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TN JHA AND KP CHANSORIA TRAVEL GRANT AWARD ABSTRACTS
Year : 2020  |  Volume : 64  |  Issue : 13  |  Page : 73-82  

TN JHA and KP Chansoria Travel Grant Award Abstracts


Date of Web Publication6-Feb-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.277908

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How to cite this article:
. TN JHA and KP Chansoria Travel Grant Award Abstracts. Indian J Anaesth 2020;64, Suppl S1:73-82

How to cite this URL:
. TN JHA and KP Chansoria Travel Grant Award Abstracts. Indian J Anaesth [serial online] 2020 [cited 2020 Oct 20];64, Suppl S1:73-82. Available from: https://www.ijaweb.org/text.asp?2020/64/13/73/277908




   Comparison of ketofol versus propofol for procedural sedation and analgesia in cervical cancer brachytherapy: A prospective, randomized double blind study. Top


Ritu Verma, Udita Naithani, Monika Gupta, Pankaj Damor

RNT Medical College, Udaipur

Background and Aims: Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients.

Methods: A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P- Inj propofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K- Inj ketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.

Results: The supplementation dose required was significantly higher in propofol group(800mg) as compared to ketofol group(20mg) (p=0.00). Also, the fall in SBP and DBP was significantly less in ketofol group than propofol group (p<0.01). The mean awakening time (time from end of procedure to MRSS =3) and mean recovery time (time from end of procedure to achievement of Aldrete score 10) was more in ketofol group than propofol group (p<0.003), the difference was less than 1-2 min, so it was clinically not significant.

Conclusion: Ketamine-propofol combination in 1:2 ratio in a single syringe as ketofol is better alternative to propofol in providing sedation and analgesia with better haemodynamic stability, for outpatient brachytherapy procedure in cancer cervix patients.







REFERENCES:

  1. Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005; 26:553-557.
  2. Arikan M, Aslan B, Arıkan O, But, E. Horasanlı.. European Review for Medical and Pharmacological Sciences 2015; 19: 3522-7.



   Comparison of muscle wasting and fat loss using point of care ultrasound in critically ill patients Top


Yeshaswini. K, Rangalakhmi Srinivasan, Sahajananda Hiremathada

Rajarajeshwari Medical College and hospital

Background and Aims: Survivors of critical illness experience significant skeletal muscle weakness and physical disability. Loss of muscle mass is associated with prolonged ventilation, longer admission and higher mortality. Muscles of the lower limb are prone to early atrophy. Measurement of fat thickness is used to assess malnutrition. This study was designed to determine which parameter amongst fat and muscle thickness reduces first in the early phase of critically ill patients.

Methods: An observational study was done using point of care ultrasound in 100 patients admitted to intensive care unit. Thickness of the rectus femoris muscle and fat thickness in the anterior part of thigh were taken on day 1, 3 and 7 of ICU admission.

Results: Of the 100 patients, this study showed that on day 3 the rectus femoris thickness was 1.26 ± 0.41 as compared to 1.37 ± 0.41 on day 1 (P < 0.001). On day 7, thickness was 1.22 ± 0.47, this difference was highly significant (P < 0.001). The fat thickness showed a slight increase which was statistically not significant.

Conclusion: Amongst critically ill patients, point of care ultrasound showed that muscle wasting occurred early and rapidly during the first week of critical illness. Fat layer did not decrease as much as the muscle layer, we infer that the cause is unlikely due to under-nutrition. There is potential utility of ultrasound for early detection and probable corrective measures to prevent ICU associated weakness. This can in turn lead to reduction in morbidity and hasten recovery.

REFERENCES:

  1. Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, Hopkins RO, Hough CL, Kress JP, Latronico N, Moss M. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit–acquired weakness in adults. American journal of respiratory and critical care medicine. 2014 Dec 15;190(12):1437-46.
  2. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, Hopkinson NS, Phadke R, Dew T, Sidhu PS, Velloso C. Acute skeletal muscle wasting in critical illness. Jama. 2013 Oct 16;310(15):1591-600.



