Deepak Sadashiv Phalgune

Introduction: The data in the published literature on the use of dexmedetomidine in various dosages during extubation from India is modest. We have compared the effectiveness of intravenous dexmedetomidine 0.5 µg/Kg body weight and 0.75 µg/Kg body weight during endotracheal extubation. Materials and Methods: Seventy-four patients aged more than 18 years posted for elective surgery under general anaesthesia were included in this randomised double- blind controlled study. Group D1 and Group D2 patients received 0.5 µg/Kg and 0.75 µg/Kg body weight intravenous dexmedetomidine respectively. The primary outcome measures were to compare haemodynamic parameters, whereas secondary outcome measures were to compare extubation quality, and post-extubation sedation. Results: The mean heart rate at reversal, and after endotracheal extubation was considerably elevated in group D1 as compared to D2. The mean systolic blood pressure, diastolic blood pressure and mean arterial pressure after endotracheal extubation were considerably elevated in group D1 as compared to D2. The mean respiratory rate at reversal, and after endotracheal extubation were considerably elevated in Group D1 as compared to Group D2. The mean sedation score after endotracheal extubation was considerably elevated in Group D2 as compared to Group D1. Conclusions: The haemodynamic parameters were better in Group of patients who received intravenous dexmedetomidine 0.75 µg/Kg body weight as compared to Group of patients who received dexmedetomidine 0.50 µg/Kg during endotracheal extubation.   Keywords: Dexmedetomidine, Haemodynamic parameters, Tracheal extubation.

Introduction: There are many studies in India that have compared direct laryngoscopy and video laryngoscopy in adults but the published data regarding paediatric population which needs special consideration is limited. The present study was aimed to compare the efficacy of video laryngoscopy and direct laryngoscopy in endotracheal intubation in paediatric patients. Materials and Methods: The present randomised controlled research was done in 64 children of one to five years that underwent pre-planned surgery. Children were divided into direct laryngoscopy and video laryngoscopy groups by randomization. The comparison of the time required for the best visualisation of glottis was the primary outcome measure. The comparison of the time to intubation and number of attempts were the secondary outcome measures. An unpaired student’s t-test and the Chi-square/ Fisher’s exact tests were used to compare the quantitative and qualitative variables respectively. Results: Mean time required for the best visualisation of video laryngoscopy and direct laryngoscopy was 6.1 sec and 5.3 sec respectively (p-value = 0.010). The mean time to intubation of video laryngoscopy was 15.3 sec while that of direct laryngoscopy was 13.1 sec (p-value = 0.001). The first attempt success rate was 29/32 (90.6%) in the video laryngoscopy group whereas it was 28/32 (87.5%) in the direct laryngoscopy group (p-value = 0.580). Conclusion: Time required for the best visualisation of glottis and time to intubation were significantly higher in video laryngoscopy as compared to direct laryngoscopy group.   Keywords: Direct laryngoscopy, Video laryngoscopy, Time required for best visualization, Time to intubation.

Introduction: There is paucity of Indian data regarding the use of sedation for endobronchial ultrasound. We compared the efficacy of etomidate and propofol in patients undergoing endoscopic bronchial ultrasound for the achievement of satisfactory sedation. Materials and Methods: Seventy patients aged more than 18 years posted for endoscopic bronchial ultrasound under sedation for diagnostic and therapeutic purpose were included in this randomised double- blind controlled study. Patients were randomly allocated to propofol and etomidate group. Comparison of cardiovascular adverse events and haemodynamic parameters were the primary objectives. Comparison of gag reflex, visual analogue scale score and recovery from sedation using Modified Aldrete Score were the secondary objectives. Results: Patient satisfaction in terms of visual analogue scale score was the same in both propofol and etomidate groups. Endoscopist’s satisfaction was significantly higher in etomidate group as compared to propofol group. The post-operative hypotension was significantly lower in etomidate group as compared to propofol group. The post-operative bradycardia was significantly lower in etomidate group as compared to propofol group. Conclusions: Endoscopist’s satisfaction and the haemodynamic control was better in etomidate group as compared to propofol group during endobronchial ultrasound.   Keywords: Endobronchial ultrasound, Etomidate, propofol, Gag reflex, Visual analogue scale, Haemodynamic parameters

