Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface landmark technique (SLT), the individual's tracheal length (distance between mid-thyroid and manubrium-sternum) was estimated and 3 cm was deducted from it to obtain the desired intratracheal ETT length of insertion. Being a new technique, its reliability in providing optimal placement is yet to be evaluated. Hence, to assess the utility and reliability of SLT in achieving optimal placement, this study was planned.

Material and methods: In this prospective study, 406 participants were equally randomized between SLT and intubation guide mark (IGM) groups for ETT placement. In both groups, ETT tip-carina distance (D_TC) was measured to assess optimal placements. The placements were compared by paired t-test. The receiver operating characteristic (ROC) curve analysis was used to assess optimal ETT placement between techniques.

Results: The mean D_TC in the SLT (3.52 ± 0.68 cm) group was significantly higher than in the IGM (2.23 ± 1.01 cm) group, with P < 0.0001. Consequently, optimal placements were significantly higher in the SLT group (190 [95%]) compared to the IGM (121 [60.5%]) group (P < 0.0001). On ROC, at a cut-off value for D_TC of 1.5 cm, the observed area under the curve to assess optimal ETT placements was significantly better in SLT (0.997, 95% confidence interval [CI] 0.997-1.000) compared to IGM (0.968, 95% CI 0.933-0.988), with P < 0.0001.

Conclusion: Based on the measurement of an individual's tracheal length, SLT is a reliable and useful technique to achieve optimal tube placement.

Background and aims: Ondansetron and dexamethasone combination is effective for prophylaxis against postoperative nausea and vomiting (PONV). Ondansetron, when compared to dexamethasone, is known to cause more adverse effects and is relatively expensive. The present study evaluated the efficacy of standard dose and low dose ondansetron, i.e. 100 μg/kg and 50 μg/kg, respectively, with dexamethasone 8 mg for PONV prophylaxis in laparoscopic cholecystectomy (LC).

Material and methods: After the approval from the Institutional Ethics Committee-Human Research [IEC-HR] and prospective CTRI registration, this randomized, double-blind interventional study was conducted following informed consent from each participant. Patients aged 18-65 years of either sex, with ASA physical status I or II, undergoing LC under general anesthesia, were included and divided into groups C and L. Patients in groups C and L received 100 μg and 50 μg of ondansetron, respectively, in combination with 8 mg dexamethasone. The incidence of PONV in first 6 hrs, PONV score, rescue antiemetic consumption, rescue analgesia, and hemodynamic parameters were recorded.

Results: A total of 110 patients were included with 55 in each group. Incidence of PONV in the first 6 hours was found to be higher in 1-2 hour- and 2-3-hour time intervals in group L; but was significant only at 1-2-hour time interval (P < 0.05). Proportion of patients needing rescue antiemetic in the first 6 hours was higher in group L but was not statistically significant.

Conclusion: We observed that 50 μg/kg combination of ondansetron was associated with higher incidence of post operative nausea in the immediate postoperative period than 100 μg/kg dose; however, no significant difference was observed in incidence of post-operative vomiting between two doses following LC.

There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labor epidurals among practicing obstetric anesthetists. A Google form based questionnaire was circulated to 300 members of the Association of Obstetric Anesthesiologists (AOA) of India of which 128 (42.7%) responded. According to our survey, labor analgesia is routinely practiced by only 40 (32%) responders. Sixty-eight (53.1%) responders reported placement of an epidural catheter at the patient's request. Less than 50% reported the use of test dose for epidural catheter placement confirmation. Ninety-eight (76.6%) responders give the test dose at the time of catheter placement while 22 (17.1%) give it every time before injecting the local anesthetic as a top-up. The majority preferred using 3-4 mL of 2% lidocaine as test dose. Seventy-three (57%) responders relied on the use of conventional test dose of lidocaine with epinephrine. 8.5% of responders had experienced side effects with epidural test dose during labor analgesia. This survey highlights not just variations in the clinical practice regarding epidural test dose for labor analgesia but gross deviation from the current recommended standard of practice. The issue can be addressed by developing clear practice guidelines.

