Anesthesia, Essays and Researches最新文献

Background: Pain and its alleviation have been a challenge for humans for centuries. Sub arachnoid block is most commonly practiced method for anaesthesia for lower limb surgeries. Adjuvants like opioids and alpha 2 agonists have proven benefits in augmentation of effects of local anaesthetics for spinal anesthesia. The aim of this study was to compare the effects of morphine and dexmedetomidine for sub arachnoid block in lower limb orthopaedic surgeries.

Material and methods: This is a prospective randomised controlled trial done in 120 patients who were posted for lower limb orthopaedic surgery. Along with bupivacaine, Group A received intrathecal dexmedetomidine while group B received intrathecal morphine.

Results: the demographic profile was comparable in both the groups. The mean duration of motor block in Group A was 359.33 ± 34.4 and in Group B was 265.71 ± 28.47. The duration of rescue analgesia was almost double in Group A as compared to Group B with P < 0.0001 (CL 95%).

Conclusion: Intrathecal dexmedetomidine and morphine both provided good postoperative analgesia. Dexmedetomidine provided a longer duration of analgesia than morphine, thereby increasing the time for first rescue analgesia, but at the cost of greater side effects.

Background: Coronavirus disease 2019 (COVID-19) pandemic is the biggest threat of the century. Associated with this disease, are a number of rhino orbital cerebral mucormycosis cases seen as post COVID sequelae. Amphotericin B and surgical debridement are the treatment modalities.

Aims: This study aimed to describe the clinical characteristics and perioperative outcomes of patients with ROCM.

Settings and design: This was a prospective, observational study.

Materials and methods: We carried out a study of 238 patients with confirmed ROCM posted for functional endoscopic sinus surgery, craniotomies, maxillofacial surgeries, and orbital exenteration under general anesthesia and the perioperative challenges therein.

Statistical analysis used: Data were entered in the excel sheet. Descriptive statistics were used to summarize the data. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27:0. Categorical variables were expressed as counts and percentages.

Results: 78% had diabetes mellitus, 64% had received steroids, 59% had a preoperative oxygen saturation of less than 90%, 86% had a 4-6 zone involvement on chest radiograph, and more than 50% had an anticipated difficult airway. Postsurgery, 13% of patients required intensive care. The 15-day mortality rate was 3% among the operated cases.

Conclusion: Post-COVID ROCM is challenging in terms of preoperative poor general condition, difficult airway, intraoperative concerns due to pathophysiology of the disease and its effect on organ systems, and the requirement of postoperative vigilant monitoring.

Background: Magnetic resonance imaging (MRI) under sedation requires faster recovery for early discharge and feeding resumption in children with neuropsychiatric disorders. The use of dexmedetomidine alone results in delayed recovery. Propofol, when used alone, can cause hypotension and respiratory depression. A new regimen for sedation was evaluated by exploiting the properties of these drugs, to allow faster recovery with minimal adverse events.

Materials and methods: One hundred and fifty children aged 2-12 years requiring MRI were randomly allocated to these three groups. Group P (n = 50) received propofol bolus at 2 mg.kg^-1 over 10 min followed by infusion at 100 μg.kg^-1.min^-1. Group D (n = 50) received dexmedetomidine bolus of 2 μg.kg^-1 over 10 min followed by infusion at 1 μg.kg^-1.h^-1. Group PD (n = 50) received propofol bolus at 2 mg.kg^-1 over 10 min followed by dexmedetomidine infusion at 1 μg.kg^-1.h^-1. Recovery characteristics were noted.

Results: Recovery following sedation in Group PD (15 ± 7.0 min) and Group P (17.35 ± 7.4 min) were comparable and significantly (P = 0.03) lesser than Group D (27.58 ± 8.09 min). Emergence delirium scores were significantly less in Group PD (5 ± 1.08) and Group D (5.6 ± 2.4), unlike scores in Group P (9 ± 2.43). About 79.5% (39/49) of children in Group P, 88.2% (45/51) of children in Group D, and 86% (43/50) of children in Group PD completed MRI without any movement. Seven (14.58%) in Group P, 2 (4%) in Group D, and 5 (10.20%) in Group PD required rescue sedation.

