Accuracy of the upper lip bite test; modified Mallampati classification in predicting difficult endotracheal intubation

To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficult laryngoscopic intubation. Cross sectional Study. The study was carried out at Department of Anaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009. Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled after written informed consent. The airways of the patients were evaluated by using the modified Mallampati classification [MMP] and the Upper lip bite test [ULBT]. MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view was graded by Cormack and Lehane classification [Gold standard]. Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4 to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for both the tests separately by using the 2x2 table. ULBT had a higher accuracy of 94%, specificity of 99.2% and positive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%. The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that it be compared with the other prevailing tests as well which are often used to assess difficult intubations

Use of a portable oxygen concentrator and its effect on the overall functionality of a remote field medical unit at 3650 meters elevation

The supply of oxygen is a complex issue in disaster situations and snowbound mountainous areas. Innovative solutions are required for safe anesthesia practice; one such innovation is a small portable oxygen concentrator for oxygen therapy in remote austere environment. We conducted this study to ascertain the economy achieved by employing this equipment to improve functionality of a surgical unit in an austere environment. Retrospective review of patient records and cylinder consumption from 1st October 2008 to 30th March 2009 was carried out and this data was classified as group A. While group B consisted of all the patients, who required oxygen therapy from 1st October 2009 to 30th March 2010, and were divided into sub-groups, on the basis of type of anesthesia or oxygen therapy. They were further categorized with respect to use of oxygen concentrator or oxygen cylinder for oxygen provision. The percentages of patients in these subgroups were summed to ascertain the economy achieved in the use of oxygen cylinders by comparing cylinder/patient ratio between group A and B respectively. Percentage economy achieved was then calculated. In group A cylinder/patient ratio [21/53] was '0.4' as compared to [3/81] '0.03' of group B. Percentage economy achieved was hence found to be [0.4/0.03%]] 1333%. Use of oxygen concentrator is an innovation which is economical, easily applicable and highly recommended in remote austere environments

Efficacy of single dose perioperative intravenous steroid [dexamethasone] for postoperative pain relief in tonsillectomy patients

To determine the efficacy of single dose perioperative intravenous steroid [dexamethasone] for postoperative pain relief in patients undergoing tonsillectomy. Quasi-experimental study. Combined Military Hospital, Lahore, from November 2009 to June 2010. Sixty patients were divided into two equal groups. A single dose of dexamethasone was given to patients of group A during induction of anaesthesia, whereas no steroid was given to the patients in group B. Postoperative pain scores were assessed at 2, 6 and 12 hours in both groups using visual analogue scale [VAS]. Pain was classified as mild [0-3], moderate [4-7] and severe [8-10] on visual analogue scale. There was no significant difference in pain scores after 2 hours postoperatively. Pain scores of Group A at 6 and 12 hours postoperatively were found to be significantly low than Group B. Single dose perioperative intravenous injection of dexamethasone in tonsillectomy patients reduces postoperative tonsillectomy pain

Effect of pre-operative heart rate on post spinal hypotension in obstetric patients

The purpose of the study was to determine the association between of pre-operative heart rate and post spinal hypotension in women undergoing cesarean section. It was a quasi-experimental study. It was conducted at Anaesthesia Department Combined Military Hospital Lahore and was of one year duration from June 2006 to May 2007. Two hundred patients undergoing caesarean section were included in the study selected on non probability convenience sampling technique. The patients were divided into two groups depending upon their pre operative heart rate. Spinal anesthesia was administered and number of patients developing hypotension was noted. Among 200 patients, who were included in the study, 112 were placed in group A and 88 were placed in group B depending on mean heart rate of 90 beats per minute or less or 91 beats per minute or more respectively. In group A 14 [11.86%] patients developed hypotension where as in group B 28 [31.82%] patients developed hypotension. Pre operative heart rate is significantly associated with post spinal hypotension in obstetric patients undergoing cesarean section

Comparison of haemodynamic changes after laryngeal mask airway insertion with propofol versus sevoflurane

To compare haemodynamic changes on Laryngeal Mask Airway [LMA] insertion using tidal volume induction technique with sevoflurane at high concentration versus an intravenous induction with propofol. Randomized Controlled Trial [RCT]. Place and Duration of study: The study was carried out at Department of Anaesthesiology, Intensive Care and Pain Management, Military Hospital Rawalpindi from May 2006 to April 2007. One hundred patients were enrolled after written informed consent. Patients were divided in two groups. Group A received propofol and group B received sevoflurane for induction of general anaesthesia. Heart rate and mean arterial pressure [MAP] were recorded one minute before induction of anaesthesia and three minutes after induction and LMA placement. Independent sample "t-test" was applied to compare means for MAP and mean heart rate in both the groups and p value was inferred to judge the significance. In group A 20 males and 30 females were enrolled for the study while in group B there were 16 males and 34 females. The mean age of the patients in group A was 30.5 +/- 4.8 years while in group B was 28.4 +/- 5.2 years. Mean weight was 60.5 +/- 5.8 and 62.2 +/- 4.7 kilograms respectively in both groups. Twenty two patients were ASA I and 28 were classified as ASA II in group A while 27 were ASA I and 23 were ASA II in group B. In the group A, MAP was recorded to be 90 +/- 5.3 mmHg before induction and 79.9 +/- 7.5 mmHg after LMA placement following propofol induction. Whereas MAP in Group B before induction of anaesthesia and after LMA placement were 90 +/- 4.8 and 84.2 +/- 7.03 mmHg respectively. The fall in MAP was found to be significant in Group A when compared to Group B after induction and insertion of LMA [p value < .005]. In group A, mean HR was recorded to be 79.1 +/- 4.3 before induction and 82.2 +/- 8 per minute after LMA placement following propofol induction. While mean HR in Group B was 78.1 +/- 7.8 before induction and 83.3 +/- 8.0 per minute after LMA placement following sevoflurane induction. Hence, we found no significant difference in terms of change in mean HR between the two groups [p value > 0.4] before and after LMA insertion. Considering more fall in the MAP following propofol induction in group A and as there was no significant change in MAP and heart rate before and after sevoflurane induction, we conclude that sevoflurane provided better haemodynamic stability than propofol for LMA insertion