ABSTRACT
Introduction: Intubating trachea and securing the airway remain a challenge although it is a routine practice for theanesthesiologist. Failure to successfully intubate the trachea remains a leading cause of morbidity and mortality in anestheticand emergency setting.Aim: This study aims to compare the intubating conditions in adult surgical patients using Airtraq optical laryngoscope withMacintosh laryngoscope with respect to ease of intubation, the time taken for intubation, airway trauma, and hemodynamicresponse to laryngoscopy.Methods: In a single-center, prospective, randomized, parallel group, open-label, interventional study, 40 adult patients postedfor surgery under general anesthesia need of endotracheal intubation were recruited and allocated into two groups: Group A(n = 20) intubated with Airtraq laryngoscope and Group B (n = 20) intubated with conventional Macintosh laryngoscope instandard intravenous induction.Results: Mean duration of intubation with the Airtraq group was 15.93 s, whereas in the Macintosh group, it was found to be38.70 s (P < 0.0001). The increase in mean heart rate from the pre-induction to post-intubation in Airtraq group was 20.9/min,whereas in Macintosh group was 31.9/min. The increase in mean arterial pressure from pre-intubation to post-intubation inAirtraq group was 12.6 mmHg, whereas in Macintosh group was 30.3 mmHg. Three patients in the Macintosh group and twopatients in the Airtraq group experienced trauma to the airways (P = −0.958).Conclusion: A study concluded that endotracheal intubation is easier, less time is taken for intubation, less trauma, and lesshemodynamic response when using Airtraq laryngoscope than Macintosh laryngoscope.
ABSTRACT
Introduction: Baska mask is a 3rd generation Supraglottic Airway Device (SGA). One of the major limitations of the SGA device is the risk of aspiration. Aim of the study: Evaluate the advantages of Baska mask over Proseal LMA in providing adequate laryngeal seal and ease of insertion. Materials and methods: A Randomized prospective single-blinded study. A study group of 40 female patients recruited and divided into 2 groups. Group I (BM-Baska Mask) with 20 patients and Group II (PLM- Proseal LMA) with 20 patients. All patients received general anesthesia with control ventilation. SGA device insertion was done once patients were anesthetized. Baseline intraoperative hemodynamic parameters and capnography were monitored. The ease of insertion was assessed by a number of attempts, time of insertion and any extra maneuver required. The airway pressure calculated as the plateau pressure with fresh gas flow at 6L and APL valve at 70cm H20. In Proseal LMA it was calculated using a handheld manometer. Results: The success rate of insertion was comparable in 2 groups. The mean time for insertion was 13.3 s while it was 19.7s for PLMA (Pvalue of 0`001). The mean airway sealing pressure was significantly higher in the BM group (p= 0.000). The seal pressure ranged from 20 -29 and 24 -37 in group I and II respectively with P value of 0.001 which makes it significant. There was no significant post-operative laryngopharyngeal morbidity in both groups. Conclusion: Baska mask provides an adequate seal with better ease of insertion when compared to Proseal LMA.
ABSTRACT
Background: Dexmedetomidine is the newer highly selective alpha 2-adrenoreceptor agonist. It has sympatholytic, sedative and analgesic properties with no respiratory depression. Various studies have evaluated the usefulness of Dexmedetomidine as an adjuvant to general anesthesia, reducing the requirements of inhalational agents and opioids, and for attenuating the intubation stress. A single dose of Dexmedetomidine has been found effective in attenuation of the airway and circulatory reflexes during extubation. Aim of the study: To compare the effects of intravenous Dexmedetomidine and lignocaine on Attenuation of hemodynamic responses and sedation score, Attenuation of airway responses to extubation after intracranial surgeries under general anesthesia. Materials and methods: This was a prospective, randomized, double-blinded study conducted at our institute between June 2018 and July 2018 in Tirunelveli government medical in the department of anesthesiology after getting institutional Ethical committee approval. Written informed consent was obtained from all subjects participating in the study. 50 patients of ASA Grade I and II undergoing craniotomies for non‑vascular ICSOL under general anesthesia were recruited. Patients were divided into two groups of 25 each by computer-generated random numbers. Group D (n=25) received 0.5 microg/kg Dexmedetomidine intravenously. Group L (n=25) received 1.5 mg/kg Lignocaine intravenously. Anesthesiologist who administered the drug and the observer were blinded to the study. Intravenous drugs were prepared by another anesthesiologist not involved in the study. Ebenezer Joel Kumar E, G Vijay Anand, B.S. Aswathy R. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic and airway responses following extubation. IAIM, 2019; 6(2): 79-86. Page 80 Results: A decrease in HR, SBP, and DBP were observed up to the A5 stage in group D which was statistically significant. In group L the changes in HR, SBP, and DBP at these stages were statistically insignificant. There was an increase in HR, SBP and DBP in both groups during (E) and immediately after extubation (E1). This was more in group L compared to group D which was statistically significant. Thereafter in group D these values continued to decrease and remained below the pre-drug administration value (A0) at the end of the study (E15). Whereas in group L, these values although decreased from E and E1 values but remained above the A0 values at the end of the study period (E15). This difference was statistically significant (p-value less than 0.05). The degree of sedation was higher in Group D after extubation. 5 patients (20%) showed Grade 2 sedation and 20 patients (80%) showed Grade 3 sedation in Group D. In contrast, only 20% (n=5) patients had mild sedation (Grade 2) whereas 80% (n=20) patients were anxious and agitated or restless or both (Grade 1) in group L. The difference between both groups was statistically significant. Conclusion: From our study, we concluded that administration of a single dose of Dexmedetomidine (0.5 mcg/kg) provides significant attenuation of circulatory and airway responses during extubation when compared to lignocaine in craniotomies for ICSOL. Though patients were sedated in the immediate post-extubation period, the levels of sedation were acceptable without any incidence of desaturation