{"title":"Reflections on posterior transversus abdominis plane block versus fascia transversalis plane block in inguinal hernia repair","authors":"R. Sethuraman","doi":"10.4103/sja.sja_149_24","DOIUrl":"https://doi.org/10.4103/sja.sja_149_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C-section is usually performed under spinal anesthesia also known as a subarachnoid block (SAB) over general anesthesia. Because of the lesser amount of dose used, there is a lower risk of local anesthetic toxicity and minimal transfer of drugs to the fetus. Obstetric patients have a higher risk of having post-dural puncture headache (PDPH). PDPH occurs due to leakage of the cerebrospinal fluid (CSF) through the hole created by a spinal needle. There are many elements affecting the frequency of PDPH, these elements can also consist of age, female sex, needle size, and types, pregnancy, preceding records of PDPH, median–paramedian distinction in approach, a puncture level. PDPH is commonly in the form of a frontal, occipital, or retro-orbital headache that starts in 12–72 h after the dural puncture and will increase when standing and decrease when lying down or resting. We aimed to learn about headache frequency between elective and emergency lower segment cesarean section using 26-G Quincke spinal needle in full-term pregnant patients. To study the incidence of PDPH using the 26G Quincke spinal needle. To analyze the causal factors/determinants such as adequate preloading of fluids, size of spinal needle, number of pricks, and technique of lumbar puncture effects on the incidence of PDPH. This study is a prospective questionnaire-based comparative observational study using the convenience sampling method. The patients were interviewed with a structured questionnaire at the Symbiosis University Hospital and Research Centre, Lavale, Pune. The patients observed for the study were between 20 and 40 of age group, posted for emergency or elective lower segment cesarean section, with body mass index (BMI) less than 14.5 to 24.9 and with ASA I and II grades. Patients with any comorbidities, recurrent headaches, obesity, and spine deformity were excluded. According to the review of the literature and with the help of a formula, the sample size was calculated as 20; 10 patients for elective LSCS, and 10 patients for emergency LSCS. Out of 20 patients, 10 patients were posted for elective LSCS, and the rest 10 patients were for emergency LSCS under spinal anesthesia. The incidence of PDPH was found only in 2 out of 10 emergency LSCS patients, and no patients from elective LSCS cases showed up with the incidence of PDPH.
{"title":"Incidence of post-dural lumbar puncture headache (PDLPH) in comparison between emergency and elective lower segment cesarean section (LSCS) with 26G Quincke–Babcock cutting-beveled spinal needle","authors":"Monika Kambale, Sammita J Jadhav","doi":"10.4103/sja.sja_950_23","DOIUrl":"https://doi.org/10.4103/sja.sja_950_23","url":null,"abstract":"\u0000 \u0000 C-section is usually performed under spinal anesthesia also known as a subarachnoid block (SAB) over general anesthesia. Because of the lesser amount of dose used, there is a lower risk of local anesthetic toxicity and minimal transfer of drugs to the fetus. Obstetric patients have a higher risk of having post-dural puncture headache (PDPH). PDPH occurs due to leakage of the cerebrospinal fluid (CSF) through the hole created by a spinal needle. There are many elements affecting the frequency of PDPH, these elements can also consist of age, female sex, needle size, and types, pregnancy, preceding records of PDPH, median–paramedian distinction in approach, a puncture level. PDPH is commonly in the form of a frontal, occipital, or retro-orbital headache that starts in 12–72 h after the dural puncture and will increase when standing and decrease when lying down or resting. We aimed to learn about headache frequency between elective and emergency lower segment cesarean section using 26-G Quincke spinal needle in full-term pregnant patients.\u0000 \u0000 \u0000 \u0000 To study the incidence of PDPH using the 26G Quincke spinal needle. To analyze the causal factors/determinants such as adequate preloading of fluids, size of spinal needle, number of pricks, and technique of lumbar puncture effects on the incidence of PDPH.\u0000 \u0000 \u0000 \u0000 This study is a prospective questionnaire-based comparative observational study using the convenience sampling method. The patients were interviewed with a structured questionnaire at the Symbiosis University Hospital and Research Centre, Lavale, Pune. The patients observed for the study were between 20 and 40 of age group, posted for emergency or elective lower segment cesarean section, with body mass index (BMI) less than 14.5 to 24.9 and with ASA I and II grades. Patients with any comorbidities, recurrent headaches, obesity, and spine deformity were excluded. According to the review of the literature and with the help of a formula, the sample size was calculated as 20; 10 patients for elective LSCS, and 10 patients for emergency LSCS.\u0000 \u0000 \u0000 \u0000 Out of 20 patients, 10 patients were posted for elective LSCS, and the rest 10 patients were for emergency LSCS under spinal anesthesia. The incidence of PDPH was found only in 2 out of 10 emergency LSCS patients, and no patients from elective LSCS cases showed up with the incidence of PDPH.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ex-utero intrapartum treatment (EXIT) is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. This procedure technique lies in a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without the interruption of maternal-fetal circulation. Anesthetic management in the EXIT procedure is substantially different from that of the standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia, and placental blood flow preservation. We report the first case of an EXIT procedure performed on a fetus with a prenatal diagnosis of multiple oral masses at King Khalid University Hospital, Riyadh, Saudi Arabia.
