A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.
Background and Aims:
Transverse abdominus plane (TAP) block provides good quality analgesia with minimal side effects. Addition of adjuvant like dexmedetomidine to the local anesthetics has been shown to prolong the action of the block in earlier studies. In this prospective randomised study TAP block with levobupivacane with or without dexmedetomidine was compared with control group for post-operative analgesia following cesarean delivery.
Material and Methods:
Ninety healthy women undergoing cesarean delivery under spinal anesthesia were randomized into three groups (GroupC, GroupL and Group LD). And following this Group L received ultrasound guided bilateral TAP block with 20 ml 0.25% levobupivacaine on each side, while Group LD received TAP block with same volume of levobupivacaine with 1μg/kg of dexmedetomidine. Group C, the control group did not receive TAP block. Postoperatively, time for first request for rescue analgesia and the number of women requesting analgesia in 6 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on movement for the first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h.
Results:
Time for first rescue analgesia was significantly longer and patient satisfaction scores were significantly higher in patients who received TAP block (Groups LD and L) as compared to control (Group C). Pain scores were also lower in the TAP block groups compared to control group. Among the women who received TAP block, those with dexmedetomidine group (Group LD) asked for rescue analgesia significantly later compared to group L. Patient satisfaction score was highest in the Group LD compared to Group L which in turn was better than control group. There were no significant differences in the observed side effects.
Conclusion:
Bilateral TAP block with 0.25% levobupivacaine provides good quality analgesia for early postoperative period. Adding dexmedetomidine further improves pain control and gives higher patient satisfaction without any added side effects.
Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher's exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P<0.05). There was a significant delay of mean time to onset of motor block to Bromage score 1 in group 2(P<0.001). The mean duration of complete motor blockade was significantly more in group 1 (P value <0.001). Hypotension was most commonly seen in group 1. Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.
Background and Aims:Bag mask ventilation (BMV) allows for oxygenation and ventilation of patients until a definitive airway is secured and when definitive airway is difficult/impossible. This study hypothesised that the EO (thumb and index finger form a O shape around the mask) technique of mask holding provides better mask seal with the novices compared to the classic EC clamp technique (thumb and index finger form a C shape around the mask).Methods:Sixty patients participated in this double blinded, prospective, crossover study. The patients were randomly allocated to either EC or EO group. After adequate anaesthesia and neuromuscular blockade, a novice (experience of less than five attempts at BMV) held the mask with preferred hand with the allotted technique, while the ventilator provided five breaths at set pressure control of 15 cm H2O with one second each for inspiration and expiration. After recording the exhaled tidal volume (primary objective) for each breath for five consecutive breaths, the study was repeated with the other technique. Secondary outcome variables were minute ventilation, audible mask and epigastric leak.Results:The tidal volume and minute ventilation were significantly better with EO technique compared with the EC technique (P = 0.001, a tidal volume difference of 46 mL and P = 0.001, a minute volume difference of 0.51 L).Conclusion:The EO technique provides better mask seal (superior tidal volumes) than the conventional EC technique during single-handed mask holding performed by novices in the absence of other factors contributing to difficulty in mask ventilation.
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