Comparison of Gastric Insufflation Volume Between Ambu AuraGain and ProSeal Laryngeal Mask Airway Using Ultrasonography in Patients Undergoing General Anesthesia: A Randomized Controlled Trial.

INTRODUCTION: Ambu AuraGain and ProSeal laryngeal mask airway are second-generation supraglottic airway devices (SADs) with added advantage of gastric drain and better oropharyngeal sealing pressure. The primary objective was to study the difference in the gastric insufflation volume between Ambu AuraGain and ProSeal LMA in patients undergoing general anesthesia. METHODS: This randomized controlled trial involving 120 adult patients scheduled under general anesthesia were randomized into either Ambu AuraGain or LMA ProSeal group. Gastric cross-sectional area was measured using ultrasonography at baseline, after mask ventilation, and at the end of surgery. Gastric volume was calculated from the measured cross-sectional area. Oropharyngeal sealing pressure, peak airway pressure, and postoperative complications were noted. Statistical analysis was done using SPSS version 22 (Armonk, NY: IBM Corp.) and p < 0.05 was considered statistically significant. RESULTS: Demographic profile of the study groups was comparable. There was a significant difference in gastric volume between the groups at the end of surgery with 5.91 ml (±9.68 ml) in Ambu AuraGain group and 12.28 ml (±13.05 ml) in the LMA ProSeal group (p = 0.001). Similarly, there was a difference in volume between baseline and at the end of the surgery within the groups also (Ambu AuraGain group, p=0.0012; LMA ProSeal group, p=0.0015, respectively). Though the oropharyngeal sealing pressure and peak airway pressures were comparable, increased incidence of postoperative complications was observed with LMA ProSeal. CONCLUSION: Thus, Ambu AuraGain resulted in a lower gastric insufflation volume than LMA ProSeal with lesser incidence of postoperative complications.

Evaluation of Cognitive and Psychomotor Functional Changes in Anesthesiology Residents after 12 hours of Continuous Work in Operation Theater: An Observational Study.

Background: Prolonged working hours in operation theater may impair cognitive and psychomotor function. Aims: This study was done to evaluate the changes in cognitive and psychomotor changes in the anesthesia residents after 6 and 12 h of continuous work in operation theater. Settings and Design: Sixty anesthesia residents whose working hours were expected to be longer than 12 h were recruited for this prospective, observational study. Methods: The study consisted of a set of five tests used for assessing the cognitive and psychomotor functions. The tests were conducted for the participants at 0, 6, and 12 h of work and the total scores at the respective time period were noted. The tests were manual dexterity test using purdue peg board, finger tapping test, visual spatial capacity memory test, digit symbol substitution test (DSST), and frontal assessment battery. Statistical Analysis: The observations of the purdue peg board test, finger tapping test, and digit symbol substitution test at 0, 6, and 12 h were tested using the repeated measures analysis of variance and paired t-test. The observations of visual spatial capacity memory test and frontal assessment battery were tested using the Chi-square test. Results: In the purdue peg board test, there was significant reduction in the mean number of pins assembled by the participants over 12 h of work. There was a significant difference in the number of finger taps by the dominant hand between 0 and 12 h and also between 6 and 12 h. In the visual spatial memory test, there was no significant difference in the performance of the participants with incorrect response at 0 and 12 h of duration. There was a significant decrease in the number of correct response among the participants in the digit symbol substitution test at 0 and 12 h of work. There was no significant difference in the scores obtained in frontal assessment battery test which was used to assess the cognitive function. Conclusion: There was a significant reduction in the psychomotor functions of the anesthesiology residents after 12 continuous hours of work in the operation theater and there was no significant reduction in cognitive function observed during that period.

Time course of psychomotor recovery after intravenous dexmedetomidine infusion as a part of balanced anaesthetic technique: A randomised, double-blind study.

