Deepak Dwivedi

A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children

Emergence delirium is a common problem in children recovering from general anaesthesia. We performed a study comparing emergence characteristics in 100 patients who were randomly allocated to receive either 0.3 μg.kg−1 dexmedetomidine, 1 mg.kg−1 propofol or saline 0.9% and undergoing infra‐umbilical surgery. The Pediatric Anesthesia Emergence Delirium scale was used to grade emergence delirium. Emergence delirium occurred in 9.4% of children in the dexmedetomidine group compared with 13.9% in the propofol group and 40.6% in the control group (p = 0.004). In the dexmedetomidine group, sedation occurred in 62.5% of children at 10 min after transfer to the recovery area, compared with 44.4% in the propofol group and 12.5% in the control group (p = 0.010). We conclude that dexmedetomidine significantly reduced the incidence of emergence delirium but this was at the expense of a greater incidence of sedation in the recovery period.

The challenges in anesthetic management of pediatric craniopharyngioma

Craniopharyngiomas constitute about 2–6% of all the intracranial tumors in the pediatric age group. Management of craniopharyngiomas in children is challenging for not only surgeons and endocrinologists but for anesthesiologists as well, owing to the developing neurological and physiological status, handling of a growing brain, perioperative endocrinological complications, and the management of hydration. We report a case of a 4-year-old child who had presented to our hospital with progressive loss of vision over a period of 2 months.

Comparison of flange slide pack technique using macintosh laryngoscope blade with conventional laryngoscopy-guided throat packing: A pilot study

Context: An analytical pilot study was conducted prospectively to ascertain the efficacy of a new method of throat packing “Flange Slide Pack Technique” (FSPT) in patients undergoing nasal, faciomaxillary, and oral surgeries. Aim: To compare the conventional technique of throat packing guided by direct laryngoscopy with FSPT where the Macintosh laryngoscope blade is used as aid for throat packing. Settings and Design: A comparative observational pilot study was conducted at a tertiary care hospital. Subjects and Methods: Subjects were randomly allocated into two groups based on the technique for throat packing by computer-generated random numbers as Group A (conventional technique) and Group B (FSPT). Primary outcomes measured were total time duration taken for packing the throat with a standardized length of ribbon gauze and changes in heart rate and change in Mean Arterial Pressure (MAP) from baseline. Secondary outcomes measured were incidence of postoperative sore throat (POST) at 6 h postoperatively and ease of insertion of the throat packs. Statistical Analysis: Parametric data were analyzed using “unpaired t-test.” Comparison of proportions and data were analyzed using Chi-square test. SPSS Version 17 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: The time taken to pack the throat was shorter in Group B; percentage increase of MAP from baseline was higher in Group A. Ease of insertion of throat pack was more in Group B. POST results were insignificant. Conclusions: FSPT can prove to be an alternative technique to the conventional method of packing the throat by minimizing duration of laryngoscopy and thereby limiting the stress response.

Giant sacrococcygeal teratoma: Management concerns with reporting of a rare occurrence of venous air embolism

A 24‐hour‐old, term neonate, weighing 3.4 kg, born by cesarean section presented with a huge sacral mass of size 20 cm × 20 cm, involving coccyx, extending to both buttocks, with intact skin [Figure 1]. Tumor resection was planned at 24 h of birth. Preoperative hemoglobin was 16 g/dl, and other investigations were within normal limits. Blood for grouping and crossmatching was sent. Chest roentgenogram was normal. Echocardiography showed a small patent ductus arteriosus with patent foramen ovale with left‐to‐right shunt, and computed tomography scan showed a large heterogeneous sacrococcygeal mass with little intrapelvic extension [Figure 2].

Evaluation of two different dosages of local anesthetic solution used for ultrasound-guided femoral nerve block for pain relief and positioning for central neuraxial block in patients of fracture neck of the femur

