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Background Spine surgery needs a special consideration as regards minimizing the movement during intubation to avoid the hazards to spinal cord. The present study aims to highlight the preferable technique for cervical intubation. The Intubating Laryngeal Mask Airway (ILMA, Fastrach™ laryngeal mask company, Henle-on-Thomes, U.K.) is a supraglottic device specially designed to be an effective ventilator device and blind intubation guide in patient with normal and abnormal airways. Methods 40 patients were involved and randomly assigned to two equal groups according to the used technique of endotracheal intubation: (Group 1): Intubating Laryngeal Mask technique and (Group 2): Direct laryngoscopy technique. Anesthesia was induced using a combination of 1 μg/kg fentanyl, 5 mg/kg thiopental sodium (sleeping dose) and atracurium 0.5 mg/kg (Intubating laryngeal Mask or the Macintosh blade) was used to secure the airway according to the patient group. Meanwhile a continuous videofluoroscopy was recorded. The radiographs were analyzed for movements in the cervical segments C1/2 and C2/3. A reference line was drawn following the dorsal alignment of C2. Another two lines, one connecting the anterior and posterior arch of C1, and one through the basal plate of C3, were drawn to transect the above mentioned reference line. Results The mean cervical spine extension at C1/C2 was 77.2 ± 3.5 before intubation, 74.8 ± 4.3 during intubation, and 75.9 ± 4.2 after intubation for group 1, while it was 74.95 ± 4 before, 65.9 ± 4.4 during, and 68.75 ± 3.9 after intubation for group 2 there was statistically significant difference between LMA group (group 1) and direct laryngoscopy group (group 2) in the motion of cervical spine extension at C1/C2 during and after intubation where the p -value was Conclusion The ILM (Fastrach) is a satisfactory alternative to the currently used methods of airway management in cervical spine injuries and reduces movement of the cervical spine.

BackgroundHyperglycemia is common among critically ill patients and is associated with increased morbidity and mortality and there is no clear answer to the question: which to apply tight or conventional glycemic control?ObjectiveEvaluation and comparison of the effects of tight versus conventional glycemic control on critically ill patients in our surgical intensive care unit (ICU).DesignProspective randomized controlled trial.Methods120 Patients were divided into two groups: group (I) received intensive insulin therapy targeting blood glucose level between 80 and 110mg/dl, who referred to as intensive treatment group, and group (II) received conventional insulin therapy targeting blood glucose level between 150 and 200mg/dl, and referred to as conventional treatment group.Results120 Patients were enrolled in the study, the incidence of hypoglycemia (blood glucose

Objective To evaluate the effect of general anaesthesia with either continuous i.v. opioids (G/O) or thoracic epidural analgesia (G/EP) on postoperative transient myocardial ischaemia (TMI) in type 2 diabetic patients undergoing open cholecystectomy. Methodology This randomised controlled study was conducted on 50 patients with D.M. Patients were divided into G/O group or G/EP group. All patients had negative stress exercise test and at least two cardiac risks preoperatively. Epidural analgesia was established by 15 ml of ropivacaine 0.2% with fentanyl 2 μg/ml followed by 5–8 ml/h of ropivacaine 0.1% with fentanyl 1 μg for 24 h postoperatively. Both studied groups received same general anaesthesia. Continuous i.v. fentanyl 100 μg/h was given intraoperatively in group G/O followed by i.v. morphine PCA. Primary outcome measured postoperative TMI using 24 h continuous ST segment analysis, endothelin-1(ET-1), troponin T, creatine kinase MB (CK-MB), and CKMB/CK preoperatively, 8 h and 24 h postoperatively. Second outcome measured dynamic stress (perioperative heart rate, blood pressure and postoperative pain). Results Endothelin-1 was above cutoff level preoperatively and rose up dramatically postoperatively in both studied groups. G/EP attenuated ET-1 elevation than G/O. Troponin T and CK-MB did not rise postoperatively in both studied groups. Postoperative CK-MB/ CK ratio was higher than 10% in 12 and eight patients in group G/O and G/EP, respectively. Twelve cardiac ischaemic events were noticed in four patients in group G/O and four events in two patients in group G/EP without significant difference in total duration of ischaemia between groups. G/EP lowered HR more significantly intraoperatively and gave better pain control for 4 h postoperatively. In conclusion, D.M was associated with high ET-1 level. Upper abdominal surgery increased ET-1 release. G/EP attenuated ET-1 release more than G/O and produced more stable haemodynamic parameters and less postoperative pain. No superior cardioprotective effect was noticed in G/EP over G/O.