Sheerin Lysander, G. Kumar, Anusha Balasubramanian, Rajarajeswaran Krishnan, M. Raghuraman, S. Narayanan
Background: Laparoscopic surgery in recent times has noteworthy advantages over conventional surgery, yet recovery is prolonged due to debilitating shoulder tip pain (STP) and operated site pain. Various studies have compared the effect of trocar site, intraperitoneal instillation of local anesthetic (LA) for pain relief while only a few studies have tested the combination of these two techniques. Hence, this study was undertaken to compare the combination of these two techniques versus trocar site alone for STP particularly. Subjects and Methods: This prospective, randomized, comparative study was conducted on 52 patients who were undergoing laparoscopic abdominal surgery. The patients were allocated into either of the two groups. Group I (n = 26): trocar site infiltration (20 mL) and intraperitoneal instillation (20 mL) of 0.25% levobupivacaine and Group II (n = 26): trocar site infiltration (20 mL) of 0.25% levobupivacaine and saline (20 mL) intraperitoneally. Postoperative STP was the primary outcome while surgical site pain, nausea, and vomiting were secondary outcomes. Results: There were no statistically significant differences between the groups with regard to shoulder pain, surgical site pain, total rescue analgesics, and incidence of nausea and vomiting (P > 0.05). Conclusion: Trocar site infiltration with intraperitoneal instillation of LA or trocar site infiltration alone was found to be equally effective. However, we suggest that it is better to provide a combination of trocar site infiltration plus intraperitoneal instillation of LA if we have to restrict opioid usage such as in day-care surgeries.
{"title":"Comparison of Trocar Site versus Trocar Site Plus Intraperitoneal Instillation of Local Anesthetic for Shoulder Pain Following Laparoscopic Abdominal Surgery","authors":"Sheerin Lysander, G. Kumar, Anusha Balasubramanian, Rajarajeswaran Krishnan, M. Raghuraman, S. Narayanan","doi":"10.4103/aer.aer_156_21","DOIUrl":"https://doi.org/10.4103/aer.aer_156_21","url":null,"abstract":"Background: Laparoscopic surgery in recent times has noteworthy advantages over conventional surgery, yet recovery is prolonged due to debilitating shoulder tip pain (STP) and operated site pain. Various studies have compared the effect of trocar site, intraperitoneal instillation of local anesthetic (LA) for pain relief while only a few studies have tested the combination of these two techniques. Hence, this study was undertaken to compare the combination of these two techniques versus trocar site alone for STP particularly. Subjects and Methods: This prospective, randomized, comparative study was conducted on 52 patients who were undergoing laparoscopic abdominal surgery. The patients were allocated into either of the two groups. Group I (n = 26): trocar site infiltration (20 mL) and intraperitoneal instillation (20 mL) of 0.25% levobupivacaine and Group II (n = 26): trocar site infiltration (20 mL) of 0.25% levobupivacaine and saline (20 mL) intraperitoneally. Postoperative STP was the primary outcome while surgical site pain, nausea, and vomiting were secondary outcomes. Results: There were no statistically significant differences between the groups with regard to shoulder pain, surgical site pain, total rescue analgesics, and incidence of nausea and vomiting (P > 0.05). Conclusion: Trocar site infiltration with intraperitoneal instillation of LA or trocar site infiltration alone was found to be equally effective. However, we suggest that it is better to provide a combination of trocar site infiltration plus intraperitoneal instillation of LA if we have to restrict opioid usage such as in day-care surgeries.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"144 1","pages":"375 - 378"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77543074","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}
Roniya Roy, Rajesh Kesavan, S. Rajan, Niveditha Kartha, L. Kumar
Background: Sympathetic response due to laryngoscopy and endotracheal intubation though transient, could be life-threatening in patients with underlying cardiovascular diseases. Aim of the Study: The aim of this study is to assess the effects of dexmedetomidine and esmolol on the hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing general anesthesia for elective surgery. Settings and Design: Prospective, randomized study conducted in a tertiary care center. Materials and Methods: Sixty patients were recruited and randomly divided into two groups. Group A received 0.5 mcg.kg−1 dexmedetomidine and Group B 0.5 mg.kg−1 esmolol infusions over 10 min. All patients were induced with propofol 2 mg.kg−1 followed by succinylcholine 2 mg.kg−1 and intubated. The heart rate (HR) and mean arterial pressure (MAP) were recorded at different time points. Statistical Analysis Used: Chi-square test, independent sample t-test, and paired t-test. Results: Baseline HR was statistically different in both groups. There was significant decrease in percentage change in baseline HR in Group A compared to Group B at preinduction (20.44% ± 10.82%, 13.63% ± 11.84%), before intubation (23.49 ± 12.62, 13.95 ± 14.86), and 7 min after intubation (14.65 ± 12.62, 6.80 ± 16.11). Percentage change in HR remained comparable in all other time points. Baseline MAP was comparable between the groups. Percentage change from baseline of MAP was significantly higher in Group B before intubation. All other time points MAP were comparable. The incidence of hypotension was comparable in both groups. Conclusions: Both dexmedetomidine and esmolol suppressed the hemodynamic response to laryngoscopy and intubation, but dexmedetomidine was more effective than esmolol in maintaining hemodynamic stability.
