Does Baska mask deserve its own niche among extraglottic airway devices? A prospective, single-arm study.

Background and Aims: A variety of extraglottic airway devices (EADs) are available. Main concerns with EADs are protection against aspiration and ability to ventilate patients with high airway pressures. Baska mask meets these criteria and is the only third-generation device available for clinical use. Methods: After institutional ethics committee approval and informed consent were obtained, this prospective study was performed in 100 adult patients undergoing surface surgeries at a tertiary referral centre. The primary outcome was the success rate of insertion, while the secondary outcomes were the sealing pressure, stability of the device and the perioperative complications of Baska mask. We then compared it with other currently used EADs. Results: The first attempt at insertion and overall success rates, showed values of 81% and 98%, respectively. Insertion was quick (median 12; interquartile range [IQR] 9-15 s). The mask sealing pressure, was 35 cmH2O (median [IQR 20-50 cmH2O]). Also, the mask remained stable in 95% of patients intraoperatively. Sore throat and dysphagia were seen in 37% and 24% of patients, respectively. No patient had laryngospasm or desaturation at any time. It compared favourably well with other EADs, while achieving higher sealing pressures. Conclusion: We found that the Baska mask performs well with excellent first attempt at insertion and overall success rates, higher sealing pressures and minimal complications compared to currently used EADs in clinical anaesthesia.

Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth-POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries.

BACKGROUND: Identification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) can be used in patients undergoing head and neck oncosurgery. METHODS: We conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P-POSSUM scores. RESULTS: POSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality. CONCLUSIONS: We found that POSSUM had moderate discrimination and good calibration for morbidity prediction in head and neck cancer surgeries, as well as for the selected subgroup.

Comparison of palonosetron and dexamethasone with ondansetron and dexamethasone for postoperative nausea and vomiting in postchemotherapy ovarian cancer surgeries requiring opioid-based patient-controlled analgesia: A randomised, double-blind, active controlled study.

BACKGROUND AND AIMS: Patients undergoing ovarian cancer surgery after chemotherapy and requiring opioid-based patient-controlled analgesia (PCA) are at high-risk of postoperative nausea and vomiting (PONV). We aimed to assess the effect of palonosetron and dexamethasone combination for these patients for prevention of PONV. METHODS: This study included 2 groups and 150 patients. At the time of wound closure, patients in group A received ondansetron 8 mg intravenous (IV) + dexamethasone 4 mg IV and group B received palonosetron 0.075 mg IV + dexamethasone 4 mg IV. Postoperatively for 48 hours, group A patients received ondansetron 4 mg 8 hourly IV, group B patients received normal saline 8 hourly IV in 2 cc syringe. The primary objective was the overall incidence of PONV. Independent t-test, Chi-square test, and Fisher's exact test were used and multivariate regression analysis was done. RESULTS: Vomiting was significantly higher in group A (37.3%) as compared with group B (21.3%) at 0-48 hours (P = 0.031). Significantly more patients in Group A had nausea as compared with group B at 90-120 minutes (30.66% vs 18.66%, P = 0.043) and 6-24 hours (32.0% vs 22.66%, P = 0.029). PCA opioid usage in microgram was significantly higher in group A at 0-24 hours (690.53 ± 332.57 vs 576.85 ± 250.79, P = 0.024) and 0-48 hours (1126.10 ± 512.18 vs 952.13 ± 353.85, P = 0.030). CONCLUSION: Palonosetron with dexamethasone is more effective than ondasetron with dexamethasone for prevention of PONV in post-chemotherapy ovarian cancer surgeries receiving opioid-based patient controlled analgesia.

The growing burden of cancer in India: epidemiology and social context.

Cancer can have profound social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. In age-adjusted terms this represents a combined male and female incidence of about a quarter of that recorded in western Europe. However, an estimated 600,000-700,000 deaths in India were caused by cancer in 2012. In age-standardised terms this figure is close to the mortality burden seen in high-income countries. Such figures are partly indicative of low rates of early-stage detection and poor treatment outcomes. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Social factors, especially inequalities, are major determinants of India's cancer burden, with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. In this first of three papers, we examine the complex epidemiology of cancer, the future burden, and the dominant sociopolitical themes relating to cancer in India.

Does cuff pressure monitoring reduce postoperative pharyngolaryngeal adverse events after LMA-ProSeal insertion? A parallel group randomised trial.

PURPOSE: The incidence of postoperative pharyngolaryngeal complications after laryngeal mask airway (LMA) insertion can be as high as 50%. Over-inflation of the LMA cuff may be a causal factor. We conducted a single-centre parallel group randomised trial to determine whether maintaining LMA-ProSeal intra-cuff pressures below 60 cm H2O decreases postoperative pharyngolaryngeal complications. METHODS: We recruited 120 adult patients who were scheduled to undergo elective surgery under general anaesthesia. Appropriate sized LMA-ProSeal was inserted and the cuff was inflated with air (to no more than the maximum recommended volume) until there was no audible leak. Patients were randomised to either the control group (n = 60), where the intra-cuff pressure was noted and no further action was taken, or to the pressure-monitored group (n = 60), where intra-cuff pressure was maintained below 60 cm H2O. Pharyngolaryngeal complications consisting of sore throat, dysphonia and dysphagia were assessed at 1, 2, and 24 h postoperatively. Patients, anaesthesiologists and assessors were blinded to group allocation. The primary outcome was a composite endpoint of any pharyngolaryngeal complication at any of the three time points. Secondary outcomes were the incidence of individual outcomes at each time point. RESULTS: The incidence of pharyngolaryngeal complications at any time point was 42% in the routine care group and 32% in the pressure-monitored group (95% CI for difference +28 to -7%, p = 0.26). There was no difference between groups for any of the secondary outcomes. CONCLUSION: Our study failed to demonstrate a statistically significant reduction in postoperative pharyngolaryngeal complications by limiting intra-cuff pressures in the LMA-Proseal.

Innovative use of the fiberoptic bronchoscope.

Tracheostomy can be challenging, especially in the presence of edema or infiltrative malignancy. We present a case in which a fiberoptic bronchoscope that is routinely used for difficult intubation helped to locate the trachea in an emergency situation. A 50 year-old male, a diagnosed case of anaplastic carcinoma of thyroid, presented with respiratory distress and was immediately taken to the operating theater for an emergency tracheostomy. Following an inhalational induction, the patient was intubated with an endotracheal tube. Surgical tracheostomy was extremely difficult as, on neck exploration, there was a plaque of disease infiltrating various tissue planes. When even after considerable dissection the trachea could not be located, we passed a fiberoptic bronchoscope through the endotracheal tube. This helped as it was seen as a trans- illumination and the tracheal position could be confirmed. The rest of the tracheostomy was uneventful.