Research and Innovation in Anesthesia

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Volume 5, Number 2, July-December 2020

Original Article

Pallavi Waghalkar, Manish Pawar

Audit of Blood Transfusion Practice during Intraoperative Period in Adult Spine Surgery

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:23 - 27]

Keywords: Audit, Blood transfusion, Chi-square, Cross-match transfusion ratio, Hemoglobin, Indices, Spine surgery, Transfusion index, Transfusion probability

PDF  |  DOI: 10.5005/jp-journals-10049-0087  |  Open Access |  How to cite  | 

Abstract

Background: Transfusion of blood is regarded as of key importance in the spinal procedure. In spite of increase in rate of spinal surgeries, the audit of blood transfusion throughout spinal procedures in regional traumatic centers is important. Therefore, the present study was undertaken to evaluate blood transfusion practices in adult spine surgeries and also determine the extent of utilization, wastage of blood products, and prescription of blood during spine surgery with the help of indices (C/T, %T, and TI) for assessing blood ordering. Materials and methods: A retrospective observational study among 130 patients was conducted to audit the blood transfusion practice during the intraoperative period for adult spine surgery over a period of 1 year. The rate of blood transfusion and indices of blood utilization were calculated. Results: Out of 510 blood units cross-matched for 130 study subjects, just 112 units were transfused to 60 cases, indicative of only 46.15% of cases required transfusions of blood. We observed that factors related to a greater chance of transfusion of blood were preoperative hemoglobin, indication of surgery, surgical approach, and region of spine by Chi-square. Of all of these variables, only indication of surgery was relevant in the multivariate model. The transfusion probability (%T), “transfusion index” (TI), and “cross-match transfusion (C/T) ratio” were 46.2, 0.86, and 4.5%, respectively. Conclusion: The independent factor associated with more number of blood transfusions was indication of surgery. Transfusion probability and TI in the present study are indicative of optimal utilization of blood. However, the high C/T ratio suggests the over cross-matching, which should be minimized in future.

Original Article

Shalaka R Sonavane, Sunil K Gvalanil, Pratika P Bhokare

Comparison between Conventional Macintosh Laryngoscope and King Vision Video Laryngoscope in Endotracheal Intubation for Elective Surgeries: A Prospective Randomized Study

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:28 - 32]

Keywords: Intubation, King Vision, Macintosh, Pressor response, Prospective randomized study

PDF  |  DOI: 10.5005/jp-journals-10049-0090  |  Open Access |  How to cite  | 

Abstract

Introduction: Securing the airway with an endotracheal tube is an essential anesthesia skill. Despite improvements in intubation devices, tracheal intubation is still accomplished using the traditional method of direct laryngoscopy.1 The failure of direct laryngoscopy to provide an adequate glottic visualization, coupled with a major pressor response, has led to the development of newer intubation devices. Video laryngoscope is one such intubation device with advantages of a higher success rate, better glottic visualization, safer intubation, faster learning curve, and the opportunity for dynamic interaction during airway management.3 In our study, we have used King Vision Video Laryngoscope (KVVL) for tracheal intubation and compared its efficacy, ease, safety, and shorter learning curve with that of the conventional Macintosh direct laryngoscope. The laryngoscopic view, hemodynamic response, and the attempts and time of endotracheal intubation of both Macintosh and KVVL have been compared in this prospective randomized study. Materials and methods: A total of 200 patients were assigned into two groups, I and II, where group I consists of patients receiving general anesthesia with endotracheal intubation using conventional Macintosh blade; and group II consists of patients receiving general anesthesia with endotracheal intubation using KVVL. Preoperative anesthesia check-ups and airway assessments were done which included mouth opening, MPC grading, and measurement of thyromental distance. The parameters studied were laryngoscopy view (using modified Cormack–Lehane scoring system), assessment of laryngoscopy and intubation procedure (number of attempts for successful intubation, maneuvers used during laryngoscopy, endotracheal tube insertion time), and hemodynamic response (heart rate, mean arterial blood pressure, and SpO2). Results: The hemodynamic response to laryngoscopy and intubation was significantly lower with KVVL. Also, KVVL had superior glottic vision and less maneuver requirement during laryngoscopy. Conclusion: From our study of comparison between Macintosh and KVVL, we conclude that KVVL is more effective in reducing hemodynamic response to intubation and requires less optimization maneuvers. Clinical significance: This study aims at providing evidence to guide the anesthesiologists regarding the merits and demerits of video laryngoscopes and aid them in safer airway management techniques without complications.