{"title":"Prospective Randomized Study Comparing the Usefulness of Dexmedetomidine versus Esmolol in Blunting Hemodynamic Responses to Intubation in Surgical Patients","authors":"Roniya Roy, Rajesh Kesavan, S. Rajan, Niveditha Kartha, L. Kumar","doi":"10.4103/aer.aer_155_21","DOIUrl":"https://doi.org/10.4103/aer.aer_155_21","url":null,"abstract":"Background: Sympathetic response due to laryngoscopy and endotracheal intubation though transient, could be life-threatening in patients with underlying cardiovascular diseases. Aim of the Study: The aim of this study is to assess the effects of dexmedetomidine and esmolol on the hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing general anesthesia for elective surgery. Settings and Design: Prospective, randomized study conducted in a tertiary care center. Materials and Methods: Sixty patients were recruited and randomly divided into two groups. Group A received 0.5 mcg.kg−1 dexmedetomidine and Group B 0.5 mg.kg−1 esmolol infusions over 10 min. All patients were induced with propofol 2 mg.kg−1 followed by succinylcholine 2 mg.kg−1 and intubated. The heart rate (HR) and mean arterial pressure (MAP) were recorded at different time points. Statistical Analysis Used: Chi-square test, independent sample t-test, and paired t-test. Results: Baseline HR was statistically different in both groups. There was significant decrease in percentage change in baseline HR in Group A compared to Group B at preinduction (20.44% ± 10.82%, 13.63% ± 11.84%), before intubation (23.49 ± 12.62, 13.95 ± 14.86), and 7 min after intubation (14.65 ± 12.62, 6.80 ± 16.11). Percentage change in HR remained comparable in all other time points. Baseline MAP was comparable between the groups. Percentage change from baseline of MAP was significantly higher in Group B before intubation. All other time points MAP were comparable. The incidence of hypotension was comparable in both groups. Conclusions: Both dexmedetomidine and esmolol suppressed the hemodynamic response to laryngoscopy and intubation, but dexmedetomidine was more effective than esmolol in maintaining hemodynamic stability.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"239 1","pages":"357 - 361"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76777854","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}
MURCS syndrome is a more severe form of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal agenesis/ectopia (R), and cervical somite dysplasia (CS). A common presentation is primary amenorrhea in adolescent females. An anesthetist must consider the benefits and limitations of both regional and general anesthesia for these patients based on site of surgery and severity of malformations. We report successful anesthetic management of a 21-year-old female with MURCS syndrome scheduled for a creation of neovagina under spinal anesthesia using ultrasound guidance.
MURCS综合征是一种更为严重的mayer - rokitansky - k ster- hauser (MRKH)综合征，MRKH是一个缩写，意思是勒氏管发育不全/发育不全(MU)、先天性肾发育不全/异位(R)和宫颈体发育不良(CS)。青春期女性原发性闭经是一种常见的表现。麻醉师必须根据手术部位和畸形的严重程度考虑局部麻醉和全身麻醉对这些患者的益处和局限性。我们报告一位21岁女性MURCS综合征患者在超声引导下脊髓麻醉下新阴道的成功麻醉处理。
{"title":"Anesthetic Management in a Case of MURCS Syndrome","authors":"J. Rekha, Poonam Arora, R. Arora, Monica Arora","doi":"10.4103/aer.aer_137_21","DOIUrl":"https://doi.org/10.4103/aer.aer_137_21","url":null,"abstract":"MURCS syndrome is a more severe form of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal agenesis/ectopia (R), and cervical somite dysplasia (CS). A common presentation is primary amenorrhea in adolescent females. An anesthetist must consider the benefits and limitations of both regional and general anesthesia for these patients based on site of surgery and severity of malformations. We report successful anesthetic management of a 21-year-old female with MURCS syndrome scheduled for a creation of neovagina under spinal anesthesia using ultrasound guidance.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"177 1","pages":"454 - 456"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73333379","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}
H. I. Saber, A. Farid, Tamer A. Wafa, Hani I. Taman
Background: In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications. Patients and Methods: This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded. Results: Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). [Table 2] summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches. Conclusion: Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.
背景:在新生儿中，经皮中心静脉导管(CVC)的插入通常是一项具有挑战性的技术。最近的报道报道了超声(US)指导在进行这种干预时的疗效。我们进行了这项研究，以比较美国引导和最小手术CVC插入的时间、插入的便利性、可靠性和并发症。患者和方法:这项前瞻性随机研究纳入了92名计划进行CVC插入的新生儿。他们被分为两组:A组(46名新生儿)采用us引导入路，B组(46名新生儿)采用手术入路。记录两组患者的尝试次数和手术持续时间。并记录术中及术后并发症。结果:两组患者的年龄、性别、体重、置管指征均具有统计学上的可比性。试验数在a组显著增加(Bp <0.001组为1.52 vs 1.07)。然而，同一组的手术时间明显缩短(3.68 vs. 10.21 Bp <0.001组)。[表2]总结了以往的研究结果。A组仅有1例(2.2%)手术失败，改为开放手术。总的来说，两种入路并发症的发生率无明显差异。结论:尽管美国引导的CVC植入与试验数量的增加有关，但随着其使用，该过程的持续时间显着缩短。此外，除了并发症与传统手术方法相当外，它具有很高的成功率。
{"title":"Central Venous Access in Neonates: Comparison of Ultrasound-Guided Percutaneous Access and Minimal Surgical Open Methods","authors":"H. I. Saber, A. Farid, Tamer A. Wafa, Hani I. Taman","doi":"10.4103/aer.aer_138_21","DOIUrl":"https://doi.org/10.4103/aer.aer_138_21","url":null,"abstract":"Background: In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications. Patients and Methods: This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded. Results: Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). [Table 2] summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches. Conclusion: Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"38 1","pages":"395 - 400"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80922513","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: Dexmedetomidine, alpha 2 agonist, with its anxiolytic, sympatholytic and sedative property can be good adjuvant in anesthesia by modifying stress response to various stimuli during laparoscopic cholecystectomy including laryngoscopy, intubation, pneumoperitoneum, and extubation. We aimed to evaluate low dose dexmedetomidine for reducing hemodynamic perturbations to stressful events with secondary aim of evaluating propofol dose reduction and postoperative analgesia. Methods: Sixty patients of American Society of Anesthesiologists Physical Status (ASA PS) Classes I and II were randomized to two groups of 30 each to receive dexmedetomidine infusion (0.5 mcg.kg−1.h−1) starting 15 min before induction (Group A) and normal saline (Group B). Patient induced and maintained with propofol infusion to keep BIS value 55–60 in both groups and heart rate (HR) and mean arterial pressure (MAP) were recorded. We stopped infusions at surgical closure. VAS score recorded till 24 h of surgery. Total propofol required in both groups were recorded. Data were statistically analyzed using the SPSS software version 15.0. Results: MAP and HR remain elevated following intubation in Group B and remain so throughout procedure and during all stressful events including CO2 insufflation and tracheal extubation and were statistically significant. Significantly lower doses (almost 30%) of Propofol required in Group A to achieve similar BIS values compared to Group B. Visual Analog Scale score remained on the lower side in Group A for 24 h than Group B. Conclusion: Low dose dexmedetomidine (0.5 mcg.kg−1.h−1) can effectively maintain hemodynamics during stressful events, reduces propofol requirement and improves postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
