Controlled hypercapnia was assessed for its effectiveness in raising cerebrospinal fluid pressure to enable descent of the suprasellar portion of pituitary macroadenomas during transsphenoidal surgery. The result was compared in a randomized, single blind trial with intermittent boluses of saline injected intrathecally. Intrathecal pressures were monitored in both groups. Twenty-seven of 29 patients in the study group and 25 of 28 patients in the control group reached the target pressure of 20 mm Hg. The mean ETCO2 at the time of maximum pressure was 42.34 +/- 4.75 mm Hg in the study group and 29.81 +/- 2.61 mm Hg in the control group, (P< .001). Mean arterial carbon dioxide was 46.90 +/- 6.55 and 31.42 +/- 4.87 mm Hg, respectively. Surgeons blinded to the technique assessed the descent of the tumor. The operating conditions were judged by the surgeons to be satisfactory for 20 patients in the study group and 17 patients in the control group. Both techniques were equally effective in raising intracranial pressure and in providing descent of the suprasellar component of the tumor. No untoward side effects occurred while using either technique. The authors conclude that controlled hypercapnia is effective in producing descent of the suprasellar portion of a pituitary adenoma.

Introduction:The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease.Methods:In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size.Results:Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot.Conclusion:Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.

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The aim of the study was to compare the efficacy of periarticular injection of a cocktail of analgesic drugs (PIC) with epidural infiltration (EA), in providing postoperative pain relief and early functional improvement following Total Hip Arthroplasty (THA). Methods: 50 patients undergoing unilateral THA were randomized to receive either EA or PIC for postoperative pain control. Postoperative pain relief, as determined by the visual analogue scale (VAS), functional recovery and side effects related to EA and PIC were assessed. Results: PIC resulted in significantly lower VAS scores [0.48(0.71) vs 3.04(2.07)] in the first 24 h after surgery [mean (SD)], when compared to EA. The pain relief continued to be significantly lower even on the 10th postoperative day. Functional recovery was significantly better in the PIC group, with patients being able to walk longer distances and climb steps more quickly following THA. EA, unlike PIC was associated with side effects like nausea, vomiting, motor weakness, back pain and urinary retention. The overall satisfaction rate with treatment was significantly better in PIC group (9.04/10) than those who received EA (7.76/10). Conclusion: PIC provides significantly better pain control and functional recovery in the early postoperative period, with less side effects when compared with EA. PIC should be the choice for pain control following THA.