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Introduction: Multimodal anaesthesia techniques includeregional anaesthesia in the form of paravertebral block andvarious anaesthetic drugs which acts on different sites of painpathway with different mechanism of action, results in goodquality of analgesia with minimal side effects. They improverecovery along with early mobilization and rehabilitationand early resumption. This technique lowers the level ofinflammatory cytokines. Due to this we aim to evaluate theeffects multimodal anaesthesia technique on level of IL-6inflammatory cytokines in breast carcinoma surgery.Material and Methods: Patients were randomized intofollowing three groups (n=30 in each group) using a computergenerated random number tables. Group I: paracetamol 10 mg/kg, Group II: paracetamol at 10 mg/kg and dexmedetomidine0.5μg/kg, Group III: paracetamol 10 mg/kg, dexmedetomidine0.5 μg/kg and paravertebral block with levobupivacaine.Fentany (2 μg/kg) with general anaesthesia were common inall three groups. Statistical Analysis: All the categorical datawas compared by using student “t” test, chi-square test andparametric data by analysis of variance (ANOVA).Results: Patients of group III was haemodynamically morestable as compared to group II and I. IL-6 level was 358.15, ingroup I, 354 in group II and 346.65 in group III preoperativelywhile 324.85 in group I, 320.95 in group II, 278.35 in group IIIafter 2 hour surgery. IL-6 level was significantly different ingroup III as compared to group II and group I postoperatively.Conclusion: Multimodal approach is a better anesthetictechnique in terms of hemodynamic stability with decreasedlevels of IL-6 inflammatory cytokines.
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Introduction: Preoperative diagnostic validity of airwayassessment help for prediction of difficult airway. Severalmodels were established for prediction of difficult intubation.In this study, we aim to predict difficult intubation in nonobese patients from various airway predictive indices suchas modified mallampati grade, neck movement (NM), neckcircumference (NC), thyrometal distance (TM), NC/TMD.Material and Methods: Total 121 patients with 18-72 yearsof age, ASA grade I or II, scheduled for elective surgerythat required general anaesthesia. Difficulty of intubationwas assessed using the IDS for each non-obese patient. Thestudy population was divided into two groups Easy (IDS <5)and Difficult intubation (IDS ≥5). Preoperative assessmentsincluded Mouth Opening (MO), modified mallampati grade,neck movement (NM), neck circumference (NC), thyrometaldistance (TM), NC/TMD. Multivariate analysis was usedto predict independent risk factors. Receiver OperatingCharacteristic Curve analysis (ROC analysis) was performedfor the airway assessment tests. The area under curve (AUC)was calculated.Results: The weight (59.74±7.76 kg and 65.00±5.92 kg)and BMI (21.51±1.79 and 23.8157±1.09) were significantlydifferent in between easy and difficult intubation. TheMouth Opening, NC, TMD, and NC/TMD were significantlyindependent risk factor for difficult intubation. NC/TMDwas showed higher sensitivity, specificity, positive predictivevalue (PPV) and a negative predictive value (NPV) with thirdlarge area under the curve (AUC) on the ROC curve.Conclusions: This study shows that the NC/TMD ratio canbe considered as a better predictor of difficult intubation innon-obese patients.
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Reactive oxygen species are a part of the normal physiology of the biological system but their subsequent defence undergoes alteration during diseased conditions. Administration of anaesthesia for surgery may also alter the formation of reactive oxygen species. The present work deals with the comparative status of oxidative stress (lipid peroxidation) and anti-oxidant defence markers (superoxide dismutase and catalase) in blood in 3 groups of 15 patients each receiving halothane, relaxant vecuronium and spinal form of anaesthesia with lignocaine 5% heavy. The results obtained depict that the formation of malonyl dialdehyde as well as decrease in superoxide dismutase and catalase activities was highest in spinal anaesthesia followed by halothane and then relaxant group. Therefore, it seems important to consider the pre-operative anti-oxidant status while administering anaesthesia to such patients in order to provide biologically safe anaesthesia.