Yogendra Singhal

Abstract

Background: Laryngoscopy and intubation have been associated with increased sympathetic responses such as hypertension, tachycardia, arrhythmias, and myocardial infarction. This response is usually transient and variable but might be life threatening in cardiovascular and cerebrovascular compromised patients. So controlling this response is utmost goal of anaesthesia. We evaluated the effectiveness of dexemedetomidine/clonidine to attenuate pressor response. Aims: Evaluation of efficacy of addition of Dexemedetomidine/ clonidine to fentanyl in attenuation of pressor response of laryngoscopy and intubation. Materials and Methods: 96 patients were enrolled and randomly divided in three groups having 32 patients each. Group NS received 10 ml normal saline, Group CL received 2mcg/kg Inj. Clonidine and Group DE received 1mcg/kg Inj. Dexemedetomidine infusion over 10 min before laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were studied immediately after premedication, 10 min after study drug infusion and then at 1, 2,3,4,5 and 10 min intervals. Results: There was significant fall in mean HR and mean MAP after 10 min of study drug infusion. Clonidine and dexemedetomidine groups had significantly less rise in heart rate and mean arterial pressure after intubation and then at 1,2,3,4,5 and 10 min time intervals compared to placebo group. No significant side effects were observed. Conclusion: Use of dexemedetomidine 10 min before laryngoscopy was associated with significantly less rise in pressor response compared to placebo group. Dexemedetomidine better attenuates the pressor response compared to clonidine but the difference was statistically insignificant. Keywords: Dexemedetomidine, Intubation, Laryngoscopy, Pressor response.

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Abstract

Introduction: Tracheoesophageal fistula (TEF) is one of the common congenital anomalies presented at birth. Management of TEF is a challenging task as outcome of these cases not only depends on surgeon and anaesthesiologist’s skills but also depends on various factors associated with new born. This prospective study evaluates the association of various factors on survival of TEF patients. Materials and Methods: 16 newborn patients in a calendar year were enrolled in this prospective study and impact of various factors like age, weight, parity of mother, associated congenital anomalies and family history, mode of delivery, place of delivery, associated hydramnios and type of TEF were evaluated on the survival of neonates born with TEF. Results: Male, female ratio was equal. Patient with birth weight >2.5 kg had higher survival rate (100%) compared to patient Conclusion: Birth weight remains the single most important predictor of mortality among TEF patients, as suggested with Waterston risk classification. Keywords: Tracheoesophageal fistula, Birth weight, Neonates, Waterston classification.

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Abstract

Introduction: A prospective observational study was conducted in 4085 caesarean sections performed under Regional anaesthesia (RA) from February 2014 to January 2017 in tertiary care centre. The incidence and various contributing factors leading to total or partial failure of RA and the conversion rate to GA were determined. Materials and Methods: All parturients posted for elective or emergency caesarean section received 10-12 mg 0.5% of hyperbaric bupivacaine added to 25 µg of inj. Fentanyl, administered through a 25-27G Whitacre needle. A structured proforma was prepared to note the demographic data, type of RA, insertion position, position after insertion, local anesthetic volume, loss of sensation to pin prick and grade of motor block. Results: In this 3 year period 4085 CS were performed, out of which 4054 (99.27%) were conducted under RA, [4034 (99.5%) under spinal anesthesia, 14 (0.34%) under CSE and 6 (0.14%) under epidural]. 30 (0.73%) cases received GA primarily, the incidence of conversion rate from neuroaxial anesthesia to GA was 100 (2.5%) out of which 1.77% were of elective surgery and 3.1% were in emergency surgery. Partial failure occurred in 1.68% and complete failure in 0.79% patients. Spinal failure occurred due to anesthetic factors like early start of surgery, before establishment of adequate block, inadequate dose of LA, inappropriate recording of block, ineffective batch of drug and technical or surgical factors. Conclusion: Minimizing the incidence of block failure requires close attention to minute details. Keywords: Failed Spinal, Failed Intubation, Regional Anesthesia.

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