Comparison of ease of I-gel insertion with standard and rotational techniques in adults

Objective: To compare number of attempts, mean time of Insertion, mean airway leak pressure, insertion success and blood staining at removal of l-gel insertion through standard and rotational techniques, in adult anesthetized patients

Study design Randomized clinical trial

Place and Duration of study: Department of Anaesthesiology and SICU, Jinnah Postgraduate Medical Centre Karachi, from January 2016 to April 2016

Methodology: Patients scheduled for elective surgical procedures under general anaesthesia with controlled ventilation, were included in this study. A total of 150 patients were randomly assigned by random number into Group S [standard insertion technique - n=75] and Group R [rotational technique - n=75]. Comparison was done in terms of mean time taken for I-gel insertion, mean air leak pressure, number of attempts taken for insertion and presence of blood staining on removal

Results: Mean time of insertion in Group S was 14.6 +/- 3.7 second and in Group R 13.2 +/- 2.7 seconds. Mean airway leak pressure was 23.1 +/- 4.6 cm of H2O in Group S and 24.4 +/- 2.9 cm of H2O in Group R. The median number of attempts taken for insertion in each group was 1. Success of insertion was 93.3% [n=70] in Group S and 98.7% [n=74] in Group R. Blood staining of I-gel at removal was noted in 22 [29.3%] and 14 [18%] patients in group S and R respectively

Conclusion: The rotational technique for I-gel insertion was better than the standard technique

Compliance and effectiveness of who surgical safety check list: a JPMC audit

Objective: To assess World Health Organization [WHO] Surgical Safety Checklist [SSC] compliance and its effectiveness in reducing complications and final outcome of patients

Methods: This was a prospective study done in Department of General Surgery [Ward 02], Jinnah Postgraduate Medical Centre [JPMC], Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of history sheets in ward. Files were checked to confirm the compliance with regards to filling the three stage checklist properly and complications were noted

Results: In 1st year, out of 840 surgical procedures, SSC was properly marked in 172 [20.4%] cases. In 2[nd] year, out of 857 surgical procedures 303 [35.3%] cases were marked which increased in 3rd year out of 935 surgical procedures 757 [80.9%] cases and in 4th year out of 932 surgical procedures 838 [89.9%] cases were marked. No significant change in site and side [left or right] complications were noted in all four years

Surgical Site Infection [SSI] was noted in 59 [7.50%], 52 [6.47%], 44 [4.70%] and 20 [2.12%] cases in 1st, 2nd, 3rd and 4th year respectively. SSI in laparoscopic cholecystectomies was 41 [20.8 %], 45 [13%], 20 [5.68%] and 4 [1.12%] in 1st, 2nd, 3rd and 4th year respectively. No significant change in chest complications were noted in all four years. Mortality rate also remained same in all four years

Conclusion: WHO SSC is an effective tool in reducing in-hospital complications thus producing a favorable outcome. Realization its efficacy would improve compliance