Abhijit Kumar

Abstract

Background: The aim of anaesthesia in Total knee replacement (TKR) is to provide adequate analgesia and early ambulation. The recent success of adductor canal block in providing post-operative analgesia and achieving early ambulation has evoked interest in studying the effects of local anaesthetic agents and various adjuvants. Materials and Methods: This study was a randomized three arm parallel group comparative study conducted in a tertiary care center in India on 135 patients undergoing unilateral total knee replacement under spinal anaesthesia. After completion of the surgery, the adductor canal block was performed with ultrasound guidance at mid-thigh level in all three groups. In group A, 20 ml 0.375% ropivacaine was only used but in group B and C Dexmedetomidine was added to ropivacaine (total volume of 20 ml; 0.375%) at a dose of 0.25 µg/kg and 0.50 µg/kg respectively. The primary outcome of the study was to compare duration of analgesia after the adductor canal block. Results: Duration to rescue analgesia (in hours) was significantly longer [Group A: 15.71±4.87; Group B: 16.44±6.21; Group C: 19.78±5.57 (p=0.014)] and total opioid (24 hours tramadol needed in mg) consumption [Group A: 60.00±13.94; Group B: 52.22±18.80; Group C: 33.33±13.95 (p=0.033)] was significantly lower in Group C. NRS scores both at movement and rest were significantly lesser in Group C at 18 and 24 hours time points. Patient satisfaction was significantly higher in Group C with 46.67% patient reporting better than expected peri-operative experience (p=0.022). Conclusion: The addition of dexmedetomidine, 0.5 µg/kg to 0.375% ropivacaine in adductor canal block results in longer duration of analgesia, less 24 hours opioid consumption, better motor strength and better patient satisfaction without any adverse effect after unilateral total knee replacement surgery.   Keywords: Analgesia, Dexmedetomidine, Ropivacaine, Adductor canal block, Ultrasound, Total knee replacement, Regional anaesthesia.

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Abstract

Background:  Central venous catheterization (CVC) is a routine procedure in patients admitted in Intensive Care Units (ICU) worldwide. Most commonly, seldinger technique is being practiced irrespective of the site of insertion. Though considered very safe, guide wire related complications have been reported in the literature and incidence has increased in the COVID era where intensivists have to work in personal protective equipment (PPE). Case Report:   We are reporting about a patient of severe COVID-19, admitted in ICU. His right femoral venous catheterization was done to start vasopressors. The guide wire accidentally slipped inside the femoral vein during the procedure. It was immediately detected and managed with the assistance of interventional radiologist under fluoroscopic guidance. Conclusion:  Complications like misplacement of guide wire can be catastrophic during CVC. We have discussed the measures that can prevent or reduce such complications while working in PPE in COVID ICUs.   Keywords: Central venous catheter, Guide wire, PPE, COVID- 19.

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Abstract

Trauma has been a widely studied subject in western world in past decade. Many international organizations have formulated guidelines regarding the management of victims who have threatened airway due to any kind of trauma. Indian subcontinent is following the western world in such situations but incidence and nature of trauma is different, moreover the availability of resources varies. This review article will highlight the topics like need for pre-hospital intubations, status of rapid sequence intubation, cricoid pressure, adjuncts for intubation and airway management of victims with trauma of special nature. “My heart and soul were wrecked; I was not sure whether my windpipe is going to make it or not”- Joshua Graham   Keywords: Airway, Trauma, Cervical spine, Endo Tracheal Tube, Tracheostomy.

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