COMBINED USE OF VIDEO LARYNGOSCOPY AND FIBEROPTIC FOR AIRWAY MANAGEMENT IN A PATIENT WITH FIXED CERVICAL SPINE

Airway management may be difficult in patients with fixed cervical spine who have undergone previous spine surgery. Among the various techniques, fiber-optic intubation is a preferred method for securing the airway in such situation. However, it has some limitations also like identification of landmarks, especially in a case of distorted anatomy of the airway. To overcome this inadequacy, we used video laryngoscopy as a complement, to guide the tip of bronchoscope beneath the epiglottis into the trachea and thus achieving the goal. We present a case of difficult airway of fixed cervical spine with distorted anatomy in which combined use of fiberoptic and video laryngoscopy was performed to secure the airway. In our opinion, this technique can be utilized for other difficult airway case scenario also

COMPARISON OF HEMODYNAMIC STATUS AND COMPLICATIONS BETWEEN TWO DIFFERENT DOSES OF INTRAMYOMETRIAL VASOPRESSIN DURING LAPAROSCOPIC MYOMECTOMY: A RETROSPECTIVE STUDY, THE LESSER THE BETTER

Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin

COMPARISON OF VASOPRESSIN AND PHENYLEPHRINE IN TREATMENT OF DOPAMINE RESISTANT SEPTIC SHOCK – A RANDOMISED CONTROL TRIAL

Objectives: Septic shock is associated with refractory hypotension and organ dysfunction and remains an important cause of mortality in intensive care units (ICUs). Vasopressors are the first-line treatment. The present study aims to compare vasopressin and phenylephrine in the management of dopamine-resistant septic shock in the ICU setting. Methods: The study is a prospective, open-labeled, and randomized study comparing the effects of vasopressin (Group I) and phenylephrine (Group II) in the management of dopamine resistant septic shock in intensive care set up. The parameters recorded from 0 to 6 h after persistent hypotension despite maximum dose of dopamine were: Heart rate (HR) (beats/min), systemic blood pressure (mmHg), cardiac output (L/min), cardiac index (CI) (L/min/m2), stroke volume (ml), systemic vascular resistance index (dynes/cm5/m2), oxygen delivery index (IDO) (ml O2/min/m2), urine output (ml), and serum lactate (mg/dl). Results: There was a significant difference in HR, systolic blood pressure, cardiac output, and CI in both groups from 1 h to 6 h. The IDO had a significant rise in Group II. The serum lactate level also decreased in Group II at 6 h. Conclusion: From our study, we concluded that as organ perfusion and oxygenation are more important for the treatment of septic shock and to keep the vital organs functioning rather than to increase the systemic vascular resistance and blood pressure, phenylephrine showed a better result than vasopressin in the treatment of septic shock

I-Gel versus Proseal Laryngeal Mask Airway in Pediatric Airway Management: A Comparative Study

Aim: To compare the insertion characteristics of supraglottic airway devices I-Gel and Proseal laryngeal mask airway (PLMA) in pediatric airway management during elective surgeries under general anesthesia. Methodology: This prospective randomized comparative study was conducted in 60 pediatric patients divided into two groups of 30 each (Group I and Group P), aged 1 to 5 years and belonging to American Society of Anesthesiologists (ASA) Class 1 and 2 posted for elective surgeries under general anesthesia. In Group I, I-Gel was used and in Group P, PLMA was used. The primary outcome of the study was to assess proper placement of airway devices with adequate oropharyngeal sealing and the secondary outcomes were time taken for insertion, ease of insertion, number of attempts, hemodynamic changes associated with insertion of the device, ease of gastric tube passage and complications. Statistical analysis was done by SPSS version 25. Quantitative variables were analyzed through independent sample t-test and categorical variables were analyzed by Chi-square test. P value <0.05 was taken as statistically significant. Results: The demographic data, insertion time and number of attempts were comparable in both the groups. Placement of I-Gel was better in comparison with that of PLMA and was statistically significant (p - 0.010). Conclusion: I-Gel is a better supraglottic airway device when compared to PLMA in terms of ease of insertion and proper placement and there are no significant hemodynamic changes with insertion of both devices

