Background and Aims: A definitive cutoff of inferior venacava (IVC) diameter in expiration (dIVCmax) and inferior vena cava collapsibility index (IVCCI) for predicting general anaesthesia associated hypotension (GAAH) is not yet determined. Primary objective of this study was to determine the correlation of dIVCmax and IVCCI, with GAAH. Other objectives were to determine the correlation of these IVC parameters with preoperative fasting duration, temperature and humidity. The correlation of dIVCmax with patient demography was also studied. Methods: A total of 110 adult patients undergoing elective surgery under general anaesthesia were included in the study. IVC ultrasonography was done in the preoperative room, 20 to 30 minutes before shifting the patient to the operating room. Hypotension at (hypo@) 2 minutes and 10 minutes after administering vecuronium was recorded. Results: Hundred and seven patients were analysed. A significant positive correlation was present between patient height and dIVCmax (r = 0.25, P = 0.009). Area under receiver operating characteristics curve was 0.595 (95% confidence interval (CI) 0.485–0.705) and 0.568 (95% CI 0.458–0.679) for dIVCmax and IVCCI for predicting hypo@2 min, with a diagnostic accuracy of 54% and 53%, respectively. dIVCmax ≤1.14 cm had a sensitivity of 31% and specificity of 87% in predicting GAAH. IVCCI ≥63.3% could predict GAAH with 31% sensitivity and 84% specificity. No significant correlation was found between preoperative IVC parameters and preoperative fasting or environmental factors. Conclusion: Both dIVCmax and IVCCI have poor diagnostic accuracy, with good specificity and low sensitivity in predicting GAAH. A steady formula for calculating baseline IVC diameter adjusted for patient demography is needed.
Background: N95 filtering facepiece respirators (FFR) are used by health care workers for prevention of airborne infection, and its use has increased manifolds during COVID-19 pandemic. Prolonged use may result in carbon dioxide (CO 2 ) accumulation, affect hemodynamics, and blood gas values. Although arterial blood gas values accurately measure the blood CO 2 levels, venous blood gas values also show acceptable correlation. Aim: To evaluate the physiological impact of N95 FFRs on health care workers, including hemodynamic changes and venous blood levels of CO 2 during a period of 6 h. Settings and Design: Prospective observational study in a tertiary care hospital. Methods: The study was conducted on 30 health care workers who performed routine duties while wearing N95 FFR. Venous blood gas values (CO 2 , pH, and bicarbonate) and vitals (respiratory rate, heart rate, blood pressure, and saturation) were noted at baseline, 2 (T2), and 6 h (T6) after wearing the mask. Discomfort level was also measured on a Visual Analogue Scale (VAS) of 1–10. Statistical Analysis: Repeated measures analysis was done using repeated measures ANOVA or Friedman's test. Group comparisons for continuously distributed data were made using independent sample “ t ” test or Wilcoxon test. Results and Conclusion: Hemodynamic and blood gas values did not change over time. The VAS for discomfort because of respirator use was 1.33 (1.42) at T2 and 2.77 (1.91) at T6. This was a significant increase in discomfort over time ( P = 0.001). About 80% of participants experienced discomfort during this period. N95 FFR did not lead to significant alteration in hemodynamics or change in blood gas values after 6 h of continuous usage. However, discomfort significantly increased over time.
Introduction: The rationale for using an intraperitoneal route for instilling a drug, local anaesthetic or opioid is that the exposure of peritoneum to visceral nociceptive conduction provides additional mechanism of analgesia. Aim: To compare the effectiveness of intraperitoneal bupivacaine and nalbuphine for postoperative pain relief after laparoscopic cholecystectomy. Materials and Methods: The present study was a randomised clinical study in which 80 patients underwent laparoscopic cholecystectomy, received either bupivacaine or nalbuphine intraperitoneally. Each patient was monitored postoperatively, as per the institution protocol. Severity of pain was assessed using the Visual Analog Scale (VAS) at rest and at movement Immediately After Recovery (IAR), after one hour and every four hours thereafter. The time to first rescue analgesic was compared. The data analysis was carried out with unpaired Student’s t-test and Chi-square test using software Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: The study included 35 males and 45 females, with a mean age of 42.8±7.1 years. Both groups were well-matched demographically. There was no significant difference in the Heart Rate (HR) or Mean Arterial Pressure (MAP) between the groups postoperatively. However, VAS score was significantly lower in nalbuphine group at one hour (2.52±0.640) as compared to bupivacaine group (2.88±0.791, p=0.028), but on movement at 16 hours it was lower in bupivacaine group (1.43±0.501), as compared to Nalbuphine group (1.67±0.474, p=0.030). The mean time of first rescue analgesic in nalbuphine group was 20.25±7.983 minutes, while in bupivacaine group it was 26.9±6.95 minutes (p-value-0.0002). Postoperative Nausea and Vomiting (PONV) was significantly higher with nalbuphine (35% vs 12.5%). No other significant complication was noted in either group. Conclusion: Intraperitoneal instillation of nalbuphine is an effective and safe way to reduce postoperative pain in patients undergoing laparoscopic cholecystectomy
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