Comparison of surgical field quality and emergence time during endoscopic sinus surgery using propofol or desflurane: a randomized clinical trial

Objectives: Hypotensive anesthesia is necessary during endoscopic sinus surgery to achieve a bloodless surgical field. The aim of this study was to compare the quality of surgical field using propofol or desflurane anesthesia

Methodology: 40 patients of either sex, belonging to ASA physical status I and II, and age group of 18 - 60 years were randomized into two groups to receive either propofol and morphine or desflurane and morphine anesthesia. The target mean arterial pressure [MAP] was kept in a range of 65-75 mmHg. The quality of surgical field was assessed by using a validated scoring system [Fromme category scale] at every 15 min by the same surgeon in all the cases to avoid surgeon's bias

Results: The mean category scale value was 2.665 +/- 0.243 in propofol group and 2.200 +/- 0.410 in desflurane group [p=0.000]. The time to emergence was significantly less in desflurane group [9.35 +/- 1.27] as compared to propofol group [14.60 +/- 2.06 min]

Conclusion: We conclude that both the propofol and desflurane can be used to achieve a satisfactory surgical field quality but desflurane provides a rapid emergence as compared to propofol

Perioperative management of Conn's syndrome - a case report

Conn's syndrome, also known as primary hyperaldosteronism, is a disease of the adrenal glands characterized by autonomous and excessive aldosterone production, leading to sodium retention and a fall in serum potassium. It may be associated with long standing hypertension, and cardiac and neurological complications. A 51 year old, hypertensive, male patient presented with generalised muscle weakness and hypokalemia. The patient was diagnosed to have benign adrenal adenoma with Conn's syndrome and was scheduled for laparoscopic adrenalectomy. We used epidural analgesia followed by induction of general anesthesia. Intraoperative course was uneventful except for one episode of hypotension.Unilateral or bilateral adrenalectomy may be performed to treat Conn's syndrome depending on the pathology. Replacement corticosteroid and mineralocorticoid therapy is required for all patients undergoing bilateral adrenalectomy and occasionally in those undergoing unilateral adrenalectomy. Following surgery, the cure rate for hyperaldosteronism may be as high as 60-77%, though it may take a year or more for hypertension to resolve

comparative evaluation of midazolam, clonidine and dexmedetomidine as oral premedicants in children: a double blind randomized clinical trial

To evaluate and compare the efficacy of orally administered midazolam, clonidine and dexmedetomidine with regard to preoperative sedation, effect on parental separation, acceptance of face mask and recovery profile in children. This was a prospective, randomized, double blind clinical trial, conducted in a tertiary care hospital, in which 80 children in the age group of 1-4 years were included. The study population was divided into three groups and each group was premedicated with one of the three oral premedicants. Patients in Group-M received 0.5 microg/kg of oral midazolam 30 min before the surgery, Group-C received 4 microg/kg of oral clonidine 90 min before the surgery and Group-D received 4 microg/kg of oral dexmedetomidine 60 min before the surgery mixed in honey. In the waiting area sedation score, parental separation score, mask acceptance at induction were measured on 4 point scales. In the PACU, children were monitored for NIBP, EGG, SpO2 and Steward Recovery Score every 15 min for 2 hours. Nausea, vomiting, shivering or other complications if any and time taken to achieve Steward Score of 6 was noted. The statistical analysis was carried out using Statistical Package for Social Sciences [SPSS Inc., Chicago, IL, version 15.0 for Windows]. All the three groups had comparable sedation. Parental separation was easy for children in Group-M [96.6%] and Group-D [93.6%] while it was significantly low in Group-C [63-5%][p=0.001]. Significantly higher number [96.6%] of children in Group-M showed satisfactory mask acceptance in comparison to Group-C [45.8%] and Group-D [25.9%][p<0.001]. Recovery from anaesthesia was significantly faster in Group-M when compared with Group-C and Group-D [p<0.001]. Despite effective preoperative sedation [>90%] with the two alpha-2-agonists, clonidine and dexmedetomidine, parental separation and mask induction was not satisfactory as compared to midazolam

comparison of McCoy, TruView, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine

Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and TruView laryngoscopes in patients with immobilized cervical spine. 60 adult patients of ASA grade I-II with immobilized cervical spine undergoing elective cervical spine surgery were enrolled. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with isoflurane and nitrous oxide in oxygen. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh, McCoy, or TruView laryngoscopes. When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening [POGO] score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Hemodynamic parameters and any airway complications were also recorded. TruView reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the TruView laryngoscope group. However, there were no differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. The use of a TruView laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

comparison of truview EVO2 laryngoscope with Macintosh laryngoscope in routine airway management: a randomized crossover clinical trial

The Truview EVO2 blade facilitates the view of vocal cords by indirect laryngoscopy and does not require the proper alignment of the oral, pharyngeal and tracheal axes as with the Macintosh blade. In a crossover fashion, we prospectively compared the view obtained at laryngoscopy with Truview EVO2 and the Macintosh blade in 110 adult patients of either sex between the age of 18 and 60 years, who were scheduled to undergo general anesthesia with endotracheal intubation. The patients were intubated with the second laryngoscope. The preoperative airway variables, laryngoscopic view, difficulty of intubation scale [IDS] score, duration of intubation, and degree of difficulty percentage of glottic opening [POGO score] of use with each laryngoscope were compared. The IDS score was low and comparable between the two laryngoscopes. The laryngeal view was easy; Modified Cormack Lehane [MCL] grade 2a or less in 98.14% of the cases with the Truview laryngoscope compared to 78.7% of the cases with the Macintosh laryngoscope. Nineteen patients of MCL grade 3, one patient of grade 2b, and seven patients of grade 2a view with the Macintosh laryngoscope had MCL grade 1 view with the Truview laryngoscope. The duration of intubation was comparable between Truview and Macintosh laryngoscopes [12.1 +/- 3.8 s vs. 10.9 +/- 2.1 s]. Truview laryngoscope performed comparably to Macintosh laryngoscope in patients with normal airway; however, the Truview laryngoscope may be a better option in difficult airway situations when the Macintosh blade fails to show the glottic opening

Tracheoinnominate artery fistula: a case report with a review of the clinical management

Poor intensive care practices are to be blamed for development of any complication of prolonged tracheal intubation. Especially, the complications of subglottic stenosis or more rarely, a fistula between the tracheal wall and the innominate artery cannot be justified on any account. Yet, these complications may occasionally be seen in underdeveloped countries with poor nursing training and meager resources. We present a case report of this fatal complication in a 17 years old patient of tetanus who underwent surgical tracheostomy for mechanical ventilation and subsequently developed a fatal massive bleeding