Bharat Paliwal

Comparison Between Dexmedetomidine and Propofol with Validation of Bispectral Index For Sedation in Mechanically Ventilated Intensive Care Patients.

BACKGROUND AND AIM Sedation plays a pivotal role in the care of the critically ill patient. It is equally important to assess depth of sedation. The present study had been designed to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients. It also intended to verify the clinical validity, reliability and applicability of objective assessment tool bispectral index (BIS) for monitoring sedation and observe for correlation with the commonly used subjective scale, Ramsay sedation score (RSS). MATERIALS AND METHODS This prospective randomized study was carried out in 60 haemodynamically stable patients, aged between 18 to 80 years, requiring sedation and mechanical ventilation. These were divided equally into two groups. Group A received dexmedetomidine loading dose (1μg/kg) over 10 min followed by maintenance infusion of 0.5μg/kg/hr (0.2-0.7 μg/kg/hr). Group B received propofol loading dose (1mg/kg) over 5 min followed by infusion of 2mg/kg/hr (1-3mg/kg/hr). All patients received fentanyl 1 μg/kg prior to the study drugs. Vital parameters and sedation levels (using RSS and BIS) were monitored for the study period of 12 hours with level 4 or 5 of RSS as target for sedation. Ramsay score was compared with the average of BIS values. Statistical analysis was done using SPSS VERSION 17 software. RESULTS The study revealed statistically significant lower heart rates during sedation in dexmedetomidine group whereas fall in mean arterial pressure (MAP) following loading dose in propofol group. Patients sedated with dexmedetomidine were easily arousable. Need for rescue drug for achieving the desired RSS as well as incidence of bradycardia was more in dexmedetomidine group than other. Good correlation exists between Ramsay score and BIS values. CONCLUSION Dexmedetomidine reduces heart rate while propofol transiently affects MAP. However, adequate sedation is achieved with both the drugs. The data obtained from the study validate BIS monitoring for ICU sedation.

Incidental laryngeal web: Look before you leap

Laryngeal web is a thin transparent or thick fibrous membrane with an incidence of 1 in 10,000. About 75% of laryngeal webs occur at the glottis level, and the rest are supraglottic or subglottic.[1] Asymptomatic laryngeal webs diagnosed incidentally on direct laryngoscopy (DL) after anesthetic induction present a challenging situation for anesthesiologist ranging from difficult to failed intubation. We present a rare case of failed intubation in an adult, caused by unanticipated subglottic web.

Off-pump awake coronary artery bypass grafting under high thoracic epidural anesthesia.

Conventionally general anesthesia has been the preferred anesthetic technique for coronary artery bypass grafting (CABG). Ever since the first awake CABG the concept though appearing promising is still being continually evaluated. From the Indian perspective, the practice has been largely limited to certain institutions and seems to be not widely practiced across India. This case reports our experience with this technique from the western part of the country.

Is it time for yet another new safety feature in workstations

66 The Indian Anaesthetists’ Forum | December 2016 | Vol 17 | Issue 2 Overuse/repeated sterilization of reusable FMCETTs can result in complications.[1,3] The FMCETT used in this case was new, disposable, and of good quality (Mallinckrodt Medical, Athlone, Ireland) and the cause of complications was not reused. A routine check for cuff and pilot balloon integrity was also performed before intubation.

Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

Ruptured intrathoracic cyst during induction of anaesthesia: Anaesthetic challenges

Congenital benign cysts are among the rare types of mediastinal masses. When symptomatic, complete surgical excision through thoracotomy is the definitive treatment. Rarely they may present with symptoms due to complications like rupture. However, rupture following the induction of general anaesthesia poses unique challenges for anaesthesiologist. We report our experience of a rare variant of intraparenchymal cyst (lung), which was subsequently found to be a bronchogenic cyst.

Difficult extubation: A rare cause

A 7-month-old baby was posted for emergency laparotomy for intestinal obstruction. Pre-anaesthetic evaluation was normal. After applying routine monitoring such as electrocardiogram, pulse oximeter and non-invasive blood pressure, patient was pre-medicated with intravenous (IV) injection glycopyrrolate, fentanyl and ondansetron. Patient was induced with IV ketamine and rapid sequence intubation attempted with no. 3.5 uncuffed ETT (polyvinyl chloride). Since, it was difficult to negotiate beyond glottis; patient was intubated with smaller ETT (no. 3.0) orally in the next attempt. ETT was fixed after confirming bilateral equal air entry, normal end-tidal carbon dioxide (EtCO2), and 100% oxygen saturation (SpO2).

Pseudo-pulmonary oedema

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