A COMPARISON OF POST-OPERATIVE ANALGESIA WITH INTRAOPERATIVE PECTORAL NERVE BLOCK VERSUS CONVENTIONAL TECHNIQUE IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED STUDY

Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparative efficacy of sciatic obturator and femoral nerve block technique with that of adductor canal block in patients undergoing elective knee surgeries: a prospective, randomized, double-blind study

Background: Knee surgery necessitates adequate analgesia to reduce postoperative complications and promote early recovery. This study aimed to compare the efficacy of the SOFT block (a single-puncture technique to block the sciatic, obturator, and femoral nerves) and the adductor canal block for improved postoperative analgesia and early ambulation. Materials and Methods: In total, 60 patients posted for elective knee surgeries under spinal anesthesia were included. Postoperatively, they were divided into two groups. The SOFT block was administered to Group S with 45 mL of 0.2% ropivacaine and 8 mg of dexamethasone. Meanwhile, the adductor canal block was provided to subjects in Group A with 30 mL of 0.2% ropivacaine and 8 mg dexamethasone. Subjects were then reassessed at 0, 6, 12, 24, and 36 h for heart rate, mean arterial pressure, visual analog score, duration of analgesia, early mobilization, satisfaction score, and adverse events. Results: The mean duration of analgesia of the SOFT block and adductor canal block were 14.62 ± 4.50 and 11.68 ± 2.48 min, respectively (P = 0.003). The mean mobilization time was significantly shorter in Group S (19.96 ± 1.64 vs. 21.77 ± 2.34 min, P = 0.002). The patient satisfaction score was better in the SOFT block than in the adductor canal block (P < 0.001). Hemodynamic parameters and adverse events were comparable. Conclusion: SOFT block with 45 mL of 0.2% ropivacaine and 8 mg dexamethasone provides a longer duration of postoperative analgesia and early mobilization than adductor canal block with 30 mL of 0.2% ropivacaine and 8 mg dexamethasone in patients undergoing elective knee surgeries

COMPARISON OF VASOPRESSIN AND PHENYLEPHRINE IN TREATMENT OF DOPAMINE RESISTANT SEPTIC SHOCK – A RANDOMISED CONTROL TRIAL

Objectives: Septic shock is associated with refractory hypotension and organ dysfunction and remains an important cause of mortality in intensive care units (ICUs). Vasopressors are the first-line treatment. The present study aims to compare vasopressin and phenylephrine in the management of dopamine-resistant septic shock in the ICU setting.&#x0D; Methods: The study is a prospective, open-labeled, and randomized study comparing the effects of vasopressin (Group I) and phenylephrine (Group II) in the management of dopamine resistant septic shock in intensive care set up. The parameters recorded from 0 to 6 h after persistent hypotension despite maximum dose of dopamine were: Heart rate (HR) (beats/min), systemic blood pressure (mmHg), cardiac output (L/min), cardiac index (CI) (L/min/m2), stroke volume (ml), systemic vascular resistance index (dynes/cm5/m2), oxygen delivery index (IDO) (ml O2/min/m2), urine output (ml), and serum lactate (mg/dl).&#x0D; Results: There was a significant difference in HR, systolic blood pressure, cardiac output, and CI in both groups from 1 h to 6 h. The IDO had a significant rise in Group II. The serum lactate level also decreased in Group II at 6 h.&#x0D; Conclusion: From our study, we concluded that as organ perfusion and oxygenation are more important for the treatment of septic shock and to keep the vital organs functioning rather than to increase the systemic vascular resistance and blood pressure, phenylephrine showed a better result than vasopressin in the treatment of septic shock.</jats:p

COMPARISON OF HEMODYNAMIC STATUS AND COMPLICATIONS BETWEEN TWO DIFFERENT DOSES OF INTRAMYOMETRIAL VASOPRESSIN DURING LAPAROSCOPIC MYOMECTOMY: A RETROSPECTIVE STUDY, THE LESSER THE BETTER

Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin.</jats:p