Journal of Anaesthesiology, Clinical Pharmacology最新文献

Interventional endoscopy procedures are challenging for anaesthesiologists due to the various patient, procedural, logistic, and position-related issues. Complex endoscopic procedures like biliary interventions and endoscopic myotomy necessitate longer procedural duration. The mode of anaesthesia is usually deep sedation without any definitive airway device and is frequently associated with hypoxemia events which can be catastrophic. An endotracheal tube, though the gold standard for securing the airway, would prolong the anaesthesia time and delay the recovery. The laryngeal mask airway Gastro™ is a novel supraglottic airway device specifically meant for these procedures as it provides access to the gastrointestinal tract simultaneously with a patent airway. Though its purported advantages are undoubted, its clinical usage has various pitfalls that can hinder its wider acceptance and practical utility, especially when newly introduced. The literature is limited on the feasibility of this device in both the ease of endoscopy and the prevention of hypoxemia. In this review, we have discussed the device's properties, its varied use cases, the supporting evidence for the same, the caveats, and the future perspectives.

Background and aims: Bloodless surgical field during functional endoscopic sinus surgery (FESS) is an essential part, and research continues to find simple and effective regime for it. This study was aimed to compare the efficacy of oral clonidine versus oral metoprolol as premedicants regarding surgical field condition and controlled hypotension in patients undergoing FESS.

Material and methods: Sixty-eight patients of American Society of Anesthesiologists (ASA) physical status (PS) I and II aged 18-60 years, of both genders, scheduled for FESS under general anesthesia were randomly allocated in two groups. Group C (n = 34) received oral clonidine 300 μg and group M (n = 34) received oral metoprolol 50 mg, 2 h before surgery. Controlled hypotension (mean arterial pressure [MAP] 65-75 mmHg) was achieved by titrating sevoflurane (1%-3%). Primary outcome measured was surgical field visualization by Average Category Scale (ACS 0-5), and the secondary outcomes measured were hemodynamic parameters, sevoflurane requirement, recovery, and side effects. Categorical, continuous, and ordinal data were compared using Chi-square test, t-test, and Mann-Whitney test, respectively. P < 0.05 was considered as statistically significant.

Results: ACS was significantly less in group C compared to group M up to 60 min, (P < 0.05). Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP were significantly less in group C compared to group M at all time intervals (P < 0.05) Intraoperative sevoflurane requirement (vol %) was significantly less in group C (1.21 ± 0.42) compared to group M (1.68 ± 0.53) (P = 0.000).

Conclusions: Premedication with oral clonidine was found to be superior to oral metoprolol as it provided significantly better surgical field condition during FESS with much efficient controlled hypotension and anesthetic-sparing effect.Standardized Study Reporting Requirements: CONSORT: http://www.consort-statement.org/.

Background and aims: Nasotracheal intubation evokes greater hemodynamic responses than oral intubation. We compared the heart rate (HR) and mean arterial pressure (MAP) responses following nasal intubation during opioid-free anesthesia (OFA) using intravenous lignocaine versus standard regimen using morphine in cancer patients undergoing tumor resection.

Material and methods: This randomized, double-blinded study was conducted in 84 adults. Group A received lidocaine bolus 1.5 mg/kg over 10 min followed by infusion of 1 mg/kg/h. Group B received morphine 0.2mg/kg bolus over 10 min followed by infusion of 2mg/h. Protocols for induction and intubation were similar.

Results: Mean HR and MAP at preinduction, immediately after induction, and at 1, 3, and 5 min after intubation were comparable in groups A and B. Intragroup comparison of preinduction HR with subsequent values in group A showed that the HR values at 1,3, and 5 min after intubation were significantly higher than the preinduction value. HR after induction was comparable. Intragroup analysis in group B showed that preinduction HR was comparable with HR after induction and at 3 and 5 min after intubation. HR at 1 min was significantly higher. Intragroup analysis in group A showed that the MAP values were significantly lower than the preinduction value after induction and at 1,3, and 5 min after intubation. In group B, MAP was significantly lower than the preinduction value after induction and at 3 and 5 min after intubation, with the value being comparable at 1 min.

Conclusion: OFA with lignocaine bolus followed by infusion, as well as morphine did not attenuate the HR responses to nasal intubation in cancer patients. However, both techniques effectively blunted the MAP response.

Background and aims: Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma.

Material and methods: This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18-60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups (n = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and - 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed.

Results: The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine (P < 0.001) or ketamine (P < 0.001) compared to placebo. However, the NIV durations did not differ significantly between the dexmedetomidine and ketamine groups (P > 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine (P < 0.001) and placebo (P < 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine (P = 0.005) and placebo (P = 0.022) groups and required significantly less total morphine (P = 0.001) compared to the other groups.

Conclusion: The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.

Background: Traditionally, the sniffing position has been considered a standard head and neck position during direct laryngoscopy. The perfect head and neck position for video laryngoscopy has yet not been described. Hence, we planned the present study to compare the neutral and sniffing position for ease of intubation using Airtraq.

Methods: A total of 60 patients were randomized into two groups. Patients were intubated with their heads in neutral and sniffing positions in Group NP and SP, respectively. Ease of intubation was taken as a primary outcome. Laryngoscopy time, intubation time, percentage of glottic opening (POGO), the number of attempts for Airtraq and endotracheal tube, insertion of Airtraq, the success rate of intubation, optimization maneuvers, and complications were taken as secondary objectives. Data were analyzed using SPSS software, V.22.(1).

Results: For ease of intubation, we used a visual analog scale (VAS) and Fremantle scores. VAS score (mm) in the median (interquartile range [IQR]) was 32 (24, 34) and 28 (24, 32) in NP and SP groups, respectively (P = 0.37). Twenty-four (80%) patients in NP and 23 (76.67%) patients in the SP group had a Fremantle score of F1 (full view; easy intubation). One (3.33%) patient in both groups had a score of F2 (full view; modified intubation). Five (16.67%) and six (20%) patients in NP and SP groups had P1 scores. Overall, there was no difference in Fremantle's score between the groups (P = 0.945). The number of attempts, optimization maneuvers, and complications were statistically comparable between the groups.

Conclusion: There is no difference in the ease of intubation between the neutral and sniffing position using the Airtraq optical laryngoscope.