trauma patients who need intubation.
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The Glide Scope videolaryngoscope provides a suitable view for intubation, with less force required. ⋯ The incidence and severity of sore throat and hoarseness after tracheal intubation by Glide Scope were lower than in the Macintosh laryngoscope. The incidence and severity of sore throat were increased by intubation and longer operation times.
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In the present review, the analgesic effects of lidocaine in acute or chronic painful conditions in the emergency department are discussed. Lidocaine, as a medium-acting local anesthetic with short onset time, is well-recognized, not only as a valuable medication for numerous neuropathic pain conditions, but also for the management of both acute and chronic pain. ⋯ The antinociceptive properties of lidocaine are derived from multifaceted mechanisms, turning it into a medication that is safe to administer via different routes which makes it available for use in a variety of medical conditions.
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Laryngospasm is the protective reflex of tracheobronchial tree against secretions and hemorrhage. This reflex is more prevalent in adenotonsillectomy in the presence of light anesthesia, which can lead to obstruction of airway, complications, and mortality. Different methods have been studied for preventing this complication; however, none of them could reliably prevent it. ⋯ Intravenous magnesium sulfate with dose of 15 mg/kg could not prevent laryngospasm and coughing after removal of the endotracheal tube in patients undergoing adenotonsillectomy; however, it reduced coughing and laryngospasm in the magnesium sulfate group compared with the control group.
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A common and useful approach to pain management is administration of neuraxial opioids. ⋯ Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia in cesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.