Archives of Anesthesiology and Critical Care
Volume:8 Issue: 2, Spring 2022

Laryngoscopy and intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral hemorrhage. There are many studies on various pharmacological agents to attenuate pressor response. Aim of the study was to compare efficacy and safety of oral clonidine versus oral pregabalin premedication to attenuate stress response in patients undergoing elective surgery.

106 patients of American Society of Anesthesiologist (ASA) class I, aged between 18-60 years of either sex scheduled for elective surgery were randomized into two groups. Group A received oral clonidine 0.2mg and group B received oral pregabalin 150mg, 90 minutes before surgery. Primary objectives of the study heart rate(HR), systolic blood pressure(SBP) diastolic blood pressure(DBP) and mean blood pressure(MBP) were noted baseline, before induction, immediately after intubation (0) and at 1, 3, 5, 10 and 15 minutes after intubation. sedation, postoperative pain scores and any adverse effects were also noted.

The demographic data were comparable in group A and group B. There was no significant difference at baseline for mean (SD) HR, SBP, DBP, and MBP in both groups (p>0.05). The mean (SD) HR was significantly lower in group A as compared to group B, before induction and at 1, 3, 5, 10 and 15 minutes (p <0.05). The mean (SD) SBP, MBP was significantly lower in group A as compared to group B, before induction immediately after intubation and at 1, 3, and 5 minutes (p <0.05). The mean (SD) DBP was significantly lower in group A as compared to group B, before induction (p 0.012). but post-operative analgesia was better in pregabalin group. Bradycardia was more in clonidine group and sedation was more with the use of pregabalin.

We concluded that oral premedication with either clonidine or pregabalin attenuates hemodynamic response to laryngoscopy and tracheal intubation, but Clonidine is superior to pregabalin.

Opioids commonly used as adjuvant anaesthetics during spinal anesthesia, are favored technique for lower limb surgeries. Nalbuphine is an opioid adjuvant that acts as antagonist at μ-receptors and agonist at k-receptors that work reasonably potent analgesia. In this study we compare the efficacy of epidural Fentanyl with bupivacaine versus Epidural Nalbuphine with Bupivacaine for post-operative pain relief in lower limb surgeries.

Altogether 80 patients of lower limb surgeries were randomly allocated into two groups. 40 patients in Group I (Inj. 0.5% Bupivacaine (H) 2.5ml + Inj. Fentanyl 25mcg (0.5ml) and 40 patients in Group II (Inj. 0.5% Bupivacaine (H) 2.5ml+ Inj. Nalbuphine 5mg (0.5ml). Age of patients ranged from 18-65 years of age and male:female ratio in the present study was 1: 0.5. Patients in both the above groups were comparable on age, gender, anthropometric variables, and baseline hemodynamic variables.

In the study the mean age (36.30±14.10) of group II was comparatively more than the group I (33.88±9.42) while the mean weight (61.80±11.33) of group II was also comparatively more than group I mean weight (53.80±15.59). And the mean value of duration of surgery for the group I was (112.93±12.22) while it was (110.63±10.26) for group II. A significant difference was found in weight. The intergroup comparison of level of motor blockade where in group I the level of motor blockade was (65.0%) at 2 min (B/S-1) while in group II level of blockade (70.0%) at 2 min (B/S-1) after that from 8 min to 130 min it was (100%). The level of sensory blockade of group I (72.5%) at 2 min while it was (72.5%) at 6 min after that it was NA from 8 min to 130 min and in the group II level of sensory blockade (50.0%) at 2 min and (50.0%) at 8 min after that it was (100%) from 10 min to 130 min. During Intergroup Comparison of VAS significant differences was found at 30 min and 480 min.

Nalbuphine when compared to Fentanyl is almost safe and hemodynamically stable drug that can be used as an adjuvant in combined spinal epidural anesthesia with similar safety profile as for Fentanyl.