Introduction: Surgical management of the fracture femur is preferred so as to prevent complications associated with prolonged immobilization. Central neuraxial blockade (CNB) is an attractive option for these patients, and an optimal positioning of the patient is a definite requirement. Owing to the pain associated with movement of the fractured limb, it becomes difficult for the patients to give suitable positioning. Femoral nerve block (FNB) features as a rescue analgesia so as to provide adequate analgesia for facilitation of satisfactory positioning. Aim: This study aims to compare analgesic effect of two different dosages of local anesthetic (LA) solution administered for ultrasonography (USG)-guided FNB given to facilitate optimal positioning for conduct of CNB. Materials and Methods: After taking permission from the institutional review board, eighty patients were enrolled in the study to find out the efficacy of dosage of LA solution for FNB in providing pain relief caused by movement of fractured limb during conduct of regional anesthesia. Informed consent was taken. All patients were given USG-guided FNB. Patients were randomized using a computer-generated random number table, into two groups of forty patients each. Group A patients received USG-guided 12 ml of LA solution containing 10 ml lignocaine solution without preservative (2%) plus 2 ml normal saline (NS), while Group B patients received USG-guided 15 ml of LA solution containing 13 ml lignocaine solution without preservative (2%) plus 2 ml NS for positioning before combined spinal epidural. Results: A total of eighty patients, divided randomly into two groups, were enrolled in the study. Demographics (age, sex, weight, and American Society of Anesthesiologists grades) were similar in both groups. No statistical significance was found in the numeric rating scale scores at baseline, zero minutes, 5, and 15 min in both the groups. Conclusion: USG-guided FNB with 12 ml of LA solution was as effective as 15 ml of LA solution for achieving adequate pain relief so as to give optimal positioning for CNB in patients of fracture neck of femur.

Role of oral gabapentin as preemptive adjuvant with spinal anesthesia for postoperative pain in patients undergoing surgeries under spinal anesthesia

Background and Aims: The study was undertaken to evaluate postoperative benefit in patients administered tablet gabapentin as premedication with the primary outcome determining the effect on duration of analgesia with total analgesic requirement and measurement of postoperative sedation scores as our secondary outcomes. Methods: The study was a prospective randomized observational study in sixty patients undergoing surgeries in spinal anesthesia (SA). Patients were randomly assigned into two groups. Group A (n = 30) patients received tablet gabapentin (600 mg) while Group B (n = 30) received a placebo (Vitamin B complex) orally 2 h before surgery. Postoperative pain was managed with intravenous tramadol 2 mg/kg. Postoperative monitoring and assessment included pain assessment every 2 h with Numeric Rating Scale (0–10) for 12 h and then at 24 h. Results: On comparison of intergroup data, the duration of analgesia was prolonged in Group A (288.79 ± 38.81 min) as compared to Group B (218.67 ± 37.62 min) with P (0.0001). Total opioid requirement was higher in placebo group as compared to the Group A (P = 0.025). Statistical difference in mean (standard deviation) pain score at 24 h was statistically significant (P = 0.0002). Sedation scores were significantly higher in Group A at 2 and 4 h post-SA. Conclusion: Single dose of gabapentin administered 2 h before surgery provides better pain control as compared to placebo. It prolongs the duration of analgesia, reduces the total analgesic requirement during the postoperative period.

Hyperchloremic metabolic acidosis following total gut irrigation with normal saline in pediatric patients: A rare occurrence

Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. We report two cases of hyperchloremic metabolic acidosis in children posted for colorectal surgery following TGI with NS who were successfully managed.

Airway management with videolaryngoscope in a morbidly obese patient in a tertiary care centre: Are the peripheral hospitals ready for such a scenario?

© 2017 Anesthesia: Essays and Researches | Published by Wolters Kluwer Medknow After insertion with this technique, we are getting an effective oropharyngeal seal with a leak airway pressure of 25–30 cm of H2O and peak airway pressure and tidal exchange within normal limit for the patient. At present, various studies are going on with this device in our institute where we prefer this method of insertion of this device compare to the conventional technique. Therefore, we advocate using this method routinely and in situations when there is difficulty in placement of this device.

Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and retention in young doctors joining postgraduation program

Background: High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. Aims: The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. Design: The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. Methods: A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical Analysis: Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. Results: The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. Conclusion: The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.

Prolonged hoarseness following endotracheal intubation - not so uncommon?

Endotracheal intubation with direct laryngoscopy may result in injuries of the airway, which can occur even with optimal patient position and muscle relaxation. Injuries of the airway include mucosal lacerations, submucosal bleed, glottic oedema, recurrent laryngeal nerve damage and arytenoid joint dislocation. Arytenoid dislocation generally presents with persistent hoarseness or dysphagia in adults, or as stridor in children. Because of its non‐specific symptoms, diagnosis of the arytenoid dislocation is often delayed.