ABSTRACT

No abstract

SummaryWe performed a national postal survey exploring anaesthetists' practice in rapid sequence induction. All respondents used pre-oxygenation, although the technique employed, and its reliability, varied. Thiopental and succinylcholine, given after waiting for signs of loss of consciousness, were the most widely used drugs for rapid sequence induction. Propofol and rocuronium were used by more than a third of respondents, and most respondents (75%) also routinely administered an opioid. Cricoid pressure was used universally but the practice of its application varied widely. The commonest aids used if intubation was difficult were the gum elastic bougie, the long laryngoscope blade and the laryngeal mask. After failed intubation, approximately half of respondents would maintain the supine position. Failure to intubate at rapid sequence intubation had been seen by 45% of respondents but harm was uncommon. In contrast, 28% had seen regurgitation, which frequently led to considerable harm and to three deaths. In spite of this, practice of a failed intubation drill was uncommon (15%) and anaesthetic assistants were rarely known to practice application of cricoid pressure. Consultants were less likely than trainees to use rocuronium as a muscle relaxant, and more likely to choose morphine if administering an opioid. They were less likely to practice a failed intubation drill. Other aspects of practice varied little between grades. This survey suggests that many anaesthetists do not follow best practice when performing a rapid sequence induction.

Background: Increased sympathoadrenal activity invariably occurs during endotracheal intubation. Various drugs have been used to obtund this pressor response. This study was done to find out most favourable drug among fentanyl, nalbuphine and clonidine for prevention of this pressor response. Materials and Methods: This was a randomized, prospective study involving ninety patients of ASA grade 1, equally divided into three groups. Group F, C and N received fentanyl 2 mcg /kg, Clonidine 2 mcg/kg and nalbuphine 2mg/kg i.v respectively, 5 minutes prior to induction. Vitals parameters were noted at frequent intervals Chi square test and Anova test were used for statistical analysis. P value <0.05 was considered as statistically significant. Results: Maximum increase in heart rate and blood pressure was seen at the time of intubation in F and N groups, whereas decrease in these parameters occured with clonIdine, difference was found to be stastistically significant. Haemodynamic stability was seen in F and N group after 5 minutes of intubation. Clonidine showed maximum decrease in heart rate and systolic as well as diastolic blood pressure at all time intervals from intubation as compared to other two groups. Conclusion: In this study it was found that Clonidine produced an earlier and more stable haemodynamics as compared to Fentanyl and Nalbuphine, and it can be concluded that Clonidine given intravenously in doses of 2 mcg/kg 5 minutes prior to intubation is superior to Fentanyl and Nalbuphine in preventing heamodynamic changes at the time of laryngoscopy and intubation.

Computerised dynamic posturography (CDP) can be used as an early marker of recovery to street fitness in patients undergoing ambulatory surgery. We studied three groups of patients undergoing nasal surgery. The goal of this study was to determine whether recovery, as assessed by CDP, is more rapid in patients having nasal surgery under sedation coupled with local anaesthesia or those having surgery under general anaesthesia. We further assessed the acceptability of sedation accompanied by local anaesthesia. A control group was included to determine if there is a learning curve to posturography. There was no difference between the two study groups in terms of balance. Balance was not significantly impaired at 3 h postoperative testing.

Background and Aims: Etomidate is used for induction of anaesthesia in haemodynamically unstable patients but its use is associated with undesirable side effects like myoclonus, incidence of which is 50-80%. This prospective, randomized, placebo controlled study is to compare the effect of dexamethasone and fentanyl for prevention of etomidate induced myoclonus. Materials and Methods: Ninety adult patients were randomly assigned into three groups to receive Dexamethasone (group D), Fentanyl (group F) and placebo (group P) five min before injection etomidate 0.3mg/kg IV. The patients were assessed for myoclonus using a four point intensity scoring system over a period of 5 min. ANOVA and chi square test were used for statistical analysis and P<0.05 was considered as statistically significant. Results: The incidence of myoclonus was significantly reduced in groups D and F compared with group P (p value 0.001).The incidence of pain associated with Etomidate induced myoclonus also was significantly reduced in groups D and F compared to group P (p value 0.001). Conclusion: Dexamethasone significantly reduces the incidence of myoclonus as compared to placebo. It also significantly reduces the pain associated with Etomidate injection. However its efficacy to reduce pain and myoclonus as compared to Fentanyl is much less.

Peri-anesthetic anaphylaxis is a rare but grave problem. After receiving informed consent for publication, we discuss the case of a female patient posted for laparoscopic cholecystectomy who developed an anaphylactic reaction to intravenous diclofenac, mimicking post-laparoscopy respiratory complication in the perioperative period. A 45-year-old, American Society of Anesthesiologists physical status (ASA-PS) I, female patient was posted for laparoscopic cholecystectomy under general anesthesia (GA). The procedure took 60 minutes and concluded uneventfully. In the post-anesthesia care unit, the patient complained of respiratory difficulty. Even after the supplemental oxygen and in absence of any significant finding on respiratory examination, the patient soon developed severe cardiorespiratory collapse. On evaluation, administration of intravenous diclofenac a few minutes before the event was suspected as the trigger for this anaphylactic response. The patient responded to the injection of adrenaline, and her post-surgical progress over the next two days was uneventful. The retrospective tests done for confirming diclofenac hypersensitivity were found to be positive. No drug, however safe, should be given blindly without proper observation and monitoring. The course of development of anaphylaxis can range from a few seconds to minutes and hence, the earliest recognition and prompt action can be the only deciding factor between life and death for such patients.

Introduction: Bupivacaine is one of the most widely used local anesthetics in spinal anesthesia. Clonidine is a known adjuvant added to prolong the duration of anesthesia. Amongst the complications related to spinal block, neurological complications can be the most troublesome. Case Presentation: We presented a case where the reversal of motor and sensory blockade after spinal anesthesia with bupivacaine and clonidine was extremely delayed in the absence of any neurological injury. Conclusions: Such cases remind the significance of timely and elaborate assessment in the detection of iatrogenic complications and the unpredictability of physiological and pharmacological interactions.