Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia

Comparison of thoracic vs lumbar spinal anaesthesia fo orthopaedic surgeries

Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice  for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic  spinal anaesthesia at the T9-T10 / T10-T11 interspace using  1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl.  Group L patients received  2.5 ml of  hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia  and  motor block,  haemodynamics  and neurological complications.Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory  and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups  and no neurological complication in any patient.Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.

Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used

Clinical Characteristics and Outcomes in Patients Admitted in ICU with Severe COVID-19 in a Tertiary Care Hospital in North India: A Retrospective Observational Study

Background: Many studies have reported poor clinical outcomes regarding the ICU course of patients with severe COVID 19. Our study aimed at prospectively observing the predominant clinical pattern and outcomes in patients with severe COVID 19 admitted in the ICU. Materials and Methods: This study was a retrospective, observational study of 100 patients admitted to the ICU with confirmed COVID 19. Data from all patients with confirmed COVID 19 admitted in ICU between 15 March 2021 to 25 April 2021 was included for this study. Patients were studied for their demographics, baseline comorbidities, laboratory investigations, and details of treatment. Major outcomes analyzed were clinical presentation, mechanical ventilation (MV) related mortality, and overall mortality of ICU patients. Student's independent t-test for comparing continuous variables and Chi-square test for categorical variables.Results: Out of 220 patients with COVID-19, 100 were admitted to the ICU. The most common comorbidities were hypertension (38) and diabetes (25). Twenty-eight patients required mechanical ventilation (MV), out of which only 16 survived. MV LOS was longer for survivors than non-survivors. The overall mortality rate in ICU patients was 25%, and MV-related mortality was 42.85%. Conclusion: The severity of presenting symptoms and presentation time play a major role in the outcome. Our study reports higher mortality in patients who required mechanical ventilation. This could be because of the increased severity of disease in these patients