To assess the incidence and risk factors of sore throat, cough and hoarseness in180 patients undergoing general anaesthesia and endotracheal intubation.
Postoperative sore throat is one of the common adverse events after general anaesthesia and has a reported incidence from 21 to 71%. Though it is not a life threatening complication, it is an important cause of postoperative morbidity and patient dissatisfaction during the hospital stay.

A prospective observational study was conducted on 180 patients ASA PS 1 and 2, in the age group of 18-65 years of both gender, undergoing general anaesthesia and endotracheal intubation. Preoperatively h/o smoking and tobacco chewing were recorded. Intraoperatively number of attempts of intubation, duration of laryngoscopy, presence of throat pack and ryle’s tube, position of head during surgery and duration of surgery were recorded. Post operatively complaints of sore throat, cough and hoarseness were recorded at 6hrs and 24 hrs using 4-point scale.Data were analysed with SPSS 22 version software, p value of <0.05 was considered as statistically significant after assuming all the rules of statistical tests.

The incidence of sore throat was 30.6%, hoarseness was 4.4% and cough was 2.8% in our study in patients undergoing general anaesthesia and endotracheal intubation.

The incidence of sorethroat was 30.6%, hoarseness 4.4%, and cough 2.8% in our study. Tube lubrication, position of head extension with pillow under shoulder and presence of throat pack shows higher incidence of POST.

Adjuvants to local anesthetics (LA) have proven to prolong the analgesic efficacy of Adductor canal block (ACB). The ACB when administered with lower dose of LA produces analgesia without loss of motor control of the thigh. Hence we studied the efficacy of two different doses of dexmedetomidine in ACB to prolong postoperative analgesia when used as adjuvant to ropivacaine.

Total of 90 patients between 18-65years undergoing arthroscopic ligament reconstructions surgeries of knee were randomized into three groups and given Ultrasound guided (USG) ACB. Group A - 0.2% Ropivacaine, Group B – 0.2% Ropivacaine plus Dexmedetomidine 0.50 mcg.kg-1 and Group C- 0.2% Ropivacaine plus Dexmedetomidine 1 mcg.kg-1. Primary aim of our intervention was to study the duration of post-operative analgesia and Secondary aim was to study the total dose of rescue analgesic required in 24hrs, success of early ambulation, level of patient satisfaction and any adverse effects.

The duration of analgesia was found highest in Group C (1166 ±200mins) than Group A (420±100mins) and Group B (702± 150mins). The total dose of tramadol consumption in 24 hours was highest in Group A. The number of steps walked postoperatively after 24 hours and level of patient satisfaction was maximum with Group C.

Use of 1mcg.kg-1 of dexmedetomidine as adjuvant to 0.2% ropivacaine in ACB after arthroscopic knee surgeries significantly prolongs the duration of postoperative analgesia, reducing the total requirement of rescue analgesic without causing any untoward effects and preserving quadriceps strength aiding in early ambulation and recovery.

There are inconclusive data of Ven venous extracorporeal membrane oxygenation (VV‐ECMO) VV‐ECMO for a therapeutic strategy for acute respiratory distress syndrome (ARDS).

Totally 28 critically ill patients were included into the study between 23 September 2013 and 20 january 2020. Critically ill adult patients who were refractory to conventional therapeutic modalities were eligible for veno-venous ECMO and study inclusion.

Of a total of 28 patients, 15 patients (53.6%) survived and 13 (46.42%) died. Gender frequency had no significant difference between survivors and non-survivors (P=0.07). Mean of age and BMI had no significant differences between the mentioned groups also (P>0.05). It was the same for BSA and the two groups were in the same situation (1.82±0.37 vs. 1.79±0.29; P=0.81). There were no significant differences between survivors and non-survivors regarding ECMO time (114.49±91.05 vs. 162.62±100.17 minutes; P=0.20) and ICU stays (9.65±5.11 vs. 8.93±4.96; P=0.10). The average time of ICU stay was 9.29±5.16 days. The ejection fraction in survives was significantly higher than non-survivors (52.14±6.42 vs. 57.31±4.39; P=0.02). Those patients who were in the non-survivors group had lower blood pressure (MAP<65mmHg) during the study (P=0.049), however, did not find any significant differences between the groups regarding inotropes or vasoconstrictors.