BACKGROUND AND AIMS: Dexmedetomidine is a drug that is being widely used as an adjuvant to anaesthesia because of its unique pharmacodynamic and pharmacokinetic properties. We aimed to assess the recovery of psychomotor function from balanced anaesthesia including intravenous dexmedetomidine infusion as adjunct. METHODS: Ninety American Society of Anesthesiologists I and II patients were randomised to group D (n = 45), to receive 1 µg/kg of dexmedetomidine loading dose over 10 min, with maintenance infusion of 0.5 µg/kg/h, and group S (n = 45), to receive an equal volume of 0.9% normal saline. Objective parameters were recovery of psychomotor function assessed by Trieger dot test (TDT), digit symbol substitution test (DSST) and intraoperative opioid requirement. the total fentanyl used intraoperatively in the two groups. Statistical analysis was performed using unpaired Student's t-test, Chi-squareor Fisher's exact test. RESULTS: Psychomotor recovery assessed by TDT showed statistically significant early recovery in group D compared with group S. This was seen in the maximum distance of dots missed at 30 min, 60 min, 90 min and 120 min as well as in the average distance of dots missed at identical time points. Similarly, DSST revealed early recovery at 30 min (12.4 ± 5.3 vs. 10.4 ± 3.9 P = 0.04) postoperative interval but not at other time intervals. There was significant decrease in the intraoperative opioid requirement in group D compared with group S. CONCLUSION: The addition of dexmedetomidine to balanced anaesthetic technique significantly hastened the psychomotor recovery compared with placebo.

Psychomotor recovery of dexmedetomidine compared with propofol after sedation during spinal anesthesia: A randomized control trial.

BACKGROUND AND AIMS: Early psychomotor recovery is an essential part of day care surgery which depends on brain integration of motor and sensory co-ordination. Even though dexmedetomidine is commonly used for day care procedures, the recovery profile was not studied. Hence, this study was designed to evaluate the psychomotor recovery of sedation with dexmedetomidine during spinal anesthesia. MATERIAL AND METHODS: Sixty-six patients were included. Group D received dexmedetomidine 0.5 µg/kg (loading dose) followed by 0.2-1 µg/kg/hour. Group P received propofol infusion of 25-100 µg/kg/minute. Psychomotor recovery was assessed by finger-tapping, manual dexterity, visual spatial memory capacity, and pen and paper tests. Psychomotor tasks were given to the patients postoperatively at every 30 minutes for 2 hours followed by every hour up to 4 hours after surgery. Distribution of patients, age, weight, duration of surgery, and the level of sensory blockade was compared using independent t-test. Student's t-test has been used to find the significance of parameters such as heart rate, mean arterial pressure, oxygen saturation (SpO2), psychomotor recovery between two groups. P < 0.05 was considered as significant. RESULTS: The motor recovery using finger tapping test was faster in Group D than Group P (73.94 ± 42.13 vs 101.21 ± 37.98 minutes, P-value = 0.007). Motor recovery using peg board test was faster in Group P than Group D (82.12 ± 40.37 vs 99.39 ± 43.08 minutes, P-value = 0.098). Visual spatial capacity memory test and pen and paper test were unaffected. CONCLUSIONS: We conclude that patients who received dexmedetomidine showed earlier recovery with finger tapping test. Hence, we suggest to use dexmedetomidine for complete psychomotor recovery and fast-track discharging of the patient after spinal anesthesia.

Effect of immobilised cervical spine on oropharyngeal sealing pressure with Ambu AuraGain™ Supraglottic airway: A randomised crossover trial.

BACKGROUND AND AIMS: Ambu® AuraGain™ laryngeal airway (AuraGain) is one of the newer supraglottic airway device introduced in 2014. Cervical spine stabilisation with hard cervical collar makes insertion of supraglottic airways and tracheal intubation difficult. This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure (OSP) and fibreoptic view of the glottis (Brimacombe score) in airways secured with the AuraGain. METHODS: The study was a randomised crossover trial. Thirty five ASA 1-3 patients undergoing elective surgery under general anaesthesia were recruited for the study. In each patient AuraGain was inserted twice in a crossover manner once with and once without a hard cervical collar in situ, with the sequence of insertion randomised. During each insertion of AuraGain the OSP, fibreoptic view of the glottis, insertion parameters, ventilator data and complications were noted. RESULTS: The mean OSPs in both the groups were similar with no significant difference (29.6 ± 3.7 cmH2O without collar and 30.1 ± 3.1 cmH2O with collar [P = 0.310]). The fibreoptic view of glottis was also similar in both groups. The insertion with collar was more difficult than without collar. The number of attempts for successful insertion was same in both the groups. The time taken for appropriate placement of LMA was significantly prolonged in patients with collar. CONCLUSIONS: We conclude that the Ambu AuraGain can be used to provide effective ventilation in patients whose cervical spine is immobilised with a hard cervical collar.

Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study.

