Thoracoscore: Does it predict mortality in the Indian scenario? - A retrospective study.

Background and Aims: Preoperative risk stratification helps in better prognostication and allocation of resources. However, risk scoring models are less often used in thoracic surgery. Thoracoscore, a risk score model for thoracic surgery was originally developed on a French population and was later validated in many countries. As there is no literature on its ability to predict mortality in the Indian population, we aimed to validate Thoracoscore in Indian thoracic surgical patients. Methods: This retrospective study was carried out in a tertiary care centre after obtaining institutional ethics committee clearance. Patients who were operated for lung pathologies via a posterolateral thoracotomy incision between January 2014 and December 2018 were included in the study. Data on Thoracoscore variables and few additional factors (pulmonary arterial hypertension (PAH), redo surgery, blood loss, blood transfusion, duration of anaesthesia, one lung ventilation and surgery) was collected along with observed mortality statistics. Mortality was predicted using online calculator from the site https://sfar.org/scores2/thoracoscore2.php.Significant continuous and categorical variables in causation of mortality were identified using unpaired t-test and Chi-square tests, respectively. These variables were subjected to multivariate logistic regression to find independent risk factors for mortality. The calibration and discrimination of the Thoracoscore model was analysed by using Hosmer-Lemeshow test and area under the curve of receiver operating characteristic curves. Results: Overall observed mortality in the study was 3.2% while predicted mortality was 0.44%. The Thoracoscore had poor calibration and fair discrimination ability. PAH and re-operative surgery along with Thoracoscore were found to be independent risk factors of mortality in thoracic surgery. Conclusion: Thoracoscore fails to predict mortality in the Indian population.

Comparison of Airtraq DL™ and Macintosh laryngoscope for double-lumen tube placement in simulated difficult airway: A randomised study.

Background and Aims: The Airtraq DL ™ is a prototype channeled video laryngoscope, designed specifically for endobronchial intubation with a double-lumen tube (DLT). Evidence on its superiority over Macintosh laryngoscope for DLT placement in the difficult airway is limited. This study compared the efficacy of both these laryngoscopes in the simulated difficult airway. Methods: A prospective randomised controlled study was conducted on 52 patients undergoing elective thoracic surgery with lung isolation using a left-sided DLT. The patients were randomised into Airtraq DL ™ group (group A) and Macintosh group (group M). The primary objective was to compare the time required for intubation, and the secondary objectives were to evaluate time to best glottic view, Cormack-Lehane (CL) grading, intubation difficulty score (IDS), manoeuvres, attempts at intubation, haemodynamic response and complications. Operating anaesthesiologists were also asked to grade the ease of laryngoscopy and intubation for both devices on a 4-point Likert scale. Results: The mean time to intubation was found to be lesser in group A than in group M (18 ± 6.91 s vs 25.48 ± 9.47 s, P = 0.003). Group A showed better CL grading (P ≤ 0.001), lesser requirement of manoeuvres (P = 0.02) and lower IDS (P = 0.003). Also, group A had significantly better Likert scale results as compared to group M. Conclusion: The Airtraq DL ™ is superior to Macintosh laryngoscope as it requires lesser time for intubation and provides favourable intubating conditions (better CL grading, lesser manoeuvres, lower IDS and improved Likert scales) for double-lumen placement in the simulated difficult airway.

Normative Transesophageal Echocardiographic Values of Cardiac Structures in the Indian Population-Indian Normative TEE Measurements (INTEEM) Study.

