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Evaluation of effect of lung recruitment manoeuvres on perioperative atelectasis in laproscopic cholecystectomies: a randomised controlled trial.

2022-01-01T00:00:00Z

Title: Evaluation of effect of lung recruitment manoeuvres on perioperative atelectasis in laproscopic cholecystectomies: a randomised controlled trial. Authors: Apurva Kumari Abstract: BACKGROUND: Approximately 90% of patients undergoing general anesthesia encounter atelectasis, especially after laparoscopic cholecystectomy. Pneumoperitoneum during laparoscopic surgeries significantly hinders pulmonary function, leading to notable atelectasis. The lung recruitment maneuver may mitigate hypoxia caused by atelectasis and minimize postoperative pulmonary complications. METHODS: Patient selection was randomized; Group UC did not receive lung recruitment, while Group URM did. All patients underwent ultrasonography at four time points: T1 - just before anaesthesia induction, T2 - post-surgery, T3 - 15 minutes post-extubation, and T4 - 30 minutes post-extubation. Only participants from the URM group received lung recruitment, which was guided by real-time ultrasound. Ultrasonic scanning indicated the absence of collapsed areas following manual adjustment of airway pressure from 10 cmH2O to 20 cmH2O, with a FiO2 of 0.4. Every patient received lung ultrasonography at 15 (T3) and 30 (T4) minutes following extubation to evaluate persistent atelectrauma and desaturation. CONCLUSION: At T3 and T4, the URM group exhibited a significantly reduced aeration loss of 22% and 51%, respectively, when compared to the UC group, which showed losses of 53% and 87% (p < 0.01). The URM group exhibited better oxygenation post-surgery compared to the UC group, with mean SpO₂ values of 98.10 ± 1.744% versus 94.54 ± 1.286% (p = 0.001). The increased alveolar recruitment and gas exchange in the URM group accounted for this outcome. In conclusion, the utilization of ultrasound for facilitating lung recruitment techniques may decrease atelectasis during surgeries, improve oxygenation, and result in enhanced pulmonary outcomes in laparoscopic cholecystectomy.

A Study To Compare The Analgesic Efficacy Of Dexamethasone And Dexmedetomidine As An Adjuvant To Bupivacaine For Bilateral Superficial Cervical Plexus Block In Patients Undergoing Thyroid Surgeries – A Randomised Clinical Trial

2021-01-01T00:00:00Z

Title: A Study To Compare The Analgesic Efficacy Of Dexamethasone And Dexmedetomidine As An Adjuvant To Bupivacaine For Bilateral Superficial Cervical Plexus Block In Patients Undergoing Thyroid Surgeries – A Randomised Clinical Trial Authors: Vanishree, Deshpande Abstract: BACKGROUND AND AIMS: Thyroid surgeries being one of the most common endocrine surgical procedures carried out throughout the world. Pain control is one of the many challenges faced by the perioperative physicians in post thyroid surgeries patients which when untreated proceeds to become chronic pain. The goal in the initial postoperative period is to provide good analgesia and better quality of recovery along with eliminating the side effects of systemic analgesics. Regional anaesthesia techniques have become a popular tool in achieving this goal. BSCPB is one of the simple and easy locoregional techniques used in managing pain in post thyroid surgery patients. This study aims at comparing the analgesic efficacy of dexmedetomidine and dexamethasone as an adjuvant with bupivacaine for BSCPB in patients undergoing thyroid surgeries. METHODOLOGY: • Written informed consent obtained. • Nil by mouth status confirmed. • IV access was secured 20 Gauge cannula. • Patients underwent thorough Pre-anaesthetic evaluation with detailed history, airway examination, systemic examination. Patient was explained about the BSCPB procedure and sensitized about Visual analogue scale. Routine blood investigations were done along with thyroid profile. • General anaesthesia was given. Before the incision, BSCPB was given with 10ml 0.5% bupivacaine either with 50mcg dexmedetomidine in Group A or 8mg dexamethasone in Group B. Patients were monitored for 24 hours for postoperative pain. RESULTS: • Age and gender were comparable and statistically insignificant. • Intraoperative hemodynamic parameters (SBP, DBP, MAP, HR) monitored at specific time intervals were significantly lower in Group A. • VAS scores were significantly better up to 8 hours in Group A. • The time taken for first analgesic dose request is significantly longer in Group A than Group B. • The total postoperative analgesic consumption was significantly lower in Group A than in Group B. • Group B had significantly lower incidence of postoperative nausea and vomiting. CONCLUSION: In conclusion, with all the above findings which are statistically significant, Dexmedetomidine performs better than dexamethasone as an adjuvant to bupivacaine for BSCPB for post operative analgesia in patients undergoing thyroid surgeries.

Evaluation of gastric residual volume using ultrasound in fasting diabetic patients and non diabetic patients scheduled for elective surgeries; A Comparative study

