Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients

Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure [IOP], tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation [P = 0.217, 0.726, and 0.110 respectively]. The only significant difference in IOP was at 1 min after intubation [P = 0.041]. No significant difference noted between groups in mean arterial pressure [P = 0.899, 0.62, 0.47, 0.82 respectively] and heart rate [P = 0.21, 0.72, 0.07, 0.29, respectively] at all measurements. GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope

Comparison of levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lidocaine 2% for superficial extraconal blockade

To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia with levobupivacaine 0.5% versus bupivacaine 0.5%, both combined with lidocaine 2% for patients undergoing phacoemulsification. In this prospective, double blind study, 150 patients were randomly divided into two groups: group-1 received a Peribulbar block [PB] with a mixture of evobupivacaine 0.5% and lidocaine 2% while group-2 received a PB with a mixture of bupivacaine 0.5% and lidocaine 2%. The block was performed by insertion of a short needle [15 mm] in infra-temporal space just above inferior orbital notch. An initial volume of 6 9 ml of either mixture was injected until total upper eyelid drop. Akinesia score was assessed at 2, 5, and 10 min after the block. The degree of pain was assessed by a verbal rating scale immediately after block, at the end of surgery and 4 h postoperatively. The patients and surgeons were asked to rate their satisfaction level of the quality of block postoperatively. Data were analyzed with the unpaired, two-tailed t-test and the Chi-square test as appropriate. P < 0.05 was considered statistically significant. There were no significant differences between groups with respect to the akinesia score [P = 0.2] at 2, 5, and 10 min, the number of supplementary injections [P = 0.84] and initial and total required volume of local anesthetics [P = 0.80 and 0.81, respectively]. There was no significant difference between the groups regarding surgeon and patient satisfaction [P = 0.53 and P = 0.74, respectively]. Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups [P > 0.05 all cases]. The need for additional intra-operative topical anesthetic was also similar between the groups. [P = 0.69]. Superficial extra-conal block with a mixture of levobupivicaine 0.5% and lidocaine 2% or bupivicaine 0.5% and lidocaine 2% provides similar block quality and efficacy

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale [ISAS]. The Student's t-test was used to determine the significance of IOWA score in both groups. P < 0.05 was considered significant. Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia [P=0.004, 0.000, 0.002, respectively]. In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia [P=0.022, 0.000, 0.000, respectively]. Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery

Periocular hematoma secondary to subperiosteal injury by a short needle

Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. Detailed management to improve the outcome is discussed

Endotracheal reintubatioin in post-operative cardiac surgical patients

The reported incidence of reintubation in patients who were weaned from mechanical ventilation after cardiac surgery is 6.6%4 in a retrospective study, but little work has been done prospectively to find out the incidence and causes for reintubation in a cardiac surgical ICU. We conducted this study to find out incidence and the causes of endotracheal reintubation in patients who were electively ventilated after open heart surgery and were extubated after fulfilling preset criteria for extubation. A total of 1229 consecutive patients were included in the study. On arrival to ICU after cardiac surgery, all patients were electively ventilated with standardized ventilatory parameters. Routine monitoring of all patients was done and patients were extubated once they met the criteria for extubation. The patients, who met the reintubation criteria, were reintubated and the reason[s] noted. Once they stabilized and fulfilled the extubation criteria, they were extubated. A total of 47[3.82%] patients required reintubation after weaning from the ventilation during the study period, and in 5[10.63%] patients out of these, reintubation was needed more than once. We found a higher incidence of reintubation, 11.84% and 10.63%, in patients after single and double valve replacement surgery respectively. The incidence was much lower [2.14%] among coronary artery bypass grafting [CABG] patients. The patients undergoing valve replacement surgery are more prone to reintubation in postoperative period as compared to CABG patients. Impending respiratory failure, cardiovascular [hemodynamic] instability and impaired conscious level are the common indications for reintubation

effects of duration of propofol injection on hemodynamics

The aim of study was to see whether increasing the time of injection of standard dose of Propofol during induction can prevent fall in blood pressure in female patients; as is commonly observed with this anesthetic agent. Comparative, non-interventional, prospective, and randomized and single blind study. The study was carried out on female in-patients admitted and surgically operated at a specialized, tertiary care hospital and was completed with in 6-months. The hemodynamic effects of Propofol were compared in three groups of patients undergoing minor surgical procedures. Each group comprised of 25 patients. A 2 mg/kg Propofol was administered for 30, 60 and 120 seconds in patients of group-A, group-B and group-C respectively. Baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressures were recorded before induction of anesthesia. The same hemodynamic variables were recorded after induction at one-minute intervals for 10-minutes. Anesthesia was maintained with 1.5% enflurane and 60% nitrous oxide in oxygen. Complications such as pain on injection, dystonic movements, erythema, laryngeal spasm, episodes of desaturation, hypoventilation and the number of additional boluses required to induce hypnosis were also recorded. The fall in blood pressure was statistically insignificant between the three groups of patients. The incidence of dystonic movements was the highest in group-A while pain on injection was highest in group-C. Additional boluses of Propofol to induce hypnosis were required for patients in group-B and group-C. Varying the speed of injection of Propofol during induction of anesthesia in adult female patients does not cause any major difference in the drop of their heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure