Pub Date : 2022-07-01DOI: 10.4103/theiaforum.theiaforum_14_22
Vinod Krishnagopal, S. Krishnakumar, R. Purushotham, R. Sudhakaran
{"title":"Sacroiliac joint pain - A diagnostic dilemma","authors":"Vinod Krishnagopal, S. Krishnakumar, R. Purushotham, R. Sudhakaran","doi":"10.4103/theiaforum.theiaforum_14_22","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_14_22","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"147 - 148"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49225165","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}
Background: Determining the appropriate size of an endotracheal tube (ETT) in infants and children remains a challenge for anesthesiologists. We conducted this study to assess the accuracy of middle finger length (MFL) in predicting the appropriate ETT size for pediatric patients in comparison with the age-based estimation and derive a formula based on MFL for the estimation of ETT size. Materials and Methods: In the study, South Indian children 1–10 years of age, requiring general anesthesia were intubated by consultant anesthesiologists based on their discretion with an appropriately sized ETT. Subsequently, the MFL of the children was measured and tracheal tube size calculated from the age-based formula was also noted. The actual size of the ETT inserted was compared with the MFL and age-based formula using Pearson's correlation. Results: In children between 1 and 10 years of age, the age-based formulae (ABF) was found to correlate with ETT estimated with the correlation coefficient (r = 0.885; P < 0.001) and MFL (r = 0.783 and P < 0.001). ABF showed a stronger correlation with the ETT inserted compared to the MFL, nevertheless, we were able to arrive at a formula to predict tracheal tube size based on MFL: ETT ID (mm) =1.1+ (0.7 × MFL [cm]). Conclusion: Although age-based Cole's and Motoyama's formulae are better predictors of pediatric ETT size, MFL can still be used to predict the tube size in cases when age and weight are unknown.
{"title":"Prediction of endotracheal tube size for pediatric patients from the length of the middle finger in comparison with standard age-based formula in South Indian population","authors":"Rama Rani Krishna Bhat, Ramya Kamlekar, Malavika Kulkarni","doi":"10.4103/TheIAForum.TheIAForum_40_22","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_40_22","url":null,"abstract":"Background: Determining the appropriate size of an endotracheal tube (ETT) in infants and children remains a challenge for anesthesiologists. We conducted this study to assess the accuracy of middle finger length (MFL) in predicting the appropriate ETT size for pediatric patients in comparison with the age-based estimation and derive a formula based on MFL for the estimation of ETT size. Materials and Methods: In the study, South Indian children 1–10 years of age, requiring general anesthesia were intubated by consultant anesthesiologists based on their discretion with an appropriately sized ETT. Subsequently, the MFL of the children was measured and tracheal tube size calculated from the age-based formula was also noted. The actual size of the ETT inserted was compared with the MFL and age-based formula using Pearson's correlation. Results: In children between 1 and 10 years of age, the age-based formulae (ABF) was found to correlate with ETT estimated with the correlation coefficient (r = 0.885; P < 0.001) and MFL (r = 0.783 and P < 0.001). ABF showed a stronger correlation with the ETT inserted compared to the MFL, nevertheless, we were able to arrive at a formula to predict tracheal tube size based on MFL: ETT ID (mm) =1.1+ (0.7 × MFL [cm]). Conclusion: Although age-based Cole's and Motoyama's formulae are better predictors of pediatric ETT size, MFL can still be used to predict the tube size in cases when age and weight are unknown.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"105 - 110"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43967285","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}
Pub Date : 2022-07-01DOI: 10.4103/TheIAForum.TheIAForum_93_22
Rajasekhar Metta, M. Eeshwar, G. Biyani
Despite few inherent issues, ultrasound (US) has emerged as a new frontier in the assessment and management of pediatric airway due to easy availability of US machines in operation theaters, noninvasive and radiation-free properties, and reproducibility. In this narrative review, we discussed the ergonomics and equipment needed to perform the airway scan, types of scans performed and their clinical applications, normal appearance of airway structures, and important clinical applications of US in the management of pediatric airway. The greatest advantage of US lies in accurate location of cricothyroid membrane and tracheal rings, in measuring the narrowest part of the airway (cricoid) to determine the size of the endotracheal tube, to rule out esophageal intubation, and in assessing the movements of the vocal cords, among others. In our view, upper airway US is a convenient, cost-effective, noninvasive, first-line airway assessment tool which is dynamic in nature. It can be used preoperatively, intraoperatively for real-time guidance in performing interventional procedures, and in the postoperative period.