   A comparative study of dexmedetomidine as an adjuvant with ropivacaine(0.2%) and ropivacaine plain(0.2%) in fascia iliaca compartment block in lower limb orthopedic surgeries under sub arachanoid block for pre and post-operative analgesia Top


Rishi Dwivedi, Col. M. Kapadia, Sadhana Sanwatsarkar

Sri Aurobindo Medical College And P.G. Institute,Indore

Background and Aims : Pain before SAB and after orthopaedic surgeries is the most common complaint of the patients with lower limb fracture. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method of achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0.2% ropivacaine and ropivacaine 0.2% along with dexmedetomidine in FICB in reducing preoperative and postoperative pain.

Methods : 50 patients of ASA I-III with age group 18-70 years scheduled for elective # lower limb surgery were enrolled in the study and separated into two groups. Patient in group RD and RS received fascia iliaca compartment block with 30 ml 0.2 % ropivacaine along with dexmedetomidine(1mcg/kg) and 30 ml 0.2 % ropivacaine plain respectively in FICB 45 minutes before SAB in recovery room. Data including blood pressure, heart rate and VAS before and after FICB and at the time of positioning for SAB and time for rescue analgesia was collected on a prestructure proforma.

Results: Early onset of anesthesia , longer duration of postoperative analgesia and late rescue analgesic requirement was seen in patient with group RD as compare to group RS.

Conclusion: The study demonstrates that ropivacaine(0.2%) along with dexmedetomidine produces good and superior preoperative and postoperative analgesia than ropivacaine(0.2%) alone.



REFERENCES:

1. Li Y,Geng J,Wen L,Chen J,Wu Z. Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery.Saudi j Anaesth 2019;13:100-5

2. Kumar H, Tripathi A, Somvanshi M. Efficacy of dexmedetomidine as an adjuvant to ropivacaine in femoral nerve block for acute pain relief in patients with fracture of femoral shaft and neck. Indian J Pain 2018;32:86-90.


   Comparative evaluation of two different volumes of 0.5% bupivacaine in ultrasound guided interscalene brachial plexus block for proximal humerus surgeries. Top


Abha Singh, Amit Agrawal, Vineeta Dwivedi

Jawaharlal Nehru Hospital And Research Centre, Bhilai, Chhattisgarh

Background and Aims: We compared two different lower volumes of 0.5%bupivacaine in patients undergoing surgery of proximal humerus using USG interscalene block & note the time to achieve complete sensory and motor block along with duration of postoperative analgesia and incidences of complications.

Methods: This prospective randomised study was carried on 40 ASA grade I& II patients after ethics approval and informed consent. Patients were randomly assigned into group T receiving 10ml of 0.5%bupivacaine and group F receiving 15ml of 0.5%bupivacaine.Time after which complete sensory and motor block achieved in the target segments were noted with help of hollmen scale & bromage scale along with total duration of post operative analgesia and occurance of diaphragmatic paresis,Horner's syndrome,voice change. Mean, SD, Unpaired t test, p-value were used for statistical analysis.

Results: Demographic data were statistically insignificant (p>0.05).There was statistically no significant difference in duration after which complete motor and sensory block achieved in both groups. Overall duration of postoperative analgesia as well as incidences of complications were significantly more with 15ml of drug but both lower volumes provided adequate analgesia in early postoperative period.



Conclusion: A low volume of 10ml of 0.5%bupivacaine provided safer and satisfactory level of anesthesia with adequate pain relief in early postoprative period over 15ml of same drug.

REFERENCES

  1. Gautier P,Vandepittec Hadzic A .The miminum effective anesthetic volume of 0.75% ropivacaine in USG guided interscalene block.Anesth Analg2011;113:951-5.
  2. Riazi ,Awad I McCartney CJ.Effect of local anesthetic volume (20ml vs 5ml) on efficacy and respiratory consequencesof USG Guided interscalene brachial block.Br J Anaethesia2008;101:549-556



   Quadratus lumborum block (ql) versus transversus abdominis (tap) plane block for postoperative pain after cesarean delivery - a randomised controlled study. Top


Mohammad Amir, Ashok Jadon.