In this study, the mortality rate was 46.42%. Bleeding, hypotension and dialysis were the risk factors for mortality among study participants.

Hip fractures are a common and disabling injury caused by osteoporosis of the joints, and they have a significant socioeconomic impact. Any movement at the hip joint, whether during the transfer to the hospital or during a radiological procedure followed by OT, causes excruciating pain. Multiple comorbidities increase the need for regional analgesia and anaesthesia in elderly people. The primary purpose was to compare the analgesic efficacy of ultrasound guided supra inguinal FICB to that of PENG block for positioning during spinal anaesthesia. Comfort of anaesthetist while giving spinal anaesthesia and patient’s acceptance score were secondary objectives.

The 60 patients in this prospective, double-blinded, randomized controlled research were scheduled to undergo elective surgery for hip fractures under spinal anaesthesia. They were allotted in two groups- group FICB(n=30) and group PENG(n=30). Ultrasound guided Supra inguinal FICB was performed in FICB group and PENG block was performed in the PENG group with 20ml of 0.25% bupivacaine in each group. Evaluation of pain before intervention, just before positioning and while positioning patients for spinal anaesthesia was done using NRS score. Comfort of the anaesthetist while positioning for spinal anaesthesia and patient acceptance was also assessed.

The NRS score did not differ significantly between the two groups (p= 0.853). On a scale of 0 to 3, the anaesthetist's comfort delivering spinal anaesthesia did not differ significantly between the two groups (p= 0.553). There was no statistically significant link between anaesthesia acceptance and group preference (p= 0.504)

The newly invented PENG block to facilitate sitting positioning in fracture hip joint patients for spinal anaesthesia was equally effective to supra inguinal FICB.

Peritrochantric fracture is common especially in elderly patients. Very often we are faced with elderly and fragile patients with several comorbidities. In these cases a careful anesthetic technique is crucial to reduce comorbidity and mortality. Currently the pericapsular nerve group (PENG) block are introduced as an analgesic technique. We used PENG block for purpose of hip surgical Anesthesia.

In this single-centre, case series, patients undergoing gama nailing for peritrochanteric fractures. The PENG block was performed with the patient in the supine position using ultrasound guidance. Pain scores were measured by numeric rating score (NRS) at rest and with a straight leg raise of the affected limb to 15 degrees before and 30 minutes after block performance.

 Totally, 10 patients of ASA Grades II, III and were included who came with peritrochantric hip fracture and were scheduled for gamma nailing. The mean age of the study participants was 77 years. Significantly, pain scores reduced as compared with baseline. No such adverse events were recorded for any of the patients.

In this article the PENG block has been determined to be safe and effective as an anesthetic technique in gamma nailing of peritrochantric fractures but more research in larger-sized studies are needed to better assess the PENG block.

Interscalene block is a commonly performed procedure for surgery of shoulder and upper arm, however very few studies have studied the effect of magnesium sulphate when added in interscalene block.

The primary aim was to compare block characteristics along with postoperative analgesia and the secondary aim was to study the side effect profile and postoperative analgesic requirements.

We randomly recruited 60 American Society of Anaesthesiologists (ASA) physical status I and II patients, undergoing surgeries of the shoulder to receive ultrasound-guided interscalene block with 1 mL normal saline or 150 mg Magnesium sulphate added to 20ml of 0.5% ropivacaine.
Statistical analysis used: Statistical Package for Social Sciences (SPSS version 21.0) was used for analysing the data. Chi-square test or Fisher’s exact probability test were used for categorical variables; while the continuous variables were compared by unpaired t-test or Mann-Whitney U test.

With the addition of magnesium sulphate, onset of sensory (10.03 ± 1.03 vs 12.73 ± 1.14 min) and motor block (15.17 ± 2.02 min vs 17.87 ± 1.41) was hastened. The duration (sensory 528.00 ± 14.98 min vs 376.83 ± 13.16 min, motor 429.83 ± 11.57 min vs 319.97 ± 6.800 min) and postoperative analgesia (527.77 ± 21.96 min vs 402.97 ± 12.83 min) (p < 0.001) were all prolonged by magnesium sulphate, with resultant decrease in requirement of postoperative analgesic dosage.

