Influence of head rotation on ease of mask ventilation: a randomized crossover study

Background: Mask ventilation is an essential part of airway management. Head rotation increases the cross-sectional area of upper airway and improves upper airway patency. Methods: A prospective crossover study in 40 patients aged 18-69, ASA physical status I, II, III and who needed general anesthesia with tracheal intubation were selected, divided into two groups of 20 each, group I and Group II. When apnea was achieved after standard general anaesthesia, mask ventilation was performed using pressure-controlled ventilation, peak inspiratory pressure 15 cm of water, 10 breaths per minute, I:E ratio 1:2. Face mask held by two hands. Group I patients received mask ventilation with the head in a neutral position for one minute, after which the head was turned to the right for one minute and the head is returned to the neutral position for one minute. In group II patients, mask ventilation was performed from right lateral position to neutral position to right lateral position. In each position, airway pressure, compliance and expiratory tidal volume were measured. Results: There was no statistically significant difference between groups with respect to demographic data. The mean expiratory tidal volume was high in head rotation than neutral position (469.545±120.09 ml vs. 397.815±86.03 ml) p value <0.05. A statistically significant (p value=0.045) seen with respect to compliance which was slightly higher in head rotation (35.83) than neutral position (29.31). Conclusions: Head rotation to the lateral position increases the expiratory tidal volume and compliance significantly as compared to head in neutral position and improves mask ventilation after induction of anaesthesia

Failed rapid sequence induction in an achondroplastic dwarf

Achondroplasia, a common cause of short limbed type of dwarfism is due to quantitative decrease in rate of endochondral ossification. This abnormal bone growth leads to disproportionate body and head structure, thus placing them under high risk for anaesthetic management. There is paucity in literatures, regarding appropriate drug dosage selection in these patients. Use of drugs as per standard dosage recommendations based on body weight or body surface area, may not be adequate in these patients owing to discrepancies in overall body weight and lean body weight, especially during rapid sequence induction. Here, we report a case of failed rapid sequence induction due to abnormal response to administered drugs in an adult achondroplastic dwarf. Standard doses of thiopentone and rocuronium had to be repeated thrice to achieve adequate conditions for intubation

Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

Background and Aims: Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000). The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects

RESPONSIVENESS OF STATE AND RESPONSE ENTROPY AND ALGESIOMETRY DURING INTRAVENOUS FENTANYL ADMINISTRATION: A COMPARISON BETWEEN MALE AND FEMALE PATIENTS

Aims and Objectives: The aim of the study was to assess the gender difference in response to fentanyl on the entropy and algesiometry and to compare hemodynamic difference in between the gender. Methods: It was a prospective observational study carried out in a group of 100 patients, of which 50 were males and 50 females. In both the groups, baseline entropy (response entropy [RE] and state entropy [SE]) and algesiometry values were recorded, 2 mic/kg of fentanyl was administered, and entropy values were recorded for 5 min and another algesiometry reading was taken at the end of 5 min. Results: Both the groups were found to be comparable age and weight (p<0.05). However, the mean height of male patients was found to be more as compared to females, and the difference was found to be statistically significant (p=0.037). There was no statistically significant difference in the American society of anesthesiologists grades of male and female patients (p=1). Comorbidities were analyzed using Pearson’s Chi-square test and both the groups were comparable in terms of distribution of comorbidities. (p=1.000). All parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen Saturation, RE, and SE at various time intervals were found to be comparable in male and female patients. There was no statistically significant difference in any of the parameters till 5 min after fentanyl administration (p>0.05). There was no significant difference in entropy values among males and females before and after fentanyl administration. Females had significantly (p=0.033) lower pain threshold and a statistically significant increase in pain threshold as compared to males after fentanyl administration (p=0.012). Conclusion: We conclude that fentanyl administration has not influenced the entropy values based on gender and females had an initial low pain threshold and a greater increase in pain threshold after fentanyl administration