Utilizing nasal-tragus length to estimate optimal endotracheal tube depth in neonates: A prospective randomized control study.

BACKGROUND: Determination of the optimal depth of endotracheal tube insertion in neonates is challenging. Various formulae have been proposed and are being commonly used for this purpose. There is no single formula that is ideal or can be applied across different populations. AIM: To compare weight and nasal-tragus length-based formulae as a guide to endotracheal tube insertion depth in term neonates undergoing surgery. Ther primary objective of the study was to determine the position of the endotracheal tube using either weight-based or nasal-tragus length-based formulae and the secondary objective was to determine the incidence of repositioning of the endotracheal tube. METHODS: A total of 120 full term neonates were divided into two groups with 60 neonates each (group N = NTL + 1 cm and group W = Weight + 6 cm). Endotracheal tube was inserted according to the pre-calculated value and fixed. A neonatal flexible fiberoptic bronchoscope was used to confirm the position of the endotracheal tube tip by measuring its distance from the carina. Repositioning was done if the distance from carina to endotracheal tube tip was less than 20 mm. Chi-squared and Mann-Whitney tests were used for the analysis. RESULTS: The mean distance measured from carina to endotracheal tube tip in group N was 9.41 ± 6.65 mm and in group W was 3.21 ± 3.45 mm (p value = <.001). A higher incidence of optimal endotracheal tube placement was observed in group N which led to repositioning in 88.3% of neonates in group N and 100% in the group W (53/60 and 60/60, respectively, p value < .05). CONCLUSION: Based on the results from the studied sample, NTL +1 cm formula is a better predictor than Weight + 6 cm formula to determine endotracheal tube insertion depth in term Indian neonates.

A Boy Who Knows No Pain: Anaesthetic Management of Congenital Insensitivity to Pain With Anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disorder with an absence of pain perception, anhidrosis, heat intolerance, and varying degrees of mental retardation. Though cases of CIPA have innate analgesia, they have been known to have tactile hyperesthesia, thus making anesthesia necessary in case of any surgery. Perioperative complications due to abnormal autonomic functions like bradycardia, hypotension, and hyperthermia are major challenges in the anesthetic management of these cases. Here, we report a case on the anesthetic management of CIPA.

Low tidal volume ventilation strategy and organ functions in patients with pre-existing systemic inflammatory response.

BACKGROUND AND AIMS: Ventilation can induce increase in inflammatory mediators that may contribute to systemic organ dysfunction. Ventilation-induced organ dysfunction is likely to be accentuated if there is a pre-existing systemic inflammatory response. MATERIAL AND METHODS: Adult patients suffering from intestinal perforation peritonitis-induced systemic inflammatory response syndrome and scheduled for emergency laparotomy were randomized to receive intraoperative ventilation with 10 ml.kg-1 tidal volume (Group H) versus lower tidal volume of 6 ml.kg-1 along with positive end-expiratory pressure (PEEP) of 10 cmH2O (Group L), (n = 45 each). The primary outcome was postoperative organ dysfunction evaluated using the aggregate Sepsis-related Organ Failure Assessment (SOFA) score. The secondary outcomes were, inflammatory mediators viz. interleukin-6, tumor necrosis factor-α, procalcitonin, and C-reactive protein, assessed prior to (basal) and 1 h after initiation of mechanical ventilation, and 18 h postoperatively. RESULTS: The aggregate SOFA score (3[1-3] vs. 1[1-3]); and that on the first postoperative day (2[1-3] vs. 1[0-3]) were higher for group L as compared to group H (P < 0.05). All inflammatory mediators were statistically similar between both groups at all time intervals (P > 0.05). CONCLUSIONS: Mechanical ventilation with low tidal volume of 6 ml/kg-1 along with PEEP of 10 cmH2O is associated with significantly worse postoperative organ functions as compared to high tidal volume of 10 ml.kg-1 in patients of perforation peritonitis-induced systemic inflammation undergoing emergency laparotomy.

Presentation of research in anesthesia: Culmination into publication?

BACKGROUND: To assess the quality of research presentations made in conferences, its success or failure to be published in a peer-reviewed journal is a well-accepted marker. However, there is no data regarding the publication of research presentations made in Indian conferences of anesthesiology. OBJECTIVE: The primary objective was to determine publication rate of research presented at the largest and best attended national conference in anesthesiology, the Indian Society of Anaesthesiologists' Conference (ISACON), and also compare it with the rate from an international conference American Society of Anesthesiologists (ASA annual meeting) held in the same year. MATERIALS AND METHODS: All 363 abstracts presented as poster or podium presentations at the ISACON, and an equal number of randomly selected abstracts presented at ASA annual meeting were searched on Pubmed and Google Scholar for their full-text publications in peer-reviewed journals using a standardized search strategy. As secondary observations, abstracts were assessed for completeness by noting certain components central to research methodology. Also, changes between abstract of the presentation and published paper were noted with respect to certain components. RESULTS: The publication rate of presentations at ISACON and ASA meetings was 5% and 22%, respectively. The abstracts from ISACON lacked central components of research such as methods and statistical tests. The commonest change in the full-text publications as compared with the original abstract from both conferences was a change in authorship. CONCLUSION: Steps are required to augment full-text publication of Indian research, including a more rigorous peer review of abstracts submitted to ISACON to ensure their completeness.