Introduction: The incidence of a post-operative sore throat (POST) varied from 21%–100% in intubated patients. Numerous non-pharmacological and pharmacological measures have been used for attenuating POST with variable success. The aim of the present study was to compare the efficacy of amyl meta cresol-2,4-dichlorobenzyl alcohol (AMC-2,4-DCBA) lozenges against warm normal saline (0.9%) gargles versus control in preventing and treating POST after extubation of the patients who have undergone surgical procedures under general anaesthesia. Materials and Methods: This single-blind randomised controlled study was conducted in 120 patients. Group S patients received one honey and lemon-flavoured AMC-2,4-DCBA lozenge. Group G and Group C patients received warm normal saline and distilled water for gargling respectively. Assessment of POST was carried out at 1 h, 12 h and 24 h. The primary outcome measure was to compare the degree of sore throat whereas secondary outcome measure was to compare patient comfort in terms of relief of symptoms. Comparison of quantitative and qualitative variables was done using analysis of variance test and chi-square test/Fisher’s exact test respectively. Results: There was no statistically significant difference between Group S, Group G and Group C in relation to Ramsay sedation score, supplemental analgesics given, three-point assessment score at 1 h, 12 h, and 24 h. AMC-2,4-DCBA lozenges offered the maximum benefit in terms of patient comfort of POST symptoms at the end of 24 h post-surgically. Conclusions: Amyl meta cresol-2,4-dichlorobenzyl alcohol lozenges and warm normal saline gargles did not show a significant benefit in relieving post-operative sore throat in the post-surgical period as compared to the placebo.   Keywords: Amyl meta cresol-2, 4-dichlorobenzyl alcohol lozenges, Distilled water, Post-operative sore throat, Ramsay sedation scale, Warm normal saline

Introduction: The postoperative sore throat (POST) occurs in approximately ? 50% of individuals after general anaesthesia. An attempt is made in the present research to evaluate the efficacy of alkalinized 2% lignocaine with conventional air as cuff inflating media, in preventing POST and coughing in patients undergoing a surgical procedure under general anaesthesia. Materials and Methods: This randomised double-blinded controlled study was conducted in sixty patients. In Group A, the endotracheal tube (ETT) cuff was filled with air, whereas in Group B, it was filled with 2% lignocaine. Coughing and POST were recorded immediately, at 1 hour, 12 hours and 24 hours. We have compared coughing, POST following tracheal extubation, and volume of inflation medium and intra-cuff pressure at the start and at the end of surgery between the two groups. Results: The mean volume at the end of the surgery was 7.9 mL and 4.5 mL in Group A and Group B respectively (p-value = 0.001). The mean intra-cuff pressure at the end of the surgery was 32.5 cm and 19.8 cm in Group A and Group B respectively (p-value = 0.001). The percentage change in the volume at the end of the surgery was + 49.7 and -12.7% in Group A and Group B respectively (p-value = 0.001). The percentage change in the intra-cuff pressure at the end of the surgery was + 62.5 and -1.0% in Group A and Group B respectively (p-value = 0.001). The incidence of coughing at one hour postoperative was 26.7% and 3.3% in Group A and Group B respectively (p-value = 0.026). Conclusion: The intracuff alkalinized lidocaine is useful adjunct to endotracheal intubation.   Keywords: Postoperative sore throat, Lidocaine, Air, Endotracheal tube.

Background: Epidemiological studies have established a strong association between primary headaches and psychiatric disorders and the reported prevalence was 66.1% of depressive and anxiety disorders. The primary objective of this research was to study association of vertigo with anxiety and/or depression in patients of migraine or tension type headache (TTH) whereas secondary objective was to study prevalence of anxiety and depression in migraine or TTH patients. Methods and Materials: This cross sectional observational study was conducted between September 2015 and February 2017 in patients aged 18 to 70 years of either sex with migraine or TTH with or without vertigo. We used The International classification of headache disorders 3 for diagnosis of migraine, and TTH. Hamilton anxiety rating scale (HAM-A) and Hamilton depression rating scale (HAM-D) were used to assess anxiety and depression respectively. Chi-square test or Fisher’s exact test was used to find the association between HAM-A and HAM-D. Odds ratio was calculated to find the chances of occurrence of anxiety or depression in vertigo with the type of headache. Results: In patients of migraine and TTH with history of vertigo, anxiety and depression was 6.2 times and 2.1 times more prevalent respectively as compared to those without vertigo. Higher percentage of patients with migraine type of headache had depression as compared to TTH patients. Conclusions: Anxiety and depression is common in patients with migraines and TTH therefore proper diagnosis and treatment of anxiety and depression are needed for improved management of patients of migraine and TTH. Keywords: Anxiety, Depression, Migraine, Tension type headache, Vertigo.