{"title":"Anesthetic considerations of EXIT procedure: A case report","authors":"Narjes S. Alotaibi, Mansour Aqil, Yasser Sabr, Jumana Baaj, Reem Alsafar","doi":"10.4103/sja.sja_900_23","DOIUrl":"https://doi.org/10.4103/sja.sja_900_23","url":null,"abstract":"The ex-utero intrapartum treatment (EXIT) is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. This procedure technique lies in a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without the interruption of maternal-fetal circulation. Anesthetic management in the EXIT procedure is substantially different from that of the standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia, and placental blood flow preservation. We report the first case of an EXIT procedure performed on a fetus with a prenatal diagnosis of multiple oral masses at King Khalid University Hospital, Riyadh, Saudi Arabia.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tariq Wani, Ayesha Y. Siddique, Wajahat N. Khan, S. Rehman, Nguyen K. Tram, Joseph D. Tobias
The use of cuffed endotracheal tubes (ETTs) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients. The study included patients ranging in age from 1 month to 10 years who underwent neck and chest CT imaging that required general anesthesia and endotracheal intubation. The location of the ETT and of the cuff within the airway was determined from axial CT images at three levels (proximal, middle, and distal). Anatomical orientations were tabulated, and percent chances of each orientation were determined for the ETT and the cuff. The study cohort included 42 patients ranging in age from 1 to 114 months. An ETT with a polyvinylchloride cuff was used in 24 patients, and an ETT with a polyurethane cuff was used in 18 patients. The ETT was located near the posterior wall of the trachea in approximately 24–38% of patients, being most likely to be centrally located at the proximal end and at its mid-portion. The middle part of the cuff was most likely to be positioned in the mid-portion of the trachea but tended to skew anteriorly at both the proximal and distal ends. This is the first study using CT imaging to identify the uniformity of cuff inflation within the trachea in children. With commonly used cuffed ETTs, cuff inflation and the final position of ETT cuff within the tracheal lumen were not uniform. Future investigations are needed to determine the reasons for this asymmetry and its clinical implications.
使用带袖带的气管插管（ETT）已成为儿科医疗的标准。使用带充气罩囊 ETT 的理由是在提供有效气道密封的同时最大限度地减少环状带周围的压力。但是，安全护理要求气管插管后充气罩囊位于环甲膜环的远端。目前的研究证明了计算机断层扫描（CT）成像在确定插管患者 ETT 袖套位置方面的能力。 研究对象包括年龄从 1 个月到 10 岁的患者，他们都接受了颈部和胸部 CT 成像检查，需要全身麻醉和气管插管。根据三个层面（近端、中间和远端）的轴向 CT 图像确定 ETT 和充气罩囊在气道内的位置。将解剖方向制成表格，并确定 ETT 和充气罩囊在每个方向的几率。 研究对象包括 42 名患者，年龄从 1 个月到 114 个月不等。24 名患者使用了带聚氯乙烯袖带的 ETT，18 名患者使用了带聚氨酯袖带的 ETT。约有 24%-38% 的患者的 ETT 位于气管后壁附近，最有可能位于近端和中段的中心位置。充气罩囊的中间部分最有可能位于气管的中段，但在近端和远端往往偏向前方。 这是第一项使用 CT 成像确定儿童气管内充气罩囊充气均匀性的研究。对于常用的带袖带式 ETT，气管腔内的袖带充气和 ETT 袖带的最终位置并不一致。今后需要进行调查，以确定这种不对称的原因及其临床影响。
{"title":"Endotracheal tube cuff position in relationship to the walls of the trachea: A retrospective computed tomography-based analysis","authors":"Tariq Wani, Ayesha Y. Siddique, Wajahat N. Khan, S. Rehman, Nguyen K. Tram, Joseph D. Tobias","doi":"10.4103/sja.sja_36_24","DOIUrl":"https://doi.org/10.4103/sja.sja_36_24","url":null,"abstract":"\u0000 \u0000 The use of cuffed endotracheal tubes (ETTs) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients.\u0000 \u0000 \u0000 \u0000 The study included patients ranging in age from 1 month to 10 years who underwent neck and chest CT imaging that required general anesthesia and endotracheal intubation. The location of the ETT and of the cuff within the airway was determined from axial CT images at three levels (proximal, middle, and distal). Anatomical orientations were tabulated, and percent chances of each orientation were determined for the ETT and the cuff.\u0000 \u0000 \u0000 \u0000 The study cohort included 42 patients ranging in age from 1 to 114 months. An ETT with a polyvinylchloride cuff was used in 24 patients, and an ETT with a polyurethane cuff was used in 18 patients. The ETT was located near the posterior wall of the trachea in approximately 24–38% of patients, being most likely to be centrally located at the proximal end and at its mid-portion. The middle part of the cuff was most likely to be positioned in the mid-portion of the trachea but tended to skew anteriorly at both the proximal and distal ends.\u0000 \u0000 \u0000 \u0000 This is the first study using CT imaging to identify the uniformity of cuff inflation within the trachea in children. With commonly used cuffed ETTs, cuff inflation and the final position of ETT cuff within the tracheal lumen were not uniform. Future investigations are needed to determine the reasons for this asymmetry and its clinical implications.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141387146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Merin Varghese, Reshma B. Muniyappa, SS Harsoor, Gangisetty Sri Madhuri
Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management.
