Context:The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings.Aim:To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage.Settings and Design:A prospective observational study conducted in the general surgical operation room of a tertiary care hospital.Materials and Methods:Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made.Results:Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively). The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%), succinylcholine (92.63%), lignocaine (92.51%), mephentermine (83.80%), and atropine (81.82%). The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01) of the total cost of drugs issued/loaded (Rs. 34,449.44). Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16) of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856), vecuronium 5.23% (Rs. 840), and neostigmine 4.12% (Rs. 661.50).Conclusions:Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.
Background and Aims:Second-generation supraglottic airway devices are widely used in current anaesthesia practice. This randomised study was undertaken to evaluate and compare laryngeal mask airway: ProSeal laryngeal mask airway (PLMA), Supreme laryngeal mask airway (SLMA) and I-gel.Methods:Eighty-four adult patients undergoing elective surgery were randomly allocated to three groups: group P (PLMA), group I (I-gel) and group S (SLMA) of 28 patients each. Insertion times, number of insertion attempts, haemodynamic response to insertion, ease of insertion of airway device and gastric tube, oropharyngeal leak pressure (OLP) and pharyngolaryngeal morbidity were assessed. The primary outcome measure was the OLP after successful device insertion. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0 software using Chi-squared/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests. P < 0.05 was considered statistically significant.Results:The demographic profile of patients was comparable. OLP measured after insertion, 30 minutes later and at the end of surgery differed significantly between the three groups (P < 0.001). The mean OLP was 32.64 ± 4.14 cm·H2O in group P and 29.79 ± 3.70 cm·H2O in group S. In group I, the mean OLP after insertion was 26.71 ± 3.45 cm H2O, which increased to 27.36 ± 3.22 cm H2O at 30 minutes and to 27.50 ± 3.24 cm H2O towards the end of surgery. However, these increases were not statistically significant (P = 0.641). Device insertion time was longest for group P (P = 0.001) and gastric tube insertion time was longest for group I (P = 0.001). Haemodynamic response to insertion and pharyngolaryngeal morbidity were similar with all three devices.Conclusion:PLMA provides better sealing pressure but takes longer to insert. I-gel and SLMA have similar sealing pressures. I-gel insertion time is quicker.
Thoracoscopy has major advantages over thoracotomy. We report a successful management of foregut duplication cyst thoracoscopically in a child with review of literature.
Objectives:To evaluate the clinical effects of hyperbaric ropivacaine alone and with clonidine or fentanyl for spinal anaesthesia for knee arthroscopy. Methods: Sixty ASA I/II patients were randomised to receive spinal anaesthesia with hyperbaric ropivacaine alone (Group R), or with clonidine 15 μg (Group RC) or fentanyl 30 μg (Group RF). The sensory and motor block, time to micturition and side effects were assessed.
Results:The three groups were similar in mean time to onset of sensory block at T10, height of block and time to maximum block. Sensory regression to S2 took longer in Groups RF and RC compared with Group R (p = 0.001 and p < 0.01, respectively). Time to requirement of rescue analgesia was longer in Groups RF and RC compared with Group R (p = 0.023 and 0.002, respectively). Time for complete regression of motor block and time to voiding were longer in group RC compared with group R (p = 0.022 and p = 0.013, respectively).
Conclusion:The addition of fentanyl 30 μg to hyperbaric ropivacaine may be superior to the addition of clonidine 15 μg for knee arthroscopy as it provides a similar prolongation of sensory block and analgesia without prolonging motor block and time to micturition.
Background:
Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-COV-2). Many aspects of its pathology and pathogenesis are not well understood.
Material and Methods:
We describe a series of spontaneous air leak cases we found in our coronavirus disease 2019 (COVID-19) positive 1086-patient cohort.
Results:
Two out of six patients eventually required mechanical ventilation and succumbed to COVID-19. We presume that acute lung injury leading to SARS-CoV-2 with associated acute respiratory distress syndrome predisposes patients to this complication.
Conclusion:
This series is presented to highlight the emerging association of COVID-19 with spontaneous air leaks leading to pneumomediastinum, pneumothorax, and subsequent subcutaneous emphysema even in patients who have never received invasive mechanical ventilation and this may be more likely with the institution of high flow nasal cannula.
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