Recent advances in perioperative blood management.

Transfusion of blood and blood products has many adverse effects and should be done only if patient benefits outweigh the associated risks. Current understanding of blood transfusion has improved dramatically, revolutionising the care of surgical, trauma, obstetric and critically ill patients. Most guidelines advise a restrictive approach for stable patients with non-haemorrhagic anaemia for red blood cell transfusion. The rationale for red blood cell transfusion has historically been to improve oxygen transport capacity and consumption-related parameters in anaemic patients. Current understanding casts serious doubts about the true potential of red blood cell transfusions to improve these factors. There may not be any benefit from blood transfusion beyond a haemoglobin threshold of 7 g/dL. In fact, liberal transfusion may be associated with higher complications. Guideline-based transfusion policy should be adopted for the administration of all blood products including fresh frozen plasma, platelet concentrates and cryoprecipitate etc. This should be integrated with clinical judgement.

Comparison of spinal anaesthesia with isobaric chloroprocaine and general anaesthesia for short duration ambulatory urological procedures.

Background and Aims: Chloroprocaine is a short-acting local anaesthetic agent for spinal anaesthesia (SA) that has been used in day care surgeries due to its faster recovery characteristics and faster discharge rates compared to other local anaesthetics. This study aimed at finding out its efficacy for the same as compared to general anaesthesia (GA). Material and Methods: This observational study was conducted on 60 patients belonging to the American Society of Anaesthesiologists (ASA) physical status I and II who underwent short elective urological procedures (<60 min) under GA (group GA) as per standard of care in our hospital (n = 30) and SA (group SA) with 50 mg 1% isobaric 2-Chloroprocaine (n = 30). Time taken to meet the discharge criteria, modified Aldrete score and modified post anaesthesia discharge score in each group were noted. The cost of the anaesthetic procedure, anaesthetic procedural time, hemodynamics, supplemental analgesia, complications related to the procedure were noted and compared. Results: Patient characteristics and duration of surgery were comparable. Time taken by group SA was significantly higher than group GA to meet the discharge criteria. Cost of GA [2624.76 (166.16) units] was significantly more than SA [1561.63 (81.32) units, P < 0.05]. There was no requirement of supplemental analgesia in group SA and no hemodynamic instability or complications in either group. Conclusion: GA is significantly better as compared to SA with 50 mg 1% isobaric 2-Chloroprocaine as an anesthetic technique in day care urology surgeries in terms of faster recovery and faster discharge rate but is costlier.

Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients.

BACKGROUND: The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique. MATERIALS AND METHODS: This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed. RESULTS: Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group). CONCLUSIONS: LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.