TNF-α-308 G/A polymorphism is significantly associated with the development of postoperative sepsis and with increased expression of cytokines TNF-α, IL-6, and IL-8.
Background: Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared.Methods: American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed.Results: Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups.Conclusions: All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.
The development of sepsis was associated with a greater capacity to produce TNF-α after surgery. The Nco1 polymorphism of the TNF-β gene was associated with the development of post-operative sepsis with an increased serum concentration of TNF-α. In patients without post-operative sepsis, polymorphism of the TNF-β gene was not related to different levels of TNF-α production. This indicates an association between polymorphism of the TNF-β gene and post-operative sepsis, suggesting the TNFB2/B2 genotype as a high-risk factor for the development of sepsis after elective surgery.
Background: Ultrasonography-guided supraclavicular brachial plexus block has demonstrated safety as compared with landmark or nerve stimulation techniques. However, the minimum effective analgesic volume (MEAV) necessary for adequate blockade has not been determined. This study was undertaken to assess under fluoroscopy the postinjection spread of different drug volumes with clinical correlation. Secondary outcome measures included correlation of onset of block, block quality, and incidence of side effects.Methods: This randomized, multiarm, cross-sectional, observational study was conducted at a single tertiary care center. A total of 549 patients were randomly allocated to 3 groups (20 ml, 30 ml, and 40 ml of drug mixture). A local anesthetic drug mixture with a radiopaque dye was administered under ultrasonographic guidance, and postinjection fluoroscopic drug spread was studied.Results: Surgical anesthesia was achieved in 494 (89.98%) patients with 85.25%, 92.97%, and 91.71% in 20-, 30-, and 40-ml groups, respectively, being significantly low (p ¼ 0.0317) in the 20-mL group. Cephalad and infraclavicular spread was higher in the 40-mL group than in other two groups (p ¼ 0.103). Horner syndrome (HS) was seen in 51.18% of patients. First, ipsilateral superficial cervical plexus block was also observed in 40.22% of patients.Among patients who developed both, ~60% of patients (99/167) belonged to the 40-mL group.Conclusions: Optimal MEAV appears between 20 and 30 mL. Higher drug volumes are associated with more cephalad spread and side effects. Drug spread can predict block efficacy as well. It is postulated that loss of sensation in the ipsilateral neck can be used to predict development of hemidiaphragmatic paresis similar to HS.
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