Introduction: Tracheal intubation and laryngoscopy may cause sympathetic stimulation, which can cause tachycardia and hypertension. To abolish the pressor response to laryngoscopy and endotracheal intubation, many medication combinations have been tried with varying degrees of efficacy.
Materials and methods: This randomized comparative study was double-blinded and included 106 subjects. Patients including those aged 18-60 belong to the American Society of Anesthesiologists (ASA) 1 and 2. These subjects were divided into two study groups. Group A received dexmedetomidine 0.5mcg/kg (200mcg diluted in 50ml syringe with normal saline (NS) up to 50cc 4mcg/ml) through an infusion pump over 40min before induction. Group B received dexmedetomidine intranasally (1mcg/kg) in undiluted which is prepared from parental preparation (100mcg/ml) and an equivalent dose of NS to the other group. The intranasal drug was dripped into both nostrils in equal volume using a 1ml syringe in a supine head-down position about 40min before induction. Both groups received an intravenous placebo and an intranasal placebo with normal saline.
Results: In our study, intranasal and intravenous groups were compared. There was no statistically significant difference in hemodynamic variables like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) between the two groups (majority p value >0.05). Hence both routes can be preferred for attenuation of pressor responses.
Conclusion: Study findings demonstrate dexmedetomidine can be utilized as a premedication to lessen hemodynamic surges during endotracheal intubation with more or less the same efficacy via intranasal and intravenous routes. This result could be attributable to the fact that both intravenous and intranasal dexmedetomidine stop central catecholamine levels from rising.
Background and objectivesPresently, neck ultrasonography is used as a tool to predict a difficult airway. There are no standardized ultrasonographic criteria that help to predict a difficult airway. This study aims to ultrasonographically assess the anterior neck soft tissue thickness preoperatively based on two parameters-the minimal distance from the hyoid bone to skin (DSHB) and the distance from the skin to the epiglottis midway between the hyoid bone and thyroid cartilage (DSEM)-and find out whether these parameters can predict a difficult airway in adults by correlating with the Cormack-Lehane (CL) grading.
Background and objectivesAfter obtaining ethical committee clearance and patient consent, we conducted this study on 96 patients aged between 18 and 60 years, belonging to American Society of Anesthesiologists (ASA) classes one and two, who were admitted for elective surgery under general anesthesia with endotracheal intubation to RL Jalappa Hospital and Research Centre, Tamaka, Kolar, from January 2020 to May 2021. The exclusion criteria were patients with anticipated difficult airway cases, such as obesity, pregnancy, head and neck anatomical pathologies, maxillofacial anomalies, and edentulous patients. The sonography of the airway was first performed preoperatively by an anesthesiologist along with standard clinical tests such as Mallampati (MP) grading. The sonography included two parameters: DSHB and DSEM. The patients were later classified as having easy or difficult laryngoscopy based on USG criteria from the available literature. A DSHB value of greater than 0.66 cm was predicted to be a difficult airway, and less than 0.66 cm was predicted to be easy. A DSEM value greater than 2.03 cm was predicted to be a difficult airway, and less than 2.03 cm was predicted to be easy.After induction of anesthesia, another experienced anesthesiologist performed direct laryngoscopy in the sniffing position with an appropriate-sized Macintosh blade and CL grades. CL grades I and II were considered to be easy laryngoscopies.The quantitative data were presented by mean SD and confidence interval (CI). The qualitative data were presented in percentages, and p-values less than 0.05 were considered statistically significant. To determine the discriminative power of individual tests, the receiver operating characteristic curve and the area under the curve with a 95% confidence interval was noted.
ResultsThe two USG parameters DSHB and DSEM may be used to predict difficult laryngoscopy in adult patients, as both have very strong statistical significance. Of the two parameters, DSHB seems to have a better diagnostic value for predicting a difficult airway in our study, as supported by the area under the curve (AUC) of 97.4% compared to DSEM with an AUC of 88.8%. DSHB has better sensitivity (100%), and DSEM has better specificity (89.77%).
ConclusionOur study showed that DSHB and DSEM may aid in predicting difficult laryngoscopies, as a strong statistical significance was present between sonographic measurements and CL ...
Anaesthesiology today is a vast speciality in medical science. In a healthcare setting, the expectations of teachers, parents, and patients augment the stress experienced by postgraduate trainees and registrars due to their hard workload, long duty hours, night shift, limited vacation time, insufficient sleep and food, and study.The study aims to assess factors influencing the selection of anaesthesia as a speciality choice and to assess stress levels while working as a postgraduate in anaesthesia.A questionnaire-based study was done among 265 junior anaesthesia residents for 2 months. A semi-structured was used to collect the data. Data were statistically analyzed using IBM SPSS statistics version 20.Of 265 participants, most participants lie in the age group of 26-35 years (82.3%) with a mean age of 28±4 years and the least in >35 years (5.3%). Most of the participants in the current study are females (54.3%), and the rest are males (45.7%). 177 (81.2%) were MD postgraduates with stress and DNB postgraduates (80.9%). However, there was no significant association between the post-graduation degree and perceived stress. Most women students reported statistically significant stress. Anaesthesiologists need to emphasize the positive aspects and scope of the speciality outside the operating room, like trauma, critical care and pain management.
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