Effect of dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block with levobupivacaine-A prospective double-blind randomized controlled trial.

BACKGROUND AND AIMS: Levobupivacaine, a less cardiotoxic s-isomer of bupivacaine, is proved to be similar to bupivacaine, hence, proposed as a safer alternative for nerve blocks. We aimed to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block (BPB) performed with levobupivacaine. The aim of this study is to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular BPB performed with levobupivacaine. MATERIAL AND METHODS: A prospective, randomized double-blind control trial done on 120 patients undergoing elective upper limb surgical procedures under supraclavicular BPB. The enrolled patients were allocated to one of the three groups: Group L - 0.5% levobupivacaine +0.9% normal saline (NS) IV infusion; Group LDI - 0.5% levobupivacaine + dexmedetomidine (1 mcg/kg) in NS IV infusion; and Group LDP - 0.5% levobupivacaine +1 mcg/kg of dexmedetomidine perineural + NS IV infusion. The onset and duration of sensory and motor blockade were recorded in minutes. One-way ANOVA was used to observe any differences between the groups, and post hoc comparisons were conducted after Bonferroni correction for multiple comparisons. RESULTS: The onset of sensory and motor blockade in Group LDP was significantly shorter than Group L and Group LDI. The duration of sensory blockade in Group LDP was significantly longer than Group LDI and Group L. The duration of motor blockade in Group LDP was prolonged compared to Group LDI and Group L. CONCLUSIONS: When dexmedetomidine is added as adjunct to levobupivacaine in supraclavicular BPB, onset of sensory and motor blockade is faster in perineural group, whereas duration of sensory and motor blockade and duration of analgesia are more prolonged when used perineurally than intravenously.

Distal tracheal resection and reconstruction through right posterolateral thoracotomy.

Many retrospective series have been reported on the outcomes of tracheal resection for adenoid cystic carcinoma. However, demonstration on techniques of surgery and ventilatory management during the procedure are rare. We, herewith demonstrate a surgical video, wherein a distal tracheal resection was performed through right posterolateral thoracotomy.

Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group.

BACKGROUND: Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. METHODS: We retrospectively analyzed 37 pediatric case records who presented from January 2014-December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. RESULTS: Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non -vegetative. CONCLUSION: Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.

Ratio of height-to-thyromental distance and ratio of height-to-sternomental distance as predictors of laryngoscopic grade in children.

BACKGROUND AND AIMS: Failure to secure the airway is an important cause of morbidity and mortality in children. Children are often uncooperative for routine examination and pose problems for obtaining external measurements. We aimed to evaluate ratio of height-to-thyromental distance (RHTMD) and ratio of height-to-sternomental distance (RHSMD) as predictors of laryngoscopic grade in children aged 1-12 years. MATERIAL AND METHODS: This study was an observational study conducted in children aged between 1 and 12 years scheduled for elective surgery under general anesthesia. Children unable to stand, having limited mouth opening/neck mobility, cleft palate or with midline neck masses were excluded. Weight, height, and thyromental and sternomental distances were measured preoperatively. Following induction of anesthesia and full-muscle relaxation, laryngoscopy was performed and Cormack-Lehane view with Cook's modification was noted. Receiver operating characteristic (ROC) curve analysis using RHTMD and RHSMD was performed for predicting poor laryngoscopic view. RESULTS: A total of 138 children with mean age of 6.6 ± 3.4, RHTMD of 17.7 ± 2.1, and RHSMD of 10.0 ± 1.0 were included. No Grade 3 or 4 laryngoscopic views were obtained. ROC curve analysis was done for predicting 2b view (restricted), incidence of which was 10.1%. RHTMD was a better predictor of 2b laryngoscopic view with an area under curve (AUC) of 0.792 compared to RHSMD (AUC = 0.463). CONCLUSIONS: In children aged 1-12 years, RHTMD is a better predictor of restricted view compared to RHSMD.

Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia.

BACKGROUND AND AIMS: Entropy monitoring entails measurement of the effect of anesthetic on its target organ rather than merely the concentration of anesthetic in the brain (indicated by alveolar concentration based on which minimum alveolar concentration [MAC] is displayed). We proposed this prospective randomised study to evaluate the effect of entropy monitoring on isoflurane consumption and anesthesia recovery period. MATERIAL AND METHODS: Sixty patients undergoing total abdominal hysterectomy under general anesthesia using an endotracheal tube were enrolled in either clinical practice (CP) or entropy (E) group. In group CP, isoflurane was titrated as per clinical parameters and MAC values, while in Group E, it was titrated to entropy values between 40 and 60. Data including demographics, vital parameters, alveolar isoflurane concentration, MAC values, entropy values, and recovery profile were recorded in both groups. RESULTS: Demographic data and duration of surgery were comparable. Time to eye opening on command and time to extubation (mean ± standard deviation) were significantly shorter, in Group E (6.6 ± 3.66 and 7.27 ± 4.059 min) as compared to Group CP (9.77 ± 5.88 and 11.63 ± 6.90 min), respectively. Mean isoflurane consumption (ml/h) was 10.81 ± 2.08 in Group E and 11.45 ± 2.24 in Group CP and was not significantly different between the groups. Time to readiness to recovery room discharge and postanesthesia recovery scores were also same in both groups. CONCLUSION: Use of entropy monitoring does not change the amount of isoflurane consumed during maintenance of anesthesia or result in clinically significant faster recovery.

Addition of intrathecal fentanyl to bupivacaine clonidine mixture effect on quality of subarachnoid block and postoperative analgesia.

CONTEXT: This study was undertaken in 100 patients scheduled for lower limb orthopaedic surgeries. AIM: The objective of this study was to study the effect of addition of intrathecal fentanyl to bupivacaine clonidine mixture on the quality of subarachnoid block and compare it with intrathecal bupivacaine clonidine mixture without fentanyl. SETTINGS AND DESIGN: In this prospective and double blind randomized controlled study, one hundred patients, between 20-40 years of age, of either sex, weighing between 40-65 Kg, measuring more than 150 cm in height, of ASA Grade I and II who were undergoing orthopaedic lower limb surgeries were selected in order to study the quality of subarachnoid block and post-operative analgesia produced by a combination of bupivacaine clonidine and fentanyl in comparison with bupivacaine clonidine. MATERIALS AND METHODS: The patients were randomly divided in two groups of 50 each: Group BC: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 µg) clonidine + 0.4 ml of 0.9% NaCl. Group BCF: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 µg) clonidine + 0.4 ml (20 µg) of fentanyl. The total volume of solution in both the groups was 3.0 ml. The quality of subarachnoid block and post-operative analgesia were studied. STATISTICAL ANALYSIS USED: The data thus obtained was statistically analysed using the following tests: Unpaired student's t-test. Average % change in data over baseline values to detect trends. A 'P' value of <0.05 was considered to be statistically significant. RESULTS: There was no significant difference in duration of sensory and motor blockade in group BCF compared to BC. The duration of analgesia as assessed by, either VAS score of >5 or demand of additional analgesia was > 524.6 ± 32.21 mins in group BC and > 774.4 ± 59.59 mins in group BCF. This prolongation of duration of analgesia in group BCF compared to group BC has statistical significance. Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF. CONCLUSIONS: In conclusion, this study has demonstrated that addition of 20 µg fentanyl to intrathecal 30 µg clonidine and 12 mg bupivacaine enhanced the duration of post-operative analgesia with moderately increased sedation and was not associated with hemodynamic instability or other complications.