Effect of tracheostomy on pulmonary mechanics: an observational study

This study was undertaken to find out the effect of early tracheostomy on weaning from mechanical ventilation. Pulmonary mechanics and arterial blood gases were assessed before and after tracheostomy in patients with severe head injury [Glasgow coma score < 8] requiring prolonged mechanical ventilation. Patients and Methods: The study included 20 mechanically ventilated patients of either sex between 20 and 45 years of age, who had suffered brain injury due to head trauma during admission [Glasgow coma scores < 8]. Mean airway pressure, peak airway pressure, plateau pressure, PaO2, and PaCo2 were measured 24 h before and after tracheostomy. Static and dynamic compliances were calculated. Plateau airway pressures were not affected by tracheostomy, but peak airway pressure was reduced [29.90 +/- 3.21 cmH2O before tracheostomy versus 24.30 +/- 1.83 cm H2O after tracheostomy, P < 0.001].Dynamic compliance, but not static compliance, was improved by tracheostomy. Tracheostomy did not affect PaCo2, but it improved PaO2 [83.09 =/- 5.99 mmHg before versus 90.84 =/- 5.61 mmHg after, P

Ultrasound-guided central venous catheterization in prone position

Central venous catheterization [CVC] is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placeman of CVC in right internal jugular vein [IJV], which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without compilations'. Ultrasound-guided CVC placement ca be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique

Endotracheal tube defects: Hidden causes of airway obstruction

Manufacturing defects of endotracheal tube [ETT] are still encountered in anesthesia practice. Many such defects go unnoticed during routine inspection prior to their use. Such defects in ETT may lead to partial or complete airway obstruction in an intubated patient. We report a case of partial airway obstruction with a prepacked, single use, uncuffed ETT due to a manufacturing defect in the form of a plastic meniscus at the distal end of the tube. This case report highlights the significance of standard monitoring of ventilation and the role of a vigilant clinician in detecting such defects in avoiding critical events as can arise from the use of such defective ETTs. It also emphasizes the need for double checking ETTs prior to their use

Ventricular tachycardia during microdebrider-assisted turbinectomy: an electrocardiographic artifact

Interference of monitored electrocardiogram is common during different surgical procedures using electrical equipment. The electrical devices used induce artifacts in the electrocardiographic tracing, which may resemble serious arrhythmia. We describe a case of electrocardiographic artifact resembling ventricular tachycardia with the use of a Storz unidrive microdebrider during inferior turbinectomy under general anesthesia. This case report highlights the importance of knowledge of various equipment-related electrocardiographic artifacts in avoiding unnecessary and harmful therapeutic interventions

Is nitrous oxide necessary for general anaesthesia?

Nitrous oxide [N[2]O] has been used for about 150 years in clinical anaesthesia. Several recent reviews of the effect of nitrous oxide have concluded that there are certain contraindications to the use of this gas for general anaesthesia and its ecological effects, ozone depleting potential, immune depression and the proven factor of PONV have questioned the routine use of nitrous oxide in patients undergoing surgical procedures in general anaesthesia. This study comprised of 200 adult patients undergoing general anaesthesia with 40% O[2] and Sevoflurane with and without N[2]O. All patients had standard anaesthetic care and monitoring with BIS monitoring in 120 patients. The effect of avoiding N[2]O was observed on anaesthetic perioperative management and haemodynamics, PONV and pain in PACU. Demographic and perioperative characteristics were similar to both groups. Nitrous oxide free group needed only 0.233% [mean] more Sevoflurane. There was a marked reduction in incidence of PONV [11% to5%] in N[2]O free group. Duration of surgery [97.72 +/- 52.393 in N[2]O group, 103.75 +/- 48.671 in N[2]O free group] and induction dose of propofol [155.30 +/- 38.572 in N[2]O group and 158.50 +/- 36.164 in N[2]O free group] did not differ significantly in the two groups. The omitting of N[2]O from anaesthetic regimen has a substantial impact on patient comfort after surgery by reducing incidence of PONV and it does not have any justifiable indication of its use in General anaesthesia