{"title":"Effects of Dexmedetomidine Infusion in Low Dose on Dose Reduction of Propofol, Intraoperative Hemodynamics, and Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy","authors":"Vijay Kalaskar, D. Ruparel, R. Wakode","doi":"10.4103/aer.aer_123_21","DOIUrl":"https://doi.org/10.4103/aer.aer_123_21","url":null,"abstract":"Background: Dexmedetomidine, alpha 2 agonist, with its anxiolytic, sympatholytic and sedative property can be good adjuvant in anesthesia by modifying stress response to various stimuli during laparoscopic cholecystectomy including laryngoscopy, intubation, pneumoperitoneum, and extubation. We aimed to evaluate low dose dexmedetomidine for reducing hemodynamic perturbations to stressful events with secondary aim of evaluating propofol dose reduction and postoperative analgesia. Methods: Sixty patients of American Society of Anesthesiologists Physical Status (ASA PS) Classes I and II were randomized to two groups of 30 each to receive dexmedetomidine infusion (0.5 mcg.kg−1.h−1) starting 15 min before induction (Group A) and normal saline (Group B). Patient induced and maintained with propofol infusion to keep BIS value 55–60 in both groups and heart rate (HR) and mean arterial pressure (MAP) were recorded. We stopped infusions at surgical closure. VAS score recorded till 24 h of surgery. Total propofol required in both groups were recorded. Data were statistically analyzed using the SPSS software version 15.0. Results: MAP and HR remain elevated following intubation in Group B and remain so throughout procedure and during all stressful events including CO2 insufflation and tracheal extubation and were statistically significant. Significantly lower doses (almost 30%) of Propofol required in Group A to achieve similar BIS values compared to Group B. Visual Analog Scale score remained on the lower side in Group A for 24 h than Group B. Conclusion: Low dose dexmedetomidine (0.5 mcg.kg−1.h−1) can effectively maintain hemodynamics during stressful events, reduces propofol requirement and improves postoperative analgesia in patients undergoing laparoscopic cholecystectomy.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"26 1","pages":"391 - 394"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89572239","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}
S. Vidhya, N. Prakash, A. Swain, Sharad Kumar, Rajiv Shukla
Background: Modifications of curved and straight laryngoscope blades have been used for airway management since a long time. While McCoy blade with an elevated tip is commonly used to intubate patients with anticipated difficult airway, the Miller's straight blade is used for intubations in children and less commonly adults. In this study, we revisit the paraglossal technique of Miller's straight blade as a method to improve laryngeal view especially in difficult intubations. Aim: This study aimed to compare laryngoscopic view and ease of intubation (EOI) using McCoy blade elevated tip and Miller's straight blade paraglossal technique. Materials and Methods: A prospective single-blind study was conducted on 170 patients undergoing elective surgery under general anesthesia. They were randomly allotted to two groups. In Group A, laryngoscopy was performed by Miller's blade paraglossal approach, whereas in Group B, laryngoscopy was performed by McCoy blade with an elevated tip. Laryngeal view was graded using the modified Cormack–Lehane grading, and EOI was graded using EOI score. These were compared with preoperative intubation prediction score. Statistical analysis was done using "Medcalc" version 19.0.3. Numerical and categorical data were analyzed by Student's t-test and Chi-square test, respectively. A P < 0.05 was considered statistically significant. Results: The paraglossal approach with Miller's blade offered better laryngoscopic view as compared with McCoy blade with an elevated tip in normal (54.1% vs. 25.9%) and difficult airway (44.7% vs. 11.8%). Tracheal intubation was easier with McCoy blade with an elevated tip although the success rate of intubation improved with the assistance of a bougie with Miller's straight blade paraglossal approach. Conclusion: The laryngeal view was significantly better with the paraglossal approach of Miller's straight blade even in difficult airway. McCoy blade with an elevated tip was also found to be a useful tool to have in difficult airway, as EOI is significantly higher. The study also highlights the usefulness of adjuncts such as a gum elastic bougie while intubating.
