ABSTRACT
Background and Aims: There are possibilities of insufficiency in blood flow through carotid arteries during head positioning in thyroid surgeries under general anesthesia which is usually compensated by collateral circulation in normal conditions. This compensation may be hampered in patients with congenital abnormalities or diseases such as atherosclerosis. We aimed to elucidate the changes in common carotid artery blood flow related to head positioning during thyroid surgery by Doppler examination. Methods: In this observational prospective study, Doppler examination of both common carotid arteries including arterial diameter, peak systolic velocity, average velocity, and blood flow volume of forty patients who had undergone elective thyroidectomy under endotracheal anesthesia was done. Three sets of data (baseline, after induction, and after surgery) were collected and analyzed. Results: There was a significant reduction in the diameter (P = 0.002) and the blood flow (P = 0.0001) in both carotid arteries and an increase in peak and mean velocity which was more pronounced immediately after head positioning and persisted till the end of the procedure. There was no correlation between the hemodynamic parameters with the carotid artery diameter, blood flow, and velocity. Conclusions: The head-and-neck positioning during thyroidectomy surgery reduces the blood flow through the carotid arteries which continued till the end of the procedure.
ABSTRACT
BACKGROUND AND AIMS: Elderly patients with hip fractures pose a medical challenge for the anesthesiologist and are often associated with a high incidence of perioperative morbidity and mortality. We aimed to compare the efficacy of lumbar plexus block (LPB) with subarachnoid block (SAB) in elderly patients undergoing closed reduction and internal fixation for hip fractures. METHODS: In this observational study, 50 patients with femoral intertrochanteric fracture were divided into LPB group and SAB group of 25 each by convenient sampling. Patients in the LPB group were given 20-25 ml of 0.5% bupivacaine to block the ipsilateral lumbar plexus with nerve stimulator assistance, whereas the patients in the SAB group received 0.5% bupivacaine intrathecally. Student's t-test was used for comparing the time for performing block, the time to achieving block, the time to the first request for analgesia, and the hemodynamic variables. RESULTS: Lumbar plexus blockade took a longer time for performing and achieving block (P < 0.001). The time for the first request for analgesia was significantly longer in the LPB group (P < 0.001). A statistically significant reduction in blood pressures was noted in the SAB group. CONCLUSIONS: Lumbar plexus blockade offered more stable intraoperative hemodynamics and longer duration of postoperative analgesia in elderly patients undergoing hip fracture surgery.
ABSTRACT
BACKGROUND AND AIMS: The perioperative behavioural studies demonstrate that children are at greater risk of experiencing turbulent anaesthetic induction and adverse behavioural sequelae. We aimed to compare the efficacy of midazolam 0.5 mg/kg with triclofos sodium 100 mg/kg as oral premedication in children undergoing elective surgery. METHODS: In this prospective, randomised and double-blind study, sixty children posted for elective lower abdominal surgery were enrolled. The patients were randomly divided into midazolam group (Group M) and triclofos sodium group (Group T) of thirty each. Group M received oral midazolam 0.5 mg/kg 30 min before induction, and Group T received oral triclofos sodium 100 mg/kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. Mann-Whitney U-test was used for comparing the grade of sedation, ease of separation and acceptance of face mask. RESULTS: Oral midazolam produced adequate sedation in children after premedication in comparison to oral triclofos (P = 0.002). Both drugs produced successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. CONCLUSIONS: Oral midazolam is superior to triclofos sodium as a sedative anxiolytic in paediatric population.
ABSTRACT
BACKGROUND AND AIMS: Induction of general anaesthesia per se as also the use of 100% oxygen during induction of anaesthesia, results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. We aimed to assess the effect of application of a continuous positive airway pressure (CPAP) of 5 cm H2O during pre-oxygenation and induction of anaesthesia on the period of apnoea before the occurrence of clinically significant desaturation. METHODS: In this prospective, randomised, and double-blind study, 40 patients posted for elective surgery were enrolled. Duration of apnoea was measured as the time from the administration of succinylcholine hydrochloride to the time when oxygen saturation fell to 93%. Student's t-test was used for comparing the duration of apnoea. RESULTS: The safe duration of apnoea was found to be significantly longer in patients receiving CPAP of 5 cm H2O (Group P; n = 16) compared to the group receiving no CPAP (Group Z; n = 20), that is, 496.56 ± 71.68 s versus 273.00 ± 69.31 s (P < 0.001). CONCLUSION: The application of CPAP of 5 cm H2O using a Mapleson A circuit with a fixed positive end-expiratory pressure device during 5 min of pre-oxygenation with 100% oxygen prior to the induction of anaesthesia provides a clearly longer duration of apnoea before clinically significant arterial desaturation occurs.
