Tonsillectomy (±adenoidectomy) is performed for recurrent tonsillitis or obstruction of the upper airway. Post tonsillectomy pain cumulates within first postoperative days and decreases gradually following the fourth day in pediatric patients with many adverse effects on the patients with 1% readmission was reported due to dysphagia and dehydration. The present study has been planned to assess the analgesic effect of tonsillar bed infiltration of levobupivacaine compared to levobupivacaine and magnesium after tonsillectomy in pediatric patients. Eighty American Society of Anesthesiologists (ASA) I children aged 7-13 years scheduled for elective tonsillectomy (±adenoidectomy) were included in current study. The patients' Visual Analogue Scale (VAS) for pain were registered at 15th min after arrival to Postanesthesia Care Unit (PACU) and 1st, 2nd, 3rd, 6th, 12th and 24th h postoperatively. The time at the first analgesia request and additional analgesic requirements were also reported and patients were followed up for one week. Postoperative bleeding, infection, Post-Operative Nausea and Vomiting (PONV), abdominal pain, constipation, arrhythmia and allergic reactions were documented. Levobupivacaine plus magnesium gave significantly less VAS of pain in comparison to levobupivacaine alone at 12 and 24 h postoperatively. While this lower VAS of pain was found statistically non-significant at earlier periods of assessment. In addition, the time to first analgesic request was lengthened and total number of analgesic requests in the first 24 h were decreased in combined group when compared to levobupivacaine alone. In addition, laryngospasm significantly decreased in levobupivacaine plus magnesium group with no reported increase in complications. Adding magnesium to Levobupivacaine local infiltration in tonsillar bed is safe and significantly augments the analgesic effect of levobupivacaine after tonsillectomy in pediatric patients.

Background: Fiberoptic intubation requires long nasopharyngeal journey and mostly requiring jaw thrust to visualize larynx especially if done under general anesthesia. Use of split nasopharyngeal airway of appropriate length for better glottis visualization has been compared with the classic one. Methods: Adult 68 patients; ASA I and II; undergoing surgery under general anesthesia were allocated randomly and equally into CL group in which classic nasal FOI with jaw thrust was done and NP group in which appropriate length of SNPA was inserted nasally followed by insertion of the scope with the application of jaw thrust if needed. Preprocedural heart rate, blood pressure and saturation and every minute for 5 min and also procedure and endoscopy time required to visualize the larynx (T1 and T3 respectively), carina (T4) and to remove the scope (T5) were recorded. Results: Heart rate showed a statistically significant increase in CL and NP group during study time compared to pre-procedure reading. The MAP showed also statistical increase but only in CL group. There was a statistical (not clinical) significant increase between the percent of HR and MAP change in the CL group compared to NP group. T1, T3, and T5 in NP group were significantly shorter than in CL group but not for T4. Seven cases after SNPA needed jaw thrust. Conclusion: Use of SNPA is safe and effective in reducing time to visualize larynx and intubate trachea. Developing longer specific "Naso-laryngeal (not nasopharyngeal) FOB intubating aid" is assumed to be more appropriate.

Background: New intubating optical stylets that facilitate visualization have been developed to overcome obstacles faced with management of the difficult airway. Objective: The aim of the study was a comparison of the efficacy and safety of each of Levitan and Shikani optical stylets either used alone or with direct laryngoscopy for tracheal intubation. Methods: This study was carried out on two hundred ASA physical status I & II of both sex adult patients who were scheduled for elective surgery under general anesthesia with tracheal intubation. Patients were randomly classified according the used aid for endotracheal intubation into four equal groups (each one consisted of fifty patients). In group I (L/A), Levitan optical stylet was used alone for tracheal intubation with manual chin lift and in group II (L/L), Levitan optical stylet was used with a Macintosh laryngoscope aid to retract the base of the tongue. In group III (S/A), Shikani optical stylet was used alone and in group IV (S/L), Shikani optical stylet was used with the aid of Macintosh laryngoscope. Intubation success rate, intubation time and intubation related complications were recorded in each group. Results: Statistically, the patients of the four groups were similar in demographic data (age, sex, weight, height, mallampati grade, thyromental distance and interincisor gap). The overall intubation success rates of the four groups were statistically similar. The intubation time and the degree of difficulty in group I (L/A) were significantly lesser than in group III (S/A) and in group II (L/L) were significantly lesser than in group IV (S/L). Also the intubation time and the degree of difficulty in group II (L/L) were significantly lesser than in group I (L/A) and in group IV (S/L) were significantly lesser than in group III (S/A) (Table -2).The incidence of the various intubation related complications are statistically similar in the four groups. In conclusion: Levitan optical stylet with or without the aid of direct laryngoscopy is more effective than Shikani optical stylet with or without the aid of direct laryngoscopy for tracheal intubation with similar incidence of intubation related complications.