Romanian journal of anaesthesia and intensive care最新文献

Background and aims: Securing the airway without morbidity is of prime importance. The difficult airway cart should have some advanced airway aids if not all. In this study we evaluated Airtraq laryngoscope and Intubating Laryngeal Mask Airway (ILMA) as intubating devices in novice users who were well accomplished in intubation using direct laryngoscope with Macintosh blade. Both the devices were used because of relatively lesser cost, portability and all in one compact design not requiring any setup. Methods: 60 consenting American Society of Anaesthesiology (ASA) Grade I and II patients, weighing 50 to 70 were randomly assigned to be intubated by Airtraq or ILMA. Primary Aim was to compare success rate and intubation time. Comparison of ease of intubation and postoperative pharyngeal morbidity were the secondary end points.

Results: Success rate of intubation was higher in ILMA group (100%) than Airtraq (80%) [P = 0.0237]. However, in successful intubations the time for intubation was significantly less with Airtraq (Group A = 45.37 ± 27.55, Group I = 77.6 ± 31.85; P = 0.0003). No significant difference was noted in ease of intubation, number of optimizing manoeuvres to facilitate intubation and postoperative pharyngeal morbidity.

Conclusion: In Clinicians who are well versed with laryngoscopy using Macintosh blade but new to Airtraq and ILMA, success rate of intubation is higher with ILMA. Prolonged intubation time in ILMA should not deter its use in difficult airway scenarios because of the ability to ventilate through it.

Background and aims: Pain remains the most common reason patients seek assistance in emergency rooms. However, the level of pain management during emergencies, and subsequently during disasters and mass casualty incidents, remainsdisturbing.

Methods: A cross-sectional study was conducted using a structured anonymous questionnaire among a random sample of doctors working in different tertiary hospitals of Athens and of rural regions. The data were analysed using descriptive statistics and statistical significance tests via R-Studio, version 1.4.1103.

Results: The aforementioned sample yielded101 questionnaires. Results show suboptimal knowledge and attitudes regarding acute pain management among emergency healthcare providers in Greece. The majority of responders are unaware of the term multimodal analgesia (52%), of newer pain treatment methods (59%), they have not attended pain management seminars (84%), nor are they aware of pain treatment protocols in their workplace (74%). Participants appeared to disregard successful pain relief due to time constraints (58%), while leaving certain parts of the population (children under 3 years of age -75%, pregnant women-48%) significantly undertreated in terms of analgesia. Demographic correlations showed that clinical experience and pain management education were associated with older and more experienced emergency healthcare workers. Specialties with a previous core training containing pain education (anaesthesiologists, emergency physicians) again showed better results in the majority of the questions.

Conclusions: Educational programs/seminars along with standardised algorithms should be developed in order to cover existing needs and misconceptions.

Objectives: To determine that ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone, thyrohyoid membrane, and anterior commissure levels can be used to predict difficult laryngoscopy.

Materials & methods: The present study included 100 patients of age group 18-60 years undergoing elective surgery under general anaesthesia. It was a prospective observational study which included patients with ASA physical status I and II. Excluded patients were with facial and neck deformities, neck trauma, or those undergoing surgery of the larynx, epiglottis and pharynx. Comparison analysis was performed using t-test for continuous variables and chi-square or Fisher exact test for non-continuous variables. Correlation analysis performed using Pearson test.

Results: There were 39 out of 100 patients categorised as difficult laryngoscopy. Thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM) and anterior commissure (DSAC), MMS (modified Mallampati score), and BMI (body mass index) were greater in the difficult laryngoscopy group (p < 0.001). TMD (thyromental distance) was less in the difficult laryngoscopy group (p < 0.001). There was a strong positive correlation between DSEM and DSAC (r = 0.784). Moderate positive correlation was between DSEM and DSHB (r = 0.559), DSEM and MMS(r=0.437). The area under curve (AUC) of DSHB, DSEM, DSAC, TMD and MMS is >0.7. The optimal cut-off values for DSEM, DSHB, DSAC and TMD were 1.34 cm, 0.98 cm, 1.68 cm and 6.59 cm, respectively, in predicting difficult airway.

Conclusion: Ultrasound measurement of soft tissue thickness at hyoid bone, thyrohyoid membrane, and anterior commissure of vocal cord are good independent predictors for difficult laryngoscopy. When combined with traditional screening tests it improves the ability to predict difficult laryngoscopy.