Airway management is a critical aspect of medical care, especially in unconscious or anesthetized patients. Following administration of sedatives, loss of upper airway tone and supraglottic airway obstruction are common, resulting in adverse respiratory events. The anesthesiologist frequently performs a manual jaw thrust in these scenarios to maintain the upper airway patency. Manual jaw thrust, on the contrary, requires a dedicated assistant to assist with ventilation, which can be challenging if manpower is limited during an airway crisis. A more recent device, the Lubo™ airway collar, can provide continuous mandibular thrust with cervical spine immobilization. Limited research has been conducted on the safety and effectiveness of this novel airway device. This narrative review focuses on the scope and current evidence of the Lubo™ airway collar in the field of anesthesia.

Background and aims: Emergence delirium (ED) is a common postoperative complication in pediatric patients. To avoid postoperative ED, sedative medications have been utilized in addition to general anesthesia. In this study, the primary objective was to assess the incidence of postoperative emergence of delirium at 0-, 10-, 20-, 30-, and 60-min intervals. Secondary objective was to assess postoperative analgesia (0, 10, 20, 30, and 60 min) and hemodynamic parameters (mean arterial pressure, pulse, oxygen saturation).

Material and methods: In this randomized controlled study, 105 American Society of Anesthesiologists I and II patients, aged between 3 months and 2 years, scheduled for orofacial cleft surgery were enrolled. Patients of group I received dexmedetomidine (0.3 μg/kg), group II received ketofol (a mixture of ketamine 0.25 mg/kg and propofol 1.0 mg/kg), and group III received normal saline 10 min before extubation. The incidence of postoperative ED using the Watcha scale and the postoperative pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale were recorded.

Results: The Watcha scale at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 0 (1), 1 (1.75), 1 (1), 2 (2), and 3 (2) in group I, 1 (1), 2 (1), 2 (2), 2 (3), and 3 (2) in group II, and 2 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. On comparing group I with groups II and III, the difference was significant (P < 0.01). The FLACC score at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 1 (1), 1 (1), 1 (1), 2 (2), and 3 (2) in group I, 2 (2), 2 (1), 2 (2), 2(3), and 3 (2) in group II, and 4 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. The FLACC score was also lower in group I in comparison to groups II and III. The difference among the groups was significant (P < 0.01). The incidence of postoperative delirium was lower in group I at 20% (7/35) than in group II at 29% (10/35) and in group III at 49% (17/35), and difference among the groups was significant (<0.01).

Conclusions: We conclude that both dexmedetomidine and ketofol are effective in reducing postoperative ED. Dexmedetomidine is more effective than ketofol in preventing postoperative ED in the pediatric population.

In this article, we explored 18 studies showing the impact of the intraoperative recruitment maneuver on patients with obesity undergoing laparoscopic surgery. A recruiting maneuver accompanied by a more significant positive end-expiratory pressure enhances intraoperative oxygenation and respiratory mechanics in obese patients undergoing surgery. They are safe and do not have unfavorable hemodynamic consequences.

Background and aims: Raised intracranial pressure (ICP) is believed to be one of the side effects of prolonged Trendelenburg position in robotic gynecologic surgeries. Optic nerve sheath diameter (ONSD) corresponds to a rise in ICP. However, the data from robotic hysterectomy surgeries is limited. So, we had planned this study with an aim to detect and compare the change in ONSD during prolonged steep Trendelenburg position in robotic hysterectomy compared to open total abdominal hysterectomy in a supine position.

Material and methods: This was a prospective, observational, parallel-group, single-center study. Patients undergoing elective robotic hysterectomy and open total abdominal hysterectomy were included in this study. ONSD, end-tidal carbon dioxide (EtCO₂), heart rate, and mean arterial pressure were assessed in both the groups after intubation (T0), after steep Trendelenburg position (T1), at 30 min (T2), 90 min (T3), and 180 min after docking (T4), and at the completion of surgery (de-docking) (T5). In patients undergoing open hysterectomy, the same parameters were recorded immediately after intubation (T0), at skin incision (T1), at 30 min (T2), 90 min (T3), and 180 min after skin incision (T4), and at the completion of surgery (T5).

Results: Compared to the patients undergoing open hysterectomy, robotic hysterectomy patients had a significantly higher ONSD at time points T2, T3, and T4, with the maximum difference noted at the time point T4. EtCO₂ was higher in patients undergoing robotic hysterectomy, though the difference was significant only at time point T2. No patient in our study had any symptom or sign of raised ICP in the postoperative period.

Conclusion: The steep Trendelenburg position used in robotic hysterectomy causes a significant increase in ONSD intraoperatively, and that the changes are reversible after the procedure. Further, we did not observe any complication of raised ICP postoperatively.