Bindu George

Abstract

Introduction and Objectives: Endotracheal intubation involving conventional laryngoscopy elicits a hemodynamic stress response which can be deleterious in susceptible individuals. The study was aimed to see if King Vision video laryngoscope has any advantages over conventional Macintosh laryngoscope in attenuating the hemodynamic response during endotracheal intubation. Materials and Methods: 80 ASA I and II patients (aged 18-59 years) who fit the eligibility criteria and scheduled for elective surgery under general anesthesia were recruited for the study after obtaining permission from the institutional review board. By randomization they were allocated into two groups. Group A underwent intubation with King Vision video laryngoscope (KVVL) and group B were intubated with Macintosh laryngoscope (MDL). Systolic BP, diastolic BP, mean arterial pressure, heart rate and Sp02 were measured at baseline, post induction, prelaryngoscopy and post intubation at 1, 3 and 5 minutes. The time duration for intubation, numbers of attempts for intubation and postoperative pharyngeal morbidities were also noted. Results: The duration of laryngoscopy and intubation was significantly longer in group A (KVVL) when compared to group B (MDL) patients (18.28 6.555 Vs. 14.75 3.678 seconds)(p = 0.004). However, patients in group A (KVVL) had less hemodynamic response compared to group B (MDL) with statistically significant heart rate changes at 3 minutes post intubation. (86.3715.255 Vs 94.4519.123 beats/minute respectively)(p = 0.040). There were no significant differences between both the groups in terms of number of attempts and post operative oropharyngeal morbidities. Conclusion: We conclude that King Vision video laryngoscope is a useful alternative to traditional Macintosh laryngoscope for reducing hemodynamic stress response during endotracheal intubation. Keywords: King vision video laryngoscope, Macintosh laryngoscope, Hemodynamic response, Intubation time.

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Abstract

Introduction: Ultrasound guidance has resulted in a renewal of interest in supra clavicular approach of brachial plexus block for surgeries below the shoulder. There is a necessity for an additive that increase the duration of local anaesthetics providing effective postoperative analgesia also after one shot injections. Dexmedetomidine and clonidine are the common adjuvants used, but in higher doses. The aim of this study was to see which among them is a better analgesic additive in lower doses. Materials and Methods: Sixty patients, aged 18-55 years, posted for hand and forearm surgeries under Ultrasound directed supraclavicular brachial block were divided randomly in to 2 groups using computer generated tables. Group C: Clonidine 0.5 ?g /kg added to 25ml of 0.375% bupivacaine. Group D: Dexmedetomidine 0.5 ?g /kg and 25ml of 0.375% bupivacaine. The onset and the duration of analgesia, motor block and sedation scores were noted. Results: Onset of sensory block was 11.6 +/-3.4 minutes in group C, 14.4 +/-4.5 minutes in group D. The onset of motor block was 17.6 +/-4.9 in group C, 20.6+/-5.9 in group D. The mean time of sensory block in Group C was 9.7+/-1.6 hours, 13.3+/-1.9 hours in Group D. Motor blockade (hrs) was for 9.1+/-1.7 in Group C, 12.1+/-2.0 in Group D. Analgesia and motor blockade were longer in dexmedetomidine group. Rescue analgesic was given at 10.5 ± 1.7 hrs in clonidine category and at 15 ± 2.2 hrs in dexmedetomidine category. 10% of subjects in Dexmedetomidine category had adverse reactions, it was not there in clonidine. Conclusions: Dexmedetomidine showed features of a superior additive compared to clonidine as it enhanced the quality and duration of analgesia with lesser complications at lower doses. Keywords: Bupivacaine, Dexmedetomidine, Clonidine, Ultrasound, Supraclavicular brachial plexus block.

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Abstract

Introduction: Postoperative visual loss (POVL) after posterior approach to spine surgeries is a devastating complication necessitating a prospective study. The primary aim was to identify ophthalmological changes contributing to POVL (visual acuity, anterior segment, intraocular pressure (IOP), fundus, field of vision, external ocular examination). Secondary objectives was to evaluate the relationship between ophthalmological changes and various perioperative data including patient comorbidities, positioning and other intraoperative details. Materials and Methods: After getting necessary approvals and consent, thirty patients posted for the posterior spine surgeries were assessed preoperatively. Ophthalmological examination was conducted preoperatively, the day before surgery and postoperatively twice (first within an hour of completion of surgery and second at twenty four hours). Perioperatively, data including type of surgical frame, headrest used, duration of prone positioning, total blood loss, total intravenous fluids administered, lowest mean arterial pressure for more than ten minutes, blood transfusion details and use of hypotensive anaesthesia were noted. Data were analyzed using chi-square test, paired t test, and correlation coefficient. Results: There were no changes in visual acuity, anterior segment, fundus and field of vision postoperatively. But 12 patients had a rise in IOP and six developed lid edema and chemosis. There was a minimal increase in IOP at one hour post operatively (right eye- 2.8 mm Hg (p=0.001, and left eye- 3 mmHg(p<0.001). The analysis of perioperative data revealed no relationship with ophthalmological changes noted. Conclusion: There were no clinically significant ophthalmological changes contributing to POVL in spine surgeries in prone position. Observed ophthalmological changes did not have any correlation with patient comorbidities, positioning and other intraoperative details. Keywords: Intraocular pressure, Chemosis, Postoperative visual loss, posterior spine surgery, Prone position.

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