Conclusion: The regimen with propofol bolus and dexmedetomidine infusion provided adequate sedation and better recovery characteristics in children aged 2-12 years without systemic complications, as compared to the use of either agent alone.

Background: Routine tests before ophthalmologic surgery in adult patients are no longer recommended. However, there are limited data on the utility of routine preoperative tests for children.

Aims: We aimed to describe the effect of routine preoperative tests on systemic perioperative complications by hospital discharge or by day 30 following eye surgery.

Settings and design: This was a single-center, observational, and descriptive study.

Subjects and methods: We examined all patients ≤ 17 years old for whom ophthalmologists consulted with anesthesiologists before eye surgery under general anesthesia in an academic teaching tertiary care hospital from January 2010 to December 2019.

Results: A total of 708 pediatric patients were analyzed. The mean patient age was 8.5 ± 4.6 years. The most frequently performed procedure was strabismus surgery in 433 patients (61.2%). Following anesthetic consultations, 15 patients (2.1%) underwent surgery postponed due to abnormalities at the physical examination. Routine tests identified that the two patients (0.3%) required additional evaluations due to elevated serum creatine kinase and electrocardiographic abnormalities. However, further examinations found that these abnormalities were unremarkable. The remaining 691 patients (97.6%) underwent surgery as scheduled. Substantial intraoperative blood loss was observed only in three patients with malignant tumors or trauma. The incidence of systemic complications was 0 (0%; 95% confidence interval, 0%-0.05%).

Conclusions: These data indicated that the development of systemic perioperative complications following pediatric ophthalmic surgery is rare. Preoperative tests should be requested only if they are clinically indicated or before potentially bleeding procedures, such as malignancy or trauma surgery.

Background: One of the most feared symptoms of any disease is PAIN. It is a complex phenomenal experience, especially in children. Various methods and medications have been administered through different routes. Regional anesthesia produces marvelous postoperative analgesia and cessation of stress response in infants and children. Caudal epidural analgesia is the most acceptable and popular method of providing intra- and postoperative analgesia for abdominal, perineal, and lower limb surgeries in children. The use of preservative-free morphine as an adjunct to ropivacaine increases the quality and duration of analgesia despite the various side effects. Various articles use various doses of morphine as an adjuvant in caudal epidural analgesia. Hence, we conducted the study to compare the two dosages of morphine that is 20 μg.kg^-1 and 30 μg.kg^-1 of caudal epidural morphine for infraumblical surgeries with regard to its efficacy and safety and side effect profiles.

Materials and methods: The study is a prospective, randomized, double-blinded study. Sixty patients were divided into two groups. Group A: 20 μg.kg^-1 of morphine was added to 0.2% ropivacaine 1 mL.kg^-1 and the solution was made. Group B: 30 μg.kg^-1 of morphine was added to 1 mL.kg^-1 of 0.2% ropivacaine. Heart rate, systolic blood pressure, diastolic blood pressure, SPO₂, pain score, and sedation score were recorded immediately, after 15 min, 30 min, 45 min, 1 h, 2 h, 4 h, 8 h, 12 h, 16 h, 18 h, and 24 h were recorded.

Results: The mean duration of analgesia is similar in both groups (P = 0.011). The mean duration was 20.517 ± 1.9143 h in Group A and 22.233 ± 1.6853 h in Group B. Children with the requirement of one dose of rescue analgesia in Group A was 83.3% which was higher than Group B being 66.7%. Children with no analgesic requirement were 16.7% in Group A and 33.3% in Group B. The incidence of side effects was more in Group B (8 [26.7%] children with nausea and vomiting; 1 [3.3%] children with urinary retention) than in Group A (2 [6.6%] children with nausea and vomiting.