BACKGROUND: Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation. AIMS: The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation. SETTINGS AND DESIGN: In this study, 200 patients belonging to age group 18-60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled. Patients with upper airway pathology, neck mass, and cervical spine injury were excluded from the study. MATERIALS AND METHODS: An attending anesthesiologist conducted preoperative assessment and recorded parameters such as body mass index, modified Mallampati grading, inter-incisor distance, neck circumference, and thyromental distance (NC/TMD). After standard anesthetic induction, laryngoscopy was performed, and intubation difficulty assessed using intubation difficulty scale on the basis of seven variables. STATISTICAL ANALYSIS: The Chi-square test or student t-test was performed when appropriate. The binary multivariate logistic regression (forward-Wald) model was used to determine the independent risk factors. RESULTS: Among the 200 patients, 26 patients had difficult intubation with an incidence of 13%. Among different variables, the Mallampati score and NC/TMD were independently associated with difficult intubation. Receiver operating characteristic curve showed a cut-off point of 3 or 4 for Mallampati score and 5.62 for NC/TMD to predict difficult intubation. CONCLUSION: The diagnostic accuracy of NC/TM ratio and Mallampatti score were better compared to other bedside tests to predict difficult intubation in Indian population.

Postoperative analgesia after inguinal hernia repair - Comparison of ropivacaine with bupivacaine: A randomized controlled trial.

BACKGROUND: Postoperative pain management by surgical site infiltration has an edge over other methods of analgesia as it is simple and has lesser side effects. This study was designed to compare the analgesic effects provided by bupivacaine, a classical long-acting local anesthetic and ropivacaine, a new amino amide local anesthetic agent. SUBJECTS AND METHODS: Ninety patients scheduled for elective inguinal herniorrhaphy were randomly allocated to one of the three groups: Group I - R 0.5, group II - R 0.25, and group III - B 0.25. General anesthesia was given. The surgical site was infiltrated before incision with 20 ml of drugs - ropivacaine 0.5% in group I, ropivacaine 0.25% in group II, bupivacaine 0.25% in group III. Intraoperatively hemodynamics were recorded every 15 min until the end of surgery and at the time of skin incision, at the time of cord pulling, and at the time of skin closure. Postoperatively, rest pain, pain on coughing, and pain on movements were assessed using visual analog scale (VAS) score immediately at the end of the surgery and hourly up to 4 h. The time of the first request for rescue analgesia was noted. RESULTS: VAS scores at rest, during coughing and movements were higher in group R 0.25 and the time of rescue analgesia was shorter with group R 0.25 when compared with other groups. CONCLUSION: Ropivacaine is less potent than bupivacaine at equal concentrations.

Fractured tracheostomy tube presenting as a foreign body in a paediatric patient.

Tracheostomy tube fracture and aspiration into the tracheobronchial tree leading to airway obstruction is a dangerous complication after tracheostomy. We report a case of a fractured tracheostomy tube in a 6-year-old child who had been maintained on a tracheostomy tube for the past 5 years. The tracheostomy tube got fractured at the junction of the tube and neck plate, and impacted in the trachea and right main bronchus. Rigid bronchoscopy performed through the tracheostomy stoma to retrieve the fractured tracheostomy tube and the anaesthetic management during the period are discussed.

Use of i-gel for caesarean section with kyphoscoliosis.

We describe the anaesthetic management using i-gel for airway maintenance in a patient with kyphoscoliosis presenting for emergency caesarean section due to fetal distress and scar tenderness. The patient had a history of previous caesarean section under general anaesthesia, and presently her cardiorespiratory status is stable. We used i-gel, the new supraglottic airway device, for maintaining the airway under intravenous anaesthesia using propofol.

Oral ketamine and dexmedetomidine in adults' burns wound dressing--A randomized double blind cross over study.

Study was designed to compare analgesic efficacy and side effects of oral dexmedetomidine and ketamine in adults for burn wound dressing. Sixty healthy adults with thermal burns with burn area (20-50%) were randomly assigned into 2 groups. In Group K 5mg/kg ketamine and in Group D 4 mcg/kg dexmedetomidine was given orally. Patients crossed over to the other group the following day. Visual analogue score, sedation score, haemodynamic parameters were recorded from 30min after drug administration to 2h after procedure. Patients' preference was also recorded. Mean VAS score was significantly reduced from baseline in both the groups at all time points (P<0.05). Pain relief in Group K (overall mean VAS 2.6±0.6cm) was significantly better when compared to Group D (overall mean VAS 3.8±0.8cm). Patients in group K were significantly more sedated (median 3) when compared to group D (median 2), P<0.05. Delirium and excessive salivation were significant complications observed with ketamine. More patients preferred ketamine (63.3%) than dexmedetomidine (36.7%), P<0.05. Oral ketamine and dexmedetomidine produced significant pain relief during burns wound dressing. Oral ketamine produced significantly better pain relief than dexmedetomidine but was associated with delirium and excessive salivation.