{"title":"Use of ultrasound in pediatric airway: Revisiting the past, reviewing the present, and recommending for the future","authors":"Rajasekhar Metta, M. Eeshwar, G. Biyani","doi":"10.4103/TheIAForum.TheIAForum_93_22","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_93_22","url":null,"abstract":"Despite few inherent issues, ultrasound (US) has emerged as a new frontier in the assessment and management of pediatric airway due to easy availability of US machines in operation theaters, noninvasive and radiation-free properties, and reproducibility. In this narrative review, we discussed the ergonomics and equipment needed to perform the airway scan, types of scans performed and their clinical applications, normal appearance of airway structures, and important clinical applications of US in the management of pediatric airway. The greatest advantage of US lies in accurate location of cricothyroid membrane and tracheal rings, in measuring the narrowest part of the airway (cricoid) to determine the size of the endotracheal tube, to rule out esophageal intubation, and in assessing the movements of the vocal cords, among others. In our view, upper airway US is a convenient, cost-effective, noninvasive, first-line airway assessment tool which is dynamic in nature. It can be used preoperatively, intraoperatively for real-time guidance in performing interventional procedures, and in the postoperative period.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"83 - 90"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41455471","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}
Pub Date : 2022-07-01DOI: 10.4103/TheIAForum.TheIAForum_39_22
A. Khare, Poonam Awana, Beena Thada, Veena Mathur, P. Kumar
Background and Aims: Blockbuster laryngeal mask airway (LMA), a newer supraglottic airway device, provides a quick and reliable seal of the airway, making it useful for positive pressure ventilation. This randomized comparative study was undertaken to compare the safety and efficacy of I-gel and Blockbuster LMA used in short surgical procedures under general anesthesia. Materials and Methods: Hundred patients of either sex aged between 18 and 60 years belonging to the American Society of Anesthesiologist physical Status I and II undergoing general anesthesia were randomized into two groups of 50 patients each, using either I-gel (Group IG) or Blockbuster LMA (Group BB). After standard monitoring and induction of anesthesia, LMA was inserted according to their randomized groups and adequate ventilation was achieved. The primary objectives were grading of ease of insertion and time taken for successful insertion of device, while number of attempts for insertion, oropharyngeal seal pressure (OSP), hemodynamic changes, and adverse effects such as blood staining of device, injury of lips, tongue and teeth, postoperative hoarseness of voice and sore throat were secondary objectives. Data were analyzed using SPSS version 3.0.0.34. Results: The ease of insertion was graded as very easy in 46 patients in Group BB and 26 patients in Group IG (P < 0.001). The mean time for insertion was less with Group BB (24.30 ± 3.91 s) as compared to Group IG (29.50 ± 12.5 s) (P < 0.0001). 48 patients in Group BB while 37 patients in Group IG (P = 0.008) were required one attempt for insertion. The average OSP was 22.59 ± 1.44 cmH2O in Group BB as compared to 20.88 ± 2.22 cmH2O in Group IG (P < 0.0001). Hemodynamic changes were comparable at different time intervals. Complications such as blood stain of device and sore throat were more with I-gel. Conclusions: The Blockbuster LMA is an effective alternative to I-gel with faster, easier insertion, required a smaller number of attempts, high airway sealing pressure with stable hemodynamic, and less incidence of blood staining and postoperative sore throat.
