ABSTRACT
OBJECTIVE: Bleeding due to inadvertent trauma is a troublesome complication of nasal intubations. A lot of methods have been suggested to minimise this problem. A flexible bougie can be passed atraumatically via the nasal route to the trachea and an appropriate-sized endotracheal tube can be railroaded over it to avoid this problem. The primary objective of the study was to compare the severity of bleeding with bougie-guided and conventional nasotracheal intubations on a subjective scale. The time taken for successful intubations and the number of attempts required were also noted. METHODS: This randomised controlled study was performed in 40 adult patients requiring nasotracheal intubations for various elective surgeries over a 3-month period in a teaching hospital. The patients after satisfying the inclusion criteria were randomised into two groups of 20 each: Bougie-guided (Group B) and Not Bougie-guided (Group NB). Group B patients were intubated by railroading the endotracheal tube over a flexible bougie, and Group NB patients were intubated conventionally without the bougie. The degree of bleeding was noted on a subjective scale as nil, mild, moderate or severe. The time taken for intubation in seconds and the number of attempts taken were noted. The degree of bleeding was compared using Mann-Whitney U test, and the time taken for intubation was compared using the Student's t test after assessing normalcy. An alpha error of 5% was used, and p values less than 0.05% were considered significant. RESULTS: All patients randomised completed the study. The degree of bleeding was lesser in the Bougie-guided group than in the conventional group (p=0.02), and the time taken for intubation was longer in the bougie-guided group (p<0.01). CONCLUSION: Using a bougie routinely for nasal intubations might minimise trauma during nasal intubations but increase the time taken for intubation marginally. The success rates for intubations may also be better.
ABSTRACT
A successful peripheral nerve block not only involves a proper technique, but also a thorough knowledge and understanding of the physiology of nerve conduction and pharmacology of local anesthetics (LAs). This article focuses on what happens after the block. Pharmacodynamics of LAs, underlying mechanisms of clinically observable phenomena such as differential blockade, tachyphylaxis, C fiber resistance, tonic and phasic blockade and effect of volume and concentration of LAs. Judicious use of additives along with LAs in peripheral nerve blocks can prolong analgesia. An entirely new group of drugs-neurotoxins has shown potential as local anesthetics. Various methods are available now to prolong the duration of peripheral nerve blocks.
