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Access statistics : Table of Contents
2017| June | Volume 61 | Issue 6
Online since
June 12, 2017
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ORIGINAL ARTICLES
Comparative evaluation of Ambu AuraGain™ with ProSeal™ laryngeal mask airway in patients undergoing laparoscopic cholecystectomy
Kriti Singh, Pavan Gurha
June 2017, 61(6):469-474
DOI
:10.4103/ija.IJA_163_17
PMID
:28655951
Background and Aims:
Second generation supraglottic airways are increasingly being used in surgical patients undergoing laparoscopic surgery. Preventing aspiration at higher airway pressures may be at the expense of a higher cuff pressure which can impair mucosal perfusion. We attempted to elucidate whether Ambu AuraGain™ (AAU) would provide a higher oropharyngeal leak pressure (OLP) with a lower mucosal pressure in comparison to ProSeal™ laryngeal mask airway (PLMA).
Methods:
This was a prospective randomised study involving sixty patients undergoing laparoscopic cholecystectomy under general anaesthesia, using either AAU (Group AAU [
n
= 30]) or PLMA (Group PLMA [
n
= 30]) for elective ventilation. Primary outcome measure was the OLP. Number of insertion attempts, ease of insertion, time required for placement and calculated pharyngeal mucosal pressure were the secondary outcome measures. Data were analysed using Student's
t
-test and Chi-square test.
Results:
No significant difference in the OLP was noted in both groups. The ease of insertion and success rate at first attempt was similar between the groups. Time taken for insertion in Group AAU was longer than Group PLMA (13.57 ± 1.94 vs. 11.60 ± 2.22 s). The calculated pharyngeal mucosal pressures were lower with Group AAU than Group PLMA for all 3 sizes. The minimum cuff pressure and minimum cuff volume required to prevent leak were found similar in both groups.
Conclusion:
AAU provides adequate sealing pressures and effective ventilation with lower calculated pharyngeal mucosal pressure, compared to PLMA.
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REVIEW ARTICLE
Peri-operative blood management
Alex Eeles, Ravishankar Rao Baikady
June 2017, 61(6):456-462
DOI
:10.4103/ija.IJA_341_17
PMID
:28655949
Anaemia and allogeneic blood transfusions in surgical patients are associated with poor outcomes. Patient blood management (PBM) has been developed as an evidence-based clinical tool, by which clinicians can optimise anaemia, manage peri-operative bleeding, avoid unnecessary blood transfusion and improve patient outcome. This article aims to highlight the recent updates regarding evidence-based PBM in the perioperative period, following a thorough literature review involving original research articles, published guidelines and consensus documents discovered through an extensive PubMed and Medline search. PBM addresses three main pillars of the patient's journey through the pre-operative, intra-operative and post-operative periods. PBM encourages a restrictive approach to transfusion of blood products and promotes alternatives to blood transfusion to maximise clinical efficacy while minimising risks. Anaemia has been identified as an independent risk factor for poor outcomes. PBM highlights the importance of treating anaemia in the pre-operative period. Major elective surgery may be postponed until anaemia is corrected preoperatively. The intra-operative approach to PBM is a collaborative effort between the anaesthesia, surgery and transfusion laboratory teams. Use of tranexamic acid, meticulous haemostasis and cell salvage techniques play an important role during the intra-operative management of surgical and traumatic haemorrhage. Point-of-care coagulation tests with visco-elastographic methods and haemoglobin measurement ensure that the transfusion prescription is tailored to a patient. In the post-operative period, PBM highlights the need for patients to be optimised before discharge from the hospital. Implementation of the PBM has been shown to have individual health as well as economic benefits.
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ORIGINAL ARTICLES
Comparison of ultrasound and anatomical landmark-guided technique for superior laryngeal nerve block to aid awake fibre-optic intubation: A prospective randomised clinical study
Uday S Ambi, BK Arjun, Shilpa Masur, Archana Endigeri, Vinod Hosalli, SY Hulakund
June 2017, 61(6):463-468
DOI
:10.4103/ija.IJA_74_17
PMID
:28655950
Background and Aims:
Ultrasonography has emerged as a novel, portable, non-invasive tool encouraging airway assessment and procedural interventions. This study assesses the feasibility of ultrasound for block of internal branch of superior laryngeal nerve (ibSLN) block during upper airway anaesthesia to aid awake fibre-optic intubation.
