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Rapid sequence labor analgesia for Eisenmenger complex 艾森曼格综合征快速分娩镇痛术
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_46_23
Ramya Ravi, C. Thangaswamy, Rajasekar Ramadurai, Hemavathi Balachander
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引用次数: 0
Let awake transorbital fiberoptic intubation solve the triple trouble 让清醒的经眶纤支镜插管解决三重烦恼
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_16_23
Mayank Gupta, Gegal Pruthi, Vaibhav Saini, Jyoti Sharma
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引用次数: 0
Video rhino-laryngoscope-guided bougie insertion through a supraglottic airway device in an unanticipated difficult airway: An alternative to the fiberoptic bronchoscope 在视频鼻喉镜引导下,通过声门上气道装置插入通气导管,解决意外的困难气道:纤维支气管镜的替代方案
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_28_23
Amarjeet Kumar, Gayatri D. Sagdeo, Athira Jayan
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引用次数: 0
Minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion: Randomized triple-blinded trial 剖宫产术中使用或不使用预防性去甲肾上腺素输注鞘内高压布比卡因的最小有效剂量:三盲随机试验
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_189_23
A. Tyagi, Monika Mathur, Rashmi Salhotra, R. Rautela
Vasopressor usage can affect the rostral spread of intrathecal drug and, hence, its requirement during cesarean delivery. Although a decreased spread is evidenced with phenylephrine, there is no data for norepinephrine usage. The present study aimed to evaluate the minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion. Patients scheduled for elective cesarean section under combined spinal–epidural block were randomized to receive intravenous infusion of norepinephrine (0.05 μg/kg/min) or normal saline (placebo), initiated immediately after intrathecal injection. Postspinal hypotension in either group (systolic arterial pressure ≤0.8 baseline) was treated with norepinephrine 4 μg rescue. Dose of intrathecal hyperbaric bupivacaine (0.5%) was decided for individual patients using up-and-down sequential allocation method. Primary outcome measure was the minimum effective dose of intrathecal hyperbaric bupivacaine (0.5%) defined as ED50, while secondary observations included spinal block characteristics and neonatal outcomes. Demographic parameters were statistically similar between both groups (P > 0.05). ED50 of intrathecal hyperbaric bupivacaine was 7.8 mg (95% confidence interval [CI]: 6.7–8.8) and 7.4 mg (95% CI: 6.1–8.7) for normal saline and norepinephrine group respectively (P = 0.810). Block characteristics were similar between both groups as was neonatal APGAR score, but umbilical artery base excess was greater for norepinephrine versus normal saline group (−4.4 ± 3.6 vs. −6.5 ± 2.4, P = 0.038). Use of prophylactic norepinephrine (0.05 μg/kg/min) during cesarean delivery does not require adjustment of intrathecal hyperbaric bupivacaine.
使用血管抑制剂会影响鞘内药物的喙侧扩散,从而影响剖宫产时对药物的需求。虽然使用苯肾上腺素会减少药物的扩散,但目前还没有使用去甲肾上腺素的数据。本研究旨在评估在使用或不使用预防性去甲肾上腺素的情况下,用于剖宫产的鞘内高压布比卡因的最小有效剂量。 计划在脊柱-硬膜外联合阻滞下进行择期剖宫产的患者被随机分为两组,分别接受去甲肾上腺素(0.05 μg/kg/min)或生理盐水(安慰剂)的静脉注射,注射后立即开始鞘内注射。任何一组出现椎管后低血压(收缩压≤0.8 基线)时,均使用去甲肾上腺素 4 μg 进行抢救。鞘内高压布比卡因(0.5%)的剂量根据患者的具体情况采用上下顺序分配法决定。主要观察指标是鞘内高压布比卡因(0.5%)的最小有效剂量,即ED50,次要观察指标包括脊髓阻滞特征和新生儿预后。 两组的人口统计学参数相似(P > 0.05)。正常生理盐水组和去甲肾上腺素组的鞘内高压布比卡因 ED50 分别为 7.8 毫克(95% 置信区间 [CI]:6.7-8.8)和 7.4 毫克(95% 置信区间 [CI]:6.1-8.7)(P = 0.810)。两组阻滞特征相似,新生儿 APGAR 评分也相似,但去甲肾上腺素组的脐动脉基底超出量大于生理盐水组(-4.4 ± 3.6 vs. -6.5 ± 2.4,P = 0.038)。 在剖宫产过程中使用预防性去甲肾上腺素(0.05 μg/kg/min)无需调整鞘内高压布比卡因。
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引用次数: 0
Anesthetic management of an infant with Holt–Oram syndrome 霍尔特-奥拉姆综合征婴儿的麻醉管理
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_74_23
Neha Goyal, Rashmi Syal, Nehal Singh, Rakesh Kumar, Pradeep Bhatia
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引用次数: 0
Comparison of grooved and conventional Macintosh laryngoscope blades for throat pack insertion: A randomized control trial 插入喉袋时使用带槽喉镜刀片和传统 Macintosh 喉镜刀片的比较:随机对照试验
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_318_23
Jyothi Elizabeth John, A. Nileshwar