背景:长期以来，弯曲和直型喉镜刀片的改良被用于气道管理。McCoy拔尖刀片通常用于预期气道困难的患者插管，而Miller的直刀片则用于儿童插管，较少用于成人。在这项研究中，我们重新审视米勒的直叶片的伞翼技术，作为一种方法，以改善喉部视野，特别是在困难插管。目的:比较McCoy刀尖抬高技术和Miller的直刀滑翔技术在喉镜下的观察效果和插管的便便性。材料与方法:对170例全麻下择期手术患者进行前瞻性单盲研究。他们被随机分为两组。A组采用Miller’s叶片副伞入路喉镜检查，B组采用McCoy叶片抬高尖端喉镜检查。采用改良的Cormack-Lehane分级法对喉视图进行分级，采用EOI评分法对EOI进行分级。并与术前插管预测评分进行比较。使用“Medcalc”19.0.3版本进行统计分析。数值数据和分类数据分别采用Student's t检验和卡方检验。P < 0.05为差异有统计学意义。结果:在正常气道(54.1% vs. 25.9%)和困难气道(44.7% vs. 11.8%)中，Miller刀的副伞入路比McCoy刀的尖端升高提供了更好的喉镜视野。虽然在Miller的直叶滑翔入路的辅助下插管成功率提高，但采用抬高尖端的McCoy刀片插管更容易。结论:即使在困难气道下，经米勒直刀入路的喉视镜也有明显改善。由于EOI显着更高，因此发现尖端升高的McCoy刀片也是困难气道的有用工具。该研究还强调了辅助工具的实用性，如在插管时使用口香糖弹性橡皮筋。
{"title":"An Inquiry on Airway Management by McCoy Blade with Elevated Tip and Miller Straight Blade with Paraglossal Technique: Relevance for Difficult Airway Management in Current Infectious Times","authors":"S. Vidhya, N. Prakash, A. Swain, Sharad Kumar, Rajiv Shukla","doi":"10.4103/aer.aer_163_21","DOIUrl":"https://doi.org/10.4103/aer.aer_163_21","url":null,"abstract":"Background: Modifications of curved and straight laryngoscope blades have been used for airway management since a long time. While McCoy blade with an elevated tip is commonly used to intubate patients with anticipated difficult airway, the Miller's straight blade is used for intubations in children and less commonly adults. In this study, we revisit the paraglossal technique of Miller's straight blade as a method to improve laryngeal view especially in difficult intubations. Aim: This study aimed to compare laryngoscopic view and ease of intubation (EOI) using McCoy blade elevated tip and Miller's straight blade paraglossal technique. Materials and Methods: A prospective single-blind study was conducted on 170 patients undergoing elective surgery under general anesthesia. They were randomly allotted to two groups. In Group A, laryngoscopy was performed by Miller's blade paraglossal approach, whereas in Group B, laryngoscopy was performed by McCoy blade with an elevated tip. Laryngeal view was graded using the modified Cormack–Lehane grading, and EOI was graded using EOI score. These were compared with preoperative intubation prediction score. Statistical analysis was done using \"Medcalc\" version 19.0.3. Numerical and categorical data were analyzed by Student's t-test and Chi-square test, respectively. A P < 0.05 was considered statistically significant. Results: The paraglossal approach with Miller's blade offered better laryngoscopic view as compared with McCoy blade with an elevated tip in normal (54.1% vs. 25.9%) and difficult airway (44.7% vs. 11.8%). Tracheal intubation was easier with McCoy blade with an elevated tip although the success rate of intubation improved with the assistance of a bougie with Miller's straight blade paraglossal approach. Conclusion: The laryngeal view was significantly better with the paraglossal approach of Miller's straight blade even in difficult airway. McCoy blade with an elevated tip was also found to be a useful tool to have in difficult airway, as EOI is significantly higher. The study also highlights the usefulness of adjuncts such as a gum elastic bougie while intubating.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"22 1","pages":"401 - 407"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87130660","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}
Congenital lobar emphysema (CLE) is a rare malformation of lungs, which presents usually in neonatal period or infancy as acute hypoxia and respiratory distress. It is characterized by the lobar over aeration of the normal lung followed by respiratory distress due to partial obstruction of bronchus by ball-valve effect. We would like to present the case of a 3-month-old female preterm (31 weeks) baby who presented to our neonatal intensive care unit with respiratory distress for 1 day. The baby was diagnosed with left-sided CLE having severe mediastinal shift to the right side and a dextroposition heart. Her venous blood gas showed PaCO2 of 70 mmHg and SpO2 of 70% with 15 L high-flow nasal oxygen. We would like to highlight the anesthesia techniques of airway management and ventilation during the critical period of induction till thoracotomy and exteriorizing the emphysematous lobe.
