Anesthesia, essays and researches
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Video laryngoscopes resemble traditional laryngoscopes, but they have a video chip embedded in the tip of laryngoscope blade. This enables the operator to "look around the corners" which is not possible with conventional direct laryngoscopes. The present study was undertaken to compare Truview video laryngoscope and Macintosh laryngoscope for glottis visualization, ease of tracheal intubation, and associated hemodynamic response. ⋯ Truview propaganda cum distribution laryngoscope provides a better glottis view than the Macintosh laryngoscope. Although it requires a longer time to intubate using Truview, the overall IDS score was lower as compared to Macintosh laryngoscope. Hemodynamic changes remained similar in both the groups.
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Ultrasound is evolving as a probable tool in airway assessment. The upper airway is a superficial structure and has sonographically identifiable structures which makes it ideal for evaluation with the ultrasound. ⋯ Ultrasound measurements of skin to hyoid bone and skin to thyrohyoid membrane distance fail to eclipse clinical parameters in accurately predicting a difficult laryngoscopy.
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Dexmedetomidine and magnesium sulfate (MgSO4) as an adjuvant to local anesthetics and ultrasound guidance improves the quality of peripheral nerve block. ⋯ Dexmedetomidine provides earlier onset of sensory and motor block as well as prolonged duration of sensory and motor blocks and duration of analgesia is longer and postoperative rescue analgesia is less as compared to patients receiving MgSO4. The incidence of hypotension and bradycardia and sedation score was higher with dexmedetomidine.
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The supraclavicular brachial plexus block is a very safe, useful and effective method for upper limb surgeries. Among local anesthetics, ropivacaine has special applications in neuraxial and peripheral nerve blocks due to its low cardiotoxicity and less toxicity to central nervous systems compared to bupivacaine and lignocaine. Dexmedetomidine is a newer and potent alpha-2 receptor agonist which has 10 times higher selectivity for alpha-2 receptors as compared to clonidine, So far, very few studies have been undertaken to compare the efficacy of clonidine and dexmedetomidine to provide and prolong postoperative analgesia, especially with the use of ultrasound for nerve localization. ⋯ The ropivacaine-dexmedetomidine group in our study provided earlier sensory block and more prolonged postoperative analgesia as compared to ropivacaine-clonidine group. Thus ropivacaine-dexmedetomidine combination may be effectively used in all painful upper limb surgeries specially orthopaedic procedures.
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Despite the advances in medical sciences, the morbidity and mortality due to sepsis in critically ill medical or surgical patients remains high, hence the need for an early and accurate diagnosis. In the current armamentarium, we have various biomarkers such as procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), CRP, and band cell percentage for an early clue. ⋯ The addition of PCT to the standard workup of critically ill patients with suspected sepsis increases diagnostic certainty and generates improved patient management. Band cell percentage also provides a cost-effective alternative to PCT with an analogous diagnostic performance.