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BACKGROUND: This was a randomized, double-blinded clinical trial to study the effects of a single oral dose of pregabalin 150 mg in postoperative pain management after mastectomy. DESIGN: forty nine patients ASA I or II, aged between 20-60 years, scheduled for mastectomy with or without axillary lymph nodes dissection (ALND) were recruited into this study. They were randomized into two groups, placebo (n = 24) or pregabalin (n = 25) receiving either oral pregabalin 150 mg or placebo when called to operation theatre (OT). The assessment of pain score were performed at recovery, 2, 4, 6 and 24 hours postoperatively at rest and on movement, using the verbal numeral rating score (VNRS). RESULTS: VNRS scores for pain at rest were lower in the pregabalin group at 2 (p = 0.024), 4 (p = 0.006) and 6 (p = 0.003) hours postoperatively, and also at 4 (p = 0.005) and 6 (p = 0.016) hours postoperatively on movement compared to the placebo group. Incidences. of dizziness were common, however, side effects such as nausea and vomiting, headache, somnolence and visual disturbance were low and comparable in both groups. CONCLUSION: A single dose of 150 mg pregabalin given preoperatively compared to placebo significantly reduced postoperative pain scores after mastectomy.

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BACKGROUND: This was a prospective randomized single-blinded clinical trial comparing the glottic views obtained during direct laryngoscopy between the 'sniffing the morning air' position and simple head extension. METHODS: A sample of 378 patients, aged 18 to 75 years old with ASA physical status I or II, scheduled for elective surgery under general anesthesia with endotracheal intubation, were randomized into 2 groups. Group A used the sniffing position during the first laryngoscopy while Group B was put in simple head extension position. Positions were then interchanged for the second laryngoscopy. Sniffing position was obtained by placing a 7 cm height non-compressible cushion under the patient's head. In simple head extension, patient's head was placed flat. Glottic visualization was assessed based on the Cormack & Lehane scale. Intubation was performed after second laryngoscopy and success rate of first attempt intubation was compared. RESULTS: The distribution of patients with different Cormack & Lehane scores between the two intubation positions were significantly different (p < 0.001). Changing over to the 'Sniffing position' resulted in improvement of the Cormack & Lehane scores in 109 (57.7%) patients, no change in 75 (39.7%) or worsening in 5 (4.8%) patients. Successful intubation at first attempt was better (p < 0.05) with Group A: 156 (83.5%) while Group B: 121 (64.0%). CONCLUSION: Sniffing position provided better glottic visualization score and increased the successful rate of intubation as compared to simple head extension.

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BACKGROUND: Postoperative sore throat after minor pediatric surgery although uncommon and the symptoms are mild, the incidence may be affected by several factors. This study was designed to compare the frequency and severity of post operative sore throat in children undergoing elective surgery following the use of proseal LMA (PLMA) compared to classic LMA (cLMA). METHODS: Two hundred children, 6 to 12 years old undergoing general anesthesia were selected and randomly divided into two groups which involved the use of the PLMA and the cLMA respectively. Induction of anesthesia was done with fentanyl 1 mcg/kg and propofol 2-3 mg/kg or sevoflurane 8% depending on the preference of the clinicians. Postoperatively, airway devices were removed when patients were fully awake and given supplemental oxygen via face mask. RESULTS: At 6 hours postoperatively, the incidence of sore throat was lower in the Proseal LMA group (p<0.001). CONCLUSION: The incidence of sorethroat was lower in the Proseal LMA group compared to Classic LMA at 6 hours postoperatively.

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Anxiety and depression could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease (CHD). The aim of this study was to investigate the incidence of anxiety and depression in patients with acute CHD. In a period from March to December 2008, the views of 108 CHD patients, hospitalized in a tertiary hospital, were solicited using Hospital Anxiety and Depression Scale (HADS) and sociodemographic questionnaires. Patients with CHD had a low level anxiety and depression scores. There was significant differences in the total HADS score of participants stratified for marital status (P=0.027) or co-morbidity of diseases (P=0.012). Also, there were significant differences in the scores of depression subscale stratified for marital status (P=0.021) or co-morbidity of disease (P=0.007). However, there was no significant difference between the total HADS score or depression subscale score of the participants stratified based on age, gender, race, education, or income. Moreover, unmarried CHD respondents possessed higher depression level compared to the married respondents, and CHD respondents with co-morbid diseases showed a high level of depression. The findings might be taken as evidence to suggest that CHD patients should be evaluated early for the detection of anxiety and depression for appropriate referral and support.

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PURPOSE OF REVIEW: Updates on developments in critical incident monitoring in anaesthesia, and assesses its role in improving patient safety. RECENT FINDINGS: Critical incident reporting has become more widely accepted as an effective way to improve anaesthetic safety, and has continued to highlight the importance of human errors and system failures. The establishment of an international database also improves critical incident reporting. Experiences from the national reporting and learning system in the UK have provided some solutions to the many problems and criticisms faced by the critical incident reporting technique. Direct observations to detect errors are more accurate than voluntary reporting of critical incidents, and may be a promising new approach. SUMMARY: Critical incident monitoring is a valuable tool in ensuring patient safety due to its low cost and the ability to provide a comprehensive body of detailed qualitative information. The qualitative information gathered can be used to develop strategies to prevent and manage existing problems, as well as to plan further initiatives for patient safety. Novel approaches should complement existing methods to achieve better results. The development of a culture which emphasises safety should go hand in hand with current audit activities.

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We compared the efficacy of IV fentanyl with IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blind study we recruited 90 patients aged between 18 and 65 yr, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 3 groups: group F received 2 mL IV fentanyl 50 microg/mL (100 microg), group L received 2 mL of preservative-free lidocaine 2% (40 mg), and group P (placebo) received 2 mL of normal saline. The incidence of withdrawal response after rocuronium was 57%, 30%, and 7% in the placebo, lidocaine, and fentanyl groups, respectively. We found a significant reduction in incidence of withdrawal response in both the fentanyl and lidocaine groups when compared with the placebo group (P < 0.05), with the fentanyl group being most effective (P < 0.05). In conclusion, both fentanyl and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with fentanyl being more effective.

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