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KOPS AWARD ABSTRACTS: PRACTITIONERS FORUM
Year : 2020  |  Volume : 64  |  Issue : 13  |  Page : 48-53  

KOPS Award Abstracts: Practitioners Forum


Date of Web Publication6-Feb-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.277905

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How to cite this article:
. KOPS Award Abstracts: Practitioners Forum. Indian J Anaesth 2020;64, Suppl S1:48-53

How to cite this URL:
. KOPS Award Abstracts: Practitioners Forum. Indian J Anaesth [serial online] 2020 [cited 2020 Feb 21];64, Suppl S1:48-53. Available from: http://www.ijaweb.org/text.asp?2020/64/13/48/277905




   Abstract ID: ISAP616: An interventional audit on perioperative hypothermia during arthroscopic shoulder surgeries – a quality improvement project Top


Arun BG, Shishir C, Pradeepa C, Banarji BH

Sakra World Hospital, Bangalore

Background & aims: Large volumes of irrigation fluid used during arthroscopic shoulder surgery predisposes to perioperative hypothermia. Hence, we conducted an audit to determine the incidence of hypothermia and its preventive measures.

Methods: An initial audit performed at our hospital on 25 patients undergoing arthroscopic shoulder surgeries showed increased incidence of perioperative hypothermia. After analysing the data, we implemented the use of full-length gown and blankets in pre-operative area, increased the ambient temperature in operation theatre (OT) to 210C, education of nurses, ensured compliance in usage of warm intravenous fluids and continuous forced air warmer till extubation. Surgeons declined the use of warm irrigation fluid for fear of bleeding in the joint. A re-audit was done 3 months later.

Results: Initial audit revealed the incidence of hypothermia at induction - 68%, hypothermia at extubation - 48%, ambient OT temperature -190 C, warm intravenous fluids usage -76% and usage of forced air warmer -100% but was switched off prematurely before completing extubation. Reaudit showed the incidence of hypothermia at induction – 44%, hypothermia at extubation -28% and 100% compliance in usage of warm intravenous fluids and forced air warmer till extubation.



Conclusion: Our audit emphasises that simple interventions like the use of full length gowns and blankets in pre-operative area, increasing the ambient temperature in OT to 210C, education of nurses, 100% compliance with the use of warm intravenous fluids and continuous forced air warmer till extubation decreases the incidence of perioperative hypothermia during shoulder arthroscopic surgeries despite the reluctance from surgeons for usage of warm irrigating fluids.

REFERENCES:

  1. Sessler DI. Perioperative thermoregulation and heat balance. Lancet 2016;387:2655-64
  2. Duff J, Di Staso R, Cobbe KA, et al. Preventing hypothermia in elective arthroscopic shoulder surgery patients : a protocol for a randomized controlled trial. BMC Surg 2012;12:14.



   Abstract ID: ISAP240: Supra-clavicular brachial plexus block in supra-condylar fracture of humerus in paediatric patients. A study of 25 cases. Top


Vandana Amit Deo

Aayush hospital, Vapi

Background and aims : The study aims at finding a safe and effective technique of anaesthesia while simultaneously providing prolonged and complication free post - operative analgesia in children.

Methods: The study was conducted in Aayush Hospital ,Vapi, Gujarat. 25 patients of ASA grade 1 & 2 of the age group 2-12 years were given PNS guided supra-clavicular block after sedating with inj. Glycopyrrolate 0.004mg/kg, inj. midazolam 0.01mg/kg, inj. butrum 0.01mg/kg, inj. ketamine 0.5mg/kg and inj. propofol 0.5mg/kg. Patients with active URTI and those with documented median and ulnar nerve palsy were excluded from the study.

Drugs used in the block were inj. xylocard 2% 2-4mg/kg, inj. bupivicaine 0.5% 1-2mg/kg and inj. dexona 4 mg.