{"title":"A Randomized comparative study to observe the safety and efficacy of I gel and blockbuster laryngeal mask airway used in patients undergoing short surgical procedure under general anesthesia","authors":"A. Khare, Poonam Awana, Beena Thada, Veena Mathur, P. Kumar","doi":"10.4103/TheIAForum.TheIAForum_39_22","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_39_22","url":null,"abstract":"Background and Aims: Blockbuster laryngeal mask airway (LMA), a newer supraglottic airway device, provides a quick and reliable seal of the airway, making it useful for positive pressure ventilation. This randomized comparative study was undertaken to compare the safety and efficacy of I-gel and Blockbuster LMA used in short surgical procedures under general anesthesia. Materials and Methods: Hundred patients of either sex aged between 18 and 60 years belonging to the American Society of Anesthesiologist physical Status I and II undergoing general anesthesia were randomized into two groups of 50 patients each, using either I-gel (Group IG) or Blockbuster LMA (Group BB). After standard monitoring and induction of anesthesia, LMA was inserted according to their randomized groups and adequate ventilation was achieved. The primary objectives were grading of ease of insertion and time taken for successful insertion of device, while number of attempts for insertion, oropharyngeal seal pressure (OSP), hemodynamic changes, and adverse effects such as blood staining of device, injury of lips, tongue and teeth, postoperative hoarseness of voice and sore throat were secondary objectives. Data were analyzed using SPSS version 3.0.0.34. Results: The ease of insertion was graded as very easy in 46 patients in Group BB and 26 patients in Group IG (P < 0.001). The mean time for insertion was less with Group BB (24.30 ± 3.91 s) as compared to Group IG (29.50 ± 12.5 s) (P < 0.0001). 48 patients in Group BB while 37 patients in Group IG (P = 0.008) were required one attempt for insertion. The average OSP was 22.59 ± 1.44 cmH2O in Group BB as compared to 20.88 ± 2.22 cmH2O in Group IG (P < 0.0001). Hemodynamic changes were comparable at different time intervals. Complications such as blood stain of device and sore throat were more with I-gel. Conclusions: The Blockbuster LMA is an effective alternative to I-gel with faster, easier insertion, required a smaller number of attempts, high airway sealing pressure with stable hemodynamic, and less incidence of blood staining and postoperative sore throat.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"111 - 117"},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46222846","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_169_21
B. Krishna, N. Pathak, Sengottaian Sivakumar, Santvana Kohli
{"title":"A film you should definitely see: A case of endotracheal tube obstruction by packaging film","authors":"B. Krishna, N. Pathak, Sengottaian Sivakumar, Santvana Kohli","doi":"10.4103/theiaforum.theiaforum_169_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_169_21","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"79 - 80"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47166738","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_168_21
Vinod Krishnagopal, R. Murugan, A. Priya, S. Krishnakumar
{"title":"Caught between the devil and deep sea: Anesthetic management of a patient with hereditary cerebellar ataxia and iatrogenic median and ulnar entrapment neuropathy posted for fixation of both bone forearm","authors":"Vinod Krishnagopal, R. Murugan, A. Priya, S. Krishnakumar","doi":"10.4103/theiaforum.theiaforum_168_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_168_21","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"77 - 79"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43694627","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_41_21
Joseph Paarel, V. Rao, Anand Ganesh, Sukesh Nair, S. Dharmalingam, B. Kurien, R. Sahajanandan
Background: Transfusion of blood and blood products is strongly associated with increased morbidity and mortality in cardiovascular surgery. This includes transfusion-related acute lung injury, transfusion-associated circulatory overload, renal injury, anaphylactic reactions to blood products, and sepsis. Transfusion of blood products based on the clinician's judgment often results in excessive transfusion. Research suggests that the use of point-of-care (POC) coagulation tests coupled to algorithm-based management decrease transfusion requirements in cardiac surgery. Objectives: To determine abnormal thromboelastograph (TEG) values among patients who received blood products based on clinical judgment and to determine if a POC coagulation test could have resulted in reduced transfusion rates in these patients. Methods: A total of 45 cardiac surgical patients who received blood products during a 3 months period were included in the audit. Coagulation profile and TEG were sent before transfusion for all patients. Data were entered using EPIDATA software. Descriptive analysis was used to define the data. The Fisher exact test was used to assess differences between groups for categorical variables. Results: The R time was abnormal in 4.4% of patients, the Alpha angle was abnormal in 51.1% of patients, maximum amplitude was abnormal in 2.2% of patients, and there was no evidence of fibrinolysis on TEG in these patients. Conclusion: Clinical judgment about the need for blood transfusion had poor correlation with dynamic tests of coagulation. A POC test-based algorithm would have avoided a significant amount of blood product transfusion both in terms of choice of therapy and the dose of component used.
