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Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer.A study to compare these two methods, using the manometer as the reference standard, was then carried out. The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff.Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.

Background:The use of nitrous oxide and carboperitoneum in laparoscopic cholecystectomy lead to increase in endotracheal tube cuff pressure. It may impair tracheal mucosal perfusion with subsequent tracheal damage. The purpose of this study was to evaluate cuff pressure and incidence of post-operative sore throat in patients undergoing laparoscopic cholecystectomy. Methods:In this prospective observational study, 128 patients aged 18-65 years of American Society of Anesthesiologist physical status I and II undergoing laparoscopic cholecystectomy were enrolled and allocated alternately into two groups, Study Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/nitrous oxide mixture; 40/60), Control Group (Maintenance of anesthesia with sevoflurane 1-2%, oxygen/air mixture; 40/60) were analysed and comapared. Each group contained 64 patients. Aneroid manometer was used to monitor cuff pressure. Volume of air used to inflate the cuff, baseline cuff pressure, comparison of intraoperative cuff pressure and incidence of postoperative sore throat were measured. Results:The study results demonstrated higher cuff pressure in study group at all times after the creation of carboperitoneum (p=0.00) with increased incidence of sore throat(p=0.004). Conclusions:Increase in endotracheal tube cuff pressure was noted with the use of nitrous oxide in laparoscopic cholecystectomy with subsequent post-operative airway complication. Monitoring of cuff pressure is simple, noninvasive and efficient way of achieving therapeutic cuff pressure of 20-30 cm of H2O and thus recommends its use.

Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced more increase in blood sugar level compared to base line value which was statistically significant (P<0.05). Similarly, Glycaemia was significantly higher in the General anesthesia group (p < 0.05) when compared with Spinal Anesthesia group suggesting poor control of stress response during general anesthesia.Conclusion: Based on capillary blood glucose level, spinal anesthesia proved more effective in suppressing stress response as compared to general anesthesia in elective surgical patients. BJHS 2018;3(2)6: 458-462

A 55-year-old white male was found to have the Zollinger-Ellison syndrome in 1971. Supposed total gastrectomy was performed at that time. When an esophageal ulcer was found, six years later, esophagoscopic biopsy revealed residual gastric mucosa. The patient was given cimetidine 300 mg qid because it was felt he could not tolerate further surgery. After eight months of cimetidine therapy, the patient was admitted to the hospital because of retrosternal pain. Pneumopericardium was discovered, and at autopsy a large penetrating gastrojejunal ulcer was demonstrated.

SM Sharma, ZZ Ali, A Case of Intraoperative Blood Salvage and Retransfusion. 2003; 23(5): 294-295 Retransfusion of autologous blood collected fron body cavities may be a life-saving measure when compatible homologous blood is not available. It may also prove to be a blessing in disguise because it eliminates the possibility of transfusion hazards such as iso-immunization, mismatch, and transmission of diseases. Spread of HIV and AIDS through the use of whole blood and blood products lends further support to the use of autohemotransfusion. 1,9,10 Use of blood collected from the peritoneal cavity in patients suffering from a ruptured ectopic gestation or splenic rupture has been a fairly common practice in the past.2 Despite being the most readily available source of compatible blood this method has not gained wide clinical importance because of cumbersome technique and lack of adequate knowledge about changes occurring in the blood shed into body cavities before and during the procedure of collection and retransfusion.3 Use of blood obtained by intraoperative salvage may be complicated by hemolysis, disseminated intravascular coagulation, sepsis and air embolism. 4 Various techniques have been employed for collection, filtration and transfusion of salvaged blood.7 A successful case of retransfusion of salvaged blood using a simple technique is reported. Case ReportA 25-year-old female was admitted with complaints of hypogastric pain and vomiting of 4 days' duration. She was not constipated, but had a low-grade fever (37.6°C). On admission she had a haemoglobin of 10 g/dL with a haematocrit of 30%. She had mild tachycardia (heart rate 110/min) with an arterial pressure of 98/70 mm Hg. Next morning (about 20 hours later) she was found to be grossly anaemic with the haemoglobin level having dropped to 5.0 g/dL. A peritoneal tap was haemorrhagic. No compatible blood was available in the hospital as the patient was found to belong to the B Rh-negative blood group.In view of intra-abdominal bleeding an emergency laparotomy was performed. Before incising the peritoneum arrangements had been made to collect the blood in the peritoneal cavity into sterile bottles containing acid-citratedextrose solution through a sterile 1.8 meter long rubber tube of 5 mm internal diameter. Approximately 2 litres of blood could be collected in about 7 minutes using a high vacuum suction apparatus. This blood was sieved aseptically through two layers of sterile gauze moistened with isotonic saline (0.89% NaCl solution) into four 500 mL capacity autoclaved glass bottles. On opening the abdomen a ruptured ectopic gestation was found. It was managed by the gynaecologist.Anaesthetic management consisted of inducing anaesthesia with diazepam (5 mg) and ketamine (75 mg), endotracheal intubation facilitated by use of suxamethonium (50 mg). Anaesthesia was maintained using pancuronium (6 mg), morphine (6mg), nitrous oxide and oxygen (50:50). Intra-operatively, crystalloids (1.5 L) including 1000 mL of lactated Ringer's solution, and 500 mL of i...

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.