{"title":"Emergency Thoracotomy for Congenital Lobar Emphysema – Anesthesiology Concerns","authors":"Muthukumar Rajagopalan","doi":"10.4103/aer.aer_14_22","DOIUrl":"https://doi.org/10.4103/aer.aer_14_22","url":null,"abstract":"Congenital lobar emphysema (CLE) is a rare malformation of lungs, which presents usually in neonatal period or infancy as acute hypoxia and respiratory distress. It is characterized by the lobar over aeration of the normal lung followed by respiratory distress due to partial obstruction of bronchus by ball-valve effect. We would like to present the case of a 3-month-old female preterm (31 weeks) baby who presented to our neonatal intensive care unit with respiratory distress for 1 day. The baby was diagnosed with left-sided CLE having severe mediastinal shift to the right side and a dextroposition heart. Her venous blood gas showed PaCO2 of 70 mmHg and SpO2 of 70% with 15 L high-flow nasal oxygen. We would like to highlight the anesthesia techniques of airway management and ventilation during the critical period of induction till thoracotomy and exteriorizing the emphysematous lobe.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"34 1","pages":"460 - 462"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85448624","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: Blocking the medial branch of the lumbar facet joints plays a fundamental diagnostic and therapeutic role in the treatment of lumbar pain. Attempts to replace the typical guided X-ray techniques with ultrasound-guided techniques have also involved treating the lumbar medial branches. By applying the cumulative sum control chart (CUSUM method), we sought to evaluate the learning curve associated with ultrasound-guided block of the lumbar medial branches in operators experienced in locoregional anesthesia but without expertise in pain therapy. Aim: This study aimed to use a repeatable method to identify the learning curve of the ultrasound-guided medial branch block. Settings and Design: This study was a prospective application of over forty consecutive procedures of ultrasound lumbar medial branch block. Materials and Methods: The ultrasound medial branch blocks were performed under ultrasound guidance with confirmation of correct positioning using fluoroscopy on a population of patients with low back pain with any body mass index (BMI). Statistical Analysis: The operator's performance was assessed using the learning curve cumulative summation test (LS-CUSUM). Results and Conclusions: The correct target was reached in 29 procedures out of a total of 40 (72.5%) and in 29 out of 36 procedures performed on patients with BMI <30 (80.5%). According to the CUSUM algorithm, 11 further consecutive successes would have been necessary (47 procedures in total) to achieve a proven learning of the technique in the group with only patients with a BMI <30, with a further 22 consecutive successes (62 procedures in total) in the general group. Ultrasound-guided block of the lumbar medial branch appears not to be optimal for training beginner/intermediate operators seeking to replace guided X-ray procedures with guided ultrasound.
