Observational study of segmental epidural anesthesia for orthopedic surgeries

Background: Epidural anaesthesia is suitable technique for lower abdominal and lower limb surgery. Compared to conventional epidural anesthesia (EA), segmental epidural anaesthesia (SEA) denotes the use of a small volume enough to block only the segments involved in the field with stable hemodynamics and limited spread of analgesia. We decided to do study of SEA for lower limb surgeries. Aim was to observe characteristic of sensory and motor block, quality of analgesia, hemodynamics and peri-operative complications. Methods: After institutional ethical committee approval, prospective observational study of SEA for orthopedic surgeries was carried out in 130 patients of 18 to 60 years of either sex with ASA grade І-Ш. For SEA, we used bolus dose of lignocaine with adrenaline (L+A) 2% 8 to 12 ml injected over 4 minutes according to anticipated segments required to be blocked and patient’s condition and type of surgery. Top up dosages were repeated every 60 minutes.  Quality of analgesia and block, total local anesthetic used and hemodynamics were recorded intraoperatively. Results were analysed statistically and were compared using the student’s paired ‘t’ test. P value <0.05 was considered as significant. Results: Requirement of bolus dose was 8 ml, 10 ml and 12 ml in 78 patients, 31 patients and 7 patients respectively. In all patients 1st top up dose was given while 2nd top up was required in 32 patients only. Intra op MAP remains near to baseline. Quality of block was excellent in 66 patients (55%), good in 35 patients (29%) and fair in 15 patients (12.5%). Conclusions: We concluded that SEA is a safe and reliable technique for orthopedic surgeries with stable hemodynamics, limited spread of analgesia involving only required segments with minimal side effects

Study of the impact of training of registered nurses in cardiopulmonary resuscitation in a tertiary care centre on patient mortality

Background and Aims: Nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills to be able to implement effective interventions during in-hospital cardiac arrest. The aim of this descriptive study was to assess mortality impact after nurses' CPR training with pre-CPR training data at our institute. Methods: Training regarding CPR was given to nurses, and CPR mortality 1-year before basic life support (BLS) and advanced cardiac life support (ACLS) training were collected and compared with post-training 1-year CPR mortality. Results: A total of 632 adult patients suffering in-hospital cardiac arrest over the study period. CPR was attempted in 294 patients during the pre-BLS/ACLS training period and in 338 patients in the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 58 patients (19.7%) had return of spontaneous circulation (ROSC), while during the post-BLS/ACLS training period, 102 patients (30.1%) had ROSC (P = 0.003). Sixteen of the 58 patients (27.5%) who achieved ROSC during the pre-BLS/ACLS training period survived to hospital discharge, compared 54 out of 102 patients (52.9%) in the post-BLS/ACLS training period (P < 0.0001). There was no significant association between either the age or sex with the outcomes in the study. Conclusion: Training nurses in cardiopulmonary resuscitation resulted in a significant improvement in survival to hospital discharge after in-hospital cardiac arrest

Anaesthetic Management of Cataract Surgery in a Patient with Sturge-Weber Syndrome

Sturge-Weber Syndrome (SWS), also called as encephalo trigeminal angiomatosis, is a rare congenital syndrome, characterized by lepto meningeal haemangioma, a facial port-wine stains distributed over the trigeminal nerve area, (usually involving one side) and glaucoma. During cataract surgery, there may be rupture of choroid haemangioma, leading to excessive bleeding, or of haemangioma involving the airway, leading to difficult mask ventilation, laryngoscopy and intubation. We discuss the anaesthetic management of the patient with SWS for cataract surgery

Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery

Aims: This prospective double-blinded study was designed with the aim of comparing the analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine with that with bupivacaine alone in patients undergoing laparoscopic surgeries. Materials and Methods: A total of 100 patients of either sex undergoing elective laparoscopic surgery were randomly divided into two groups containing 50 patients in each group. Group B received intraperitoneal instillation with 50 mL of bupivacaine 0.25% (125 mg) and groups B + D received 50 mL of bupivacaine 0.25% (125 mg) + 1 μg/kg of dexmedetomidine. Pain was assessed using visual analogue scale (VAS) at 0.5 h, 1 h, 2 h, 4 h, 6 h, and 24 h after the surgery. The requirement of rescue analgesics were recorded. Result: Duration of analgesia was longer in group B+D (14.5 hr) compared to group B (13.06 hr). The requirement of rescue analgesic in 24 hours was less in group B+D (1.76) compared to group B (2.56) which were statistically significant (P < 0.05). The mean number of total rescue analgesia given in 24 h was less in group B+D was 1.76 whereas in group B was 2.56 that were statistically significant. Conclusion : Intraperitoneal instillation of dexmedetomidine with bupivacaine prolongs the duration of postoperative analgesia as compared to that with bupivacaine alone. And also there is less number of rescue analgesics that are required postoperatively when dexmedetomidine is supplemented as an adjuvant to bupivacaine

I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

Background: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. Materials and Methods: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. Results: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. Conclusion: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries