ObjectiveTo assess the effect of intravenous dexmedetomidine on subarachnoid anesthesia with the help of hyperbaric bupivacaine when administered as a bolus or as an infusion.Materials and methodsThis randomized control trial was conducted at the Department of Anesthesia, Nishtar Hospital, Multan, Pakistan, from January 2017 to December 2018. Seventy patients were enrolled in the study. Patients were segregated into three groups. At the T10 level, a sensory blockade was noted. The motor blockade was also periodically measured until a modified Bromage score of three was achieved. The depth of sedation was measured with the help of the Ramsay Sedation Scale score. Oxygen saturation and other factors were also measured and recorded. Nausea, vomiting, diarrhea, and pruritus were the adverse effects noted during the study. To check and compare the statistical differences among the variables from different groups, the Chi-square test and analysis of variance test were performed. A probability (p) value of <.05 was considered statistically significant.ResultsThe duration of the sensory blockade was shortest in the control group receiving only bupivacaine (Group B) and longest in the group receiving bupivacaine plus dexmedetomidine as a single bolus (Group BDexB; p: <.001). The time of complete sensory and motor recovery was longest in Group BDexB and shortest in Group B. The difference was statistically significant (p: <.001). The Ramsay score was >2 (i.e., 3 or 4) in five patients from Group B, 19 from Group BDexB, and 17 from the group receiving intrathecal bupivacaine plus dexmedetomidine as an infusion (Group BDexI). Between these groups, a statistically significant difference was found (p: <.001).ConclusionsIntravenous administration of dexmedetomidine as either a bolus or infusion prolonged the duration of the sensory and motor blockade.
Objective: To evaluate the diagnostic accuracy of auscultation in the detection of inappropriate positioning of endotracheal tube, in patients undergoing elective surgeries, by taking fiberoptic bronchoscopy as gold standard. Study design: cross sectional study Place and duration: Department of anesthesia, Nishtar Hospital, Multan Methodology: A total of 205 patients admitted in general surgery ward were included in the study. The pre-operative assessment was done one day before surgery. The level of difficulty of intubation was assessed during pre-operative assessment. SPSS version 23 was used for data analysis. Tests of significance chi square and t-test were applied. P-value < 0.05 was taken as statistically significant. Results: Therefore, the estimated sensitivity was 72.03%. The estimated specificity was 65.6%. Positive predictive value was 73.9% and negative predictive value was 63.3%. Two hundred and five patients were included in this study of both genders. Gender distribution revealed as n=144 (70.2%) males and n=61 (29.8%) females. The mean age of the patients was 38.92±10.61years. ASA status I and II observed as n=121 (59.0%) and n=84 (41.0%), respectively. Mallampati grading I and II observed as n=127 (62.0%) and n=78 (38.0%), respectively. Laryngoscopy grading I and II observed as n=135 (65.9%) and n=70 (34.1%), respectively. Practical Implication: The main objective of this study was to evaluate the relative diagnostic accuracy of auscultation during GA. Therefore, we evaluated each technique's sensitivity, specificity, (PPV), (NPV) and overall accuracy in detecting incorrect endotracheal tube positioning. Conclusion: The five point auscultation technique is a reliable method of confirmation of endotracheal intubation, as verified by flexible fiberoptic bronchoscope. Keywords: Auscultation, Fiberoptic bronchoscopy, General analgesia, Diagnostic accuracy, sensitivity.
Objective: To validate modified mallampati test with addition of thyromental distance and sternomental distance in prediction of difficult endotracheal intubation in adults presenting in surgical emergency. Study Deign: Prospective, single-blinded observational study Place and duration: Department of Anesthesia and intensive care Nishtar Hospital, Multan from August 2021 to January 2022 in one year duration. Methodology: A total of 120 patients were included in the study. Difficult intubation was predicted by measuring modified mallampati test following thyromental distance and sternomental distance. Validation of mallampati test and combining predictors was assessed by measuring sensitivity, specificity, positive & negative predictive value. Contingency table 2x2was designed. Results: The sensitivity and specificity of this procedure was 62.5% and 80.0%, respectively. Validity of combining all parameters to predict the difficult in endotracheal intubation was shown in table IV. The sensitivity and specificity of this procedure was 25.0% and 27.0%, respectively. Practical Implication: Endotracheal intubation is a common pre-operative complication having potential to lead poor post operative results. This study will help the anesthesiologists to overcome the problem of intubation and reduce the incidence of post operative complications in routine practice. Conclusion: Specificity of modified mallampati is too high, validity of combine parameters modified mallampati, sternomental distance and thyromental distance is very high when compared with mallampati test alone. All three parameters MMT, SMD and TMD can be used collectively for assessment of difficult airway in adult patients planned for surgery under general anesthesia. Keywords: Validity, anaesthesia, modified Mallampati test, endotracheal intubation, thyromental distance, sternomental distance
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