BACKGROUND:Although there are many preoperative tests to predict difficult airway, they are far from being ideal i. e. easy to perform, highly sensitive and specific, having high positive predictive value with few false positive predictions. AIMS: to elucidate the role of upper lip bite test (ULBT) with other prevailing tests, hyomental/thyrosternal distance ((HMD/ TSD), and mandible length (ML) in predicting difficulty in endotracheal intubation. MATERIAL AND METHOD: 300 patients meeting inclusion criteria, aged 21-60 yrs. having ASA I and II status, posted for elective surgery under general anesthesia with endotracheal intubation were enrolled in this study. Preoperatively anesthesiologist not involved in intubation evaluated and assessed the ULBT class and obtained measurements of HMD, TSD, ML. Laryngoscopy was assesed by anesthesiologist blinded to the measurements and was graded according to Cormack and Lahane's Grading system. ULBT of class III, HMD<3.5cms, TSD<6.5cms and ML <9cms were considered as markers of a potentially difficult intubation. STATISTICAL ANALYSIS: Data was analysed using kappa agreement and sensitivity, specificity, positive predictive value, negative predictive value with their 95% confidence interval was calculated. RESULTS: The negative predictive value (NPV) and positive predictive value (PPV) of ULBT were 100% and 92. 2% respectively. These corresponding figures for HMD, ML, and TSD were 57.14, 0, 81.82 and 87, 71, 86.39, 89.27 respectively. Specificities for ULBT, HMD, ML, TSD were 45, 10, 0, 22.5% respectively. Sensitivity for ULBT, HMD, ML, TSD was 100, 98.85, 99.23, 97.69 respectively. ULBT showed greatest agreement with laryngoscopic grading (kappa=. 59 with p-value <0.0001). An agreement between HMD, ML, TSD and laryngoscopic grading which was comparatively weaker also existed (0.14, 0.31, -0.04, respectively.) CONCLUSION: The high specificity, NPV, PPV, and accuracy of ULBT as revealed in this study could be a good rationale for its application in the prediction of difficulty or easiness in intubation. The quantitative parameters, ML and HMD, had a slight and fair agreement with kappa coefficient. Hence, either of them can be useful in combination with a qualitative parameter, ULBT, so as to get acceptable and dependable result as it enhances its potential value in being diagnostic in airway assessment.
Laryngoscopy and tracheal intubation causes intense autonomic reflex responses such as tachycardia, hypertension and a rise in intraocular pressure (IOP). Rise in IOP is further compounded by the use of succinylcholine. Various drugs used to attenuate the rise in IOP are pretreatment with non-depolarizing muscle relaxant, lignocaine, narcotics, nifedipine and nitroglycerine, but none is found to abolish it completely. To obtain haemodynamic response lignicaine, opiods, nitroprusside, nitroglycerine, vearpamil, nifedipine, esmolol, clonidine etc. have been used. AIMS AND OBJECTIVES: We investigated whether dexmedetomidine an α2 agonist could attenuate the rise in IOP after succinylcholine and intubation. Simultaneously, its effect on attenuation of haemodynamic response (Heart rate and MAP) to laryngoscopy and intubation was also evaluated. MATERIALS AND METHODS: Eighty patients without pre-existing eye disease undergoing general anesthesia was randomly premedicated by iv dexmedetomidine 0.6µg or saline. Heart rate (HR), mean arterial pressure (MAP), IOP (using Schioetz tonometer) was measured before, after the premedication, after thiopental, after succinylcholine, immediately after intubation and then every minute for 3 minutes. Statistical Analysis: descriptive and inferential statics using chi-square test, z-test and Wilcoxon sign rank test was done. Software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0. Data was reported as mean value ± SD & p-value < 0.05 was considered as level of significance. RESULTS: Succinylcholine and intubation increased IOP in both the groups. However, in the dexmedetomidine group, it was not significantly different from baseline values (z value=0. 93, p=0. 358) and was significantly lower than in the control group (z =6. 644, p=0. 000). After intubation the MAP in the control group (z=17. 4, p=0. 000) was higher than that in the dexmedetomidine group (z=8, p=0. 000) and exceeded the baseline value (p<0.05). The heart rate also showed a less fluctuation in the dexmedetomidine group than in the control group. (z=7. 73, p<0.05 after succinylcholine and z=9. 22, p<0.05 after intubation) CONCLUSION: IV dexmedetomidine 0.6µg premedication is advantageous as it is found to be effective in reducing the rise in IOP. It is also beneficial in attenuating the haemodynamic response of succinylcholine, laryngoscopy and intubation to prevent its consequences.