Conclusion: From the above observations, it can be concluded that morphine of less dosage (20 μg.kg^-1) when added to 0.2% ropivacaine for the caudal epidural block has better efficacy than morphine of higher dosage (30 μg.kg^-1) as the duration of analgesia is similar with decreased incidence of side effects.

Background: The two most common techniques for mask ventilation are CE and jaw thrust (JT) technique. However, few studies have validated their efficiency in terms of tidal volume (TV).

Aims: This study aimed to compare the effectiveness of the CE technique and JT technique during pressure-controlled ventilation (PCV) by the mean of returned TV on apneic anesthetized adults.

Design: This was a prospective, randomized cross over study.

Settings: This study was conducted in a tertiary care hospital.

Methods: Ethical Committee approval from our institution was taken (ss-1/EC 049/2017) and was registered in Clinical Trials Registry of India (CTRI/2018/04/012958). Sixty-five American Society of Anesthesiologists Physical Status classes I and II adult patients were enrolled in the study. After induction and muscle relaxation, mask ventilation was performed with CE and JT technique on PCV mode (Pinsp 15 cm H₂O, respiratory rate 15) for 1 min each. The mean of returned TV of last 12 breaths, gastric insufflation, audible mask leak, and operator comfort in each technique were compared.

Statistical analysis: Statistical software namely IBM SPSS 22.0 and R environment version 3.2.2 (IBM Corp. SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA) were used for data analysis. Microsoft Excel was used to generate graphs and tables. Data were expressed as mean ± standard deviation for continuous variables and number (%) for categorical variables. Student's t-test (two tailed, independent) was used to find the significance of the study parameters on a continuous scale. Chi-square/Fisher's exact test was used to find the significance of the study parameters on a categorical scale between two or more groups.

Results: There was a significant increase in mean TV generated by JT technique over CE technique (591.46 ± 140.27 mL vs. 544.59 ± 159.08 mL; P < 0.001). Gastric insufflation (12.9% vs. 14.5%) and mask leak (11.3% vs. 38.7%) were more in CE technique. Operator comfort (79% vs. 19.4%) was more in JT technique.

Conclusion: A two-handed JT technique is more effective than a one-handed CE technique for mask ventilation in apneic anesthetized adults.

Background: Perioperative pain management is a major challenge for anaesthesiologists. IV lidocaine and dexmedetomidine have been utilised for peri-operative pain management.

Aims and objectives: To analyse the effects of intraoperative intravenous lignocaine/dexmedetomidine on pain relief, opioid consumption, peri-operative hemodynamic and side-effect profiles/unique interactions in patients undergoing laparoscopic surgeries.

Materials and methods: Prospective, interventional, single-centric, double-blind, randomised, active-controlled, Helsinki protocol-compliant clinical study was conducted on 90 ASA I/II class patients aged 18-60 yrs. This Patients were block-randomised to Group-L (2% Lignocaine), Group-D (dexmedetomidine) and Group C (Control/Placebo/0.9% normal saline). Hemodynamic were noted at pre-defined time frames intra-/post-operatively. Post-operative VAS score and Richmond Agitation Sedation Score monitoring was done.

Results: Demographic parameters of were comparable. Mean intra-operative fentanyl consumption amongst the three groups were 20.5 ± 20.05 mcg, 26.5 ± 17.57 mcg and 46.83 + 21.31 mcg (Group-L, Group-D, Group-C; P value Group-L vs Group-D:0.22, Group L/D vs Group C: <0.0001). Group-D exhibited the lower heart rates and MAP (P < 0.05). Extubation- First rescue analgesic phase was comparable for the Group-C and Group-L (59.17 ± 46.224 min vs 61.64 ± 53.819 min) and significantly greater in Group-D (136.07 + 55.350 min; P < 0.0001).

Conclusion: Both Dexmedetomidine and lignocaine can be useful intra-operative pain relief adjuncts. Dexmedetomidine delayed First rescue analgesic and total analgesic consumption more than lignocaine. Dexmedetomidine patients exhibited bradycardia intraoperatively more than the other groups. we recommend, Dexmedetomidine in the intra-operative phase and lignocaine in the post-operative phase can be an alternative in patients who are poor candidates for post-operative opioids/sedation/contraindicated regional anaesthesia regimes.

