We carried out a retrospective case-control study in 80 patients who underwent a revision total hip replacement. Group A (40 patients) received tranexamic acid and intra-operative cell salvage. Group B (40 patients) was a matched control group and did not receive this management. Each group was divided into four subgroups: revision of both components, revision of both components with bone grafting, revision of the acetabular component with or without bone graft, and revision of the femoral component with or without bone graft. In group A the total number of units transfused was 52, compared with 139 in group B, representing a reduction in blood usage of 62.5%. The mean amount of blood transfused from cell salvage in each group was 858 ml (113 to 2100), 477 ml (0 to 2680), 228 ml (75 to 315) and 464 ml (120 to 1125), respectively. There was a significant difference in the amount of blood returned between the groups (p < 0.0001). In group A, 22 patients needed transfusion and in group B, 37 (p < 0.0001). A cost analysis calculation showed a total revenue saving of pounds sterling 70 000 and a potential saving throughout our facility of pounds sterling 318 288 per year. Our results show that a significant reduction in blood transfusion can be made using combined cell salvage and tranexamic acid in revision surgery of the hip.
No anaesthesiologist like to face scenario of unanticipated difficult intubation, as it may cost patients life. Many tests are there to predict difficult intubation, amongst those tests Modified Mallampati test [MMT] is a gold standard test. Upper lip bite test [ULBT] is an acceptable option for predicting difficult intubation. Our study aimed to compare both the tests to predict difficult intubation. Objectives: To analyse positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy of ULBT and MMT. To compare the results of both the tests to predict difficult intubation. Aim: To ascertain whether ULBT can be incorporated in standard protocol of airway assessment along with other tests to increase predictive accuracy of difficult endotracheal intubation Materials and Methods: It was prospective randomised comparative observational study carried out at single centre. Three hundred patients of either sex, aged between 16-60 yrs scheduled for elective surgery under general anaesthesia with endotracheal intubation were enrolled in the study. Preoperative evaluation of airway was done with ULBT and MMT and findings were documented.MMT class III,IV and ULBT class III were considered as predictors of difficult intubation. On the day of the surgery after direct laryngoscopy laryngeal view was noted and was classified according to Cormack and Lehane classification. Patients with Cormack Lehane class III,IV considered as difficult to intubate. Cormack Lehane classification (C &L class) redings were compared with ULBT and MMT. Observations and Results: Demographic data and ASA grade was same for both the groups as participants were same. By comparing ULBT with Cormack and Lehane score we got 88.46% sensitivity, 92.74% specificity, 71.87% Positive predictive value (PPV), 97.45% ne gative predictive value (NPV) and 92% accuracy. For MMT we go t 19.23% sensitivity, 91.93% specificity, 33.33% PPV, 84.44% NPV a nd 79.33% accuracy. Thus results showed accuracy, sensi tivity, PPV and NPV of ULBT were superior than MMT while specificity of both the tests was similar. Conclusion: With higher level of sensitivity, PPV, NPV and accuracy ULBT is a better choice for predicting difficult airway than that of MMT. ULBT should be incorporated in standard airway assessment protocol along with other tests.
BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P < 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain
INTRODUCTION :Hypotension is the most common complication during induction of general anesthesia. Hypotension is the decrease in systolic blood pressure below the normal accepted value, that is less than 90mm of Hg or decrease in mean arterial pressure of less than 65 mmHg. It is asymptomatic while induction of anesthesia and recognition requires proper predictors on multipara monitors like systolic blood pressure and mean arterial blood pressure. To prevent hypotension many methods like co-loading with intravenous crystalloids, vasopressors have been tried. In our study we are using prophylactic intravenous phenylephrine to prevent fall in blood pressure and to measure the SBPand MAPafter induction of anaesthesia and intubation in the study and control group. (At 5 minutes, 10 minutes, and 15 minutes)” METHODOLOGY-The study was conducted at “Dr. D. Y. Patil medical college, hospital, and research institute” from March 2021 to August 2022 after institutional ethical approval. Total of 120 patients were selected and were divided into two groups, the study group (n =60) the control group (n =60). Routine systematic preoperative assessment and investigation were performed according to the study protocol. RESULTS- SBP was observed to be signicantly declined in the “control group” compared to the “study group” when observed at 10min and 15min time intervals. MAPwas found to be effectively reduced in the “control group compared to the “study group” when observed at 10 min and 15min time intervals. CONCLUSION-From the study it was concluded that the “prophylactic intravenous phenylephrine is effective in preventing fall in blood pressure associated with propofolinduced hypotension at the time of induction during general anaesthesia”
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