Background:Airway management in large and retrosternal goiters with tracheal compression is often fraught with challenges and is a source of apprehension among anesthesiologists globally.Aims:In this study we attempt to delineate the preferred techniques of airway management of such cases in our institution and also to assess whether airway management was unnecessarily complicated.Setting and Design:Retrospective analysis.Materials and Methods:A retrospective review was conducted of thyroidectomies performed in our institution over a three year period from January 2013. Clinical, radiological, pathological, anesthetic and surgical data were obtained from hospital case records.Statistical Analysis:Qualitative data is represented as frequencies and percentages and quantitative data as mean and standard deviation.Results:Of 1861 thyroidectomies tracheal compression were present in 50 patients with minimum tracheal diameter ranging from 4-12mm (mean 7.84); with majority(95%) having a benign pathology. Critical tracheal compression (≤5 mm) was observed in four patients. Conventional intravenous induction and intubation under muscle relaxant was performed in majority (64%) of these patients. The rest of the cases (n=18) were intubated while preserving spontaneous ventilation after induction. Primary technique of airway management was reported successful in all cases with no instances of difficult ventilation or intubation. Postoperative morbidity in few cases resulted from hematoma (n=1), recurrent laryngeal nerve palsy (n=1), tracheomalacia (n=1) and pulmonary complications (n=2).Conclusion:Airway management in patients with tracheal compression due to benign goiter is quite straightforward and can be managed in the conventional manner with little or no complications.

Background:Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.Aim:The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section.Setting and Design:Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block.Materials and Methods:Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any.Statistical Analysis:Unpaired t-test and Chi-square test were used.Results:Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed.Conclusion:Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.

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Background:We conducted a prospective observational study to find out the effectiveness, complications and technical

Introduction: Transdermal Buprenorphine (TDB) patches have recently gained popularity owing to its non-invasive dosing, minimal side-effects and longer duration. Epidural opioids provide excellent analgesia thus permitting early ambulation. Aim: To compare the efficacy of epidural buprenorphine infusion and TDB to relieve postoperative pain following total abdominal hysterectomy. Materials and Methods: In this prospective observational cohort study, 116 patients undergoing total abdominal hysterectomy in a tertiary care institution, were divided into two equal groups. All patients were given subarachnoid anaesthesia using 3.4 ml 0.5% bupivacaine heavy with 60 μg buprenorphine. Group T patients had TDB (10 μg/h) patch applied 12 hours prior to procedure; while Group E patients received epidural buprenorphine infusion (10 μg/h) postoperatively. Postoperative analgesia was assessed using Numerical Rating Scale (NRS) at 2 hours, 4 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours after surgery. Inj. diclofenac 75 mg IV or Inj. paracetamol 1gm Intravenous (IV) infusion were given as rescue analgesic. The requirement of rescue analgesics was also recorded every 24 hours. Occurrence of adverse effects like sedation, respiratory depression, hypotension, bradycardia, nausea, vomiting, pruritus, headache, dizziness etc., were observed and compared between the two groups. Chi-square and Independent t-test were used for categorical and continuous variables, respectively. Results: Better postoperative analgesia with lower NRS scores were seen in Group E when compared to Group T at all the measured intervals (p-value<0.001). The median rescue analgesic requirement was significantly higher in Group T {Diclofenac 75 (0,150) mg, Paracetamol 2 (1,2) g} than Group E {Diclofenac 0 (0, 75) mg, Paracetamol 1 (0, 1) g}. Sedation was more for epidural buprenorphine at 2 hour, 24 hours, 36 hours and 48 hours. The occurrence of nausea and vomiting was more with TDB (p-value<0.001). There were no other significant adverse effects in both the study groups. Conclusion: Epidural infusion of buprenorphine is safe and more effective than an equal dose of TDB in postoperative analgesia for abdominal hysterectomy.

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