{"title":"An audit on transfusion of blood products based on clinical judgment in patients undergoing cardiac surgery","authors":"Joseph Paarel, V. Rao, Anand Ganesh, Sukesh Nair, S. Dharmalingam, B. Kurien, R. Sahajanandan","doi":"10.4103/theiaforum.theiaforum_41_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_41_21","url":null,"abstract":"Background: Transfusion of blood and blood products is strongly associated with increased morbidity and mortality in cardiovascular surgery. This includes transfusion-related acute lung injury, transfusion-associated circulatory overload, renal injury, anaphylactic reactions to blood products, and sepsis. Transfusion of blood products based on the clinician's judgment often results in excessive transfusion. Research suggests that the use of point-of-care (POC) coagulation tests coupled to algorithm-based management decrease transfusion requirements in cardiac surgery. Objectives: To determine abnormal thromboelastograph (TEG) values among patients who received blood products based on clinical judgment and to determine if a POC coagulation test could have resulted in reduced transfusion rates in these patients. Methods: A total of 45 cardiac surgical patients who received blood products during a 3 months period were included in the audit. Coagulation profile and TEG were sent before transfusion for all patients. Data were entered using EPIDATA software. Descriptive analysis was used to define the data. The Fisher exact test was used to assess differences between groups for categorical variables. Results: The R time was abnormal in 4.4% of patients, the Alpha angle was abnormal in 51.1% of patients, maximum amplitude was abnormal in 2.2% of patients, and there was no evidence of fibrinolysis on TEG in these patients. Conclusion: Clinical judgment about the need for blood transfusion had poor correlation with dynamic tests of coagulation. A POC test-based algorithm would have avoided a significant amount of blood product transfusion both in terms of choice of therapy and the dose of component used.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"62 - 67"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44485457","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_156_21
Yogesh Swarnkar, R. Gupta, Anand Arora, Tuhin Mistry
Background and Aims: Nefopam and tramadol have been used for postoperative analgesia in the various clinical settings. This study aims to evaluate and compare the postoperative analgesic effects of intravenous nefopam and tramadol in adult patients undergoing laparoscopic abdominal surgeries. Materials and Methods: One hundred and twenty-six adult patients of the American Society of Anesthesiologists physical Status I and II, age group of 20–60 years undergoing elective or emergency laparoscopic abdominal surgeries under general anesthesia were allocated randomly into two groups. In the postanesthesia care unit, patients in Group A (n = 63) and Group B (n = 63) received Nefopam 20 mg and Tramadol 100 mg, respectively, as intravenous infusion in 100 ml 0.9% saline over 15 min. The same doses were repeated every 6th hour or if the Visual Analog Scale (VAS) score was ≥4. Postoperative VAS scores were recorded at 30 min, 1.5 h, 3 h, 6 h, 12 h, 18 h, and 24 h. The hemodynamic parameters were recorded just before and after the completion of the infusion of study drugs. P < 0.05 was considered statistically significant. Results: The pain score was significantly lower in Group A (Nefopam) than in Group B (Tramadol). The difference in mean VAS scores between the two groups was statistically significant at 1.5 h, 3 h, 6 h, 12 h, 18 h, and 24 h after postoperatively (P < 0.05). There was no statistically significant difference in the incidence of side effects in both groups. Conclusion: Intravenous nefopam provided better postoperative pain relief than Tramadol in patients undergoing laparoscopic surgeries under general anaesthesia.