Original Article

Shubha D Bhat, Naina P Dalvi, Maithili D Thakur

A Prospective Randomized Double-blind Comparative Study of Hemodynamic Effects of Etomidate and Propofol in Controlled Hypertensive Patients during Induction of General Anesthesia

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:33 - 38]

Keywords: Etomidate, General anesthesia, Injection, Propofol

PDF  |  DOI: 10.5005/jp-journals-10049-0091  |  Open Access |  How to cite  | 

Abstract

Aim: To study and compare the hemodynamic effects of etomidate and propofol when used in controlled hypertensive patients as an induction agent. Materials and methods: It is a prospective randomized double-blind comparative study. After Institutional Ethics Committee approval, 60 patients with controlled hypertension undergoing surgery under general anesthesia and willing to participate in the study were included, i.e., the patients fulfilling the inclusion criteria were included. Results: The hemodynamic parameters like pulse rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were well maintained when etomidate was used as an induction agent when compared with propofol. There were no statistically significant side effects like pain on injection, nausea–vomiting, or myoclonus in either of the groups. Conclusion: IV etomidate 0.3 mg/kg provides better control of heart rate (HR), SBP, DBP, and mean arterial blood pressure (MAP) during induction, intubation, and after that throughout the procedure when compared with IV propofol 2 mg/kg in controlled hypertensive patients undergoing general anesthesia. Clinical significance: Considering the common use of propofol and etomidate as induction agents and the importance of a patient\'s hemodynamic stability, it is of utmost importance to choose an induction agent carefully in hypertensive patients to prevent more damage to their cardiovascular system.

REVIEW ARTICLE

Joanna S Rodrigues, Anil Parakh

COVID-19-associated Ergonomical Impact and Modifications in the Current Anesthesia Practice

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:39 - 42]

Keywords: Anesthesiology, COVID-19, Ergonomics

PDF  |  DOI: 10.5005/jp-journals-10049-0082  |  Open Access |  How to cite  | 

Abstract

“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”—quoted Charles Darwin. While the world grapples with the coronavirus and adapts to it, it is imperative for us anesthesiologists to also modify our practice as per the demands of the situation. Despite the ergonomical impact, we must constantly strive to be one step ahead, to be wise enough to judge the feasibility and legitimacy of the working guidelines and accommodate the fleeting ever-changing nature of this disease.

CASE REPORT

Joanna S Rodrigues, Vaishali Kulkarni, Ankit Gupta

Walking the Razor's Edge—Anticoagulation-induced Intracerebral Hemorrhage and the Perplexity in Choosing between International Normalized Ratio and Point-of-care Tests as a Reliable, Definitive, Coagulation Testing Parameter in Neurosurgical Management

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:43 - 45]

Keywords: International normalized ratio, Neurosurgery, Thromboelastography (TEG), Warfarin

PDF  |  DOI: 10.5005/jp-journals-10049-0088  |  Open Access |  How to cite  | 

Abstract

Urgent reversal of anticoagulation in patients on warfarin therapy for neurosurgical procedures can be quite tricky as well as risky. Anticoagulation reversal using blood products has its own challenges and their administration must be guided with effective, investigative tools such as international normalized ratio (INR) and point-of-care coagulation tests. However, the superiority of either in neurosurgical procedures has not been established. Hence, a careful risk calculation must be done considering the overall clinical picture of the patient as well. We present a case report in which we faced such a dilemma.

CASE REPORT

Pallavi Kharat, Hema C Solanki, Sunil K Gvalani, Harprit K Madan, Latika S Kumar Singh

Anesthesia Management of a Case of a Huge Ranula: A Case Report

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:46 - 48]

Keywords: Difficult airway, Fiberoptic intubation, Plunging ranula

PDF  |  DOI: 10.5005/jp-journals-10049-0086  |  Open Access |  How to cite  | 

Abstract

Ranulas are mucous retention cysts arising out of submandibular and sublingual salivary glands.1 They usually occupy the floor of the mouth, lifting the tongue upward, and causing potential airway obstruction. They turn out to be a challenge for airway management for anesthesiologists. A 43-year-old male patient presented with a recurrent swelling in the floor of the mouth pushing the tongue upward and to the left side and completely obstructing the view of the posterior pharyngeal wall. He was operated on for the same swelling 2 years ago and had a recurrence for the last 8 months. He was planned for complete excision of the swelling under general anesthesia. We present a case report of successful management of difficult airway by using awake fiberoptic intubation of a patient posted for excision of large plunging ranula under general anesthesia.

CASE REPORT

Shital H Borkar, Pallavi A Kharat, Sunil K Gvalani, Sudhams Tarapatala

Anesthesia Management of a Case of Subdural Hematoma in a Patient of Severe Mitral Stenosis with Warfarin Toxicity: A Case Report

[Year:2020] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:49 - 51]

Keywords: Mitral stenosis, Pulmonary hypertension, Rheumatic heart disease, Subdural hematoma, Warfarin toxicity

PDF  |  DOI: 10.5005/jp-journals-10049-0089  |  Open Access |  How to cite  | 

Abstract

Valvular heart diseases have a mixed presentation in healthcare settings all over the world. Rheumatic heart disease still forms the major cause of these valvular lesions. Mitral and aortic valvular diseases top the list of valvular pathology.1 Thereby, a thorough understanding of the pathophysiology of valvular heart disease is essential in planning anesthesia and perioperative care of such patients. Judicious use of fluids, close monitoring of the changing hemodynamics, and avoiding major reduction of cardiac output and fluid shifts are mandatory to achieve a good clinical outcome. These patients are at risk of the thromboembolic episode for which they are on long-term anticoagulation.2 So timely monitoring of the coagulation profile is needed. The risk of bleeding increases if international normalized ratio (INR) >4.5.3 We hereby present a case of subdural hematoma in a case of severe mitral stenosis with warfarin toxicity posted for burr hole surgery.

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