{"title":"Ultrasound Block of the Medial Branch: Learning the Technique Using CUSUM Curves","authors":"M. Putzu, M. Marchesini","doi":"10.4103/aer.aer_162_21","DOIUrl":"https://doi.org/10.4103/aer.aer_162_21","url":null,"abstract":"Background: Blocking the medial branch of the lumbar facet joints plays a fundamental diagnostic and therapeutic role in the treatment of lumbar pain. Attempts to replace the typical guided X-ray techniques with ultrasound-guided techniques have also involved treating the lumbar medial branches. By applying the cumulative sum control chart (CUSUM method), we sought to evaluate the learning curve associated with ultrasound-guided block of the lumbar medial branches in operators experienced in locoregional anesthesia but without expertise in pain therapy. Aim: This study aimed to use a repeatable method to identify the learning curve of the ultrasound-guided medial branch block. Settings and Design: This study was a prospective application of over forty consecutive procedures of ultrasound lumbar medial branch block. Materials and Methods: The ultrasound medial branch blocks were performed under ultrasound guidance with confirmation of correct positioning using fluoroscopy on a population of patients with low back pain with any body mass index (BMI). Statistical Analysis: The operator's performance was assessed using the learning curve cumulative summation test (LS-CUSUM). Results and Conclusions: The correct target was reached in 29 procedures out of a total of 40 (72.5%) and in 29 out of 36 procedures performed on patients with BMI <30 (80.5%). According to the CUSUM algorithm, 11 further consecutive successes would have been necessary (47 procedures in total) to achieve a proven learning of the technique in the group with only patients with a BMI <30, with a further 22 consecutive successes (62 procedures in total) in the general group. Ultrasound-guided block of the lumbar medial branch appears not to be optimal for training beginner/intermediate operators seeking to replace guided X-ray procedures with guided ultrasound.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"44 1","pages":"385 - 390"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83719454","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}
Jagadish B Alur, Vishwajeet Korikantimath, B. Jyoti, K. Sushma, Nataraj Mallayyagol
Background and Aims: Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%–70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesia Materials and Methods: After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted. Results: The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups. Conclusion: The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child.
{"title":"A Comparative Study of Analgesic Efficacy of Intrathecal Bupivacaine with Ketamine Versus Bupivacaine with Magnesium Sulphate in Parturients Undergoing Elective Caesarian Sections","authors":"Jagadish B Alur, Vishwajeet Korikantimath, B. Jyoti, K. Sushma, Nataraj Mallayyagol","doi":"10.4103/aer.aer_125_21","DOIUrl":"https://doi.org/10.4103/aer.aer_125_21","url":null,"abstract":"Background and Aims: Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%–70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesia Materials and Methods: After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted. Results: The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups. Conclusion: The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"133 1","pages":"379 - 384"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77797092","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}
M. Nagappa, J. Querney, Janet E. Martin, A. John-Baptiste, Y. Subramani, B. Lanting, C. Schlachta, Julie Von Koughnett, K. Speechley, Jeff Correa, Maoz Yunus Chohan, Nita Rrafshi, Mariska Batohi, A. Fayad, Homer Yang
Background: Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the level of preparation/satisfaction and cost associated with management of recovery in the postoperative period were evaluated. Methods: We designed this prospective study to measure patient-reported outcomes and to inform the design of a postoperative home monitoring system. Patients undergoing inpatient total hip or knee replacements were recruited from a preadmission clinic at a university hospital. Patients and caregivers completed preoperative, postoperative, and health economic questionnaires. Bivariate analyses were conducted to understand factors associated with satisfaction with care. Results: Of 239 patients and caregivers recruited, preoperative questionnaire was completed by 98.8% of patients, the postoperative follow-up questionnaire was completed by 94.2% of patients, 75% of informal caregivers completed the postoperative follow-up questionnaires, and 93.7% completed the health economic questionnaire. The postoperative satisfaction scores were higher than the preoperative needs/expectation scores for both the overall and individual subscales. Patients undergoing hip arthroplasty reported higher satisfaction scores for postoperative pain management than patients undergoing knee arthroplasty (hip arthroplasty vs. knee arthroplasty: 4.07 ± 1.11 vs. 3.37 ± 1.51; P < 0.001). Patients who underwent knee arthroplasty reported better satisfaction scores with regard to having enough information on how to manage leg stiffness at home compared to patients undergoing hip arthroplasty (knee arthroplasty vs. hip arthroplasty: 3.13 ± 1.35 vs. 2.78 ± 1.30; P = 0.04). Conclusion: Overall, patients are generally satisfied with perioperative care, but they have distinct needs and expectations regarding perioperative medication and postoperative pain management. Virtual postoperative monitoring may be a useful tool during postoperative care to address many of patients' concerns.
