Umesh Kumar Bhadani

Management of difficult airway in penetrating cervical spine injury

Management of airway in trauma victim with penetrating cervical/thoracic spine injury has always been a challenge to the anaesthesiologist. Stabilisation of spine during airway manipulation, to prevent any further neural damage, is of obvious concern to the anaesthesiologist. Most anaesthesiologists are not exposed to direct laryngoscopy and intubation in lateral position during their training period. Tracheal intubation in the lateral position may be unavoidable in some circumstances. Difficult airway in an uncooperative patient compounds the problem to secure airway in lateral position. We present a 46-year-old alcoholic, hypertensive, morbidly obese person who suffered a sharp instrument (screwdriver) spinal injury with anticipated difficult intubation; the case was managed successfully.

Effect of nasal oxygen supplementation during apnoea of intubation on arterial oxygen levels: A prospective randomised controlled trial

Background and Aims: Apnoeic oxygenation during laryngoscopy has been emphasised in recent recommendations for airway management. We aimed to compare the effect of nasal oxygen supplementation on time for pulse oximeter oxygen saturation (SpO2) to fall from 100% to 92% (desaturation safety time), to assess the arterial oxygen partial pressures (PaO2) with and without nasal oxygen supplementation and the time for SpO2 to recover from 92% to 100% after initiation of ventilation. Methods: This is a prospective randomised placebo-controlled trial involving sixty patients, where nasal oxygen supplementation given at 10 L/min during apnoea of laryngoscopy in one group of patients (Group O2) was compared to no oxygen supplementation in other group (Group NoO2). Desaturation safety period and the PaO2just after intubation were compared. Time for SpO2 to increase to 100% after initiation of ventilation was also assessed. Demographic details were compared using the Chi-square and t-tests. Students t-test for independent variables was used to compare means of data obtained. Results: Desaturation safety period at 415.46 ± 97.23 seconds in group O2versus 378.69 ± 89.31 seconds in group NoO2(P = 0.213) and PaO2(P = 0.952) and time to recovery of SpO2 (P = 0.058) were similar in both groups. Rise in arterial carbon dioxide secondary to apnoea was slower in oxygen supplementation group (P = 0.032). Conclusion: Apnoeic oxygen supplementation at 10 L/min flow by nasal prong did not significantly prolong the apnoea desaturation safety periods or the PaO2in our study.

Determination of optimal dose of succinylcholine to facilitate endotracheal intubation in pregnant females undergoing elective cesarean section

Aims: The study was carried out to find the optimal dose of succinylcholine for pregnant females, undergoing elective cesarean section under general anesthesia, in order to achieve excellent intubation conditions for a successful endotracheal intubation. Materials and Methods: One hundred and twenty pregnant females aged between 20 and 35 years were randomly allocated into 4 groups of 30 patients each. Group I received Inj. succinylcholine 0.5 mg/kg, Group II received 0.6 mg/kg, Group III received 1.0 mg/kg, and Group IV received 1.5 mg/kg intravenously. The response to ulnar nerve stimulation at the wrist was recorded using the peripheral nerve stimulator. Grading of intubation conditions was done 60 s after Inj. succinylcholine administration. Peak effect, peak time, and duration of absent respiratory movement (apnea time) was noted. Statistical Analysis: One-way analysis of variance (ANOVA) with post hoc analysis (Bonferroni test) has been applied to see significance among groups for continuous variables and the Chi-square test was performed for categoric variables. SPSS v 16 was used for statistical analysis for the study. Results: Peak effect achieved was similar with 0.6, 1.0, and 1.5 mg/kg. There was no statistically significant difference (P >0.05) in the time taken to achieve the peak effect (peak time) between 1.0 and 1.5 mg/kg. Apnea time was 242.7 ΁ 7.1 s with 1.0 mg/kg and 377.7 ΁ 28.9 s with 1.5 mg/kg (P Conclusion: The dose of 1.0 mg/kg of succinylcholine produces excellent intubation conditions in pregnant females similar to the conventional dose of 1.5 mg/kg and is associated with a significantly shorter duration of action.

Ultrasound assessment of cranial spread during caudal blockade in children: Effect of different volumes of local anesthetic

Background: Ultrasound-guided caudal block injection is a simple, safe, and effective method of anesthesia/analgesia in pediatric patients. The volume of caudal drug required has always been a matter of debate. Materials and Methods: This present prospective, randomized, double-blinded study aimed to measure extent of the cranial spread of caudally administered levobupivacaine in Indian children by means of real-time ultrasonography. Ninety American Society of Anesthesiologists I/II children scheduled for urogenital surgeries were enrolled in this trial. Anesthesia and caudal analgesia were administered in a standardized manner in the patients. The patients received 0.5 ml/kg or 1 ml/kg or 1.25 ml/kg of 0.125% levobupivacaine according to the group allocated. Cranial spread of local anesthetic was noted using ultrasound. Results: There was no difference in the spread when related to age, sex, weight, or body mass index. A significant difference of ultrasound-assessed cranial spread of the local anesthetic was found between Group 1 (0.5 ml/kg) with both Group 2 (1 ml/kg) (P = 0.001) and with Group 3 (1.125 ml/kg) (P < 0.001) but there is no significant difference between Group 2 and Group 3 (P = 0.451) revealing that spinal level spread is only different between 0.5 ml/kg and 1 ml/kg of local anesthetic. Conclusion: In conclusion, the ultrasound assessment of local anesthetic spread after a caudal block showed that cranial spread of the block is dependent on the volume injected into the caudal space. Since there was no difference between 1 ml/kg and 1.25 ml/kg, to achieve a dermatomal blockade up to thoracic level, we might have to increase the dose beyond 1.25 ml/kg, keeping the toxic dose in mind.