Magnesium when added to local anaesthetics in interscalene block, effectively improves all characteristics of block and provides better postoperative analgesia.

Acute respiratory failure (ARF) is an important presentation in emergency department (ED). Intubation and mechanical ventilation (MV) are sometimes the ultimate decisions in such emergent situations. Many of these patients are unfortunately managed in an ED. This may endanger their outcome.
This study was aimed to compare the outcome of critically ill patients with ARF under MV admitted to ED with patients admitted to ICU.

All critically ill patients with ARF who were intubated and placed under MV were enrolled in this study. Cases were either admitted to ED or ICU. Demographic data, initial diagnosis, final diagnosis, length of hospital stay, one-month mortality rate, number of times patient was intubated and number of times patient was resuscitated were all recorded and compared between the 2 groups.

Out of all 172 patients admitted to ED and ICU, 74 (43%) were females and 98 (57%) were males. Patients had a mean±SD age of 64.2±18.1 years. ICU patients (85 patients (49.4%)) had a significantly longer hospital stay (p=0.048). ICU patients had significantly more resuscitation process (p=0.006). Mortality rate in ICU was significantly higher than ED. In the meanwhile, more patients in ED finally survived (p=0.004).

In the present study, ICU patients were admitted longer to the ward than ED patients. Overall, ED mortality rate was lower than ICU. More patients finally survived in ED in comparison to ICU.

In the last days of 2019, a novel strain of coronaviruses reported in Wuhan and spread rapidly all over the world which called 2019 novel coronavirus (2019- nCoV). Almost a few months later in the early 2020 (January 2020), the WHO declared the outbreak of COVID-19 a Public Health Emergency which Compared with the other SARS- CoV, has a stronger transmission capacity. Although respiratory problems are the main clinical symptoms of COVID-19, some patients also experience other conditions and injuries, such as severe vascular damage. Therefore, it can be said that understanding the damage caused by this infection to the vascular system and its underlying mechanisms is of great importance.

A wound could happen at any accident or surgery. Generally, bleeding wounds, serious wounds and infectious wounds need to be taken care for recovery and in case of germ infection, wound recovery and management is a complicated process. The process including wound pre-cleaning, wound healing, infection prevention, germ treatment and dressings. The application of wound dressings play a very critical role in wound healing and infection prevention. When a wound is exposed to the pathogens and foreign substances but results in no signs of infection, it is then called as a contaminated wound. The colonized wounds are chronic, where in there are multiple pathogens present in the wound. This occurs frequently in patients who have diabetic foot and pressure ulcers. Hence, management of the diabetic involves great acceleration of foot ulceration. Ideally, dressing should alleviate symptoms, provide wound protection and healing. No single dressing fulfills all the requirements of patient with an infected foot ulcer and other contaminated wounds. However, every category of dressings has specific characteristics that aid selection. There are various types of wound dressings such as, foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. The hydrogel wound dressing treatment facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing iodine and silver encourage in managing wound infection and it is more efficient. For infected wounds occlusive dressings should be avoided. For the wound inspection all dressings require frequent change. Deeply exudating ulcers need regular change to reduce maceration of surrounding skin. Dressing choice should be guided by the characteristics of the ulcer, the requirements of the patient, and the involved in wound care cost. These dressings display their own advantages and disadvantages in the wound treatments. As a physician has to deal with many patients with different types of wound like acute, chronic, burn and foot ulcers conditions every day. It is thereby very important and helpful to have a good knowledge about the right type of dressing for particular wound and also the right time for wound dressings for patient’s prognosis. In this review, we will discuss the different wound dressings and its comparative effectiveness on contaminated wound and ulcer.

