Pub Date : 2024-04-08DOI: 10.4103/joacp.joacp_395_22
Jhanvi Sunil Furia, M. Nadkarni
Predicting difficult airway and preparedness for the same can help prevent catastrophic situations while handling the airway. With the increasing familiarity of anaesthesiologists to the use of ultrasound machine and its easy availability and non-invasiveness, we sought to study its utility in airway assessment, by measuring the thickness of tongue, to predict difficult laryngoscopy and intubation. A total of 85 patients undergoing elective surgeries under general anaesthesia with endotracheal intubation were examined preoperatively. Tongue thickness was measured using submental ultrasonography in the median sagittal plane along with other tests of airway assessment. Cormack Lehane grade on laryngoscopy and Intubation Difficulty Scale Score was recorded. The sensitivity, specificity, positive and negative predictive value, and accuracy was calculated for tongue thickness for predicting difficult intubation. The tongue thickness in those with difficult intubation (4.83 ± 0.62) was significantly higher than those without difficult intubation (4.38 ± 0.65). The ratio of tongue thickness to thyromental distance was also significantly higher in difficult intubation group. The area under the receiver operating characteristic curve for predicting difficult laryngoscopy and intubation was higher for tongue thickness as compared to other clinical parameters. The sensitivity and specificity of tongue thickness to predict difficult laryngoscopy was 100% and 83%, respectively, and to predict difficult intubation was 72% and 59%, respectively, with an accuracy of 72%. Ultrasound based assessment of tongue thickness can be a useful predictor of difficult airway along with clinical assessment of the airway.
{"title":"Ultrasound-based assessment of tongue thickness for prediction of difficult laryngoscopy and intubation","authors":"Jhanvi Sunil Furia, M. Nadkarni","doi":"10.4103/joacp.joacp_395_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_395_22","url":null,"abstract":"\u0000 \u0000 \u0000 Predicting difficult airway and preparedness for the same can help prevent catastrophic situations while handling the airway. With the increasing familiarity of anaesthesiologists to the use of ultrasound machine and its easy availability and non-invasiveness, we sought to study its utility in airway assessment, by measuring the thickness of tongue, to predict difficult laryngoscopy and intubation.\u0000 \u0000 \u0000 \u0000 A total of 85 patients undergoing elective surgeries under general anaesthesia with endotracheal intubation were examined preoperatively. Tongue thickness was measured using submental ultrasonography in the median sagittal plane along with other tests of airway assessment. Cormack Lehane grade on laryngoscopy and Intubation Difficulty Scale Score was recorded. The sensitivity, specificity, positive and negative predictive value, and accuracy was calculated for tongue thickness for predicting difficult intubation.\u0000 \u0000 \u0000 \u0000 The tongue thickness in those with difficult intubation (4.83 ± 0.62) was significantly higher than those without difficult intubation (4.38 ± 0.65). The ratio of tongue thickness to thyromental distance was also significantly higher in difficult intubation group. The area under the receiver operating characteristic curve for predicting difficult laryngoscopy and intubation was higher for tongue thickness as compared to other clinical parameters. The sensitivity and specificity of tongue thickness to predict difficult laryngoscopy was 100% and 83%, respectively, and to predict difficult intubation was 72% and 59%, respectively, with an accuracy of 72%.\u0000 \u0000 \u0000 \u0000 Ultrasound based assessment of tongue thickness can be a useful predictor of difficult airway along with clinical assessment of the airway.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140732233","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}
{"title":"Airway management in a pediatric patient with glottic web: An anesthetic challenge in non-operating room anesthesia","authors":"Priyanka Sethi, Balakrishnan Narayanan, Deepanshu Dang, Kamlesh Kumari","doi":"10.4103/joacp.joacp_411_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_411_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140729877","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 : 2024-04-08DOI: 10.4103/joacp.joacp_394_22
Priyanka Sethi, Manbir Kaur, Deepanshu Dang, P. Bhatia
{"title":"High thoracic erector spinae plane block for forequarter amputation: A new perspective","authors":"Priyanka Sethi, Manbir Kaur, Deepanshu Dang, P. Bhatia","doi":"10.4103/joacp.joacp_394_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_394_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"167 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731149","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 : 2024-04-08DOI: 10.4103/joacp.joacp_393_22
S. Bakshi, Nayana Amin, S. Bhosale, Sajid S. Qureshi
{"title":"An interesting case of opioid-induced hyperalgesia and acute abdomen in the postoperative period","authors":"S. Bakshi, Nayana Amin, S. Bhosale, Sajid S. Qureshi","doi":"10.4103/joacp.joacp_393_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_393_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140732088","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 : 2024-04-08DOI: 10.4103/joacp.joacp_293_22
Teena Bansal, Sudha Puhal, S. Taxak, Suresh Singhal
{"title":"Difficult airway due to inaccessible face in a child- Challenge to anesthesiologist","authors":"Teena Bansal, Sudha Puhal, S. Taxak, Suresh Singhal","doi":"10.4103/joacp.joacp_293_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_293_22","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"236 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730662","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 : 2024-03-28DOI: 10.4103/joacp.joacp_82_23
Akkamahadevi Patil, S. Vyshnavi, Thanigai Raja, V. Shastry, Srinivas H. Thammaiah, KN Archana
The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.