Throat pack insertion is required for many otolaryngological surgeries under general anesthesia. To facilitate surgery, an oral Ring, Adair, and Elwyn (RAE) endotracheal tube is used. When the Macintosh blade is used to insert the pack, the tube often moves to the left as per its design. We designed a groove in the Macintosh laryngoscope blade to hold the endotracheal tube in place during pack placement. This study was done to compare the grooved and conventional Macintosh laryngoscope blades for throat pack insertion with respect to the intraoral movement of the tube, ease of packing, time taken, and associated hemodynamic changes in patients who have been intubated with a preformed oral endotracheal tube. This randomized control trial included 80 patients after approval from the institutional ethics committee and CTRI. Informed written consent was taken from all patients. Packing of cases was done with either grooved (group G) or conventional Macintosh laryngoscope blade (group C). Student’s t-test, Chi-square test, and Mann–Whitney U test were used to analyze data. The tube remained in the center in 35/40 patients in group G as compared to 10/40 patients in group C (P < 0.0001). Packing the throat was significantly easier (P = 0.005), and time taken to pack the throat was shorter in group G as compared to group C (P = 0.0008). The endotracheal tube remains in the center more often during throat pack insertion using a grooved laryngoscope blade as compared to the conventional Macintosh laryngoscope blade. The grooved blade is easier to use and takes less time to insert the throat pack.
许多耳鼻喉科手术都需要在全身麻醉的情况下插入喉咙包。为了方便手术,需要使用口腔 Ring、Adair 和 Elwyn(RAE)气管插管。当使用 Macintosh 刀片插入气管袋时,气管往往会按照其设计向左移动。我们在 Macintosh 喉镜刀片上设计了一个凹槽,以便在放置药包时固定气管导管。这项研究的目的是比较带凹槽的喉镜刀片和传统的 Macintosh 喉镜刀片在插入喉咙填料时的喉管口内移动情况、填料的难易程度、所需时间以及使用预制口腔气管插管的患者的相关血流动力学变化。 在获得机构伦理委员会和 CTRI 批准后,该随机对照试验纳入了 80 名患者。所有患者均已获得知情书面同意。病例的填塞采用槽式(G 组)或传统 Macintosh 喉镜刀片(C 组)。数据分析采用学生 t 检验、卡方检验和 Mann-Whitney U 检验。 与 C 组的 10/40 名患者相比,G 组的 35/40 名患者的喉管保持在中心位置(P < 0.0001)。与 C 组相比(P = 0.0008),G 组患者的喉咙包装明显更容易(P = 0.005),包装喉咙所需的时间也更短(P = 0.0008)。 与传统的 Macintosh 喉镜刀片相比,使用带凹槽的喉镜刀片插入喉咙填料时,气管导管更容易保持在中心位置。凹槽刀片更易于使用,插入喉腔填塞物所需的时间也更短。
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引用次数: 0
Longitudinal axis approach versus longitudinal oblique axis approach for ultrasound-guided radial artery cannulation in adult patients: A comparative study 成人患者在超声引导下桡动脉插管的纵轴法与纵斜轴法:对比研究
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_275_23
Rakesh Kumar, Madhu Gupta, Parul Kaushik, Shyam Mohanan, Manisha Dabas
Ultrasonography (USG)-guided arterial cannulation is a frequently performed procedure in the operating room and intensive care unit. Conventionally, longitudinal/in-plane and transverse/out-of-plane approaches are used for cannulation. Recently, a longitudinal oblique approach has been described with the advantage of wide visualization area. Hence, the present study was designed to compare the success of USG-guided radial artery cannulation in longitudinal oblique axis (LOA) and longitudinal axis (LA). Seventy patients requiring radial artery cannulation were randomly allocated into two groups: group L (USG-guided radial artery cannulation in LA) and group O (USG-guided radial artery cannulation in LOA). Primary outcome was to assess cannulation success in the first attempt, while the secondary outcomes were to assess the number of attempts, failure rate, total cannulation time, and associated complications. First-attempt success was higher in group O (80%) compared to group L (54.3%), with a P value of 0.022. In group L, 31.4% required two attempts and 5.7% had three attempts, while in group O, 14.3% had two attempts and 2.9% required three attempts. Group L failure rate was 8.6%, while it was 2.9% in group O. The mean total cannulation time (sec) for group L was 146.83 ± 89.37 and group O was 63.89 ± 26.277. No complication was observed with group O, while in group L, 9% had hematoma formation. The LOA approach for USG-guided radial artery cannulation has higher first-pass success rate, total success rate, and requires less cannulation time compared to the LA approach.