Choosing appropriate anesthetic modality in patients with compromised cardiac function with the administration of peripheral nerve block ensures hemodynamic stability. We present the case of a 63y, male patient with an operative history of aortic valvuloplasty, on anticoagulant warfarin. Patient was given general anesthesia and supraglottic airway device, LMA was inserted to prevent intubation response. This was supplemented with USG guided ilioinguinal and iliohypogastric nerve blocks with inj ropivacaine 0.325%, 15ml and inj dexamethasone 2mg as adjuvant. Addition of peripheral nerve blockade to general anesthesia provided perioperative analgesia, so quick emergence and recovery was possible.

Corona Virus Disease (COVID-19) which has a common association with diabetes has led to an epidemic of mucormycosis which has been mainly attributed to rampant use of steroids owing to the severity of the disease. The mucormycosis patients presented with rhino orbital mucormycosis predominantly with or without intracranial extension making it a life-threatening condition mandating urgent debridement as treatment of choice alongside antifungal medications. Injection Amphotericin B is the first-line drug that is nephrotoxic and causes dyselectrolytemia therefore administered under strict supervision. However, we report successful management of two unique cases where patients after surgical debridement after Amphotericin B developed severe life-threatening anaemia postoperatively along with impending respiratory failure requiring Intensive care management including non-invasive ventilation. Thus, serial haematocrit monitoring is of utmost importance while the patient is being administered Amphotericin B even when a patient is receiving the relatively safe preparation that is liposomal Amphotericin B in a dose of 3.5 mg per kg body weight.

The Covid-19 pandemic has seen the emergence of various vaccines being produced at an unprecedented speed. It is not surprising that new adverse events to these vaccines are still being reported and Immune thrombocytopenic Purpura [ITP] happens to be one among them. Moderna and Pfizer vaccine have been linked to it. Association of ITP with SARS-CoV-2 vaccine is poorly understood. We present to you a case of severe symptomatic thrombocytopenia post ChAdOx1 nCoV-19 vaccination which responded to conventional therapies. Aggressive use of immunosuppressive treatment may jeopardize the intended purpose of SARS-CoV-2 vaccine. Also, the schedule and alternative vaccine for the second dose and the role early use of non-immunosuppressive treatment like Thrombopoietin receptor agonist are unclear. While the universal immunization program needs to continue, vigilance to the occurrence of severe thrombocytopenia due to vaccination is needed.

Foreign body ingestion is quite common in the pediatric age group. A six year old boy was brought by his parents to the hospital with history of foreign body (marble) ingestion. The child had been previously operated for the esophageal atresia. Imaging revealed a foreign body of 1.5cm size in the esophagus at the atretic part. The foreign body removal was initially attempted via rigid esophagoscopy but could not succeed. Hence, the procedure was changed to right thoracotomy for foreign body retrieval in the same sitting. Patient also had intraoperative itragenic trachea-esophageal fistula formation. General anesthesia was planned using single lumen cuffed ETT of 5.0mm ID for ventilation. Caudal catheter was inserted for postoperative pain management and early recovery following thoracotomy. Such cases of foreign body ingestion in an atretic esophagus should always be planned considering the unexpected extend of surgical procedure and peri-operative complications.

The prevalence of COVID 19 encouraged physicians and researchers to study the pathology of the disease and changes in patients' immunological factors. What has been proven today is the occurrence of an inflammatory outbreak in the body of patients with this infection, which causes severe immunological reactions in them. Hemoperfusion, as an extracorporeal purification method, has the potential to act as an aid in modulating or controlling this inflammatory phase. Therefore, the present study evaluates the role of hemoperfusion in controlling inflammatory conditions in patients with COVID 19.

Rumpel Leede sign(RL sign)  is characterized by the presence of a petechial rash that results from acute dermal capillary rupture. It was documented in literature quite often and it is associated with conditions like hypertension, diabetes, chronic steroid use, secondary to autoimmune disorders, mechanical trauma, thrombocytopenia and in patients taking antiplatelet drugs. we would like to report a case where we noted RL sign in patient where none of the above mentioned risk factors are present.