Intra-operative suggestions reduce incidence of post hysterectomy emesis

The influence of therapeutic intraoperative auditory suggestions on the incidence and severity of emetic episodes was investigated in 50 adults ASA I and II patients undergoing elective abdominal hysterectomy. The patients were randomly divided into two groups, each consisting of 25 patients. In group I, a blank tape was played and in group II, positive suggestion was played via headphones throughout the anaesthetic period. It was observed that there was statistically significant difference [P < 0.05] between the incidence of vomiting in group I [60%] and group II [36%]. The number of vomiting episodes per patient in group I was 3.1 +/- 1.2 as compared to 1.7 +/- 0.6 in group II. This difference was statistically significant. The patients requiring rescue antiemetic was significantly higher [P < 0.05] in group I [66.6%] as compared to group II [22.2%]. It is concluded that positive therapeutic suggestion may be considered as an alternative to antiemetic therapy

Modified laryngeal mask airway

Modified Laryngeal Mask [MLMA] aided fiberoptic intubation [FOI] using larger than 6mm ID endotracheal tube was studied in 25 adult patients and compared to unaided FOI in another 25 patients. MLMA aided FOI was successful in 96% cases compared to 56% in the unaided group. Furthermore, the time to successful intubation was increased by 67.1% when FOI was attempted without MLMA aid which was statistically significant [P < 0.001]. However, maximum fluctuations in the heart rate and mean arterial pressure in the immediate post-intubation period were statistically insignificant between the groups. We conclude that MLMA not only adds to success rate of FOI but also significantly reduces the FOI time in adult patients

CPAP with air and oxygen to non-ventilated lung improves oxygenation during one lung anesthesia

Ten adult patients undergoing one lung ventilation for elective thoracotomy were selected. All these patients failed to maintain oxygen saturation [SaO[2]] > 90% despite administration of 100% oxygen to the non-ventilated lung [NVL]. These patients were studied for the efficacy of continuous positive airway pressure [CPAP] of the NVL using air and oxygen combination [FiO20.5] employing a variable FiO2CPAP system. It was observed that application of CPAP [5-10 cm H2O] with a mixture of air and oxygen to the NVL increased the SaO2 > 90% in all these patients. This could be attributed to nitrogen in air which prevented absorption atelectasis in the NVL. This produced a better ventilation/perfusion ratio and hence the increased oxygen saturation

Clonidine premedication: a useful adjunct in producing induced hypotension with total intravenous anesthesia for middle ear microsurgery

Thirty adult patients were studied to evaluate the role of oral clonidine premedication on the dose requirement of intraoperative labetalol to produce induced hypotension during total intravenous anaesthesia [propofol I fentanyl] for middle ear microsurgery. Also studied was surgeon's satisfaction and quality of recovery. Patients with oral clonidine [4 micro g/kg] premedication [Group-II, n-15] demonstrated insignificant [p>0.05] pressor response to laryngoscopy intubation. Group II patients needed a mean of only 4.2 mg labetalol to keep the intraoperative mean arterial pressure between 60-75 mmHg as compared to 25.0 mg required in the unpremedicated group [Group I, n-15]. Surgeon's satisfaction with the operative field was similar in both the groups. However recovery time was significantly prolonged in patients receiving oral clonidine premedication

Post-anaesthetic pulmonary oedema following upper airway obstruction

Twelve cases of post-anaesthetic pulmonary oedema [PO] secondary to upper airway obstruction [UAO] are reported. All were adult male patients undergoing uneventful elective surgical procedure under general anaesthesia. Post-anaesthetic laryngospasm was the single most important factor for the upper airway obstruction [UAO] in 5 [41.6%] patients. PO secondary to partial UAO in drowsy patients was observed in the 4 [33.3%] patients. UAO due to foreign body was responsible for PO in two patients. A combination of negative intrathoracic pressure, hypoxia and associated hyperadrenergic state were the most likely causes of PO in these patients with UAO. Early recognition, maintenance of patent airway and adequate oxygenation via face mask or endotracheal tube with mechanical ventilation resolved the syndrome within 6-36 hours in all of these patients. Invasive haemodynamic monitoring or aggressive drug therapy were not applied in any of the patients. A heightened awareness among anaesthesiologists of the varied causes of post-anaesthetic UAO leading to PO may help reduce the occurrence and facilitate early management of the potential complications