BACKGROUND: Ant nociceptive treatment started before surgery is more effective in reducing postoperative pain than if started in early postoperative period. Pregabalin has demonstrated efficacy in clinical trials as pre-emptive analgesic in postoperative pain management. OBJECTIVE: This was a prospective, double blind, controlled, randomized, comparative study between pre-emptive oral pregabalin and placebo. Randomization was done by computer generated random table method; random sequence was generated by random allocation software. It was conducted in order to evaluate postoperative analgesic benefit in patients administered pregabalin for below umbilical surgeries to be performed under subarachnoid block (SAB) using 3ml 0.5%bupivacaine & to compare their postoperative efficacy with respect to duration of analgesia,24hrs postoperative requirements of total analgesics and study side effects. MATERIAL & METHODS: sixty patients of either sex (30 per group,20-65yrs, ASA gr I-II) received either oral placebo (group PC) or pregabalin 300mg (group PG) one hr preoperatively. The postoperative Visual Analogue Scale (VAS) score was assessed for 24hrs every 2hrly. The patients were given iv Diclofenac75mg as rescue analgesic at VAS ≥4.The time at which patient demanded rescue analgesic for first time & total requirement of 24 hrs postoperative analgesics was noted. STATISTICAL ANALYSIS: Software used in the analysis was EPI info software (3.4.3). Data was reported as mean value ± SD, P-value of < 0.05 was considered statistically significant. Unpaired T-test was used to find out significance between two samples. The comparison of normally distributed continuous variables between the groups was performed by means of one-way analysis of variance (ANOVA) and, if appropriate, followed by Dunnett multiple comparison tests. Nominal categorical data among study groups were compared using the chi-square test. RESULTS: Total duration of analgesia in Group-PG was significantly more than Group-PC. (632.83±103.95, Group-PG and 264.83±13.67 min. Group-PC, p=0.000), lower rescue analgesic requirement in Group-PG than in Group-PC (1.73±0.44 Group-PG, 4.03±0.66 Group-PC, p=0.000). CONCLUSION: Pregabalin proved to have a better analgesic effect, reducing the total consumption of postoperative analgesic and prolonging first rescue analgesic dose with haemodynamic stability. The main side effects were somnolence & dizziness.
BACKGROUND: Hemodynamic disturbance and uteroplacental hypoperfusion can occur due to Aortocaval Compression (ACC) in parturient which are further aggravated by SAB. Incidence of maternal hypotension due to cephalad spread of local anesthetic (LA) in subarachnoid space and ACC by gravid uterus; both these factors influenced by parturient's posture during and immediately after SAB, we tested the hypothesis that keeping parturient in sitting position for five minutes after SAB, likely limit the spread of LA, thus reduce the incidence of hypotension and Intraoperative ephedrine requirements. AIMS AND OBJECTIVES: to determine the effects of making parturient sit up for five minutes after SAB, that would have on sensory block height, incidence of hypotension and ephedrine requirements. Secondarily, to study duration of postoperative analgesia. MATERIALS AND METHODS; Single blinded randomized comparative study having 30 parturients in each group CS and CL were allocated to receive 2ml of hyperbaric bupivacaine with 0.4ml NS, Or 20 µgm fentanyl added to 2 ml hyperbaric bupivacaine group FS or FL, either in sitting group (made to sit for 5 min. post SAB before supine) or in lying group, made supine immediately. The maximum level of sensory blockade achieved and monitoring of heart rate, noninvasive blood pressure, respiratory rate and oxygen saturation were done every 2 min for first 10 min then at 15 min interval for remainder of operation. Postoperatively, onset of pain was noted. STATISTICAL ANALYSIS: By using descriptive and inferential statistics using unpaired t-test, chi Square test, and Mann-Whitney U test. The Software used was SPSS 17.0 version and Graph Pad Prism 5.0. Analyzed data was expressed as mean ± SD for continuous variables and number (%) for categorical variables. P value < 0.05 was considered statistically significant RESULTS: Sitting Groups had lower sensory block height than lying Groups; also required less ephedrine. Duration of postoperative analgesia was prolonged in both the fentanyl Groups. CONCLUSION: prolonged sitting position after spinal anesthesia not only limit the spread of LA, producing lower sensory block height but also reduces the incidence of hypotension and Intraoperative ephedrine requirement in caesarean delivery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.