ABSTRACT
Background and Aims: During awake fiberoptic intubation (AFOI), clearing secretions is usually done by suctioning. The study objectives were to assess the safety of AFOI with the use of oxygen insufflation versus suction to clear secretions from the field of vision during the procedure as assessed by incidence of desaturation <95%, ease of intubation, and time taken to secure the airway. Material and methods: This prospective randomized study was conducted in 40 adult patients with difficult airways requiring AFOI. All patients received dexmedetomidine 0.5mcg/kg intravenously, and the airway was topicalized. In Group-S suction and in Group-O oxygen was connected to the suction port of the bronchoscope to clear the secretions by activating the suction knob during bronchoscopy. Ease of intubation was scored as easy, moderate, and hard. Results: Incidence of desaturation to <95% and the need for oxygen supplementation were significantly high in Group S compared to Group O (60% vs. 10%). Incidence of easy intubation (80% vs. 75%) and time taken to intubate (50.1 ± 16.6 vs. 53.8 ± 21.0 s) were comparable. The number of times (median) suctioning was done in Group S was significantly high compared to the number of oxygen insufflations required in Group O [3 (1-6) vs. 2 (0-5), P 0.033]. Desaturation to <95% was significantly low in Group O compared to Group S during bronchoscopy (10% vs. 60%, P 0.002). Conclusion: The use of oxygen insufflation to clear secretions from the field of vision during AFOI is a safer alternative to suctioning as this technique reduces the chance of desaturation during the procedure without affecting ease of intubation, number of attempts, time taken for it, or patient comfort.
ABSTRACT
CONTEXT: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. AIMS: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. SETTINGS AND DESIGN: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. SUBJECTS AND METHODS: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. STATISTICAL ANALYSIS: Student's t-test and Chi-square test were applied. RESULTS: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. CONCLUSION: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.
