Epidural morphine in patient-controlled analgesia regimens controls postoperative pain well but easily induces pruritus and other epidural morphine-related side effects. With 90 pregnant American Society of Anesthesiologists physical status II females scheduled for elective cesarean delivery, the present study was designed to evaluate the efficacy and safety profile of patient-controlled antipruritus (PCP) use of intravenous nalbuphine-based regimens for attenuation of postoperative pruritus and related side effects in combination with epidural morphine patient-controlled analgesia with regard to the quality of postoperative pain management. Patients were randomly assigned to two nalbuphine groups (5 μg/kg/hour, Group N5 or 10 μg/kg/hour, Group N10) and bolus dose of 1.6 μg/kg for PCP or the control (normal saline) group. Comparable visual analog scale scores for rest pain at each measured time interval among the three groups demonstrated that adequate pain relief was offered; however, the cumulative dose of nalbuphine administered to the patients in Group N10 attenuated the analgesic effect of epidural morphine in moving pain at POh24 only. Fewer episodes and milder severity of pruritus were observed in patients in Groups N5 and N10 at all postoperative time intervals. Epidural morphine provided good postoperative pain relief but with incommodious side effects. In addition, intravenous nalbuphine not only attenuated the incidence of pruritus but also decreased total morphine consumption. In conclusion, intravenous administration of low-dose nalbuphine (5 μg/kg/hour) for PCP maintained analgesia produced by epidural morphine and offered low pruritus incidence.

In some situations, patients need endotracheal intubation to maintain airway patency while they are constrained in the lateral position. In this study we compared lightwand-guided intubation of 120 randomly enrolled patients placed in the supine, right, or left lateral position. Group S patients were initially placed in the supine position, and subsequent to the artificial airway having been established they were turned to the lateral decubitus position. Group R patients were initially placed in a right decubitus position during induction and intubation. Group L patients were initially placed in a left decubitus position during induction and intubation. The duration of each intubation attempt, the total time to successful intubation, and the incidence of intubation-related intraoral injury, hemodynamic changes, and postoperative sore throat and hoarseness were recorded. Intubation took a similar length of time in the supine (14.5 +/- 13.4 s), left lateral (13.3 +/- 10.2 s), and right lateral positions (15.5 +/- 13.0 s) and resulted in a similar trend in hemodynamic changes. Patients in the lateral and supine positions revealed a comparable incidence of successful first-attempt intubation, sore throat, hoarseness, oral mucosal injury, and dysrhythmia. Insignificantly more esophageal intubations were performed in the lateral position in the first attempt at intubation; however, all patients were correctly intubated shortly after reattempting intubation. We concluded that lightwand-assisted intubation is easily performed and a similar technique may be used whether the patient is in a lateral, recumbent, or a supine position. This alternative technique should be practiced and is recommended for patients who must remain in a lateral position during intubation and surgery.

The Trachway is a recently developed intubation device that resembles an illuminating stylet and incorporates a video-assisted system. This study evaluated the use of this system for tracheal intubation by novice operators. This randomized cross-over study compared the Trachway and the Airway Scope in simulated routine and difficult intubation scenarios. The difficult scenario was simulated by increasing the tongue volume of the manikin. The primary outcome measure in both airway scenarios was the time required for a successful tracheal intubation. For each scenario, the success rate, ease of intubation and operator preference were recorded for the two devices and compared. Average intubation time did not differ significantly between the Trachway and Airway Scope for the normal airway scenario (11.2 ± 6.5 vs. 9.8 ± 4.3 seconds, respectively; p = 0.07), but was significantly longer using the Trachway than with the Airway Scope on the difficult airway scenario (17.1 ± 11.1 vs. 9.5 ± 4.1 seconds, respectively; p < 0.001). The overall success rates of the Trachway and Airway Scope (96.3% and 98.6%, respectively) did not differ significantly (p = 0.13). Preference for the Airway Scope was greater in both scenarios, and particularly in the difficult airway scenario (p < 0.001). Although the devices are comparable in terms of ease of use and intubation time in normal scenarios, the ease of using the Airway Scope makes it more suitable for inexperienced operators in difficult intubation scenarios.

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