Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: There is a lack of research on the best head position for orotracheal intubation using a flexible fiberoptic bronchoscope (FOB) in cases of nasal pathology and restricted mouth opening, such as in trauma. We conducted a study to compare the effects of neutral and extended head positions for awake fiberoptic orotracheal intubation.

Material and methods: The study was a prospective, randomized comparative study on 50 patients aged 19-70. After obtaining ethical clearance and written informed consent, the patients were randomly divided into two groups, with 25 patients in each group. In Group E, a 7-cm pillow was positioned under the shoulder to keep the occiput close to the operating table. In Group N, no pillow was used during fiberoptic bronchoscopy and intubation. The primary objective entailed the comparison of the percentage of glottic opening score (POGO) between the two groups. The secondary objectives encompassed the measurement of the time required for the insertion of flexible FOB from the incisors to the carina (T1) and the time taken for advancement of the endotracheal tube into the trachea over FOB (T2).

Results: The POGO score was significantly higher in Group E compared to Group N (P < 0.0001), while T1 and T2 were significantly lower in Group E (P < 0.001). The hemodynamic parameters and postoperative complications were comparable between the groups.

Conclusion: The extended head position improves the POGO score and reduces the insertion time for oral awake fiberoptic intubation.

Background and aims: Infants are at the highest risk of oxygen desaturation during induction of anesthesia owing to their distinct anatomical and physiological characteristics. Prolongation of non-hypoxic safe apnea time by use of positive end expiratory pressure (PEEP) during induction has been studied extensively in adults. Although few studies have been conducted in infants, they lacked methodological rigor. Hence, we designed a scientifically rigorous study aimed at investigating the effects of application of PEEP during induction of anesthesia on the duration of non-hypoxic apnea time in infants.

Material and methods: Seventy-two infants were induced as per institutional protocol and mechanically ventilated for three minutes with volume-controlled ventilation and set ventilator parameters with PEEP of either 7 cm H₂O or 0 cm H₂O according to the group allocated, followed by endotracheal intubation. The duration of non-hypoxic apnea time, i.e., the duration from cessation of mechanical ventilation to the point when SpO₂ reached 95%, was noted. Inferential statistics were done by using the independent 't' test, Mann Whitney test and Chi square test.

Results: The duration of non-hypoxic apnea time was significantly longer in the PEEP group (n = 33) as compared to the control group (n = 33); 122 s (IQR = 52) vs. 95 s (IQR = 27) (P = 0.001) The duration of non-hypoxic apnea time increased significantly as the age of the infant increased.

Conclusions: Addition of PEEP of 7 cmH₂O is a useful ventilatory strategy in infants to offset undesired changes in the respiratory physiology during induction of anesthesia.

Background and aims: The incidence of postoperative nausea and vomiting (PONV) ranges between 30% and 80%, and face mask ventilation (FMV) prior to intubation may be a significant risk factor. The primary aim of this study was to investigate the effect of rapid sequence induction (RSI) on the occurrence of PONV.

Material and methods: This randomized controlled study was conducted in 128 adult patients with a moderate to high risk of PONV (Apfel score ≥2), who were scheduled to undergo elective gynecologic laparoscopic surgeries under general anesthesia. Recruited patients were divided into two groups: Control group and RSI group. In the control group, anesthesia was induced by conventional induction with FMV, and in the RSI group, anesthesia was induced by a modified RSI technique avoiding FMV. The primary outcome was to compare the incidence of PONV. Secondary outcomes included comparing the severity of PONV (Bellville score), severity of nausea [visual analogue scale (VAS)], and requirement of antiemetics.

Results: The 24-h incidence of postoperative nausea, retching, and vomiting was significantly less in the RSI group when compared to the control group [78.1% versus 17.2% (P < 0.001), 35.9% versus 9.4% (P < 0.001), and 42.2% versus 7.8% (P < 0.001), respectively]. The severity of PONV was significantly less in the RSI group, as evidenced by a reduced Bellville score [(0 (0-3) versus 2 (1-3), P < 0.001], reduced VAS score, and reduced number of episodes of retching and vomiting.

Conclusion: In patients with moderate to high risk, the incidence and severity of PONV were significantly reduced by the modified RSI technique.

Enhanced recovery after cardiac surgery (ERACS) in pediatric patients using regional anesthesia is a well-recognized modality. However, there is no research on the use of supraglottic devices in pediatric patients under cardiopulmonary bypass. Twelve patients for acyanotic congenital heart surgery were recruited. An appropriately sized I-gel was inserted, and positive pressure ventilation without any leak or increased airway pressure was confirmed. Extubation was performed on the operating table without any airway complications or hemodynamic changes. The mean ICU stay was 1.6 days. With the correct selection of patients and strict vigilance, epidural analgesia and I-gel are well-tolerated and enable ultrafast tracking of patients with smooth extubation and superior hemodynamic stability in congenital cardiac surgery.

Background and aims: Rebound pain (RP) is a distressing, yet not much explored, entity. This study aimed to evaluate and compare how adjuvants like dexamethasone and dexmedetomidine added to 0.5% ropivacaine for peripheral nerve block (PNB) can impact RP.

Material and methods: In this randomized, double-blinded study, 72 patients posted for elective upper limb surgeries under brachial plexus block were randomly divided into three groups of 24 each. Group A received 28 ml 0.5% ropivacaine +2 ml normal saline, Group B received 28 ml 0.5% ropivacaine + 8 mg dexamethasone (2 ml), and Group C received 28 ml 0.5% ropivacaine +50 µg dexmedetomidine (2 ml). The incidence and onset of RP, as well as the duration of sensory and motor block, were compared between the groups. The distribution of variables was compared using appropriate statistical tests.

Results: On postoperative days 1 and 2, the RP incidence was significantly lower in the dexmedetomidine group (12.5%, 16.67%) and dexamethasone group (25%, 20.83%), compared to the control group (54.17%, 58.33%) (P = 0.006 and 0.003 respectively). Patients in the dexmedetomidine group had a significantly delayed onset of RP (P = 0.0475). The motor and sensory block duration was prolonged in both, the dexmedetomidine group (410.83 ± 116.17 min, 442.5 ± 116.4 min) and dexamethasone group (375 ± 90.7 min, 418.54 ± 97.84 min) compared to the control group (321.25 ± 69.85 min, 358.33 ± 75.9 min). There was no significant difference between the two adjuvants in prolongation of sensory (P value 0.676) and motor blockade (P value 0.390).

Conclusions: The incidence of RP is significantly reduced when dexmedetomidine and dexamethasone are added as adjuvants to 0.5% ropivacaine in upper limb PNBs, with dexmedetomidine being superior in this regard.