Effect of Preoperative Oral Carbohydrate Fluid on Post Operative Nausea and Vomiting in Laparoscopic Cholecystectomy Patients Under General Anesthesia

Background: Postoperative nausea and vomiting (PONV), an unpleasant complication following anaesthesia and surgery has various components such as nausea, retching and vomiting. Although PONV is usually self-limiting and non-fatal, it often causes substantial patient distress and dissatisfaction, augmenting healthcare costs by delaying discharge from post anaesthesia care units and causing unexpected hospital re-admissions. Different pharmacological and non-pharmacological approaches have been used for preventing PONV. Nonetheless, the most effective prophylactic regime has not been determined. Methods: We conducted a prospective randomised study for evaluation of effect of preoperative oral carbohydrate fluid (GROUP- C) and placebo drink (clear water) (GROUP-P) on PONV in 90 adult patients undergoing laparoscopic cholecystectomy surgery under general anaesthesia. The number of episodes of nausea, retching and vomiting, total requirement of antiemetic dose in 24 hours, pre and postoperative blood glucose levels, patient satisfaction score, VAS score and haemodynamic parameters were recorded in the two groups and statistical analysis was done. Results: Demographic data was comparable between the two groups with respect to age, gender and BMI. The surgical time and intra-abdominal pressures throughout the surgery were similar in the two groups. In our study the pre-induction blood glucose levels were found to be higher in group C and preoperative thirst was found to be less in group P. Both the groups were comparable in terms of number of episodes of PONV, total requirement of anti-emetic dose in 24 hours, patient satisfaction and well-being. VAS score for pain and requirement of analgesic dose was also similar in the two groups. Conclusion: Pre-operative oral monosaccharide carbohydrate fluid does not prevent PONV, alter requirement of antiemetic, patient satisfaction and well-being, VAS score for pain, requirement of analgesic dose in patients undergoing laparoscopic cholecystectomy under general anaesthesia, as compared to placebo drink.

Pacemaker and Geriatric Anaesthesia: A special report

Geriatric medicine is a full-fledged speciality nowadays. Anaesthesia for geriatric patients is quite challenging. Elderly patients with serious cardiac problems are presenting for various surgeries, warranting the anaesthesiologist to formulate tailor-made peri-operative plan of management. We hereby present a case of an elderly male patient, posted for bilateral inguinal hernioplasty having a permanent pacemaker in situ in DDDR (dual-chamber rate-modulated) mode. The patient, on preoperative examination, was found to have a complete atrioventricular (AV) block on electrocardiogram (ECG) and electrophysiology study showed degenerative AV conduction disease and symptomatic complete AV (atrio-ventricular) block. The pacemaker mode changed to VOO (asynchronous ventricular pacing) mode preoperatively. Central neuraxial blockade was given. Beat-to-beat haemodynamic monitoring was instituted with invasive arterial catheter-transducer system. The patient tolerated the procedure of bilateral inguinal hernioplasty well and vital parameters were maintained throughout the operation. Phenylephrine infusion was given briefly to maintain the blood pressure (MAP > 65mmHg). After the operation, patient was shifted to the intensive care unit (ICU), pacemaker was reprogrammed to DDDR mode, and vigilant monitoring was done. The patient was shifted to the ward on the 2nd post-operative day. This case highlights that low-dose spinal anaesthesia along with vigilant monitoring is a reasonable choice for elderly patients with permanent pacemakers coming for elective surgeries

Comparative assessment of ProSeal™ laryngeal mask airway intervention versus standard technique of endotracheal extubation for attenuation of pressor response in controlled hypertensive patients

Background and Aims: Swapping of the endotracheal tube with laryngeal mask airway (LMA) before emergence from anaesthesia is one of the methods employed for attenuation of pressor response at extubation. We decided to compare the placement of ProSeal ™ LMA (PLMA) before endotracheal extubation versus conventional endotracheal extubation in controlled hypertensive patients scheduled for elective surgeries under general anaesthesia. Methods: Sixty consenting adult patients were randomly allocated to two groups of thirty each; Group E in whom extubation was performed using standard technique and Group P in whom PLMA was inserted before endotracheal extubation (Bailey manoeuvre). The primary outcome parameter was heart rate (HR). The secondary outcomes were systolic, diastolic and mean blood pressure (MBP), electrocardiogram, oxygen saturation and end-tidal carbon dioxide. Two-tailed paired Student's t-test was used for comparison between the two study groups. The value of P< 0.05 was considered as statistically significant. Results: The patient characteristics, demographic data and surgical procedures were comparable in the two groups. A statistically significant decrease was observed in HR in Group P as compared to Group E. Secondary outcomes such as systolic, diastolic and MBP depicted a statistically insignificant difference. Conclusion: Bailey manoeuvre was not effective method to be completely relied upon during extubation when compared to standard extubation

Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia

Background: Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation. Aim: Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Design: Randomized comparative study. Materials and Methods: After approval from Institutional Review Board and Ethical Committee, 100 patients of 18–70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique. Results: First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group. Conclusion: For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position