{"title":"Bilateral TMJ Ankylosis with limited mouth opening in pediatric patients: An anesthetic challenge","authors":"Merin Varghese, Reshma B. Muniyappa, SS Harsoor, Gangisetty Sri Madhuri","doi":"10.4103/sja.sja_29_24","DOIUrl":"https://doi.org/10.4103/sja.sja_29_24","url":null,"abstract":"Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anesthesia in patients with emphysematous giant bulla undergoing non-thoracic surgery is challenging and can cause serious complications. We report a successful case of lip mass resection in a 65-year-old male with paraseptal emphysema and giant bullae under regional anesthesia using a mental nerve block. The patient presented with a slow-growing ulcerative mass on his lower lip and had a history of non-compliant COPD management. An excisional biopsy was planned. Preoperative workup revealed extensive lung pathology with giant bullae. General anesthesia with positive pressure ventilation in patients with emphysematous giant bullae can cause compression of lung parenchyma, vena cava kinking, circulatory collapse, and even death. To circumvent such risks, regional anesthesia was preferred and surgery was successfully done under ultrasound-guided bilateral mental nerve block. The procedure was uneventful, with stable hemodynamics throughout.
{"title":"Anesthetic management of a case of a lip mass with paraseptal emphysema and multiple bilateral giant bullae for surgical resection under mental nerve block","authors":"Prajnananda Haloi, Rahul Biswas, A. K. Bora","doi":"10.4103/sja.sja_43_24","DOIUrl":"https://doi.org/10.4103/sja.sja_43_24","url":null,"abstract":"Anesthesia in patients with emphysematous giant bulla undergoing non-thoracic surgery is challenging and can cause serious complications. We report a successful case of lip mass resection in a 65-year-old male with paraseptal emphysema and giant bullae under regional anesthesia using a mental nerve block. The patient presented with a slow-growing ulcerative mass on his lower lip and had a history of non-compliant COPD management. An excisional biopsy was planned. Preoperative workup revealed extensive lung pathology with giant bullae. General anesthesia with positive pressure ventilation in patients with emphysematous giant bullae can cause compression of lung parenchyma, vena cava kinking, circulatory collapse, and even death. To circumvent such risks, regional anesthesia was preferred and surgery was successfully done under ultrasound-guided bilateral mental nerve block. The procedure was uneventful, with stable hemodynamics throughout.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Pulitanò, Marco Giudice, Enrico Di Sabatino, F. La Verde
The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department.
GlideScope® 是由 Verathon Medical 公司（位于美国华盛顿州博特尔市）生产的一种视频喉镜，目前广泛用于处理计划内或意外的困难气管插管情况。根据目前的文献，GlideScope® 已被用于涉及舌根的外科手术，如活检和射频治疗阻塞性睡眠呼吸暂停。我们描述了一例在急诊科使用 GlideScope 进行尖头异物取出的双重用途。
{"title":"Simultaneous use of GlideScope® in emergency department: A case report","authors":"R. Pulitanò, Marco Giudice, Enrico Di Sabatino, F. La Verde","doi":"10.4103/sja.sja_85_24","DOIUrl":"https://doi.org/10.4103/sja.sja_85_24","url":null,"abstract":"The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surentharraj Elangobaalan, P. Rudingwa, Manasa Rengarajan
{"title":"Challenges in the anesthetic management of a pediatric patient with glottic web – A lesson","authors":"Surentharraj Elangobaalan, P. Rudingwa, Manasa Rengarajan","doi":"10.4103/sja.sja_132_24","DOIUrl":"https://doi.org/10.4103/sja.sja_132_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivam Shekhar, Nishant Goyal, A. Mirza, Sanjay Agrawal
Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4–8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.
