Efficacy of Baska mask as an alternative airway device to endotracheal tube in patients undergoing laparoscopic surgeries under controlled ventilation.

BACKGROUND AND AIMS: Newer supraglottic devices with an additional gastric channel offer greater protection from aspiration and avoidance of laryngoscopy for their insertion would result in attenuated hemodynamic responses.The primary objective was to assess hemodynamic responses to insertion of Baska mask as compared to tracheal intubation. The time and attempts taken to secure airway and evidence of regurgitation and pulmonary aspiration of gastric contents were also assessed. MATERIAL AND METHODS: This prospective, randomized study was conducted in 80 patients undergoing laparoscopic cholecystectomy. All patients received standardized anaesthesia protocol. Baska mask was used to secure airway in Group B, while tracheal intubation was done in group T. Methylene blue was injected through Ryle's tube into stomach in both groups. At end of surgery, fibreoptic bronchoscopy was performed to detect bluish staining of trachea and/or main bronchi as evidence of aspiration of gastric contents and bluish staining in oropharynx as evidence of regurgitation. Chi-square test and Independent sample t-test were applied. RESULTS: The time taken to secure airway was significantly longer in Group B as compared to Group T (45.3 ± 12.6 vs. 24.3 ± 9.1 sec) Percentage of patients who had oropharyngeal blue stain was comparable in both groups. No patient in both groups had tracheal blue stain. Group T had significantly higher HR and MAP after intubation till 10 min later. CONCLUSION: Baska mask insertion was associated with attenuated hemodynamic responses, though more time and attempts were required for securing the airway. It could be considered as an alternative to tracheal intubation during laparoscopic surgeries.

Effect of dexmedetomidine on intracranial pressures during laparoscopic surgery: A randomized, placebo-controlled trial.

BACKGROUND AND AIMS: Laparoscopic surgeries cause an increase in intracranial pressure (ICP) after creation of pneumoperitoneum. Sonographically measured, optic nerve sheath diameter (ONSD) correlates well with changes in ICP. Dexmedetomidine (Dex), an α2 agonist is extensively used in day-care surgeries, although its effect on ICP during laparoscopy in humans has not been reported in the literature. The aim of this study was to note the effect of dexmedetomidine infusion on changes in ICPs during laparoscopic cholecystectomy. MATERIAL AND METHODS: This was a prospective, randomized, placebo-controlled, double-blind study done on 60 patients scheduled for laparoscopic cholecystectomy. The study drug, dexmedetomidine hydrochloride (Dex) or placebo saline infusion, was started 10 min before induction and continued till extubation. Changes in ICP were assessed sonographically at baseline before pneumoperitoneum, 5 min after establishing pneumoperitoneum, 10 min after positioning the patient 20° head up, and 5 min after desufflation. RESULTS: Demographically, both groups were comparable. The ONSD showed a significant increase after pneumoperitoneum in both groups (P = 0.0001 and 0.0011). Dex group could marginally attenuate this increase (P = 0.075). After changing patient's position to reverse Trendelenburg, ONSD increased further in both groups. Dex group could significantly attenuate the increase (P = 0.001). The ONSD did not return to baseline values till after 5 min of release of pneumoperitoneum in both groups. CONCLUSION: Dexmedetomidine is effective in attenuating increase in ICP associated with laparoscopic surgeries. The benefit was marked 10 min after placing patient in the reverse Trendelenburg position during laparoscopic cholecystectomy.

Effect of Pneumoperitoneum and Patient Positioning on Intracranial Pressures during Laparoscopy: A Prospective Comparative Study.

STUDY OBJECTIVE: To evaluate the effect of pneumoperitoneum and head position during laparoscopic surgery on intracranial pressures (ICPs) using sonographic measurements of optic nerve sheath diameter (ONSD). DESIGN: Prospective observational study (Canadian Task Force classification II-1). SETTING: A tertiary-level hospital. PATIENTS: Sixty-one women aged 15 to 50 years with American Society of Anesthesiologists grade 1 risk and body mass index ≤ 29 kg/m2 were admitted to the hospital between November 2015 and October 2016 for elective laparoscopic surgery and were included in this study. INTERVENTION: Patients were placed in the Trendelenburg position with head down (group I; n = 33) and reverse Trendelenburg position with head up (group II; n = 28). MEASUREMENTS AND MAIN RESULTS: ONSD was measured via sonography at 4 time points: at baseline before pneumoperitoneum, after pneumoperitoneum, after patient was placed in respective position, and once pneumoperitoneum was released. Patient demographics were comparable in all respects. ICP as indicated by ONSD showed a significant increase after pneumoperitoneum (p = .0001 in group I and p = .0011 in group II). When patients were placed in either head position, ONSD showed a further increase in ICP. This increase was more pronounced in patients assuming the head-down Trendelenburg position compared with patients in reverse Trendelenburg (head-up) position. Baseline and preoperative ONSD measurements were not reached even after 5 minutes of desufflation. CONCLUSIONS: Pneumoperitoneum causes an increase in ICP. The patient position, either head up or head down as in gynecologic laparoscopic procedures, further worsens ICP. ONSD does not revert back to baseline until 5 minutes after desufflation.

Effect of nasal oxygen supplementation during apnoea of intubation on arterial oxygen levels: A prospective randomised controlled trial.

BACKGROUND AND AIMS: Apnoeic oxygenation during laryngoscopy has been emphasised in recent recommendations for airway management. We aimed to compare the effect of nasal oxygen supplementation on time for pulse oximeter oxygen saturation (SpO2) to fall from 100% to 92% (desaturation safety time), to assess the arterial oxygen partial pressures (PaO2) with and without nasal oxygen supplementation and the time for SpO2 to recover from 92% to 100% after initiation of ventilation. METHODS: This is a prospective randomised placebo-controlled trial involving sixty patients, where nasal oxygen supplementation given at 10 L/min during apnoea of laryngoscopy in one group of patients (Group O2) was compared to no oxygen supplementation in other group (Group NoO2). Desaturation safety period and the PaO2 just after intubation were compared. Time for SpO2 to increase to 100% after initiation of ventilation was also assessed. Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. RESULTS: Desaturation safety period at 415.46 ± 97.23 seconds in group O2 versus 378.69 ± 89.31 seconds in group NoO2(P = 0.213) and PaO2(P = 0.952) and time to recovery of SpO2 (P = 0.058) were similar in both groups. Rise in arterial carbon dioxide secondary to apnoea was slower in oxygen supplementation group (P = 0.032). CONCLUSION: Apnoeic oxygen supplementation at 10 L/min flow by nasal prong did not significantly prolong the apnoea desaturation safety periods or the PaO2 in our study.