Result: Following observations were made and documented: The mean age was 6.48±2.88 yrs, 12 were females and 13 males. The onset of sensory and motor block was 7.12±2.29 min amd 12.54±3.48 min respectively and the duration of sensory and motor block was 138.33±23.89 min and 120.04±22.89 min respectively. Mean duration of analgesia was 225.83±40.31 min. one child had failed block. No other complications were noted.

Conclusion: Expertly performed supra-clavicular brachial plexus block can provide safe and efficient anaesthesia and complication free post -operative analgesia in children.

REFERENCES:

  1. Leak WD and Winchell SW. Regional anaesthesia in paediatric patients; review of clinical experience. Reg Anaesth pain med.1982;7:64-5.
  2. Yang CW, Cho CK, Kwon HU, Roh JY, Heo YM, Ahn SM. Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-. Korean J Anesthesiol. 2010;59 Suppl:S90–S94. doi:10.4097/kjae.2010.59.S.S90



   Abstract ID: ISAP054: Safety and efficacy of regional nerve blocks for head and neck surgeries: A prospective clinical study. Top


A. Naveen Kumar.

YSR Hospital, Ananthapur.

Background & aims: Head and Neck surgeries are usually done under general anaesthesia. Patients having high risk for general anaesthesia are evaluated with technique of regional nerve blocks. Aim of the study was to evaluate safety and efficacy of regional nerve blocks for head & neck surgeries.

Methods: In our study patients having high risk for General Anaesthesia scheduled for Head and Neck surgeries ranging from total laryngectomy, radical head & neck dissection, total glossectomy, parotidectomy, thyroidectomy and wide resection of lips are done under regional nerve blocks.Depending on surgery maxillary, mandibular,& cervical plexus blocks were given. 1 mg of midazolam given iv prior to block. Dexamethasone 8 mg added as an adjuvant. 0.02 mg/kg Butorphanol tartrate & Dexmedetomidine 1μg/kg used as an intraoperative analgesic. Ropivacaine 0.5% and Bupivavaine 0.25% were used as local anesthetics .

Results: The level of surgical anaesthesia was adequate in most of the cases. 15% cases required supplementation with 0.5% Sevoflurane& low doses of Propofol intermittently. There were no major intraoperative complications, patients had long duration of pain free postoperative period & required low doses of opioid analgesic and had lower incidence of vomiting.

Conclusions: Study highlights safety & efficacy of regional nerve blocks for head and neck surgeries in high risk patients.

REFERENCES:

  1. Bosenberg AT: Blocks of the face and neck. Tech Reg Anesth Pain Manag 1999;3:196–203.
  2. Singh ID, Galagali JR, Maj Abhipsa Hota. A case series of superficial parotidectomy under local anesthesia. Int J Otorhinolaryngol Head Neck Surg2015;1(1):27–30



   Abstract ID: ISAP048/R1: Smaller incision does not mean less care - a case series of minimally invasive cardiac surgery Top


Arunachala D Edukondalu, Vijit K Cherian

Name of the Institution: Miot hospital, Chennai

Background and aims: Expanded inclusion of patients is a growing demand driven by benefit from the less invasive approach in elderly frail patients and cosmetically beneficial results are especially appealing to younger patients. Anaesthesiologist 's expanded subspeciality skills is need of the hour in the modern day surgical era.

Methods: Retrospective single tertiary referral centre observational study,between Jan 2017 and Dec 2018, 67 consecutive patients underwent mini incision / video assisted cardiac surgery. VRCT scan of arterial tree, are part of preop work up. TEE, Dual temperature, Cerebral oximetry are additional to standard monitoring. With usual induction, ventilation of lung by double lumen tube / single lumen with bronchial blocker / single lumen with CPB. Multimodal analgesia used. Extubation as soon as possible in ICU.

Results: Their mean age was 55.1 ± 13.8 years, and mean EuroSCORE II was 2.25% ± 1.25%. The mean ACC and CPB times were 122.3 ± 24.3 min and 197.1 ± 32.0 min, respectively. Prolonged ventilation (>24 h), n (%) 2 (2.9). No other complications encountered



Conclusions: Less invasive procedures not suitable for all patient groups but at the same time proven safety, efficacy and durability are expected. role of anaesthesiologist in management of MICS is imperative applying several subspecialty skills without foregoing safety. One-lung ventilation (OLV), use of cerebral oximetry, additional large bore jugular vascular access, and advanced skills in TOE are specific skills needed in MICS.

Divergent institutional practice exists. Reviews of current practice and future studies may help refine the anaesthetic management in minimally invasive cardiac surgery.

REFERENCES:

  1. A. Parnell and M. Prince. Anaesthesia for minimally invasive cardiac surgery BJA Education. 2018; 18(10): 323 – 330.
  2. Malik V, Jha AK, Kapoor PM. Anesthetic challenges in minimally invasive cardiac surgery: Are we moving in a right direction? Ann Card Anaesth 2016;19:489-97.



   Abstract ID: ISAP953: Thoracolumbar curve and cobb's angle in determining spread of spinal anaesthesia in scoliosis. A prospective observational study. Top


Ballarapu Girija Kumari, Aloka Samantaray, Veldurti Ananta Kiran Kumar

Background and aims: Disparity in spread of spinal anaesthesia is a known complication in scoliosis patients. Our Primary aim was to compare this disparity based on Cobb's angle and Thoraco-lumbar spine. Secondary aim was to calculate the appropriate lateral angulation of spinal needle from midline for successful lumbar puncture.

Methods: All poliomyelitis patients with scoliosis posted for lower limb orthopaedic contracture release were enrolled. Divided into Group 1(Cobb's angle <50), Group 2(Cobb's angle >50) and on thoracolumbar curve into Group R (Right), Group L (Left). Group 1, 2, R and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of Quincke's needle from midline was noted with Goniometer in groups1 & 2. Statistical analysis was done using unpaired t test and Chi-square test.

Results: Failures in SAB (unilateral anaesthesia /inadequate/ patchy block) was Significant in Group 2 with P value 0.033. Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for Quincke's needle in Group 1 is (4.1±2.45)° and in Group 2 is (9.14±2.45)°.



Conclusions: Thoracolumbar curve is the important predictor in assessing the spread of spinal anaesthesia in scoliosis for lower limb orthopaedic surgeries. The severe the deformity of scoliosis (Cobb's angle > 50°), the higher the chances of failed spinals. Segmental disparity in spread of spinal anaesthesia will be higher in Right side curve when compared to Left side thoraco lumbar scoliotic curves. The recommended angulation of spinal needle would reduce the number of attempts for successful spinal anaesthesia.

REFERENCES:

  1. Kumari BG, Samantaray A, Kumar VA, Durga P, Jagadesh G. Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study. Indian J Anaesth. 2013 Mar;57(2):145-9.
  2. Bowens C, Dobie KH, Devin CJ, Corey JM. An approach to neuraxial anaesthesia for the severely scoliotic spine. Br J Anaesth 2013; 111:807-11.



   Abstract ID: ISAP127: Impact of goal directed intraoperative fluid administration on blood lactate levels and thromboelastography in major oncosurgery patients Top


Priyanka Ahuja, Itee Chowdhury

Rajiv Gandhi Cancer Hospital,New Delhi

Background and Aims: Cancer patients have associated hypercoagulability that makes them prone to deep vein thrombosis with increased risk for perioperative thromboembolism .Outcome of Goal directed fluid therapy(GDT )on coagulability status of oncosurgical patients have not been studied as per literature .This study was undertaken to assess the impact of GDT using Stroke volume variation(SVV) on coagulability status by Thromboelastography(TEG) .

Methods: 72 patients undergoing major abdominal oncosurgeries randomised into Groups C (control)and S(study)(n=36). In Group C, 500 ml crystalloid (available in institute,no conflict of interest) infused during induction, followed by continuous infusion 4 to 8 ml/kg/hr as per anaesthetist discretion (CVP,urine output, hemodynamic stability) . In Group S, FloTrac/Vigileo connected to radial arterial line ,500 ml crystalloids (same as used in control group) infused during induction followed by SVV guided fluid which if exceeded 10% for >5 minutes, 250 ml bolus of crystalloid given and repeated every 5 minutes if SVV remained higher than 10% and 2ml/kg/hr continuous infusion. Colloids were given to compensate maximum allowable blood loss beyond which blood was given in both groups. TEG parameters(R,K,MA, ANGLE) and blood lactate levels documented at beginning and end of surgery.

Results: Demographic characters, surgery duration and hemodynamic characters were comparable.

  1. Total fluid administration was more in Group C compared to Group S(p<0.05)
  2. Blood lactate levels were higher in Group C compared to Group S(p<0.05)
  3. TEG parameters (R, MA, ANGLE) were in normocoagulable range in Group S compared to Group C(p<0.05)
Table

Click here to view


Conclusion: This study highlights that GDT using SVV results in better outcome with regards to fluid optimization,tissue perfusion and normocoagulable status in major abdominal oncosurgery patients.

REFERENCES:

  1. Forget P1, Lois F, de Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. AnesthAnalg 2010;111(4):910-4
  2. Ruttmann TG, James MF, Finlayson J.Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery.Br J Anaesth.2002;89(2):226-30.



   Abstract ID: ISAP 015: A prospective randomised double blinded comparative study between nasal atomized dexmedetomidine and midazolam as premedicants in paediatric adenotonsillectomy Top


Shoba Philip, Suria Jacob, Lucy Tony

Lourdes Hospital, Cochin, Kerala.

Background and aims: Psychological trauma at the time of parental separation causes increase in haemodynamic variables. There are so far no studies comparing the atomized form of Dexmedetomidine with Midazolam in children to reduce anxiety. Primary aim was to compare sedation score at parental separation & mask induction, Behaviour score at parental separation & mask induction & Wake up score at extubation. Haemodynamic parameters, time to reach Modified Aldrete score of 9, side-effects were secondary aims.

Methods: 60 children aged 3- 8 years scheduled for adenotonsillectomy were included after ethical clearance in this randomized blinded study. GroupA-nasal atomized midazolam0.2mg/kg usingINSED ATOMISER&GroupB-dexmedetomidine1mcg/kg using LMA MADNASAL™ 45mts before induction. Age, sex, wt & ht were noted. Haemodynamic and respiratory parameters noted. Sedation was assessed every 15mts for 45 mts at parental separation&mask induction. Behaviour score was assessed at parental separation & mask induction. Standard protocolised balanced anaesthesia. Intraop haemodynamic and respiratory parameters noted. Wakeup score assessed at extubation. Sedation score < 5, behavior <2 and wake up < 3 were taken as satisfactory. Haemodynamic and respiratory parameters continued in the recovery. Time to reach Modified Aldrete scoreof 9 & side effects if any,were noted. Data analysed statistically. Statistical tests Chi-square test,student's t-test,repeated measures of Anova were used.

Result: Nasal atomized dexmedetomidine provides better satisfactory sedation than midazolam (93.3%vs33.3%, p=0.000) both at parental separation and mask induction.Behaviour &wakeup scores,time taken to reach Modified Aldrete score were similar.No adverse side-effects.Atomisation devices cost-effective in the Indian scenario.



Conclusion: Nasal atomized dexmedetomidine is a better sedative premedicant than midazolam in young children.

REFERENCES:

  1. RosenbaumA, etal.The place of premedication in paediatric practice. Paediatric Anaesthesia.2009 Sep;19(9):817
  2. KumarL, etal. Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatricpremedication.Indian journal of Anaesthesia.2017 Feb;61(2):125



   Abstract ID: ISAP114: Preoperative cardiology referral practices at a tertiary care centre – a retrospective observational study Top


Priyanka Pavithran

ASTER MIMS, Calicut

Background and aims: Preoperative assessment of a cardiac patient is challenging. Studies have proven that cardiology referral is an overused resource with no benefit.[1],[2] Most of these studies were done in western countries. Limited literature is available on the current scenario in India. We intended to study the appropriateness and functional utility of the preoperative cardiology referrals at our centre.

Methods: The records of 457 patients posted for elective noncardiac surgery, who underwent preoperative cardiology consults were reviewed. Appropriateness of the referral was assessed by comparing with 2014 American College of Cardiology / American Heart Association guidelines. Any recommendations made and perioperative outcome were noted. Statistics was done using Statistical Package for Social Sciences version 21.0. Continuous data was represented as Mean ± SD and Categorical data as frequency with percentage.

Results: Seventy one (15.5%) referrals were appropriate according to the guideline. Majority of the consults were for preoperative clearance, only fifty four (11.8%) posed a specific reason for the referral. The most common recommendation was to withhold antiplatelet medications. None of the consultations made any change in anaesthetic or surgical plan. Six patients had perioperative major adverse cardiac events.
Table 2: Patient characteristics

Click here to view


Conclusion: Majority of the consultations were done by surgeons and were unindicated and did not have any positive impact on patient outcome. A large proportion of these patients had low cardiac risk index and were posted for low risk surgery. As anaesthesiologists, we are the best equipped for quantifying risk and optimising patients and should be the leaders of the perioperative period and perioperative medicine.

REFERENCES:

  1. Monahan TS, Shrikhande G V, Pomposelli FB, Skillman JJ, Campbell DR, Scovell SD, et al. Preoperative cardiac evaluation does not improve or predict perioperative or late survival in asymptomatic diabetic patients undergoing elective infrainguinal arterial reconstruction. J Vas Surg. 2005;41:38–45.
  2. Aslanger E, Altun I, Guz G, Kiraslan O, Polat N, Golcuk E, et al. The preoperative cardiology consultation: Goal settings and great expectations. Acta Cardiol. 2011;66:447–52.



   Abstract ID: ISAP847: Does intraoperative lung protective ventilation affect postoperative pulmonary function? Top


H. S. Murthy, Anoop Jose, Jalaja Koppa Ramegowda, Ramachandra Karnate

Manipal Hospital Bangalore.

Background and Aims: Lung protective ventilation (LPV) with low tidal volumes, positive end expiratory pressure (PEEP) and repeated use of recruitment maneuver, has the potential to protect against post-operative pulmonary complications.1 Therefore we compared the effect of intra-operative LPV strategy and conventional mechanical ventilation (CMV) on postoperative pulmonary function tests (PFTs).

Methodology: After approval from hospital ethics committee, 46, ASA 1&2 patients undergoing open abdominal surgery lasting 2-6 hours were divided into two groups. In group A (CMV), ventilator settings included tidal volume of 7ml/kg ideal body weight without PEEP. In group B (LPV), patients received a vital capacity maneuver (VCM), by a positive inspiratory pressure of 35cm H2O maintained for 15 seconds performed after intubation, followed by ventilation with 7ml/kg tidal volume and 10cm H2O PEEP. Demography, intraoperative hemodynamics, complications during VCM, Pre-operative and postoperative PFTs, respiratory rate, oxygen saturation on room air and postoperative respiratory complications were noted upto 72 hours after surgery. Statistical analysis was done using SPSS 22.0.{Figure 1}

Results: Significant reduction in postoperative PFTs compared to preoperative values was noted in both groups (p<0.0125) (Figure). There was no difference in postoperative PFTs between the two groups. Recruitment maneuvers were not associated with intraoperative hemodynamic instability, postoperative complications or duration of hospital stay. Oxygen saturation was better in immediate post-operative period in patients given LPV (98±1% Vs 96±3%) (P=0.04).

Conclusion: Compared to conventional ventilation, lung protective ventilation did not improve postoperative PFTs upto 72 hours after surgery but resulted in better oxygenation in immediate post-operative period.

References

  1. Mimica Z, Biocic M, Bacic A, Banovic I, Tocilj J, Radonic V, et al. Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function. Respiration. 2000;67(2):153-8.
  2. Guay J, Ochroch EA, Kopp S. Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury. Cochrane Database of Systematic Reviews 2018, Issue 7.





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