ASSESSMENT OF TOTAL INTRAVENOUS ANESTHESIA BY PROPOFOL AND INHALATIONAL ANESTHESIA WITH ISOFLURANE FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Objective: The study’s key objective is to compare the propofol-based total intravenous anesthesia (TIVA) with isoflurane-based inhalational anesthesia for controlled hypotension during functional endoscopic sinus surgery (FESS). Methods: This study was a prospective randomized and controlled single-blinded clinical study. The study involved 40 patients posted for elective FESS surgery, selected randomly from the ENT department. Anesthesia was induced with Inj. Midazolam 2 mg, Inj. Fentanyl 2 μg/kg, Inj. Propofol 2 mg/kg, Inj. Vecuronium 0.1 mg/kg was ventilated using oxygen, air, and Isoflurane (FiO2 of 0.5) in patients with isofurane. Injections of 2 mg of midazolam, 2 μg/kg of fentanyl,2 mg/kg propofol, and 0.1 mg/kg vecuronium, as well as oxygen and air for ventilation, were used to induce anesthesia (FIO2 of 0.5) in TIVA group patients. Fromme boezaart scale was used as an evaluation scale for surgical site bleeding. Results: The average blood loss in the isoflurane group was 134.25±4.65 ml and in the propofol group was 66.95±4.28 ml. The quality of the surgical field in the propofol group is (3.13±0.9), and in the isoflurane group is (3.13±0.8). The results are significant. Conclusion: Total intravenous anesthesia using propofol provides notable advantages over the traditionally used inhalational anesthetic technique using isoflurane in surgical field conditions and intraoperative blood loss

ASSESSMENT OF ENDOTRACHEAL TUBE CUFF PRESSURE: FINGER PRESSURE TECHNIQUE VERSUS MINIMUM LEAK TECHNIQUE

Objective: The purpose of this study is to compare routinely used cuff insufflation techniques to finger-pressure and minimal leak procedures for achieving safe endotracheal tube (ETT) intracuff pressures in patients undergoing endotracheal intubation. Methods: It is a prospective observational study conducted in patients undergoing elective surgical procedures under general anaesthesia at GITAM Institute of Medical Sciences and Research, Visakhapatnam from January 2019 to June 2020. In Group FP, which includes 50 patients, the ETT cuff (ETTc) was inflated by palpating the pilot balloon between the index finger and thumb until it became taut. When this point was reached, the syringe was detached from the pilot balloon, and a cuff manometer was attached. The pressure reading on the cuff manometer is noted. In Group ML, which includes 50 patients, the ETTc was inflated fully, and then the air was withdrawn slowly from the cuff with auscultation over the trachea until a small leak was heard. When the point was reached, the syringe was detached, and a cuff manometer was attached; pressure readings were noted. Results: Mean inflation cuff pressure in the FP group was 45.40±21.74 cm H2O and in the ML group was 28.68±8.35 cm H2O. In Group FP, out of 50 patients, cuff pressure in 14 (28%) patients was in the normal range; in 32 (64%) patients, the cuff was over inflated, and in 4 patients (8%) cuff was under inflated. In the group ML, 24 (48%) patients have cuff pressure within the normal range; in 18 (36%) patients, the cuff has been over inflated, and 8 (16%) patients have low cuff pressures. Cuff pressure adjustment was required in 36 patients (72%) in the FP group, whereas 26 patients (52%) in the ML group. ML group has a low incidence of postoperative complications, i.e., 10%, compared to the FP group, i.e., 18%. A positive correlation was seen between the measured cuff pressure and body mass index, Volume of air insufflated. Conclusion: The main conclusion is to realize the need to use manometers or better-automated controllers during routine anaesthetic procedures