I-gel for Positive Pressure Ventilation

Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation. Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation.

I-gel for Positive Pressure Ventilation

Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. 
 Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. 
 Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. 
 Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation. 
 Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation. &#13

Our Health and Physical Education

Class 7 (Nepali Date: 2053); Language: Nepal

PREANAESTHETIC FASTING PRACTICE AND OUTCOME : A STUDY IN NEPALI CHILDREN

The purpose of this study is to compare the outcome of traditionally advised pre-anesthetic fasted children with those who fasted for lesser time in our setup. One hundred and Sixty two children undergoing surgery under general anaesthesia were selected randomly. They were divided into two groups. Group one was advised in a traditional way – no solid food after midnight and no liquid drink at least six hours before anaesthesia. Group two was given either glucose water 2-4 hours before induction or breast milk 4 hours before induction of anaesthesia. None of the children were premedicated. Anesthetic techniques were either sole intravenous anaesthesia (IVA) for minor cases or general anaesthesia (GA) and combined methods (IVA or GA with regional blocks). Patients were closely monitored for any active regurgitation and vomiting during the induction of anaesthesia, perioperative and postoperative period. Complications were analyzed in different age groups, different fasting hours and type of anaesthesia delivered. None of the children had any regurgitation or vomiting during induction and perioperative period. Few children of both groups vomited during postoperative period when they were fully conscious. As the chances of regurgitation and vomiting with clear fluid given two hours before is comparable with the traditional system, there is no need to put the child starved for prolonged period. This will avoid unnecessary dehydration, hypoglycemia and uncoperation in the children. Key Words: Pre-anaesthetic fasting, regurgitation, dehydration

Postoperative Acute Submandibular Sialadenitis: A Case Report

Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway