Journal of Research & Innovation in Anesthesia

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2021 | July-December | Volume 6 | Issue 2

Original Article

Veena Patodi, Arpit Sharma, Deepika Meena, Kavita Jain, Neena Jain, Veena Mathur

Perfusion Index as a Predictor of Hypotension Following Spinal Anesthesia in Lower Abdominal Surgery

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:5] [Pages No:31 - 35]

Keywords: Hypotension, Perfusion index, Subarachnoid block

   DOI: 10.5005/jp-journals-10049-0110  |  Open Access |  How to cite  | 

Abstract

Background: Subarachnoid block (SAB) is a gold standard anesthetic technique for lower abdominal surgeries. Hypotension is a very common observation following a SAB. Perfusion index (PI) is a new parameter that can be used as a noninvasive method to find out the chances of developing hypotension after SAB. Aim and objective: The aim and objective of this study was find out the relation between baseline PI and the likelihood of developing hypotension after SAB in lower abdominal surgeries. Materials and methods: Our study was a prospective randomized observational study. In this study, patients were allocated in two groups according to the baseline PI. Group I includes patients with baseline PI ≤3.5 and group II includes patients with baseline PI > 3.5. Subarachnoid block with 15 mg 0.5% heavy bupivacaine at l4–l5 level or l3–l4 level intervertebral space was given and hypotension was mentioned as mean blood pressure <65 mm Hg. Results: The hypotension in group I was 12.28% whereas in group II was 74.58%. The receiver operating characteristic (ROC) curve showed that baseline PI could be a useful parameter for detecting patients at risk of developing hypotension. The area under the ROC curve for the prediction of hypotension was 0.912. The specificity and sensitivity of PI (baseline) of 3.3 to find hypotension were 75.38 and 94.12%, respectively. Conclusion: For predicting hypotension, PI can be used in patients having below umbilical surgeries under SAB. Therefore, it can be said that patients with PI (baseline) >3.5 have higher chances of developing hypotension than patients with PI <3.5.

Original Article

Priyabrat Karan, Nita D'souza, Rajendra Patil

A Prospective Randomized Study to Evaluate the Analgesic Efficacy and Quality of Recovery of Perioperative Intravenous Lignocaine Infusion in Laparoscopic Surgeries

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:8] [Pages No:36 - 43]

Keywords: Analgesia, Laparoscopic surgeries, Lignocaine

   DOI: 10.5005/jp-journals-10049-0098  |  Open Access |  How to cite  | 

Abstract

Background: The role of intravenous lignocaine perioperatively is studied to evaluate whether it has an opioid-sparing effect, component of a multimodal analgesia regimen, enhancing recovery, and early discharge of the patients undergoing laparoscopic surgery. Materials and methods: A randomized prospective double-blind study was done on 80 ASA I/II adult patients of both sexes in the age group 18–60 years scheduled for elective laparoscopic surgery under general anesthesia over a period of 6 months. Group L was administered lignocaine 1.5 mg/kg i.v. bolus followed by and 1.5 mg/kg/hour i.v. infusion and group NS 10 mL of 0.9% normal saline i.v. instead of lignocaine. Results: The intubation response, length of hospital stay, ambulation time, time of the return of bowel movements, use of rescue analgesics, use of opioids, and visual analog scores (VAS) in the saline group were significantly higher as compared to the lignocaine group. Conclusion: Intravenous lignocaine as bolus and infusion demonstrated a significant decrease in the hemodynamic parameters following intubation and postextubation, provided opioids-sparing role, showed lower VAS scores, fewer rescue analgesics over 24 hours, significantly early bowel movements, ambulation, and discharge.

CASE REPORT

Robin S Chacko, Krishna Prasad Thangarasu, Hariesh Annamalai

Combined Spinal Epidural Overcoming a Lumbar Lipoma for Lower Limb Both Bone Fracture

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:2] [Pages No:44 - 45]

Keywords: Anesthesia, Epidural, Lipoma, Spinal

   DOI: 10.5005/jp-journals-10049-0103  |  Open Access |  How to cite  | 

Abstract

Lipomas are a commonly occurring tumor and this particular one brought about challenges to our plan of anesthesia owing to its location. General anesthesia was unwarranted owing to the nature of the surgery as well as the COPD that the patient was suffering from. With meticulous technique and good knowledge of anatomy, we safely executed combined spinal-epidural anesthesia for our patient, the highlight being threading the epidural catheter downward above the lipoma to position it optimally and administering the subarachnoid block from below the lipoma, which resulted in satisfactory intra- and postoperative outcomes.

CASE REPORT

SS Rahul, Senthil K Anandan, E Kathiravan

Anesthetic Considerations in Pediatric Patients Undergoing Cochlear Implantation Surgery

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:3] [Pages No:46 - 48]

Keywords: Anesthesia, Children, Cochlear implant, Sensorineural deafness

   DOI: 10.5005/jp-journals-10049-0105  |  Open Access |  How to cite  | 

Abstract

Cochlear implants have resulted in effective treatment of hearing loss in children. It is mainly associated with minimal surgical complications. As this occurs at a very early age, most are associated with congenital anomalies and other defects and syndromes which should also be taken into consideration. Anxiety reduction also plays a major role. The anesthetic technique should be able to provide a bloodless field and do not affect the cochlear implant. Postoperative complications like postoperative nausea and vomiting are common.

CASE REPORT

Shruti Hazari, Parthkumar Hirpara, Mankeerat Kaur, Raghbirsingh Gehdoo, Varsha H Vyas, Jayshree P Vashwani

Anesthesia Management in a Case of Restrictive Lung Disease

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:2] [Pages No:49 - 50]

Keywords: High BMI, Inguinal hernia, Interstitial lung disease, Post CABG, Restrictive lung disease

   DOI: 10.5005/jp-journals-10049-0104  |  Open Access |  How to cite  | 

Abstract

Anesthesia management in a case of restrictive lung disease especially interstitial lung disease (ILD) poses many challenges to anesthesiologists as these patients have decreased lung compliance and volumes with preservation of expiratory flow rates. These patients present with rapid and shallow breathing patterns with alteration in respiratory gas exchange and V/Q mismatch which causes an increase in perioperative complications. Case description: An 86-year-old man weighing 106 kg k/c/o diabetes and hypertension controlled on medications was posted for bilateral hernioplasty. He had been operated on for CABG and spine surgery with instrumentation at the lumbar region. The patient had shallow and rapid breathing. SpO2 on room air 92%. PFT revealed severe restrictive pattern; chest X-ray pa view showed hazy opacities over both lung fields CT scan suggestive of interstitial pneumonia. 2D echo showed LVEF 50–55% and hypokinetic distal interventricular septum. Due to huge inguinoscrotal swelling, the inguinal block was not feasible, spine surgery was a contraindication for neuraxial block, hence general anesthesia was the technique of choice. The patient was optimized by nebulization with duolin and budecort, antiplatelets stopped as per the cardiologist's opinion. Premedication with midazolam 0.5 mg iv and fentanyl 100 μg iv. Propofol was used for induction. Intubation was done with an 8 mm ID endotracheal tube using 40 mg iv atracurium and maintained on oxygen, air, and isofluorane. The patient was converted to pressure control with pressure settings between 20 and 25 cmH2O which delivered 300 mL tidal volume approximately. Saturation was maintained to 100% and end-tidal CO2 remained between 32 and 35 intraoperatively. The patient was electively ventilated to reduce work of breathing in a k/c/o ILD with prolonged exposure to anesthesia, hypothermia, electrolyte imbalance as the gradual weaning process is beneficial for such patients. The anesthesia management of ILD cases requires proper preoperative assessment and optimization and proper choice of anesthesia.

CASE REPORT

Kewal K Gupta, Gagan Deep, Amanjot Singh, Rupinder Kaur, Himani Garg

Anesthetic Dilemma for Management of Parturient with Severe COVID-19 Pneumonia for Emergency Lower Segment Cesarean Section

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:3] [Pages No:51 - 53]

Keywords: Cesarean section, Coronavirus disease 2019, Parturient, Perioperative management, Spinal anesthesia

   DOI: 10.5005/jp-journals-10049-0109  |  Open Access |  How to cite  | 

Abstract

Perioperative management of the pregnant patient with symptomatic coronavirus disease-2019 (COVID-19) presents a unique challenge to provide optimal medical care to both the mother and baby simultaneously along with protection of the healthcare providers from infection. Here, we report a unique case of a 28-year-old at 34 weeks of gestation with severe COVID-19 pneumonia posted for lower segment cesarean section which was successfully managed under spinal anesthesia. We aim to highlight the importance of neuraxial anesthesia in pregnant patients with symptomatic COVID-19 pneumonia.

CASE REPORT

Fatema K Mujpurwala, Pallavi A Kharat, Naina Dalvi, Jayesh Bawa, Geeta Ghag, Vipul Nandu

Management of a Case of Hypersplenism for Therapeutic Splenectomy: Anesthesia Challenges

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:3] [Pages No:54 - 56]

Keywords: Anesthesia challenges, Hypersplenism, Splenectomy, Thrombocytopenia

   DOI: 10.5005/jp-journals-10049-0112  |  Open Access |  How to cite  | 

Abstract

Hypersplenism is a clinical disorder characterized by splenic enlargement and overactivity adversely affecting a patient's hematological profile.1 Splenectomy is associated with numerous intraoperative and postoperative challenges to an anesthesiologist. A 60-year-old woman presented with pain in the abdomen and fever with physical findings of pallor, icteric sclera, and splenomegaly. She was planned for therapeutic splenectomy under general anesthesia. We present a case report of a successfully managed case of hypersplenism for splenectomy.

CLINICAL TECHNIQUE

Tural Alekberli, Leslie Yarmush

A Novel Special-shaped Stylet Technique for Intubation with GlideScope® Video Laryngoscope Devices

[Year:2021] [Month:July-December] [Volume:6] [Number:2] [Pages:4] [Pages No:57 - 60]

Keywords: Airway, Difficult intubation, Glidescope, Laryngoscope, Videolaryngoscope

   DOI: 10.5005/jp-journals-10049-0097  |  Open Access |  How to cite  | 

Abstract

The GlideScope® video laryngoscope (VL) provides direct visualization of the larynx in patients with a potentially difficult airway. A specialized rigid stylet or tracheal introducer should be used to guide the tip of the endotracheal tube (ETT) into the glottis while using the GlideScope® devices. Several studies showed the success of the GlideScope® VL. However, there have been reports of problems, complications, including failure to intubate patients successfully. Laryngeal exposure is generally the simple part of the procedure, and conversely, tube delivery to the glottic opening and advancement into the trachea is sometimes not straightforward. Alekberli–Yarmush technique: Our novel technique for improving the GlideScope® intubation's success requires preparation of the stylet and ETT before the intubation. Requirements are the following: any brand and model shapable ETT stylet, ETT, and lubricant. Firstly, lubricate the stylet with a lubricant, insert the stylet into ETT, and bend the stylet into a unique shape. Firstly bend the ETT into the two-dimensional circular C shape, then bend the tip again two-dimensionally, approximately 100–110° against the circular angle. For the final step, bend the tip toward the 3rd dimension medially, proximally 45°. Endotracheal tube insertion is usually performed in our method, as the manufacturer recommends a four-step insertion technique when using the GlideScope®. However, holding the tube with two fingers, palm up, 2/3 of the way down the tube toward the tip, is different from the traditional technique. To intubate using our novel technique, first, the GlideScope® should be introduced into the oropharynx's midline with the left hand. When the epiglottis is identified on the screen, the scope should be manipulated, and the tip of the blade should be put in vollecula and elevate the epiglottis to obtain the best view of the glottis. The ETT should then be guided into position under direct vision. The ETT should be hugging the undersurface of the tongue. When the distal tip of the ETT disappears from the direct view, it should be viewed on the monitor. In this time, rotation and angulation maneuvers are not required in our technique different than the traditional technique to direct the ETT through the glottis. After visualizing the successful intubation, a stylet should be pulled out to remove easily from the ETT. The unique shape of the novel technique described here can improve the GlideScope® intubation by decreasing the manipulation, rotation, and angulation maneuvers. Due to the medially 45° shaped tip of the ETT, the intubation may be smoother and more comfortable. The ETT's C type circular shape allows it to hug the tongue's undersurface and slide quickly and smoothly to the laryngeal space. Studies with larger patient populations are needed to determine if the new technique improves the GlideScope® intubation, better understand the mechanisms and the clinical significance, and ascertain whether this technique evolves into a useful technique.

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