Background and Aims:Awake flexible fibre-optic bronchoscope (FFS) is the standard method of intubation in difficult airway in oral cancer patients. We decided to evaluate GlideScope® video laryngoscope (GL) for intubation as compared to the standard FFS for nasal intubation in such patients.Methods:After the ethical committee approval, we included 54 oropharyngeal cancer patients divided randomly into two equal groups: Group G and Group F. After pre-medication and pre-oxygenation, awake nasal intubation was performed using GL in Group G and FFS in Group F. In both groups, we compared intubation time in seconds (mean ± standard deviation) (primary outcome), success rate of the first intubation attempt, percentage of Cormack and Lehane glottic score and incidence of complications. We assumed that GL could be a suitable alternative for the standard FFS in nasal intubation of patients with oropharyngeal cancer. Success rate of the first attempt and Cormack and Lehane glottic score were compared using Chi-square test.Results:Intubation time in seconds was significantly shorter in Group G (70.85 ± 8.88 S) than in Group F (90.26 ± 9.41 S) with (P < 0.001). The success rate of the first attempt intubation was slightly higher in Group G (81.5%) than Group F (78.8%). Cormack and Lehane glottic Score I and II showed insignificant difference between both Group G (92.6%) and Group F (96.3%). We detected three cases of sore throat in each group.Conclusion:GlideScope® could be a suitable alternative to FFS in nasal intubation of oropharyngeal cancer patients.
Background and Aims:Thoracic paravertebral block (TPB) is one of the effective methods for management of post-operative pain in thoracic surgeries. The aim of the study was to evaluate effectiveness of addition of dexmedetomidine to paravertebral block with bupivacaine in improving the postoperative pain relief and pulmonary functions in patients undergoing thoracic surgeries.Methods:A prospective randomized double-blinded study was performed on forty patients scheduled for thoracic surgery. A paravertebral catheter was secured under ultrasound guidance preoperatively for all patients. Group B (n = 20) received a bolus dose of 0.25% bupivacaine at 0.3 mL/kg followed by continuous infusion of 0.125% bupivacaine 0.1 mL/kg/h. Group (BD) received a bolus dose of 0.25% bupivacaine + dexmedetomidine 1 μg/kg at 0.3 mL/kg followed by continuous infusion of dexmedetomidine 0.2 μg/kg/h + 0.125% bupivacaine 0.1 mL/kg/h. Anaesthesia technique was standardized for all patients. Postoperatively, all patients were assessed during first 24 hours for intraoperative fentanyl and post-operative morphine requirements, Visual Analogue Scores (VAS) scores at rest and during cough, and postoperative pulmonary functions.Results:Post-operative morphine consumption in the first 24 hours and intraoperative fentanyl requirement were significantly less in group BD (2.95 ± 1.986 mg, 80.75 ± 31.551μg respectively) compared to group B (9.85 ± 3.468 mg, 186 ± 39.683 μg respectively). Group BD showed less VAS scores during cough and better postoperative pulmonary functions (P < 0.05).Conclusion:Addition of dexmedetomidine to paravertebral bupivacaine in patients undergoing thoracic surgeries provides more effective analgesia with improvement in post-operative pulmonary functions.
Background and aims: Endotracheal intubation is a crucial skill in anesthesia. Uncuffed pediatric endotracheal tube (ETT) size can be calculated by various methods like age-based formula or by using ultrasound to measure minimal transverse subglottic diameter (MTSD). This study aimed to compare both age-based formula and ultrasound to assess the advantage of routine use of ultrasound to determine pediatric ETT size. Materials and methods: Forty children of 2-10 years of age, ASA class ≤ II, Mallampati airway classes I and II, scheduled for surgery away from the head and neck, were included. Uncuffed ETT size for each child was calculated using age-based formula. After induction of balanced general anesthesia, an ultrasound was done to measure MTSD and an endotracheal tube was selected accordingly. After intubation, an air leak test was done and the ETT was accordingly changed (if needed). Results: ETT size by age-based formula strongly correlated with the size measured by ultrasound (Pearson correlation 0. 913; P < 0.001). The percentage of the need to change the endotracheal tube according to the leak test was only 7.5%. Conclusion: The ETT size calculation was similar for both age-based formula and ultrasound. So, we could not justify the routine use of ultrasound for calculating ETT size for intubation in pediatric patients.
Background:Awake fiberoptic intubation (AFOI) is one of the principal techniques in the management of difficult airway in oral cancer surgery. We hypothesized that the addition of a small dose of fentanyl could improve the sedative criteria of dexmedetomidine during AFOI technique, without the need to increase the dose of dexmedetomidine which may be associated with airway compromise.Patients and Methods:One hundred and fifty American Society of Anesthesiologists physical status 1 and 2 patients planned for AFOI for oral cancer surgery patients were allocated into three groups (fifty patients each). Group D1: Received an infusion of 1 μcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group D2: Received an infusion of 2 μcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group DF: Received an infusion of 1 μcg/kg dexmedetomidine added to 1 μcg/kg fentanyl diluted in 50 ml saline over 20 min. AFOI was done by topical anesthesia and with the same technique in all patients. All patients were assessed for: airway obstruction, intubation scores (vocal cord movement, coughing, and limb movement), fiberoptic intubation scores, and hemodynamic variables. Any episode of bradycardia or hypoxia was recorded and managed.Results:Group D2 showed more incidence of airway obstruction than the other two groups. Limb movement scores were more in Group D1 compared to the other two groups. All groups were comparable as regard fiberoptic intubation scores, coughing, and vocal cord opening scores.Conclusion:Adding a low dose of fentanyl (1 μcg/kg) to a low dose of dexmedetomidine can prevent the risk of airway obstruction associated with increasing the dose of dexmedetomidine while achieving the same favorable intubation scores.
Background Many analgesic methods have been used to control post-mastectomy pain. Both thoracic paravertebral and serratus anterior blocks are recent regional techniques with promising results. The aim of this study was to compare safety and analgesic efficacy of both techniques in controlling post-mastectomy pain. Methods The study was conducted from January 1, 2019, till January 10, 2019, on 60 female patients ASA class ≤ 2 undergoing modified radical mastectomy. After induction of balanced general anesthesia patients received either continuous thoracic paravertebral block (group P) or continuous serratus anterior block (group S). Twenty milliliters of levobupivacaine 0.25% were injected in each technique under ultrasound guidance followed by continuous infusion of 5 ml/h levobupivacaine 0.125% through a 22-gage catheter. IV morphine was given postoperatively by patient-controlled analgesia. In both groups, we measured time to first dose morphine, total 24 and 48 h morphine consumption, vital signs, visual analog scale, and side effects of each technique. Results The demographic data (age, body mass index, and duration of surgery) were comparable in both groups. The time for first dose of morphine was significantly longer in group P (368 ± 36 min) than group S (270 ± 37.65 min) with P value < 0.001. Total morphine consumption in milligram at both 24 and 48 h were significantly less in group P (8.1 ± 0.8, and 11.5 ± 1 respectively) than in group S (10.1 ± 1.3 and 14.2 ± 1.4), with limited side effects in both groups. Conclusion Both continuous paravertebral and serratus anterior plane blocks are safe good alternatives to control post-mastectomy pain. However continuous paravertebral block provides better analgesic profile.
Background:Breast surgery compromises one of the most common cancer surgeries in females and commonly followed by acute postoperative pain. Pregabalin and ketamine have been used in many previous studies and was found to have a good analgesic profile. We assumed that pregabalin and ketamine can be used in control of postoperative pain in female patients undergoing breast cancer surgery.Material and Methods:Ninety female patients scheduled for cancer breast surgery were allocated in three groups (30 patients each), control group (group c) received preoperative placebo, pregabalin group (group p) received oral 150 mg pregabalin 1 h before surgery, ketamine group (group k) received intravenous (IV) 0.5 mg/kg ketamine with induction of anesthesia followed by 0.25 mg/kg/h IV throughout the surgery. All patients received general anesthesia and after recovery, the three groups were assessed in the first postoperative 24 h for postoperative visual analog scale (VAS), total 24 h morphine consumption, incidence of postoperative nausea and vomiting (PONV), sedation score >2 and any complications from the drugs used in the study.Results:The use of pregabalin or ketamine was found to reduce total postoperative morphine consumption with P < 0.001. There was no difference between pregabalin and ketamine groups in opioid requirement. There was no difference between the three groups in postoperative VAS scores or incidence of PONV and sedation score >2.Conclusion:The use of preoperative oral 150 mg pregabalin 1 h before surgery or IV 0.5 mg ketamine with induction of anesthesia can reduce postoperative opioid consumption in breast cancer surgery without change in sedation or PONV and with a good safety profile.
Background: Paravertebral block is an effective perioperative analgesic modality in patients undergoing breast or thoracic surgery. Several adjuvants have been reported to improve the clinical profile of local anaesthetic-induced paravertebral block. In the present study, we hypothesized that the addition of magnesium sulphate could potentiate the analgesic effects of paravertebral bupivacaine in female patients undergoing modified radical mastectomy. Methods: Ninety female patients ASA physical status 1 and 2 patients scheduled for modified radical mastectomy were allocated into 2 groups (45 patients each). Group (B) received bupivacaine 0.25% 0.3 ml/kg in the paravertebral space while group (BM) received 100 mg magnesium sulphate + bupivacaine 0.25% 0.3 ml/kg in the paravertebral space. Both blocks were done guided by ultrasound before induction of standard general anaesthetic technique which was the same in both groups. The two groups were assessed in the first post-operative 24 h for post-operative visual analogue scale (VAS) scores, time to first analgesic request, total 24 h morphine consumption, number of attacks of PONV and any complications from paravertebral block or from the drugs used in the study. Results: Patients in group (BM) were found to have reduced VAS scores at 30 min, 2, 4, 6, 12, 24 h intervals post-operative. The time to first analgesic request was longer in patients of group (BM) with less amount of post-operative opioid consumption and consequently less number of attacks of PONV in first post-operative 24 h. These results were significant with a P value < 0.001. Conclusion:Adding magnesium sulphate to bupivacaine in ultrasound-guided paravertebral block resulted in more efficient analgesia and opioid-sparing in female patients undergoing modified radical mastectomy.
Intraoperative fluid management aims to maintain central euvolemia while avoiding salt and water excess. Excessive intravenous fluid administration leads to gut edema, bacterial translocation, prolonged ileus, and impaired gastrointestinal (GI) function and tolerance for enteral nutrition [1]. Several factors, such as preoperative fasting, hypertonic bowel preparations, anesthesia, and positive pressure ventilation, predispose surgical patients to a functional intravascular volume deficit [2]. How ever, optimal fluid management is difficult to achieve using standard parameters (e.g., heart rate, blood pressure, central venous pressure, or urine output) [3]. So, intraoperative fluid management should be guided by goal-directed therapy (GDT) rather than predetermined calculations [1].Pulse pressure variation (PPV) has an advantage over most of the dynamic measures of fluid responsiveness in not being affected by airway and pleural pressures [4]. Lactated Ringer's (LR) is a commonly
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