Tata Motors Hospital, Jamshedpur.

Background and Aims: Lower Segment Caesarean Section (LSCS) is a major surgical procedure with substantial post-operative pain. Good control of pain following LSCS is essential to facilitate early mobilisation and adequate care of the new born. The search for an ideal, safe and effective analgesic regimen with minimal side effects on both the mother and the child has stimulated research in this field. Multimodal analgesia is current standard of management, of which USG guided (TAP) block demonstrated an opioid-sparing effect postoperatively. A novel quadratus lumborum (QL) block might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space been tried to reduce the opioid analgesics and are believed to be effective against both somatic and visceral pain. To compare the efficacy of these two regional analgesic techniques in terms of duration of analgesia and doses of supplemental analgesics.

Methods: A randomized, double-blind, controlled trial was performed. As per inclusion and exclusion criteria, we randomized 104 patients scheduled for elective caesarean delivery under spinal anesthesia to receive the USG guided quadratus lumborum block or transversus abdominis plane block using 20ml of 0.375% ropivacaine on either side. The objective was to compare the time for first analgesic request, and total dose of tramadol required over span of 48 hrs during post op period. Presence of pain, sedation and nausea were assessed systematically in both the groups at 2, 4, 6, 8, 10, 12, 24 and 48 hours after the surgery

Results: The median time for post op. analgesia was significantly prolonged in QL GROUP (11.53 +- 1.53hrs) than TAP GROUP (9.08 +- 1.55hrs) P < 0.0001. and the number of tramadol doses in the QL GROUP ( 0.56 +- 0.44) was significantly less than in the TAP GROUP (1.06 +- 0.48) p < 0.0001.

Conclusion: The QL BLOCK provided longer duration of analgesia than TAP block ,as well as tramadol consumption was significantly reduced by QL BLOCK with no complication encountered during the study.

REFERENCES:

  1. Yousef NK. Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy: A Randomized Prospective Controlled Trial. Anesth Essays Res. 2018;12(3):742–747. doi:10.4103/aer.AER_108_18
  2. Blanco R, Ansari T, Riad W, et al. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Regional Anesthesia & Pain Medicine 2016;41:757-762.



   A prospective randomized control study on evaluation of effectiveness of serratus anterior plane block for post-operative analgesia in modified radical mastectomy surgeries. Top


Ravi Saravanan, Rajagopalan Venkatraman, Kanirajan Yogalakshmi, Krishnamoorthy Karthik.

SRM Medical College and Research Center, Chennai

Background and Aims: Ultrasound-guided Serratus Anterior Plane Block (SAPB). SAPB is a novel analgesic technique used for breast and thoracic wall surgeries. The primary objective of the study was to evaluate the duration of postoperative analgesia with SAPB in Modified Radical Mastectomy(MRM) surgeries. The secondary objectives were to assess the total morphine consumption during first 24hrs, Visual Analogue Scale(VAS)score post operatively.

Methods: After Institutional Ethical Committee (1467/IEC and CTRI/2019/01/017194) approval, forty patients undergoing MRM surgeries under general anesthesia were taken for the study with 20 patients in each group. At the end of surgery, the patients in groupA were given ultrasound guided SAPB with 20 mL 0.25% Ropivacaine with inj. Dexamethasone 8mg with patient in lateral position while groupB patients received no block. Post operatively patients were monitored continuously and assessed for VAS and vitals. PCA Morphine pump was administered for post-operative analgesia with baseline infusion 0.1mg/hr and bolus doses of 1mg with 10mins lock out interval time. Duration of postoperative analgesia was taken as the time elapsed from the administration of the block until the first dose of morphine bolus. Post-operative Morphine consumption and adverse effects in first 24hrs were recorded.

Results: The average duration of analgesia was prolonged in SAPB group (1455 Vs 144 mins) with reduced morphine consumption (3.25 Vs 10.25mg). The average VAS scores were comparatively lower in SAPB group. We observed no adverse effects related to the SAP block.



Conclusion: USG guided SAPB produces prolonged duration of analgesia and reduces morphine consumption following MRM surgeries in post-operative period with no complications.

REFERENCES:

  1. Rahimzadeh P, Imani F, Faiz SH, Boroujeni BV. Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study. Turkish journal of anaesthesiology and reanimation. 2018; 46(5):388.
  2. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013; 68(11):1107-13.



   Role of bispectral index (bis) monitoring in reducing anesthetic requirement and early emergence in thyroid surgery Top


Greeshma Sasi, R Usha Kumary, Krishnadas A.

Government Medical College, Kozhikode

Background and Aims: Propofol is the preferred induction agent for thyroidectomy but studies on BIS guided titration of the same are lacking. Aim was to study the efficacy of BIS monitoring in reducing the total anesthetic consumption and early emergence when compared to standard practice in patients receiving propofol anesthesia for thyroid surgeries

Methods: The study was a prospective observational study conducted on patients with ASA status I and II scheduled for thyroidectomy in a tertiary care centre in Kerala. A total of 100 patients were studied. These patients were randomized to two groups – Standard practice (SP) and BIS group. Patients in both groups were induced with propofol and fentanyl. In SP group, propofol infusion was set at 100 mcg/kg/min and titrated according to clinical signs whereas in BIS group, propofol infusion was titrated to get a BIS range of 40-60. After surgery and stopping propofol, time of initial wakeup events and extubation were recorded. Comparison between two groups was done using independent sample t-test, chi square test and univariate logistic regression tests.

Results : Mean propofol dose for maintainence in SP group was almost double than that of BIS group. Time delay for initial wake up events were also almost double in SP group when compared to BIS group

Conclusion: Amount of propofol infusion used in BIS group was lower when compared to SP group. BIS group patients had early emergence from anesthesia.



REFERENCES:

  1. Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia - BIS Utility Study Group. Anesthesiology. 1997 Oct;87(4):808-15.
  2. Snehadeep Arya, Veena Asthana, Jagdish P Sharma. Clinical versus bispectral index guided propofol induction of anesthesia- A comparative study. Saudi J Anesth. 2011 Jan – Mar ;7(1) : 75-79



   Comparison of effect of ringer's lactate and 0.9% normal saline on metabolic profile and electrolye variation in patients undergoing abdominal surgery Top


Pratibha Sahoo, Madhuchanda Borah, Amio Kumar Deori

Assam Medical College , Dibrugarh Assam

Background and Aims: Intravenous fluid administration during perioperative period for fluid replacement is one of the most common and universal practice. Ringer's Lactate and 0.9% Normal Saline both are used frequently. Aim was to evaluate whether Ringer's Lactate or 0.9% Normal Saline has any distinct effects on metabolic profile in patients undergoing abdominal surgery of duration 60- 120 minutes

Methods: Prospective, comparative randomised trial was carried out in 120 patients of ASA grades I and II of either sex, between 20 to 60 years of age and allocated into two groups either receiving intravenous Ringers lactate or 0.9% Normal Saline intra-operatively at the rate of 15 ml/kg/hr in patients undergoing abdominal surgery. Arterial pH and serum electrolytes were measured by Arterial Blood gas analysis using EC8 ABG Cartridge, preoperatively, immediate postoperatively and 24 hours after surgery. Results were analyzed with 'unpaired t –test', Chi square test and Repeated measures anova test.

Results: Ringer's Lactate Group had higher mean pH (7.41 ± 0.03) with lower levels of Serum Sodium (137.22± 2.31) and Serum Chloride (102.95+3.33 mmol/l) when compared with 0.9% Normal Saline Group (7.36+0.03 , 139.68 ± 3.27 and 108.48+3.86 mmol/l) in the immediate postoperative period. But no significant difference was seen amongst the groups after 24 hours.

Conclusion: Ringer's lactate maintained a more physiological picture of acid base balance in the intraoperative period but both Ringer's lactate and 0.9% Saline can be safely considered for intraoperative usage in healthy patients due to lack of impact on long term profile.

REFERENCES:

  1. Martini WZ, Cortez DS, Dubick MA. Comparisons of normal saline and lactated Ringer's resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock. Scand J Trauma Resusc Emerg Med. 2013;21:86. Published 2013 Dec 11. doi:10.1186/1757-7241-21-86
  2. Cho YS, Lim H, Kim SH. Comparison of lactated Ringer's solution and 0.9% saline in the treatment of rhabdomyolysis induced by doxylamine intoxication. Emerg Med J. 2007;24(4):276–280. doi:10.1136/emj.2006.043265



   A study of baseline perfusion index using pulse oximeter as a non invasive predictor of hypotension following spinal anaesthesia in lower segment caesarean section. Top


Neepa Patel, Nikul K. Joshi, Divyang V. Shah

Smimer Medical College, Surat

Background and Aims: Spinal anaesthesia also known as central neuraxial blockade is a most common method implemented for giving anaesthesia to parturients posted for Cesarean section by injecting local anaesthetic agent in sub arachnoid space. Hypotension following spinal anaesthesia as a result of decrease systemic vascular resistance due to blockage of preganglionic sympathetic fibers may increase Perfusion Index(PI). This study is aimed to determine predictability of perfusion Index as non invasive indicator of hypotension and to provide cut off value of baseline Perfusion Index for hypotension following spinal anaesthesia.

Methods: 52 patients of American Society of Anaesthesiologists (ASA) class I and II undergoing elective lower segment caesarean section were observed prospectively and divided in two groups, group 1 and group 2 who had baseline perfusion index <4 and ≥ 4 respectively.(n=26)Spinal Anaesthesia was administered with 12.5 mg Inj.Bupivacaine heavy 0.5% at L2 - L3 or L3-L4 intervertebral space.Incidence of hypotension,Total dose used of Inj.Mephentermine,fluid requirement measured. Statistical analysis was performed using chi sqaure test, independent sample t test,spearman's rank correlation coefficient, Reciever operating characteristics(ROC) curve.

Results: Demographic parameters,duration of surgery were comparable in both groups.Mean arterial pressure was lower in group 2 than group1(p<0.01).ROC yielded cut off value 4.05 and Area Under Curve was 0.903 for baseline perfusion index.Hypotension developed in 22 patients in group 2 as compare to 4 patients in group 1.There was significant correlation between baseline P.I.≥4 and incidence and severity of hypotension and Total dose of Inj.Mephentermine and fluid requirement.(p<0.001)

Conclusion: Baseline Perfusion index ≥4 is associated with a higher incidence of hypotension following spinal anaesthesia in lower segment caesarean section.



REFERENCES:

  1. Dugappa D ,Lokesh M,Dixit A ;Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section;Indian journal of anaesthesia;2017;61;8;649-654.
  2. Toyama, S et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery , British Journal of Anaesthesia, Volume 111, Issue 2, 235 – 241 .



   A study between two different doses of hyperbaric bupivacaine with fentanyl in subarachnoid block in lower segment ceasarean section Top


S.K. Fathimunnisa, K .Nagabhushanam, N. Syama Kumar, S. Seetharamaiah

Government Medical College, Guntur

Background and Aims: Intrathecal opioids when added to 0.5% hyperbaric bupivacaine are synergistic and intensify the sensory block and may reduce local anaesthetic requirement. Aim was to compare block characteristics, relative efficacy & adverse effects of two comparative doses of intrathecal hyperbaric Bupivacaine 0.5% with fixed dose Fentanyl in lower segment cesarean section.

Methods: 100 pregnant women posted for Elective Lower Segment Caesarean Section were included after ethical committee clearance and informed consent and randomly assigned to two groups. GROUP A received 8mg Bupivacaine 0.5% and 25mcg Fentanyl and GROUP B received 10mg Bupivacaine 0.5% and 25mcg Fentanyl. Onset and duration of sensory and motor block, hemodynamic parameters were noted.

Results: Group B has a significantly faster onset and prolonged duration of sensory and motor blockade and analgesia when compared to group A.



Conclusion: 10mg hyperbaric Bupivacaine 0.5% with 25mcg Fentanyl had prolonged duration of analgesia, due to earlier onset of sensory and motor block, prolonged duration of sensory and motor block and insignificant changes in haemodynamic status compared to 8mg hyperbaric Bupivacaine 0.5% with 25mcg Fentanyl.

REFERENCES

  1. Biswas BN, Rudra A, Bose BK, Nath S :intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Indian journal anaesthesia ,2002;46(6):469-472.
  2. Hocking G, Wildsmith J. intrathecal drug spread. British Journal of Anaesthesia. 2004;93(4):p.568-78.



   Airway anaesthesia for awake fibre optic intubation: A comparison between transtracheal lignocaine infiltration versus nebulised lignocaine inhalation Top


Amrapali Sen, Archana Roy, Dipankar Mukherjee, Manabendra Sarkar

Nil Ratan Sarkar Medical College and Hospital, Kolkata, West Bengal.

Background and Aims: Adequate airway anaesthesia is essential for awake fibreoptic intubation. This prospective randomised study compared airway anaesthesia achieved by transtracheal Lignocaine instillation and nebulised Lignocaine inhalation.

Methods: 50 adults of either sex, ASA I-II, modified Mallampati class III-IV were randomly allocated into Group T and Group N. Patients in Group T received 4 ml 4% Lignocaine transtracheally whereas Group N was nebulised with 7 ml 4% lignocaine. Awake fibreoptic intubation(FOI) was then performed. SPO2, Heart Rate, Mean arterial pressure, Systolic and Diastolic Blood Pressure before, during and then at one, three and five minutes post intubation, patient comfort score, cough and gag score along with total intubation time were noted.

RESULTS: The total time taken for intubation in Group T (47.7±6.618 secs) was remarkably lesser than that recorded for Group N (67.74±7.42 secs) and patients in Group T were more comfortable with fewer cough/gag episodes than in Group N.



CONCLUSION: Transtracheal Instillation, as compared to Nebulisation of local anaesthetic for awake FOI is faster, more comfortable for patient and requires less amount of local anaesthetic.

REFERENCES

  1. Vasu BK, Rajan S, Paul J, Kumar L. Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation. Indian J Anaesth 2017
  2. Dhasmana, S., Singh, V., & Pal, U. S. (2015). Journal of maxillofacial and oral surgery, 14(2), 398–402.



   Preoperative c-reactive protein - albumin ratio as a predictor of postoperative mechanical ventilation - a prospective observational study Top


Vaishakh Tharavath, P. Bhaskar Rao, Sukdev Nayak, Aparajita Panda

All India Institute of Medical Sciences, Bhubaneshwar

Background & Aims: ICU beds are limited resources, and thus utilization should be appropriate and cost-effective. Patients with raised C-Reactive Protein (CRP) or low albumin may be difficult to extubate postoperatively. The aim of the study was to evaluate the preoperative CRP-Albumin ratio as a predictor of postoperative mechanical ventilation (>/= 6 hours) in patients undergoing general anesthesia.

Methods: A prospective observational study was conducted in adults undergoing non-cardiac surgeries under general anesthesia (CTRI/2018/02/011718), excluding who were preoperatively on the ventilator. The sample size was 569. Preoperatively, along with parameters like demography, difficult airway and malignancy status, one venous blood sample was collected and analyzed for CRP and albumin. Intraoperative parameters like vasopressor usage, blood loss, and duration of surgery were also recorded. The patients were followed up for the requirement of mechanical ventilation (>/= 6 hours) postoperatively.

Results: In the preliminary analysis of 249 patients, preoperative CRP-Albumin ratio was found to be higher, but not statistically significant in the patients requiring postoperative mechanical ventilation (>/= 6 hours) than who didn't [median (IQR) = 0.000040100 (0.000014250 - 0.000287325) vs 0.000036300 (0.000014300 - 0.000109300)]. However, duration of surgery (Odd's ratio = 1.011; 95%CI = 1.005-1.017) and intraoperative vasopressors (Odd's ratio = 4.55; 95%CI = 1.24-16.64) were found to be predicting the need of mechanical ventilation postoperatively.

Conclusion: In the preliminary analysis, the CRP-Albumin ratio was not predicting the requirement of postoperative mechanical ventilation in patients undergoing non cardiac surgeries under general anesthesia. Instead, intraoperative vasopressors and duration of surgery were predicting the same.

[* - median (IQR), # - n (%)]

(Those variables which showed a p-value < 0.20 were considered for the logistic regression analysis.)



REFERENCES:

  1. Sun F, Ge X, Liu Z, Du S, Ai S, Guan W. Postoperative C-reactive protein/albumin ratio as a novel predictor for short-term complications following gastrectomy of gastric cancer. World J Surg Oncol. 2017;15(1):191. Published 2017 Oct 24. doi:10.1186/s12957-017-1258-5
  2. Ocakli B, Tuncay E, Gungor S, et al. Inflammatory Markers in Patients Using Domiciliary Non-invasive Mechanical Ventilation: C Reactive Protein, Procalcitonin, Neutrophil Lymphocyte Ratio. Front Public Health. 2018;6:245. Published 2018 Sep 5. doi:10.3389/fpubh.2018.00245



   A comparison between ultrasound-guided supraclavicular and infraclavicular approaches to brachial plexus block for elective upper limb surgery. Top


Guru Avinash, Sureshkumar, Balasubramanian, Dilip Chandar.

Sri Manakula Vinayagar Medical College, Puducherry

Background and Aims: Infraclavicular brachial plexus block is a lesser used approach because of less uniform landmarks, deeply situated plexus, high incidence of complications without Adjuncts, increased patient discomfort. With ultrasound guidance there is better visualization, lesser needling time, lesser complications, faster onset of blockade and higher block success rate when compared to Supraclavicular approach. The aim was to compare the clinical effect of Supraclavicular and Infraclavicular Brachial Plexus block by means of onset times, performance times and block success.

Methods: 60 patients were randomized into two groups – Supraclavicular and Infraclavicular. All patients were administered 30ml 0f 0.5% Bupivacaine. We assessed block performance time, onset of sensory and motor blockade, duration of block and hemodynamic parameters.

Results:





Mean duration of sensory and motor blockade were similar in both groups (p value of 0.341 and 0.791 respectively). There was no hemodynamic instability or complications in our study.

Conclusion: Though Ultrasound guided Infraclavicular technique took longer time to perform than the Supraclavicular technique, the Infraclavicular approach had a faster onset of blockade.

REFERENCES:

  1. Abhinaya RJ, Venkatraman R, Matheswaran P, Sivarajan G. A randomised comparative evaluation of supraclavicular and infraclavicular approaches to brachial plexus block for upper limb surgeries using both ultrasound and nerve stimulator. Indian J Anaesth 2017 Jul;61(7):581–6.
  2. Arcand G, Williams SR, Chouinard P, Boudreault D, Harris P, Ruel M, et al. Ultrasound-guided infraclavicular versus supraclavicular block. Anesth Analg 2005 Sep;101(3):886–90.



   Comparison of using aintree intubation catheter through i-gel and proseal laryngeal mask airway to facilitate endotracheal intubation Top


Jaffrey. K, Trilok Chand, Archana Agarwal.

Background and Aims: In this prospective observational study, success rate of passage of Aintree intubation catheter through the supraglottic airway devices (I-gel and proseal LMA) was compared for facilitation of endotrachel intubation through the intubation catheter.

Method: Ninety patients undergoing elective surgery were divided into groups randomly on an “odd-even basis” of 45 patients for passage of AIC through I-gel and PLMA. After attachment of standard monitors, the patients were induced. After which the supraglottic device (I-gel/Proseal LMA) was inserted and adequate ventilation was achieved. Then Aintree intubation catheter was passed blindly through the SAD and its correct position is checked and time noted.

Results: Mean time of insertion through I-gel and PLMA were 14.79secs and 21.43secs (p < 0.0001). Success rate in first attempt was 80% in the I-gel group and 53.33% in the PLMA group, while the overall success rate for I-gel and PLMA were 93.33% and 80% respectively (p = 0.025).

Conclusion: In the present study I-gel had a better success rate for blind passage of Aintree intubation catheter to be used as an alternative to conventional laryngoscopy.



REFERENCES:

  1. Berkow LC et al Use of the Laryngeal mask airway- Aintree intubating catheter- fibreopticbrochoscope technique for difficult intubation. J ClinAnesth. 2011 Nov;23(7):534-9.
  2. Blair EJ et al Tracheal intubation via the Classic and Proseal LMA: a manikin study using the Aintree Intubating Catheter. Anaesthesia.2007;62(4):385-387.



   Assessment Of Agreement Between Prepunctured Ultrasonography And Corrected Measured Skin Epidural Distance In Indian Pediatric Population Top


Chandrima Banerjee, Neelam Prasad, Maunisha Agarwal, Vandana Saith

Maulana Azad Medical College and Associated Hospitals, New Delhi.

Background & Aims: Epidural-catheter insertion is technically difficult in children. Ultrasound information regarding the skin-epidural depth (SED) may increase success rate. The study was performed to assess whether there was agreement between prepuncture ultrasonographically measured SED and the corrected SED during epidural puncture in children.

Methods: 25 infants and children aged 10 months to 10 years ( ASA I/II) undergoing thoracic, upper and lower abdominal/pelvic/perineal surgeries were included. Prepuncture ultrasonographic images in the longitudinal median, transverse and longitudinal paramedian planes were acquired from the desired intervertebral space in lateral decubitus position. Measured SED in each view was compared with the corrected perpendicular SED that was obtained from the needle depth and angle by use of a trigonometric-ratio equation. The SED was also estimated by weight-based formula. Additionally, we evaluated the ultrasound visibility of the ligament flavum and complications.

Results: The correlation coefficients between measured ultrasonographic SED and corrected perpendicular SED was slightly higher in longitudinal median and transverse views than in longitudinal paramedian view. The ligamentum flavum was best visualised in the transverse plane of ultrasound. On Bland-Altmann analysis, the corrected perpendicular SED had the highest agreement with the prepuncture ultrasonographic SED on longitudinal median view. The corrected perpendicular SED had strong correlation with the distances derived from weight-based formula, especially in the longitudinal median view. There were no suboptimal events or complications.

Conclusion: Ultrasound, particularly in the longitudinal median view, provides accurate information on the SED in infants and children. With reference to the measured distance, epidural puncture can be performed with minimal risk of complications.

REFERENCES:

  1. Chauhan AK, Bhatia R, Agrawal S. Lumbar epidural depth using transverse ultrasound scan and its correlation with loss of resistance technique: A prospective observational study in Indian population. Saudi J Anaesth. 2018;12(2):279–282. doi:10.4103/sja.SJA_679_17.
  2. Kil HK, Cho JE, Kim WO, et al. Prepuncture Ultrasound-Measured Distance: An Accurate Reflection of Epidural Depth in Infants and Small Children. Regional Anesthesia & Pain Medicine 2007;32:102-106.







 

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