超声波(USG)引导下的动脉插管是手术室和重症监护室中经常进行的手术。传统的插管方法有纵向/平面内和横向/平面外两种。最近,有人描述了一种纵向斜入路,其优点是视野开阔。因此,本研究旨在比较 USG 引导的桡动脉插管在纵向斜轴(LOA)和纵向轴(LA)上的成功率。 70 名需要桡动脉插管的患者被随机分为两组:L 组(USG 引导下桡动脉在 LA 轴插管)和 O 组(USG 引导下桡动脉在 LOA 轴插管)。主要结果是评估首次尝试的插管成功率,次要结果是评估尝试次数、失败率、总插管时间和相关并发症。 与 L 组(54.3%)相比,O 组的首次尝试成功率更高(80%),P 值为 0.022。在 L 组中,31.4% 的人需要尝试两次,5.7% 的人需要尝试三次,而在 O 组中,14.3% 的人需要尝试两次,2.9% 的人需要尝试三次。L 组的平均插管总时间(秒)为 146.83 ± 89.37,O 组为 63.89 ± 26.277。O 组未观察到并发症,而 L 组有 9% 的患者出现血肿。 与 LA 方法相比,USG 引导下桡动脉插管的 LOA 方法具有更高的首次插管成功率和总成功率,所需的插管时间也更短。
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引用次数: 0
An unidentifiably severed LMA supreme: An unanticipated critical incident 不明原因的 LMA supreme 切断:意料之外的危急事件
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_89_23
Gegal Pruthi, Jyoti Sharma, Manisha Singla, Anju Grewal
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引用次数: 0
Vasoactive-ventilation-renal (VVR) score: A potential tool for predicting early postoperative outcomes in adult mitral valve surgery 血管活性-通气-肾脏(VVR)评分:预测成人二尖瓣手术术后早期预后的潜在工具
Pub Date : 2024-03-28 DOI: 10.4103/joacp.joacp_210_23
K.S. Ram Kiran, Nirav Parikh, Rajesh S. P. Venuthurupalli, Maruti Haranal, Himani Pandya, Anuj Kapoor, Kaushal P. Patel
Vasoactive-ventilation-renal (VVR) score has been validated in predicting postoperative outcomes in pediatric cardiac surgery. The aim was to evaluate its potential in predicting early postoperative outcomes in adult patients undergoing mitral valve surgery. A single-center prospective observational study involved 100 patients undergoing mitral valve surgery. We evaluated preoperative variables (Ambler score), VVR, and vasoactive-inotropic score (VIS) on admission to the intensive care unit (ICU) and then at 12, 24, and 48 hrs postoperatively. Outcomes assessed were length of stay in ICU (LOS-ICU), length of hospital stay (LOHS), and mortality. The data were analyzed using multivariable logistic regression model, receiver operating characteristic (ROC) curves, and areas under curve (AUC). Our study showed the potential utility of the VVR score as a powerful tool for predicting early outcomes after mitral valve surgery, with VVR at 48 hrs having superior predictive capability.
血管活性-通气-肾脏(VVR)评分在预测小儿心脏手术的术后效果方面已得到验证。该研究旨在评估其预测接受二尖瓣手术的成年患者术后早期预后的潜力。 这项单中心前瞻性观察研究涉及 100 名接受二尖瓣手术的患者。我们评估了患者进入重症监护室(ICU)时的术前变量(Ambler 评分)、VVR 和血管活性-肌力评分(VIS),以及术后 12、24 和 48 小时的情况。评估结果包括重症监护室住院时间(LOS-ICU)、住院时间(LOHS)和死亡率。数据采用多变量逻辑回归模型、接收器操作特征曲线(ROC)和曲线下面积(AUC)进行分析。 我们的研究表明,VVR 评分作为预测二尖瓣手术后早期预后的有力工具具有潜在的实用性,其中 48 小时的 VVR 具有更强的预测能力。
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引用次数: 0
A study on the outcome of preoperative pulmonary function tests on a patient undergoing rheumatic mitral valve surgery 风湿性二尖瓣手术患者术前肺功能测试结果研究
Pub Date : 2024-03-15 DOI: 10.4103/joacp.joacp_317_23
Harneet S. Khurana, Sushmit Kamath, Kakali Ghosh, Arunava Biswas, C. Dasgupta
Evaluation of pulmonary function by spirometer in adult patients undergoing cardiac surgery is a simple test to assess pulmonary reserve that has important implications in operative morbidity. However, there is no established consensus regarding which patients should undergo preoperative pulmonary function tests (PFTs), including forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). The primary aim was to evaluate the outcome of preoperative PFTs on patients undergoing rheumatic mitral valve surgery. One hundred patients undergoing rheumatic mitral valve surgery, meeting the inclusion criteria, were included in this prospective observational study. The pulmonary function of the patients was assessed using a spirometer before surgery. Preoperative pulmonary artery systolic pressure (PASP) and arterial blood gas (ABG) analyses were also performed. The correlation of PFTs with early postsurgical outcome, comprising mortality within 30 days of surgery and morbidity defined as the existence of at least one of the postoperative complications, such as low cardiac output state indicated by increased requirement of inotropes, prolonged ventilation (>24 hours), postoperative new-onset hemodynamically significant arrhythmias, renal dysfunction, and post-op infection, was assessed. With the increasing New York Heart Association (NYHA) class of the patient, there was a decline of FEV1% and FVC%, which was statistically significant (P < 0.0001). There was a significant positive correlation of FVC% with preoperative saturation of peripheral oxygen (SpO2) and preoperative saturation of peripheral carbon dioxide (PaO2) and FEV1% with preoperative SpO2 and preoperative PaO2. Patients who had postoperative prolonged ventilation had lower values of FVC% and FEV1%, which was statistically significant (P < 0.001). The patients who expired had significantly lower values of FVC% and FEV1%. Preoperative lung function has an implication on intraoperative morbidity during cardiac surgery although a common consensus on its application is lacking. Preoperative spirometry can be one of the parameters for predicting postoperative morbidity and mortality in patients undergoing rheumatic mitral valve surgery. Spirometry might have a role to play in predicting patient outcomes in rheumatic mitral valve surgeries; however, larger well-powered studies are needed.
对接受心脏手术的成人患者进行肺功能测试是一项评估肺储备功能的简单测试,对手术发病率有重要影响。然而,关于哪些患者应进行术前肺功能检查(PFT),包括第一秒用力呼气容积(FEV1)和用力肺活量(FVC),目前还没有达成共识。该研究的主要目的是评估风湿性二尖瓣手术患者术前肺功能检查的结果。 这项前瞻性观察研究纳入了 100 名符合纳入标准的风湿性二尖瓣手术患者。术前使用肺活量计对患者的肺功能进行评估。术前还进行了肺动脉收缩压(PASP)和动脉血气(ABG)分析。评估了肺活量与术后早期预后的相关性,包括术后 30 天内的死亡率和至少出现一种术后并发症的发病率,这些并发症包括心输出量低(表现为肌力需求增加)、通气时间延长(超过 24 小时)、术后新发血流动力学显著性心律失常、肾功能障碍和术后感染。 随着患者纽约心脏协会(NYHA)分级的增加,FEV1% 和 FVC% 有所下降,这在统计学上有显著意义(P < 0.0001)。FVC% 与术前外周血氧饱和度(SpO2)和术前外周血二氧化碳饱和度(PaO2)呈显著正相关,FEV1% 与术前 SpO2 和术前 PaO2 呈显著正相关。术后延长通气时间的患者的 FVC% 和 FEV1% 值较低,差异有统计学意义(P < 0.001)。过期患者的 FVC% 和 FEV1% 值明显较低。 术前肺功能对心脏手术的术中发病率有影响,但对其应用缺乏共识。术前肺功能测定可作为预测风湿性二尖瓣手术患者术后发病率和死亡率的参数之一。肺活量测定在预测风湿性二尖瓣手术患者的预后方面可能有一定作用,但还需要进行更大规模的、有充分证据的研究。
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引用次数: 0
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Journal of Anaesthesiology Clinical Pharmacology
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