BackgroundExtubation has always been a critical aspect of anaesthesia. Guidelines and recommendations are in place for achieving successful extubation, but the risk of failure always persists. Through this study, we assess whether arterial blood gas (ABG) values taken intraoperatively help predict extubation success in the operation theatre.
Materials and methodsThis was a prospective observational study for one year of extubated patients whose blood gas values were not within the normal range. The patients of age 18 years and above undergoing high-risk elective and emergency surgeries where at least one intraoperative arterial blood sample was taken for blood gas analysis were included. Apart from parameters of ABG demographic data, urgency and duration of surgery, blood loss, urine output, use of intraoperative fluid(s), and blood product(s) were also observed.
ResultsOf 578 patients enrolled, 116 patients were extubated based on the predefined extubation criteria. Of these, 24 patients were reintubated within 24 hours. ABG parameters such as partial pressure of arterial oxygen (PaO 2 ) and serum HCO 3-levels were significantly lower in the reintubated patients compared to nonreintubated patients (p-values of 0.045 and 0.003, respectively).
ConclusionThis study showed that the PaO 2 <100 mm Hg or ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) of less than 200 and an HCO 3-value of less than 18 are plausible ABG parameters to decide extubation in post-surgery patients in OT. PaCO 2 , base deficit, and lactate were less reliable parameters for planning extubation.
Total hip arthroplasty (THA) surgery is usually performed in patients with trauma or old-aged osteoarthritis. There has been a recent increase in younger patients presenting with avascular necrosis (AVN) of the hip requiring replacement arthroplasty. Despite being from a younger age group, these patients may present with multiple comorbidities. We describe one such case of Cushing's syndrome with AVN in a young patient with primary adrenal insufficiency, secondary hypothyroidism, and secondary hypogonadism on replacement therapy status post-transsphenoidal pituitary surgery and bilateral adrenalectomy, currently posted for total hip replacement (THR) surgery.
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