Spontaneous intracranial hypotension caused by cerebrospinal fluid (CSF) leak is a rarely encountered cause of persistent postural headaches in the absence of trauma or dural puncture. It presents with postural headache and is characterized by radiological findings of spinal CSF leak. The mainstay of management is an epidural patch with the patient's own blood (epidural blood patch [EBP]) and/or a fibrin glue product. We report here a case of spontaneous intracranial hemorrhage presenting with persistent headaches and bilateral subdural hematomas secondary to CSF leaks at multiple levels along the spinal cord, which was successfully managed with a single lumbar EBP.

Background and aims: Video laryngoscopy has been shown to improvise Cormack-Lehane grading and rate of successful tracheal intubation and is now incorporated in most of the difficult airway guidelines. Since there is scarce literature regarding the use of channeled blade of King Vision video laryngoscope (KVVL) in anticipated difficult intubation, we planned to undertake this randomized control trial to assess the performance of channeled blade of KVVL and Macintosh laryngoscope in patients with anticipated difficult intubation.

Design and setting: This prospective randomized study was conducted in a tertiary care hospital.

Materials and methods: Patients fulfilling the inclusion criteria were randomly assigned equally to the KVVL group or Macintosh group. The primary outcome of the study was intubation success in the first attempt and number of attempts required for intubation, and the secondary outcomes were Cormack-Lehane grading and time required to intubate in both the groups.

Results: The first-pass success of intubation was 88.6% in the KVVL group and 76.5% in the Macintosh group (P = 0.035). The second attempt of intubation was required in 11.4% and 20.6% of patients in the KVVL and Macintosh groups, respectively. Cormack Lehane Grade I was achieved in 100% of patients of the KVVL group as compared to 29.4% of patients in the Macintosh group. Moreover, the difference was statistically significant (P = 0.035). The mean duration of intubation was prolonged in the KVVL group as compared to the Macintosh group, and the difference was statistically significant (P = 0.04).

Conclusion: The channeled blade of KVVL had a higher first-pass success rate and required fewer attempts to intubate when used in patients with anticipated difficult intubation. Further, the KVVL was found to be significantly better than the Macintosh laryngoscope in terms of Cormack-Lehane grading, but the time taken to intubate the trachea was more in the KVVL group.

Background: Combined spinal-epidural technique is a widely accepted and popular modality for labor analgesia. Opioids are being used as adjuvants since long time. Dexmedetomidine is a new drug that is being used as an intrathecal adjuvant.

Aim: The study aims to compare the safety and efficacy of fentanyl and dexmedetomidine as intrathecal adjuvants in labor analgesia.

Settings and design: This was a continuous, prospective, randomized controlled trial with 120 parturients.

Materials and methods: After ethical approval and written consent, participants were divided randomly into two groups: Group A - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 20 μg of dexmedetomidine in 1 mL saline intrathecally (total volume: 3 mL) and Group B - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 15 μg of fentanyl in 1 mL saline intrathecally (total volume: 3 mL). Primary outcomes were satisfactory analgesia, mode of delivery, and neonatal outcome. Participants were monitored for the onset and duration of analgesia, degree of motor block, and maternal and fetal side effects.

Results: A total of 108 parturients reported sufficient analgesia (Group A: 57; Group B: 51), and 74 patients delivered vaginally (Group A: 41; Group B: 44). The rates of normal vaginal delivery were higher in Group B. Group A reported earlier onset of analgesia (61.26 ± 18.23 s) that lasted for longer duration (124.16 ± 26.23 min) than in Group B. There were no serious side effects in any of the groups. Fetal ultrasound revealed attenuation of fetal heart rate variability. The heart rate of newborns was also found to be low in Group A.

Conclusion: Chances of vaginal delivery are higher with intrathecal fentanyl as an adjuvant. Intensity and duration of analgesia are better with intrathecal dexmedetomidine.