2021-01-01T00:00:00Z

Title: Evaluation of gastric residual volume using ultrasound in fasting diabetic patients and non diabetic patients scheduled for elective surgeries; A Comparative study Authors: JYOTHI SWAROOP, T Abstract: INTRODUCTION Gastric residual volume is vital for assessing gastric emptying and gastrointestinal function. Traditional method of measuring gastric residual volume (GRV) like aspiration through nasogastric (NG) tube are invasive and uncomfortable. Ultrasonography (USG) emerged as non invasive , reliable alternative , hence the present study is used for evaluation of gastric volume among the diabetic and non-diabetic population to minimize the intraoperative and post operative complications like pulmonary aspiration. This study considered factors such as diabetes duration, blood sugar levels, HbA1c, and fasting duration in evaluation of gastric residual volume. MATERIALS AND METHODS: It is a comparative study , conducted on 104 patients undergoing for elective surgeries at BLDE Hospital and research center, Vijayapura during the academic year 2022-2024,we divided in tot 2 groups after taking informed consent and fulfilling the inclusion criteria, group D is having 52 patients who were having history of diabetes mellitus and group ND who were non diabetic patients ,patients was then explained about the procedure and were scanned in supine position and then scanned in right lateral decubitus position ,then the ultrasonography images of both were measured with following diameters, craniocaudal(CC), anteroposterior(AP), cross sectional area (CSA) andRESULTS : The mean age of the participants was found to be 40.62 + 9.16yrs with 72.11% were male patients and 27.88% were female patient. Among the patients there is significant higher mean level of CC diameter, AP diameter and CSA in supine position in cases compared to controls. (p<0.05) Similarly, there is significant higher mean level of CC diameter, AP diameter and CSA in RLD position in cases compared to controls. (p<0.05) The gastric volume was significantly higher in Diabetics (39.07+ 8.39)compared to the Normal individuals(9.28+ 4.11) in the study. (p<0.05) CONCLUSION : Diabetic patients have significantly higher fasting gastric volumes as measured using point of care ultrasonography, in comparison to non diabetic patients.

A Comparative Study Of Infusion Of Ephedrine And Phenylephrine On Hemodynamic Stability After Spinal Anesthesia In Elderly Patients Undergoing Lower Limb Orthopaedic Surgeries

2021-01-01T00:00:00Z

Title: A Comparative Study Of Infusion Of Ephedrine And Phenylephrine On Hemodynamic Stability After Spinal Anesthesia In Elderly Patients Undergoing Lower Limb Orthopaedic Surgeries Authors: Syed Sufian, Ibrahim Abstract: AIM  To compare infusion of ephedrine and phenylephrine on hemodynamic stability after spinal anesthesia in elderly patients aged 60 years and above undergoing lower limb orthopedic surgeries. BACKGROUND • Patients aged 60 years and above undergoing lower limb orthopaedic surgeries commonly experience hypotension post spinal anesthesia • To overcome this effect and to maintain hemodynamic stability prophylactic infusion of vasopressors like ephedrine and phenylephrine are given METHODOLOGY Preliminaries: ● Written informed consent was taken. ● Nil per oral status was confirmed.  The patients were evaluated with a detailed history, general and systemic examinations in the preoperative room.  The airway, cardiovascular system and respiratory system were examined. Patients were divided into three groups, GROUP P (PHENYLEPHRINE), GROUP E (EPHEDRINE), and CONTROL GROUP. INTRAOPERATIVE  NIBP, electrocardiography, and pulse oximetry were applied to monitor PR, BP, and SpO2.  Insertion of 18G IV cannula and infusion of Ringer lactate solution 15ml/kg was administered.  The patients were positioned to sit. Using a 25 G Quincke spinal needle, a lumbar puncture was done at the L3–4 interface following skin disinfection and 2% lignocaine infiltration.  Premedication was given with Inj. Midazolam 0.5mg to alleviate anxiety of the patients.  The groups were administered intrathecally with Inj. BUPIVACAINE Heavy 15mg . Patients were turned to the supine position subsequently and Oxygen 5 L/min was delivered via a face mask.  The sensory level of blockade after spinal anesthesia was assessed by ice cubes or pinprick 5 mins after intrathecal injection.  GROUP P received a continuous infusion of 30ml 0.9% NaCl with 250 mcg phenylephrine for 30 mins after spinal anesthesia using a infusion syringe pump.  GROUP E received a continuous infusion of 30ml 0.9% NaCl with 30 mg of ephedrine for 30 mins after spinal anesthesia using a infusion syringe pump.  CONTROL GROUP were given an intravenous bolus of inj. mephentermine 6 mg after spinal anesthesia as and when required. The infusion of treatment medication in Group P and Group E was started immediately after spinal anesthesia. Non Invasive Blood pressure, heart rate, SpO2, ECG were monitored. Incidence of hypotension, bradycardia and the total dose of vasopressor used intraoperatively were noted. 15 minutes before the subarachnoid block and at intervals of 3, 6, 9, 12, 15, 20, 25, and 30 minutes following the subarachnoid block (spinal anesthesia) were used to record hemodynamic data. PROTOCOL FOR RESCUE TREATMENT; If SBP fall was greater than 30% from the baseline, bolus dose of Phenylephrine 50mcg/Ephedrine 5 mg was given according to the group. If heart rate was less than 50 beats per min Inj. Atropine 0.6 mg I/V was given. RESULTS - Age, sex , BMI and ASA Grades are comparable and are statistically insignificant. - The SBP was significantly higher in Group E when compared to other groups at all time intervals after spinal anaesthesia. - The DBP was significantly higher in Group E when compared to other groups at 3 mins, 6 mins, 9 mins, 12 mins, 15 mins and 25 mins time intervals after spinal anaesthesia - The MAP was significantly higher in Group E when compared to other groups at 3 mins, 6 mins, 15 mins and 20 mins time intervals after spinal anaesthesia. - The HR was significantly higher in Group E when compared to other groups and was significantly better at all time intervals after spinal anaesthesia. - The rescue doses were observed to be statistically insignificant. The rescue doses required in Ephedrine group was less when compared to phenylephrine and control group. - The number and percentage of Inj. ATROPINE given among all groups were observed to be statistically insignificant. The Inj. ATROPINE was required less in Ephedrine group compared to phenylephrine and control group.CONCLUSION The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were better maintained in the ephedrine group than phenylephrine and control group. The mean arterial pressure (MAP) was significantly higher in all groups but was more effective in ephedrine group. Heart rate was well maintained and prevention of bradycardia was effectively seen in ephedrine group compared to phenylephrine group.