Methods:
Forty American Society of Anesthesiologists' physical status I–II patients, aged 18–60 years, deemed to have a difficult airway (modified Mallampati class III–IV or inter-incisor distance <2.5 cm) and planned for awake fibre-optic intubation were randomised to either landmark group (L,
n
= 20) or ultrasound group (U,
n
= 20). All patients received nebulised 4% lignocaine (3 mL) and transtracheal injection 3 mL 2% lignocaine. Group L received landmark-guided bilateral ibSLN block with 1 mL 2% lignocaine. Group U received bilateral ibSLN block with 1 mL 2% lignocaine using a high-frequency ultrasound transducer to define the SLN space. The primary objective was assessment of quality of airway anaesthesia. Secondary objectives were time for intubation, haemodynamic parameters and patient perception of discomfort during procedure.
Results:
The quality of anaesthesia was significantly better in Group U than in Group L (
P
< 0.001). The mean time for intubation was shorter in Group U (71.05 ± 9.57 s) compared to Group L (109.05 ± 30.09 s,
P
< 0.001). Heart rate, mean arterial pressure and patient perception of discomfort were significantly increased in Group L.
Conclusion:
Ultrasound for ibSLN block as a part of preparation for awake fibre-optic intubation improves quality of airway anaesthesia and patient tolerance.
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Post-operative analgesic effect of dexmedetomidine administration in wound infiltration for abdominal hysterectomy: A randomised control study
Swati Singh, Chandrakant Prasad
June 2017, 61(6):494-498
DOI
:10.4103/ija.IJA_676_16
PMID
:28655956
Background and Aims:
Local infiltration of the surgical wound is one of the important components of multimodal analgesia for post-operative pain relief. This study determines the post-operative analgesic effect of addition of dexmedetomidine to bupivacaine for local infiltration of the surgical wound.
Methods:
Sixty women belonging to American Society of Anesthesiologists' Grade 1 or 2 posted for abdominal hysterectomy were randomly allocated to Group I (control group) where patients received wound infiltration with 30 mL 0.25% bupivacaine at the end of surgery, or Group II, where patients received wound infiltration with 1.0 μg/kg dexmedetomidine diluted in 30 mL 0.25% bupivacaine. The primary objective of the study was to assess post-operative pain scores. Number of patients requiring rescue analgesia and total morphine consumption during 24 h after surgery were also recorded. Statistical significance for analgesic requirement was determined by one-way analysis of variance.
Results:
Pain scores were lower at rest for 12 h and on cough for 6 h in Group II (<0.01). All patients in Group I required supplemental morphine compared to only 3 patients in Group II (
P
< 0.003). Post-operative analgesia requirement was significantly less in patients receiving dexmedetomidine in wound infiltration compared to patients receiving bupivacaine alone (
P
< 0.001).
Conclusions:
Wound infiltration of dexmedetomidine with bupivacaine provides superior pain relief compared to bupivacaine alone.
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A novel technique for insertion of ProSeal™ laryngeal mask airway: Comparison of the stylet tool with the introducer tool in a prospective, randomised study
Sheila Nainan Myatra, Vijaykumar Khandale, Friedrich Pühringer, Sushan Gupta, Sohan Lal Solanki, Jigeeshu V Divatia
June 2017, 61(6):475-481
DOI
:10.4103/ija.IJA_55_17
PMID
:28655952
Background and Aims:
The ProSeal™ laryngeal mask airway (PLMA) has a soft cuff which tends to fold on itself during insertion, resulting in reduced first-attempt success rate. We compared the standard introducer technique of PLMA insertion with a novel method to prevent folding of the cuff using a Rüsch™ Stylet
Methods:
This randomised superiority trial included 120 American Society of Anesthesiologists I–II patients between 18 and 80 years, undergoing elective surgeries under general anaesthesia using a PLMA for airway management.The PLMA was inserted using the standard introducer tool in sixty patients (Group IT), while in sixty other patients, a Rüsch™ Stylet was inserted through the drain tube up to its tip. (Group ST). The primary outcome was first-attempt success rate. Secondary outcomes included overall insertion success, number of attempts, total time to successful insertion, presence of air leaks, haemodynamic response to insertion and quality of fit assessed using Brimacombe's fibre-optic scoring. Continuous variables were compared using independent
t
-test or Mann–Whitney U-test and categorical variables were analysed using Chi-square test or Fisher's exact test.
Results:
First-attempt success rate of insertion was higher in Group ST compared to Group IT (95% vs. 82%,
P
= 0.04). Favourable grade of placement was better in Group ST (86.7% vs. 52.5%,
P
< 0.001). Overall insertion success rates and haemodynamic responses were comparable between the groups.
Conclusions:
PLMA insertion using the stylet tool has a higher first-attempt insertion success and superior placement compared to insertion using the conventional introducer tool.
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Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries: A prospective, randomised, double-blinded clinical study
Savita Gupta, Rashmi Sharma
June 2017, 61(6):499-504
DOI
:10.4103/ija.IJA_712_16
PMID
:28655957
Background and Aims:
Caudal epidural analgesia is commonly practised regional block technique in children undergoing infraumbilical surgeries but has a short duration of action after single shot local anaesthetic injection. The aim of this study was to compare ropivacaine 0.25% with dexmedetomidine and tramadol in caudal anaesthesia in paediatric infraumbilical surgeries.
Methods:
In a randomised, prospective, double-blinded study, sixty children (1–8 years) belonging to American Society of Anesthesiologists' physical status I or II scheduled for infraumbilical surgeries were included. They were randomly assigned into two groups: Group ropivacaine with tramadol (RT) (
n
= 30) received 0.25% ropivacaine 1 mL/kg with 2 mg/kg of tramadol, and Group ropivacaine with dexmedetomidine (RD) (
n
= 30) received 0.25% ropivacaine 1 mL/kg with dexmedetomidine 2 μg/kg. The primary outcome variable was the duration of analgesia, and the secondary outcome variables included motor block, sedation score, time from caudal block to skin incision, emergence time and adverse effects.
Results:
The mean duration of analgesia was 654.20 ± 78.38 min in Group RT, while in Group RD, it was 780.29 ± 71.21 min (
P
= 0.0001). The difference between the mean sedation score and mean emergence time between the two groups were statistically significant (
P
= 0.0001 and 0.0411, respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects.
Conclusion:
Caudal dexmedetomidine with ropivacaine prolongs post-operative analgesia compared to caudal tramadol with ropivacaine.
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3,471
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End-tidal capnography and upper airway ultrasonography in the rapid confirmation of endotracheal tube placement in patients requiring intubation for general anaesthesia
Chintamani Abhishek, Kartik Munta, S Manimala Rao, CN Chandrasekhar
June 2017, 61(6):486-489
DOI
:10.4103/ija.IJA_544_16
PMID
:28655954
Background and Aims:
Confirmation of correct endotracheal tube placement is essential immediately after intubation for general anaesthesia. In this study, we have compared upper airway ultrasonography (USG) with reference to capnography for rapid confirmation of endotracheal tube placement after general anaesthesia.
Methods:
A prospective, single centre, observational study was conducted on 100 patients requiring tracheal intubation for general anaesthesia. Both capnography and upper airway USG were performed immediately after intubation to confirm the endotracheal tube (ETT) placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. Agreement between the methods and time required to determine ETT placement by the two methods were assessed with kappa statistics and Student's
t
-test.
Results:
Upper airway USG detected all five cases of oesophageal intubation, but could not detect five patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.84% (95% confidence interval [CI]: 94.25%–96.84%), specificity of 100% (95% CI: 50.6%–100%), positive predictive value of 100% (95% CI: 97.3%–100%) and negative predictive value of 62.5% (95% CI: 31.6%–62.5%). Kappa value was found to be 0.76, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 8.989 ± 1.043 s vs. 12.0 ± 1.318 s for upper airway USG (
P
< 0.001).
Conclusion:
Both capnography and upper airway USG may be used as primary procedures for the confirmation of ETT placement.
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EDITORIAL
Concealing research outcomes: Missing data, negative results and missed publications
S Bala Bhaskar
June 2017, 61(6):453-455
DOI
:10.4103/ija.IJA_361_17
PMID
:28655948
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ORIGINAL ARTICLES
Effect of nitrous oxide on bispectral index values at equi-minimum alveolar concentrations of sevoflurane and desflurane
Rajeeb Kumar Mishra, Charu Mahajan, Hemanshu Prabhakar, Indu Kapoor, Parmod Kumar Bithal
June 2017, 61(6):482-485
DOI
:10.4103/ija.IJA_363_16
PMID
:28655953
Background and Aims:
Bispectral index (BIS) values may be anaesthetic agent-specific, depending on their ability to suppress the electroencephalogram (EEG) signals. We carried out a prospective, randomised clinical trial to study the effect of nitrous oxide (N
2
O) on the BIS values at an equi-minimum alveolar concentration (MAC) of sevoflurane and desflurane.
Methods:
Sixty adult patients undergoing spine surgery were randomised into two groups; Group S (sevoflurane;
n
= 30) and Group D (desflurane;
n
= 30) for the maintenance of anaesthesia in oxygen and air or oxygen and N
2
O mixture (FiO
2
-0.4) (Stage 1). BIS and fraction of inspired and end-tidal concentration of agents were noted at 1.0 MAC. In Stage 2, air or N
2
O was discontinued and the other carrier gas was introduced. At steady state of this carrier gas, values were again noted as in Stage 1. Statistical analysis was performed using two-way analysis of variance followed by Bonferroni correction, and Student's
t
-test for paired data.
P
<0.05 was considered statistically significant.
Results:
With air-oxygen as the carrier gas, sevoflurane and desflurane resulted in comparable BIS values (
P
= 0.44). With addition of 60% N
2
O, there was a significant increase in BIS values at 1.0 MAC for both the agents. Furthermore, higher BIS values were observed with sevoflurane compared to desflurane (
P
= 0.01).
Conclusion:
Sevoflurane and desflurane at equi-MAC concentration exert similar effect on BIS values when used with air-oxygen. N
2
O results in higher BIS values; this effect is more pronounced in combination with sevoflurane.
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CASE REPORTS
Management of predicted difficult airway with conventional techniques in an infant with rhabdomyosarcoma of the upper lip
Kavya R Upadhya, Chandrika Y Ramavakoda, Madhavi Ravindra, Anuradha Ganigara
June 2017, 61(6):508-510
DOI
:10.4103/ija.IJA_64_17
PMID
:28655959
In paediatric patients, airway management can be challenging due to unique anatomical and physiological variations. Hence, a thorough history, examination and pre-operative planning are essential in securing difficult airway in paediatrics. We report a case of a 7-month-old infant with rhabdomyosarcoma of the upper lip with anticipated difficult airway. The airway was managed with three different conventional techniques (modified nasal trumpet, supraglottic airway and direct laryngoscopy) for three different procedures in the same infant. The procedures were uneventful and recovery was good. This case report emphasises the use of conventional techniques in the management of difficult airway.
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2,147
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BRIEF COMMUNICATIONS
Airway ultrasound to detect endotracheal tube cuff herniation
Debendra Kumar Tripathy, R Ravindra Bhat, Sangeeta Dhanger
June 2017, 61(6):511-512
DOI
:10.4103/ija.IJA_15_17
PMID
:28655960
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2,021
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CASE REPORTS
Spontaneous arterial catheter fracture and embolisation: Unpredicted complication
Suresh Babu Kale, Senthilkumar Ramalingam
June 2017, 61(6):505-507
DOI
:10.4103/ija.IJA_181_17
PMID
:28655958
Arterial cannulation is a common procedure in the care and management of critically ill patients. Blood pressure measurement, arterial blood sampling and cardiac output determinations are a few primary reasons for arterial cannulation. This invasive catheter placement also imposes certain risks and clinical management problems like bleeding, thrombosis and hematoma formation. Fracture and embolisation of arterial catheters placed in the femoral region is a rare and serious complication that may result in arterial occlusion and thrombosis. Percutaneous retrieval of the foreign body is frequently reported to be the technique of choice, leaving the surgical option to a small group. We report two consecutive cases of catheter fracture that was successfully retrieved by a combination of surgery and balloon tip retrieval device.
[ABSTRACT]
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2,023
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ORIGINAL ARTICLES
Comparison of efficacy and cost-effectiveness of 0.55% ortho-phthalaldehyde and 2% glutaraldehyde for disinfection of laryngoscopes: A prospective pilot study
Priyanka Pradeep Karnik, Nandini Malay Dave, Gita Nataraj, Rajarshi Gupta, Madhu Garasia
June 2017, 61(6):490-493
DOI
:10.4103/ija.IJA_22_17
PMID
:28655955
Background and Aims:
The laryngoscope is a potential source of cross-infection as it involves contact with the mucous membrane, saliva and occasionally blood. This study compared efficacy and cost-effectiveness of two Centre for Disease Control approved agents for disinfection of laryngoscope blades.
Methods:
One hundred and sixty patients requiring laryngoscopy and intubation for general anaesthesia were randomly allocated into two groups. After tracheal intubation, used laryngoscope blades were cleaned with tap water. The blades were then immersed in either 2% w/v glutaraldehyde for a contact time of 20 min or 0.55% w/v ortho-phthalaldehyde (OPA) for 10 min. The handles were wiped with 0.5% w/v chlorhexidine wipes. Samples were collected using sterile cotton swabs from the tip, flange and light bulb area of the laryngoscope blade and one from the handle. They were cultured aerobically on blood and McConkey agar.
Results:
In 2% glutaraldehyde group, of 240 samples sent from the blades, 2 (0.8%) showed the growth of methicillin-resistant coagulase-negative staphylococci (MRCONS) and
Enterobacter
. In OPA group, of 240 samples, 2 (0.8%) showed growth of MRCONS. Thus, 2% glutaraldehyde and 0.55% OPA were comparable in terms of efficacy of disinfection. Growth was seen on 4 out of 160 handles.
Conclusions:
We suggest OPA for high-level disinfection of laryngoscope blades as it is equally efficacious as compared to glutaraldehyde, with a shorter contact time and available as a ready to use formulation.
[ABSTRACT]
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1,992
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LETTERS TO EDITOR
A novel approach to the anaesthetic management of a case of osteogenesis imperfecta
Jasveer Singh, Preeti Sharma, Sukanya Mitra
June 2017, 61(6):517-519
DOI
:10.4103/ija.IJA_77_17
PMID
:28655963
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1,864
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BRIEF COMMUNICATIONS
Use of Merocel
®
aids in prevention of nasal pressure ulcers following nasal intubation: Case series of 33 patients
Rahil Singh, Nishant Sood, Sukhyanti Kerai, Arun Puri
June 2017, 61(6):513-515
DOI
:10.4103/ija.IJA_26_17
PMID
:28655961
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1,732
244
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LETTERS TO EDITOR
Anaesthetic consideration for robotic nipple sparing mastectomy
Amit Kumar Mittal, Mamta Dubey, Manisha Arora, Sangeeta Bhagat, Ajay Kumar Bhargava
June 2017, 61(6):519-521
DOI
:10.4103/ija.IJA_130_17
PMID
:28655964
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1,756
197
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RESPONSE TO COMMENTS
Euglycemic diabetic ketoacidosis by sodium glucose co-transporter inhibitors: Real but preventable concern
Monish S Raut, Arun Maheshwari
June 2017, 61(6):524-524
DOI
:10.4103/ija.IJA_359_17
PMID
:28655966
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1,464
167
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LETTERS TO EDITOR
The file drawer effect: A call for meticulous methodology and tolerance for non-significant results
Priscilla Joys Nagarajan, Bharath Kumar Garla, M Taranath, I Nagarajan
June 2017, 61(6):516-517
DOI
:10.4103/ija.IJA_280_17
PMID
:28655962
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1,421
144
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COMMENTS ON PUBLISHED ARTICLE
Fluid resuscitation, laryngeal oedema and severe dengue
Viroj Wiwanitkit
June 2017, 61(6):525-525
DOI
:10.4103/ija.IJA_345_17
PMID
:28655967
[FULL TEXT]
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1,340
201
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Sodium glucose co-transporter-2 inhibitor: Patient safety and clinical importance
Subramanian Senthilkumaran, Sambathkumar Sasikumar, Florence Benita, Ponniah Thirumalaikolundusubramanian
June 2017, 61(6):522-523
DOI
:10.4103/ija.IJA_338_17
PMID
:28655965
[FULL TEXT]
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1,293
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RESPONSE TO COMMENTS
Can fluid resuscitation be a risk factor for laryngeal oedema in severe dengue?
Sai Saran, Afzal Azim
June 2017, 61(6):526-526
DOI
:10.4103/ija.IJA_350_17
PMID
:28655968
[FULL TEXT]
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1,243
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LIGHTER PLANES
Lighter Planes
June 2017, 61(6):527-527
Full text not available
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1,122
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