{"title":"Comparison of Intravenous Nefopam and Tramadol for Postoperative Analgesia in Adult Patients Scheduled for Laparoscopic Abdominal Surgeries under General Anesthesia: A Prospective, Randomized, Double-Blind Study","authors":"Yogesh Swarnkar, R. Gupta, Anand Arora, Tuhin Mistry","doi":"10.4103/theiaforum.theiaforum_156_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_156_21","url":null,"abstract":"Background and Aims: Nefopam and tramadol have been used for postoperative analgesia in the various clinical settings. This study aims to evaluate and compare the postoperative analgesic effects of intravenous nefopam and tramadol in adult patients undergoing laparoscopic abdominal surgeries. Materials and Methods: One hundred and twenty-six adult patients of the American Society of Anesthesiologists physical Status I and II, age group of 20–60 years undergoing elective or emergency laparoscopic abdominal surgeries under general anesthesia were allocated randomly into two groups. In the postanesthesia care unit, patients in Group A (n = 63) and Group B (n = 63) received Nefopam 20 mg and Tramadol 100 mg, respectively, as intravenous infusion in 100 ml 0.9% saline over 15 min. The same doses were repeated every 6th hour or if the Visual Analog Scale (VAS) score was ≥4. Postoperative VAS scores were recorded at 30 min, 1.5 h, 3 h, 6 h, 12 h, 18 h, and 24 h. The hemodynamic parameters were recorded just before and after the completion of the infusion of study drugs. P < 0.05 was considered statistically significant. Results: The pain score was significantly lower in Group A (Nefopam) than in Group B (Tramadol). The difference in mean VAS scores between the two groups was statistically significant at 1.5 h, 3 h, 6 h, 12 h, 18 h, and 24 h after postoperatively (P < 0.05). There was no statistically significant difference in the incidence of side effects in both groups. Conclusion: Intravenous nefopam provided better postoperative pain relief than Tramadol in patients undergoing laparoscopic surgeries under general anaesthesia.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"25 - 30"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44491406","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_69_21
Chhabra Alka, Karuna Sharma, Neelam Chaudhary, Milan Dave, N. Pandey, Sunanda Gupta
Background: Deep sedation has evolved as a better choice against general anesthesia in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). This study was aimed to evaluate the efficacy of dexmedetomidine and nalbuphine as an adjuvant to ketofol based deep sedation in ERCP. Methods: One hundred patients undergoing ERCP were randomly assigned to receive either IV dexmedetomidine 1 μg/kg (Group D, n = 50) or I. V nalbuphine 0.1 μg/kg (Group N, n = 50), 10 min before ketofol induction. The primary outcome was the total dose of ketofol used for induction and maintenance of deep sedation throughout the procedure. Hemodynamics and respiratory parameters, recovery characteristics, endoscopist's, and anesthetist satisfaction scores were secondary outcomes. P < 0.05 was considered statistically significant. Results: The dose of ketofol at the time of induction was significantly high in Group N as compared to Group D (P < 0.05). Supplemental dose of ketofol at the time of insertion of endoscope was equivalent in both the groups (P > 0.05) but significantly more number of patients in Group D (n = 19 vs. n = 11, P < 0.05) received supplement for facial pain score >5 compared to patients in Group N, where more patients received supplement for Ramsay Sedation Score <3 (n = 20 vs. n = 11 P < 0.05). Significant decrease in heart rate (HR) and mean arterial pressure from baseline values was found in Group D as compared to Group N (P < 0.001). Group N patients achieved postanesthesia recovery score >12 earlier than Group D (P < 0.001). Anesthetist satisfaction score was more in Group N (P < 0.05). Conclusion: Dexmedetomidine reduces the total consumption of ketofol and provides smooth hemodynamics whereas Nalbuphine provides better analgesia and early recovery with high anesthetist satisfaction for deep sedation in ERCP.