Introduction: There are no studies comparing Supreme laryngeal mask airway (LMA), I gel and Baska mask in Indian population. A comparison of the clinical performance of Supreme LMA, I gel and Baska mask was undertaken in this randomized controlled study. Materials and Methods: The present research was undertaken in 75 patients aged 18 to 60 years who underwent elective surgery for less than 3-hour duration under general anaesthesia. The patients were randomly divided into three groups; Supreme LMA, I gel, and Baska mask. The oropharyngeal leak pressure (OLP) after 30 minutes to loss of spontaneous respiration was the primary objective, whereas the secondary objectives were attempts required for insertion of LMA, ease of gastric tube insertion, time required for gastric tube insertion and post-operative morbidity. Results: The mean OLP of Baska mask group was (28.2 cm HO) as compared to Supreme LMA (25.3 cm HO) and I-gel (24.1 cm HO) groups (p-value = 0.0001). The mean gastric tube insertion time of Baska mask group was (20.7 s) as compared to Supreme LMA (6.7 s) and I-gel (9.6 s) groups (p-value = 0.0001). The three groups were comparable with regards to the number of attempts required, ease of gastric tube insertion and post-operative morbidity. Conclusion: A higher OLP was observed in Baska mass group as compared to Supreme LMA and I-gel. The three devices were similar in terms of attempts required for insertion, ease of gastric tube insertion and post-operative morbidity.   Keywords: Supreme laryngeal mask airway, Baska mask, I- gel, Oropharyngeal leak pressure, Gastric tube insertion.

Background: There is little documentation describing the correlation between plasma adiponectin and the severity of ischemic stroke in the Indian population. The present study was aimed to find the correlation between plasma adiponectin levels and severity of acute ischemic stroke using the National Institute of Health Stroke Scale (NIHSS) and Modified Rankins Scale (MRS). Materials and Methods: The present prospective observational study was conducted on 109 patients of confirmed acute ischemic stroke aged ? 30 years presenting within 24 hours of new onset of neurodeficits. NIHSS and MRS were measured within 24 hours and 5 days after onset of symptoms respectively. Plasma adiponectin levels were measured. The primary objectives were to find the correlation of plasma adiponectin levels with severity of acute ischemic stroke using the NIHSS and neurological functional outcome using the MRS. The secondary objectives were to find an association of plasma adiponectin levels with serum lipid profile and comorbidities. Results: There was a negative correlation between plasma adiponectin levels and NIHSS score (r = - 0.110, p-value = 0.253) and MRS (r = -0.041, p-value = 0.672) which was not statistically significant. The median plasma adiponectin levels were comparable between the groups of cases with co-morbidity and without co-morbidity. A significantly higher percentage of patients who had high triglyceride levels had normal plasma adiponectin levels. The distribution of other lipid parameters and hypertension did not differ significantly between the groups of cases with normal and abnormal plasma adiponectin levels. Conclusions: There was no correlation between plasma adiponectin levels and severity of acute ischemic stroke.   Keywords: Ischemic stroke, National Institute of Health Stroke Scale, Modified Rankins Scale, correlation

Abdominoplasty is generally performed with admission of the patient for one night. It is a usual beautifying technique. It is reported that abdominoplasty can cause death and morbidity. For performing abdominoplasty numerous anaesthesia techniques are reported. Morbidly obese patients with compromised heart ailment undergoing abdominoplasty pose exceptional challenges to the anaesthesiologist. It is necessary to use the anaesthetic procedure such that it causes minimal haemodynamic instabilities with supreme safety for the patient. In this case report a 53-year-old male, morbidly obese patient with a body mass index (BMI) of 43.8 Kg/m, belonging to American Society of Anaesthesiologist (ASA) grade IV, and overhanging abdomen till the level of knee, with ventricular bigeminy, severe pulmonary hypertension, obstructive sleep apnea and chronic kidney disease is described. Abdominoplasty of this patient was performed under combined spinal-epidural anaesthesia. The implications of combined spinal-epidural anaesthesia were that the hemodynamic parameters such as heart rate, respiratory rate, non-invasive blood pressure, SpO2 were stable during the procedure and no complications were observed post-operatively. The results were excellent with speedy recovery. Keywords: Abdominoplasty, Morbid obesity, Ventricular bigeminy, Pulmonary hypertension