{"title":"Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study","authors":"Shivam Shekhar, Nishant Goyal, A. Mirza, Sanjay Agrawal","doi":"10.4103/sja.sja_141_24","DOIUrl":"https://doi.org/10.4103/sja.sja_141_24","url":null,"abstract":"\u0000 \u0000 Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors.\u0000 \u0000 \u0000 \u0000 Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4–8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis.\u0000 \u0000 \u0000 \u0000 There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery.\u0000 \u0000 \u0000 \u0000 Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily Young, Tonya M. Nocera, Matthew Reilly, Joseph D. Tobias, Ajay D’Mello
During intraoperative care, ventilatory parameters including peak inflating pressure (PIP) and exhaled tidal volumes are continuously monitored to assess changes in respiratory resistance and compliance. Changes in these parameters, such as an increase in PIP or a decrease in the exhaled tidal volume, may indicate various pathologic processes that may require immediate attention to prevent inadequate ventilation resulting in hypoxemia or hypercarbia. A kinked endotracheal tube (ETT) may mimic other pathologic processes including bronchospasm, mainstem intubation, or ventilator malfunction. As newer ETTs are developed, a key factor in their design should be resistance to kinking or occlusion due to patient positioning. The current project developed and describes the process for using a repeatable in vitro mechanical test to determine resistance to kinking by an ETT. The mechanical testing procedure can be used to determine the compression force and distance required to kink an ETT under different conditions including temperature. The force required to induce devastating kink failure was lower during heated testing conditions. The addition of airflow through the ETTs during compression testing confirms the occurrence of airway obstruction at approximately the same time a mechanical kink is observed on the force-versus-distance curves. These procedures may be used to characterize and evaluate ETT designs under in vitro conditions mimicking those in the clinical practice.
在术中护理期间，要持续监测包括峰值充气压 (PIP) 和呼出潮气量在内的通气参数，以评估呼吸阻力和顺应性的变化。这些参数的变化，如充气峰值压力（PIP）升高或呼气潮气量降低，可能预示着各种病理过程，需要立即引起注意，以防止通气不足导致低氧血症或高碳酸血症。气管内导管（ETT）扭结可能会模拟其他病理过程，包括支气管痉挛、主干插管或呼吸机故障。随着新型气管插管的开发，其设计的一个关键因素应该是能够防止因患者体位造成的扭结或闭塞。 本项目开发并描述了使用可重复体外机械测试来确定 ETT 抗扭结能力的过程。 该机械测试程序可用于确定在包括温度在内的不同条件下 ETT 扭结所需的压缩力和距离。在加热测试条件下，诱发破坏性扭结失效所需的力较低。在压缩测试过程中通过 ETT 增加气流可确认气道阻塞发生的时间与在力与距离曲线上观察到机械扭结的时间大致相同。 这些程序可用于在模拟临床实践的体外条件下鉴定和评估 ETT 设计。
{"title":"An in vitro technique to measure resistance to compression and kinking of endotracheal tubes","authors":"Emily Young, Tonya M. Nocera, Matthew Reilly, Joseph D. Tobias, Ajay D’Mello","doi":"10.4103/sja.sja_15_24","DOIUrl":"https://doi.org/10.4103/sja.sja_15_24","url":null,"abstract":"\u0000 \u0000 During intraoperative care, ventilatory parameters including peak inflating pressure (PIP) and exhaled tidal volumes are continuously monitored to assess changes in respiratory resistance and compliance. Changes in these parameters, such as an increase in PIP or a decrease in the exhaled tidal volume, may indicate various pathologic processes that may require immediate attention to prevent inadequate ventilation resulting in hypoxemia or hypercarbia. A kinked endotracheal tube (ETT) may mimic other pathologic processes including bronchospasm, mainstem intubation, or ventilator malfunction. As newer ETTs are developed, a key factor in their design should be resistance to kinking or occlusion due to patient positioning.\u0000 \u0000 \u0000 \u0000 The current project developed and describes the process for using a repeatable in vitro mechanical test to determine resistance to kinking by an ETT.\u0000 \u0000 \u0000 \u0000 The mechanical testing procedure can be used to determine the compression force and distance required to kink an ETT under different conditions including temperature. The force required to induce devastating kink failure was lower during heated testing conditions. The addition of airflow through the ETTs during compression testing confirms the occurrence of airway obstruction at approximately the same time a mechanical kink is observed on the force-versus-distance curves.\u0000 \u0000 \u0000 \u0000 These procedures may be used to characterize and evaluate ETT designs under in vitro conditions mimicking those in the clinical practice.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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