{"title":"Addition of dexmedetomidine and nalbuphine as an adjuvant to ketofol for deep sedation during endoscopic retrograde cholangiopancreatography: A prospective, randomized, double-blind study","authors":"Chhabra Alka, Karuna Sharma, Neelam Chaudhary, Milan Dave, N. Pandey, Sunanda Gupta","doi":"10.4103/theiaforum.theiaforum_69_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_69_21","url":null,"abstract":"Background: Deep sedation has evolved as a better choice against general anesthesia in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). This study was aimed to evaluate the efficacy of dexmedetomidine and nalbuphine as an adjuvant to ketofol based deep sedation in ERCP. Methods: One hundred patients undergoing ERCP were randomly assigned to receive either IV dexmedetomidine 1 μg/kg (Group D, n = 50) or I. V nalbuphine 0.1 μg/kg (Group N, n = 50), 10 min before ketofol induction. The primary outcome was the total dose of ketofol used for induction and maintenance of deep sedation throughout the procedure. Hemodynamics and respiratory parameters, recovery characteristics, endoscopist's, and anesthetist satisfaction scores were secondary outcomes. P < 0.05 was considered statistically significant. Results: The dose of ketofol at the time of induction was significantly high in Group N as compared to Group D (P < 0.05). Supplemental dose of ketofol at the time of insertion of endoscope was equivalent in both the groups (P > 0.05) but significantly more number of patients in Group D (n = 19 vs. n = 11, P < 0.05) received supplement for facial pain score >5 compared to patients in Group N, where more patients received supplement for Ramsay Sedation Score <3 (n = 20 vs. n = 11 P < 0.05). Significant decrease in heart rate (HR) and mean arterial pressure from baseline values was found in Group D as compared to Group N (P < 0.001). Group N patients achieved postanesthesia recovery score >12 earlier than Group D (P < 0.001). Anesthetist satisfaction score was more in Group N (P < 0.05). Conclusion: Dexmedetomidine reduces the total consumption of ketofol and provides smooth hemodynamics whereas Nalbuphine provides better analgesia and early recovery with high anesthetist satisfaction for deep sedation in ERCP.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"31 - 37"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43229085","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}
Pub Date : 2022-01-01DOI: 10.4103/theiaforum.theiaforum_56_21
Ammu Seetha, S. Varughese
Background and Aims: Spinal cord injury resulting from the central neuraxial blockade is a rare but dreadful complication. The most likely cause is believed to be misjudged level of the intervertebral space (IVS). In our study, we assessed the accuracy of IVS marked by the anesthesiologist in 170 patients who were posted for surgery under spinal anesthesia using ultrasonography. Methodology: This was a prospective examiner-blinded observational study in 170 patients. An anesthesiologist estimated and marked the IVS using conventional palpation method (based on intercristal line), and the level was counterchecked ultrasonically by another anesthesiologist, who was blinded to the initial marked level. Statistical Analysis: The agreement between the palpation method and ultrasound assessment of IVS was analyzed using the Chi-square test. P < 0.05 was considered statistically significant. Results and Conclusion: The IVS estimated by conventional palpation method correlated with ultrasound estimation in only 49.4% of patients.
{"title":"Ultrasound versus palpation method for accurate estimation of intervertebral space: A cross-sectional observational study","authors":"Ammu Seetha, S. Varughese","doi":"10.4103/theiaforum.theiaforum_56_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_56_21","url":null,"abstract":"Background and Aims: Spinal cord injury resulting from the central neuraxial blockade is a rare but dreadful complication. The most likely cause is believed to be misjudged level of the intervertebral space (IVS). In our study, we assessed the accuracy of IVS marked by the anesthesiologist in 170 patients who were posted for surgery under spinal anesthesia using ultrasonography. Methodology: This was a prospective examiner-blinded observational study in 170 patients. An anesthesiologist estimated and marked the IVS using conventional palpation method (based on intercristal line), and the level was counterchecked ultrasonically by another anesthesiologist, who was blinded to the initial marked level. Statistical Analysis: The agreement between the palpation method and ultrasound assessment of IVS was analyzed using the Chi-square test. P < 0.05 was considered statistically significant. Results and Conclusion: The IVS estimated by conventional palpation method correlated with ultrasound estimation in only 49.4% of patients.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"23 1","pages":"44 - 48"},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44002660","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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