Background: Total hip replacement (THR) is mostly performed in patients above 65 years of age. Patients of this age group typically have comorbidities, therefore safe techniques for anaesthesia and analgesia with minimal side effects should be chosen and should allow early mobilisation. Lumbar paravertebral block is less explored in this domain. The primary objective of this study is to compare the efficacy of ultrasound-guided lumbar paravertebral and epidural block using ropivacaine (0.25%) with fentanyl as adjuvant for postoperative pain in patients undergoing unilateral THR.

Settings and design: Randomised, controlled, double-blind, prospective study carried out in the Department of Anaesthesiology at Banaras Hindu University.

Methods and material: After receiving institutional ethical committee clearance and written informed consent from patients, this study was carried out from February 2019 to February 2020. Sixty adult patients who required THR and fulfilled the inclusion criteria were randomised into two groups. The thirty patients in Group A received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar epidural catheter. The thirty patients in Group B received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar paravertebral catheter. Visual analogue scale (VAS) was used to evaluate pain scores. Rescue analgesia use and duration of hospital stay was calculated and compared in postoperative period. The statistical analysis of data was done by using software Statistical Package for Social Sciences SPSS for Windows (Version 23.0), and chi-square test was used for categorical variables. To compare the two groups of mean Student's t-test and for more than two groups one-way analysis of variance, the ANOVA test was used.

Results: In Group A, 16.7% patients required rescue analgesic, and in Group B, 26.7% required rescue analgesia which is comparable and non-significant. The mean duration of hospital stay in Group A is 7.50 days. Compared to 6.47 days in Group B, this difference is statistically significant (p-0.000).

Conclusions: Analgesia provided by paravertebral block is not superior to epidural block, but paravertebral block did reduce the duration of hospital stay and provided better haemodynamic stability.

Background: Anaemia and blood transfusion are two independent contributing factors to perioperative morbidity in cardiac surgery. While preoperative treatment of anaemia has been shown to improve outcomes, in real life, logistical difficulties remain substantial, even in high-income countries. The adequate trigger for transfusion in this population remains controversial, and there is a wide variability in transfusion rates among centres.

Objectives: To assess the impact of preoperative anaemia on perioperative transfusion in elective cardiac surgery,todescribe the perioperative trajectory of haemoglobin (Hb), to stratify outcomes based on preoperative presence of anaemia and to identify predictors of perioperative blood transfusion.

Materials: and Methods: We included a retrospective cohort of consecutive patients who underwent cardiac surgery with cardiopulmonary bypass in a tertiary centre of cardiovascular surgery. Recorded outcomes included hospital and intensive care unit (ICU) length of stay (LOS), surgical re-exploration due to bleeding, packed red blood cell (PRBC) transfusion pre-, intra- and postoperatively. Other record perioperative variables were preoperative chronic kidney disease, duration of surgery, use of rotation thromboelastometry (ROTEM) and cell saver, and fresh frozen plasma (FFP) and platelet (PLT) transfusion. Hb values were recorded at four distinct time points: Hb1 - at hospital admission, Hb2 - last Hb recorded preoperatively, Hb3 - first Hb recorded postoperatively and Hb4 - at hospital discharge. We compared the outcomes between anaemic and non-anaemic patients. Transfusion was decided by the attending physician on a case-by-case basis. Results: Of the 856 patients operated during the selected period, 716 underwent non-emergent surgery and 710 were included in the analysis. Also, 40.5% (n = 288) of patients were anaemic preoperatively (Hb <13 g/dl); 369 patients (52%) were transfused PRBCs, with differences found between anaemic and non-anaemic patients regarding the percentage of transfused patients perioperatively (71.5% vs 38.6%, p < 0.001) and in the total median number of units transfused (2 [IQR 0-2] vs 0 [IQR 0-1], p <0.001). We built a multivariate model, and logistic regression analysis showed that preoperative Hb <13 g/dl (odds ratio [OR] 3.462 [95% CI 1.766-6.787]), female sex (OR 3.224 [95% CI 1.648-6.306]), age (1.024 per year [95% CI 1.0008-1.049]), hospital LOS (OR 1.093 per day of hospitalisation [95% CI 1.037-1.151]) and FFP transfusion (OR 5.110 [95% CI 1.997-13.071]) are associated with PRBC transfusion.

Conclusions: Untreated preoperative anaemia leads to more transfusion in elective cardiac surgery patients, both as a ratio of transfused patients and as the number of units of PRBCs per patient, and this is associated with an increased use in FFP.

Background and aims: Prone positioning increases oxygenation by recruiting dorsal lung regions and draining airway secretions and improves gas exchange and survival in ARDS. We describe the efficacy of prone positioning in awake non-intubated spontaneously breathing COVID-19 positive patients with hypoxemic acute respiratory failure.

Methods: We studied 26 awake non-intubated spontaneously breathing patients with hypoxemic respiratory failure treated with prone positioning. Patients were kept in prone position for two hours in each session and four such sessions were given to patients in 24 hours. SPO2, PaO, 2RR and haemodynamics were measured before prone positioning (PRE), 60 minutes of prone positioning (PRONE), and one hour after the completion of each session (POST).

Results: 26 patients (12 males and 14 females) non-intubated spontaneously breathing with SPO2 <94% on 0.4 FiO2 were treated with prone positioning. One patient required intubation and was shifted to ICU, the rest (25 patients) were discharged from HDU. Mean hours of prone positioning were 19.4 ± 2.06 hr. There was significant improvement in oxygenation (increase in PaO2 from 53.15 ± 6.0 mmHg to 64.23 ± 6.96 mmHg in PRE and POST sessions respectively, likewise there was increase in SPO2). No complications were noted with various sessions.

Conclusion: Prone positioning was feasible and improved oxygenation in awake non-intubated, spontaneously breathing COVID-19 patients with hypoxemic acute respiratory failure.

Crouzon syndrome is a rare genetic disorder involving craniofacial skeleton development. It's characterized by a triad of cranial deformities: premature craniosynostosis, facial anomalies (mid-facial hypoplasia), and exophthalmia. The anaesthetic management challenges include the presence of a difficult airway, history of obstructive sleep apnea, congenital cardiac disorders, hypothermia, blood loss, and venous air embolism. We present the case of an infant with Crouzon syndrome who was scheduled for a ventriculoperitoneal shunt placement managed with inhalational induction.

Background: COVID-19 is a novel disease with a highly variable and unpredictable clinical course. Various clinicodemographic factors and numerous biomarkers have been identified in studies from the West and marked as possible predictors of severe illness and mortality which may be used to triage patients for early aggressive care. This triaging becomes even more significant in resource-limited critical care settings of the Indian subcontinent.

Methods: This retrospective observational study recruited 99 cases of COVID-19 admitted to intensive care from 1 May to 1 August 2020. Demographic, clinical and baseline laboratory data were collected and analysed for association with clinical outcomes, including survival and need for mechanical ventilatory support.

Results: Male gender (p=0.044) and diabetes mellitus (p=0.042) were associated with increased mortality. Binomial logistic regression analysis revealed Interleukin-6 (IL6) (p=0.024), D-dimer (p=0.025) and CRP (p<0.001) as significant predictors of need of ventilatory support and IL6 (p=0.036), CRP (p=0.041), D-dimer (p=0.006) and PaO2FiO2 ratio (p=0.019) as significant predictors of mortality. CRP >40 mg/L predicted mortality with sensitivity of 93.3% and specificity of 88.9% (AUC 0.933) and IL6> 32.5 pg/ml with a sensitivity of 82.2% and specificity of 70.4% (AUC 0.821).

Conclusion: Our results suggest that a baseline CRP >40 mg/L, IL6 >32.5 pg/ml or D-dimer >810 ng/ml are early accurate predictors of severe illness and adverse outcomes and may be used to triage patients for early intensive care.

Background: Intravenous regional anaesthesia (IVRA) is a dependable and safe technique specific anatomical knowledge is not required. The present research aimed to evaluate the effects of dexmedetomidine in combination with lidocaine and to compare the onset of motor and sensory block and evaluate the postoperative analgesia, as well as the side effects.

Methods: A prospective randomized controlled double-blinded study was conducted on 90 patients assigned randomly into three equal groups,. Group (I) received only lidocaine 2% 3mg/kg for Bier block. Group (II) received lidocaine 2% 3mg/kg with plus dexmedetomidine 0.25 μg/kg for Bier block. Group (III) received lidocaine 2% 3mg/kg plus dexmedetomidine 0.5 μg/kg for Bier block.

Results: Postoperative VAS was lower in a statistically significant way in the group III patients than those in groups I and II and this followed a reduction in the analgesic requirement in group III.

Conclusions: The combination of dexmedetomidine 0.5 μg/kg with lidocaine 2% (3mg/kg) when applying intravenous regional anaesthesia (IVRA) allowed improved postoperative analgesia. Furthermore, the combination reduced onset time, extended recovery time for sensory/motor blocks and did not affect the incidence of intra-operative and postoperative complications.