Sameer Sethi

Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Desflurane and sevoflurane are associated with postoperative emergence delirium (ED) in children. The study aimed to compare the use of desflurane and sevoflurane to determine the postoperative ED in children undergoing cataract surgery using the validated Pediatric Anesthesia Emergence Delirium (PAED) scale.

Efficacy of subtenon block in infants – a comparison with intravenous fentanyl for perioperative analgesia in infantile cataract surgery

General anesthesia with opioids provides good perioperative analgesia in infantile ocular surgeries but is associated with the risk of respiratory depression and postoperative emesis. This study aimed to assess the effectiveness of subtenon block for providing perioperative analgesia in infants undergoing cataract surgeries.

Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine.

A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia.

Cuff filling volumes for pediatric classic laryngeal mask airways: comparison of clinical end points versus adjusted cuff pressure

Clinical end points are often used to guide inflation and adequacy of cuff seal after laryngeal mask airway placement. However, clinical end points for cuff inflation have been shown to have significantly higher intracuff pressure. The adjusted cuff pressure between 55 and 60 cm H2O causes significantly better seal of laryngeal mask airway. We prospectively assessed the cuff pressures generated by cuff inflation guided by clinical end points, and the actual volume of air required to achieve cuff pressures between 55 and 60 cm H2O for sizes 1–2.5 reusable classic laryngeal mask airway.

Comparison of oropharyngeal leak pressure of air-Q™,i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial

Study Objective: Various randomized controlled trials and a meta-analysis have compared i-gel™ and laryngeal mask airway Supreme™ (LMA-S™) in adult patients and found that both the devices provided equivalent oropharyngeal leak pressure (OLP). However, no randomized controlled trial has compared air-Q™ with i-gel™ and LMA-S™ in adult patient. Hence, we designed this study to compare air-Q™ with LMA-S™ and i-gel™ in adult patients. Materials and Methods: A total of 75 adult patients of the American Society of Anesthesiologists physical status I/II of both sexes, between 18 and 60 years, were included in this prospective randomized controlled trial conducted in a tertiary care center. Randomization of patients was done in three equal groups according to the insertion of supraglottic airway device by a computer-generated random number sequence: group air-Q™ (n = 25), group i-gel™ (n = 25), and group LMA-S™ (n = 25). Primary outcome of this study was OLP. We also recorded time for successful placement of device, ease of device insertion, number of attempts to insert device, and ease of gastric tube insertion along with postoperative complications. Results: The mean ± standard deviation OLP of air-Q™, i-gel™, and LMA-S™ was 26.13 ± 4.957 cm, 23.75 ± 5.439 cm, and 24.80 ± 4.78 cm H2O (P = 0.279). The first insertion success rate for air-Q™, i-gel™, and LMA-S™ was 80%, 76%, and 92%, respectively (P = 0.353). The insertion time of air-Q™, i-gel™, and LMA-S™ was 20.6 ± 4.4, 14.8 ± 5.4, and 15.2 ± 4.7 s, respectively (P = 0.000). Time taken for air-Q™ insertion was significantly higher than time taken for i-gel™ (mean difference 5.8 s, P < 0.0001) and LMA-S™ (mean difference 5.4 s, P = 0.0001) insertion. Postoperative complications were similar with all three devices. Conclusions: We concluded that air-Q™, i-gel™, and LMA-S™ were equally efficacious in terms of routine airway management in adult patients with normal airway anatomy.

Comparison of Ambu® AuraGain™ laryngeal mask and air-Q™ intubating laryngeal airway for blind tracheal intubation in adults: A randomized controlled trial☆

Abstract Background This study has been designed to compare the performance of Ambu® AuraGain™ laryngeal mask with the air-Q™ as a conduit for blind tracheal intubation in adult patients. Methods In this prospective randomized controlled trial blind endotracheal intubation success rates were compared between Ambu® AuraGain™ and air-Q™ intubating laryngeal airway in 90 adult patients. Patients were randomized in two equal groups: Group Ambu® AuraGain™ (n = 45) and Group air-Q™ (n = 45). Results Time to insert the laryngeal airway was similar between Ambu® AuraGain™ and air-Q™ (median [IQR] 13[12–14] s versus 14[12–16] s) and in all cases laryngeal mask insertion was possible in first attempt. Intubation success rate at first attempt was significantly higher in air-Q™ group compared to in Ambu® AuraGain™ group (68.9% versus 35.6%; p = 0.002). Overall blind intubation success rate was significantly higher in air-Q™ group in comparison to Ambu® AuraGain™ (80% versus 53.3%; p = 0.007). Intubation time was significantly higher with Ambu® AuraGain™ (p < 0.0001; median difference 4.0 s, 95% CI 2.7, 5.3 s). Blind intubation was significantly easier in air-Q™ group compared to in Ambu® AuraGain™ (42.2% intubation was graded as easy in air-Q™ instead of 22.2% in Ambu® AuraGain™, p = 0.04). Comparison of fibreoptic bronchoscopic glottis view was similar between the two devices (p = 0.07). Reported complications were infrequent and similar between the two devices. Conclusion We conclude that air-Q™ laryngeal airway is superior to Ambu® AuraGain™ when used as a conduit for blind endotracheal intubation in adult patients. Trial registration Clinical Trial Registry of India (CTRI/2015/02/005553).

Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot

We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.

Effect of dexmedetomidine on emergence agitation using desflurane in pediatric cataract surgery

Background: In this study, we compared effectiveness of two doses of dexmedetomidine (0.15 μg/kg and 0.3 μg/kg) in preventing desflurane-induced emergence agitation (EA) in pediatric patients undergoing elective cataract surgery. Methods: It is a prospective double-blinded randomized study conducted on 65 American Society of Anesthesiologists 1 children (2–10 years) who underwent elective cataract surgery at our institute. They were randomized into two equal groups, who received either dexmedetomidine 0.15 μg/kg (Group D0.15) or dexmedetomidine 0.30 μg/kg (Group D0.3) intravenously after induction of anesthesia. An observer blinded to groups recorded heart rate (HR), arterial blood pressure, oxygen saturation, end-tidal carbon dioxide, and respiratory rate (RR) at regular intervals and evaluated preoperative anxiety, state of agitation, and postoperative pain using validated scores. Results: Both groups (Group D0.15, n = 27 vs. Group D0.3, n = 26) were demographically identical. In intraoperative period, the difference in HRs was significantly lower in Group D0.3from 5 min till 15 min of the surgery (P < 0.05), but thereafter, from 20 min till end of surgery, the rates were comparable in both the groups, whereas RR and blood pressure fluctuations were comparable throughout. Postoperative pain scores and postoperative agitation score were significantly lower in Group D0.3than D0.15at all time intervals (P < 0.05). Conclusions: In our study, 0.3 μg/kg intravenous dexmedetomidine was found to be superior to 0.15 μg/kg group in effectively reducing EA and postoperative pain, without producing adverse effects such as hypotension or bradycardia.

Trachlight-guided intubation in small infant with difficult airway

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Atypical presentation of acute hyponatremia in transurethral resection of prostate surgery: A case report.

We report a case of unusual presentation of transurethral resection of prostate (TURP) syndrome. A 58-year-old male patient with grade III benign hypertrophic hyperplasia was scheduled for TURP under spinal anesthesia. At 120 min of surgery, the patient presented with atypical symptoms of tightness in the chest with difficulty in breathing. The electrolyte analysis revealed an acute hyponatremia (serum Na+ 95 mEq/l). Patient was successfully treated with rapid infusion of 3% hypertonic saline along with furosemide.