OBJECTIVES: Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data. DESIGN: The Indian Normative TEE Measurements study was a multicenter, prospective observational study conducted in India. SETTING: Operating rooms for noncardiac surgeries in tertiary care-level hospitals. PARTICIPANTS: Adult patients undergoing noncardiac surgery who were free from any cardiac, respiratory, and renal diseases and had no contraindications for TEE. INTERVENTIONS: After inducing general anesthesia and achieving stable hemodynamic conditions, a comprehensive TEE examination was performed and various measurements were made. MEASUREMENTS AND MAIN RESULTS: For each of the 83 patients undergoing noncardiac surgery, 39 various measurements for left ventricle, right ventricle, both atria, and all valves were made. This included diameters and functional parameters. They were analyzed in a vendor-neutral software off-line. The absolute values of many of the measurements were higher in men, but when indexed to body surface area (BSA) they were similar in both sexes. The values were lower than most of the Western data but matched previous Indian studies using TTE. CONCLUSIONS: The authors present normative values of various echocardiographic parameters using TEE. Because of its variations, it is recommended to use India-specific data to make decisions in Indian patients. It may be prudent to use BSA-indexed values during decision-making.

Chronic pain following thoracotomy for lung surgeries: It's risk factors, prevalence, and impact on quality of life - A retrospective study.

BACKGROUND AND AIMS: Chronic post thoracotomy pain (CPTP) is a nagging complication and can affect quality of life (QOL). Studies conducted across globe have found a wide variability in the risk factors predisposing to chronic pain following thoracotomy. As no study on CPTP is available from India, we aim to detect the prevalence of CPTP, assess the predisposing factors implicated in its causation and study the impact of CPTP on QOL. METHODS: After obtaining clearance from Institutional ethics committee, medical records of patients who underwent open posterolateral thoracotomy between January 2012 and December 2015 were reviewed. Data on perioperative variables, address, and contact number were collected from the patient records. All patients were mailed the Telugu translation of medical outcome study short form -36(MOS-SF-36) QOL questionnaire and were contacted telephonically to enquire about presence of CPTP and QOL. A univariate analysis was done to assess factors associated with CPTP and a multivariate logistic regression analysis was done subsequently to identify independent risk factors of CPTP. QOL indices were compared between those patients who suffered from CPTP and those who did not. RESULTS: The prevalence of pain in our study was 40.86% (85/208). The factors implicated in the causation of CPTP were diabetes mellitus, preoperative pain, rib resection, and duration of chest tube drainage with odds ratio of 9.8, 2.6, 6.7, and 1.03, respectively. The health-related QOL showed poor scores in all domains in patients suffering from CPTP. CONCLUSION: The prevalence of CPTP was high. It significantly impacts health-related QOL.

Practice patterns of left-sided double-lumen tube: Does it match recommendation from literature - A single-centre observational pilot study.

Context: Choosing appropriate-size double-lumen tube (DLT) has always been a challenge as it depends on existing guidelines based on gender, height, tracheal diameter (TD), or personal experience. However, there are no Indian data to match these recommendations. Aim: To find out whether the size of DLT used correlates with height, weight, TD, or left main stem bronchus diameter (LMBD). We also documented clinical consequences of any of our current practice. Setting and Design: Single-center observational pilot study. Subjects and Methods: Prospective, observational study of 41 patients requiring one-lung ventilation with left-side DLT. The choice of DLT was entirely on the discretion of anesthesiologist in charge of the case. Data were collected for TD, LMBD, height, weight, age, sex, and amount of air used in the tracheal and bronchial cuff. Any intraoperative complications and difficulty in isolation were also noted. Statistical Analysis: The statistical analysis was done with the National Council of Statistical Software version 11. Results: Average TD and LMBD were 16.5 ± 0.9 and 10.7 ± 0.8 mm for males and 14.2 ± 1.1 and 9.4 ± 1.1 mm for females, respectively. There was a weak correlation between DLT size and height (R2 = 0.0694), TD (R2 = 0.3396), and LMBD (R2 = 0.2382) in the case of males. For females, the correlation between DLT size and height (R2 = 0.2656), TD (R2 = 0.5302), and LMBD (R2 = 0.5003) was slightly better. Conclusion: Although there was a weak correlation between DLT size and height, TD, and LMBD, the overall intraoperative outcome and lung isolation were good.