{"title":"A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain","authors":"Akkamahadevi Patil, S. Vyshnavi, Thanigai Raja, V. Shastry, Srinivas H. Thammaiah, KN Archana","doi":"10.4103/joacp.joacp_82_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_82_23","url":null,"abstract":"\u0000 \u0000 \u0000 The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ).\u0000 \u0000 \u0000 \u0000 Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study.\u0000 \u0000 \u0000 \u0000 The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003).\u0000 \u0000 \u0000 \u0000 PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"52 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373336","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 : 2024-03-28DOI: 10.4103/joacp.joacp_77_23
Lalit Jha, Amarjeet Kumar, George Paul, Sanjeev Kumar
{"title":"Incidental finding of internal jugular vein clot during the perioperative period: An anesthesiologist’s nightmare","authors":"Lalit Jha, Amarjeet Kumar, George Paul, Sanjeev Kumar","doi":"10.4103/joacp.joacp_77_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_77_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"20 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373023","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 : 2024-03-28DOI: 10.4103/joacp.joacp_99_23
Ajitesh Sahu, C. Mohanty, S. H. Behera, Kiran Boyina
{"title":"A palatal fracture can be a harbinger of endotracheal tube cuff leak catastrophe during nasotracheal intubation","authors":"Ajitesh Sahu, C. Mohanty, S. H. Behera, Kiran Boyina","doi":"10.4103/joacp.joacp_99_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_99_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"30 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372794","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 : 2024-03-28DOI: 10.4103/joacp.joacp_45_23
Unnikannan Shaji, Gaurav Jain, D. Tripathy, Navin Kumar, Nilotpal Chowdhury
Pneumoperitoneum creation for laparoscopic surgery increases the intraabdominal pressure and causes alveolar atelectasis. We investigated the influence of an increase in intra-abdominal pressure (IAP) on ventilatory mechanical power (MP) delivery during pneumoperitoneum creation for laparoscopic cholecystectomy. In a prospective cohort design, we enrolled 42 patients undergoing laparoscopic cholecystectomy. During pneumoperitoneum creation, the IAP was sequentially raised to three predefined IAP levels (8, 11 and 14 mmHg), keeping identical ventilatory settings (timepoints T1, T2, and T3). After that, positive end-expiratory pressure (PEEP) was sequentially raised from 5 to 8 to 11 cmH2O (timepoint T4 and T5). The primary outcome included ventilatory MP delivery at each timepoint. Other variables included respiratory driving pressure (DP), airway resistance (AR), and respiratory compliance (RC). The MP increased linearly with a rise in IAP from T1 to T3 (r = 0.71, P < 0.001); the MP increased by 0.19 per unit rise in IAP (effect size 0.90, P < 0.001). A similar positive correlation was also observed between DP and IAP from T1 to T3 (r = 0.73, P < 0.001); the DP increased by 0.72 per unit rise in IAP (effect size 0.89, P < 0.001). The MP increased significantly on increasing PEEP from T3 to T5, while the DP decreased concomitantly (P < 0.001). The AR increased significantly from T1 to T3, while RC decreased concomitantly; vice-versa was observed at T4 and T5 (P < 0.001). The ventilatory MP delivery rises linearly with an increase in IAP. Targeting an IAP-guided MP level could be an attractive approach to minimize lung injury.
{"title":"Influence of intra-abdominal pressure on ventilatory mechanical power delivery and respiratory driving pressure during laparoscopic cholecystectomy: A prospective cohort study","authors":"Unnikannan Shaji, Gaurav Jain, D. Tripathy, Navin Kumar, Nilotpal Chowdhury","doi":"10.4103/joacp.joacp_45_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_45_23","url":null,"abstract":"\u0000 \u0000 \u0000 Pneumoperitoneum creation for laparoscopic surgery increases the intraabdominal pressure and causes alveolar atelectasis. We investigated the influence of an increase in intra-abdominal pressure (IAP) on ventilatory mechanical power (MP) delivery during pneumoperitoneum creation for laparoscopic cholecystectomy.\u0000 \u0000 \u0000 \u0000 In a prospective cohort design, we enrolled 42 patients undergoing laparoscopic cholecystectomy. During pneumoperitoneum creation, the IAP was sequentially raised to three predefined IAP levels (8, 11 and 14 mmHg), keeping identical ventilatory settings (timepoints T1, T2, and T3). After that, positive end-expiratory pressure (PEEP) was sequentially raised from 5 to 8 to 11 cmH2O (timepoint T4 and T5). The primary outcome included ventilatory MP delivery at each timepoint. Other variables included respiratory driving pressure (DP), airway resistance (AR), and respiratory compliance (RC).\u0000 \u0000 \u0000 \u0000 The MP increased linearly with a rise in IAP from T1 to T3 (r = 0.71, P < 0.001); the MP increased by 0.19 per unit rise in IAP (effect size 0.90, P < 0.001). A similar positive correlation was also observed between DP and IAP from T1 to T3 (r = 0.73, P < 0.001); the DP increased by 0.72 per unit rise in IAP (effect size 0.89, P < 0.001). The MP increased significantly on increasing PEEP from T3 to T5, while the DP decreased concomitantly (P < 0.001). The AR increased significantly from T1 to T3, while RC decreased concomitantly; vice-versa was observed at T4 and T5 (P < 0.001).\u0000 \u0000 \u0000 \u0000 The ventilatory MP delivery rises linearly with an increase in IAP. Targeting an IAP-guided MP level could be an attractive approach to minimize lung injury.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"140 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369245","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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