背景:早期出院会将康复负担转移给患者，并可能使患者及其护理人员对康复过程感到焦虑。术后家庭护理必须扩大，包括适当和充分的支持，以解决家庭康复问题。在这项前瞻性研究中，评估了患者和护理人员对准备/满意度水平和与术后恢复管理相关的成本的看法。方法:我们设计了这项前瞻性研究来测量患者报告的结果，并为术后家庭监测系统的设计提供信息。接受全髋关节或膝关节置换术的住院患者从一所大学医院的入院前诊所招募。患者和护理人员完成术前、术后和健康经济问卷调查。进行双变量分析以了解与护理满意度相关的因素。结果:239名患者及护理人员中，术前问卷完成率为98.8%，术后随访问卷完成率为94.2%，术后随访问卷完成率为75%，健康经济学问卷完成率为93.7%。术后满意度得分高于术前总体和个体亚量表的需求/期望得分。髋关节置换术患者报告的术后疼痛管理满意度得分高于膝关节置换术患者(髋关节置换术vs膝关节置换术:4.07±1.11 vs 3.37±1.51;P < 0.001)。与接受髋关节置换术的患者相比，接受膝关节置换术的患者报告的满意度得分更高，因为他们对如何在家管理腿部僵硬有足够的信息(膝关节置换术vs髋关节置换术:3.13±1.35 vs 2.78±1.30;P = 0.04)。结论:总体而言，患者对围手术期护理总体满意，但对围手术期用药和术后疼痛处理有不同的需求和期望。虚拟术后监测可能是一个有用的工具，在术后护理，以解决许多患者的关切。
{"title":"Perioperative Satisfaction and Health Economic Questionnaires in Patients Undergoing an Elective Hip and Knee Arthroplasty: A Prospective Observational Cohort Study","authors":"M. Nagappa, J. Querney, Janet E. Martin, A. John-Baptiste, Y. Subramani, B. Lanting, C. Schlachta, Julie Von Koughnett, K. Speechley, Jeff Correa, Maoz Yunus Chohan, Nita Rrafshi, Mariska Batohi, A. Fayad, Homer Yang","doi":"10.4103/aer.aer_5_22","DOIUrl":"https://doi.org/10.4103/aer.aer_5_22","url":null,"abstract":"Background: Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the level of preparation/satisfaction and cost associated with management of recovery in the postoperative period were evaluated. Methods: We designed this prospective study to measure patient-reported outcomes and to inform the design of a postoperative home monitoring system. Patients undergoing inpatient total hip or knee replacements were recruited from a preadmission clinic at a university hospital. Patients and caregivers completed preoperative, postoperative, and health economic questionnaires. Bivariate analyses were conducted to understand factors associated with satisfaction with care. Results: Of 239 patients and caregivers recruited, preoperative questionnaire was completed by 98.8% of patients, the postoperative follow-up questionnaire was completed by 94.2% of patients, 75% of informal caregivers completed the postoperative follow-up questionnaires, and 93.7% completed the health economic questionnaire. The postoperative satisfaction scores were higher than the preoperative needs/expectation scores for both the overall and individual subscales. Patients undergoing hip arthroplasty reported higher satisfaction scores for postoperative pain management than patients undergoing knee arthroplasty (hip arthroplasty vs. knee arthroplasty: 4.07 ± 1.11 vs. 3.37 ± 1.51; P < 0.001). Patients who underwent knee arthroplasty reported better satisfaction scores with regard to having enough information on how to manage leg stiffness at home compared to patients undergoing hip arthroplasty (knee arthroplasty vs. hip arthroplasty: 3.13 ± 1.35 vs. 2.78 ± 1.30; P = 0.04). Conclusion: Overall, patients are generally satisfied with perioperative care, but they have distinct needs and expectations regarding perioperative medication and postoperative pain management. Virtual postoperative monitoring may be a useful tool during postoperative care to address many of patients' concerns.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"5 1","pages":"413 - 438"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86507049","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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