Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Oct 2018
Assessment of awake i-gel™ insertion for fiberoptic-guided intubation in patients with predicted difficult airway: A prospective, observational study.
Orotracheal intubation (OTI) with fiberoptic bronchoscope (FOB) in spontaneous ventilation is one of the main techniques for patients with predicted difficult airway. Latest generation supraglottic airway devices have been designed to allow OTI through them. We assessed the safety and effectiveness of FOB-guided OTI through i-gel™ device which was inserted in spontaneously breathing patients with predicted difficult airway. ⋯ I-gel insertion in spontaneous ventilation secures the airway before achieving fiberoptic intubation without the occurrence of adverse events. More studies might be necessary in order to confirm the results presented, but we consider that the technique described is a safe and effective alternative to classic OTI with FOB in spontaneously breathing patients with predicted difficult airway.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: A prospective observational study.
Various airway indices are used either singly or in combination to predict difficult laryngoscopy. Recently introduced ratio of height to thyromental distance (RHTMD) is reported to have better predictability. We aimed to assess the prediction of difficult laryngoscopy by RHTMD and compared it with other indices. ⋯ RHTMD is a single best preoperative test for predicting difficult laryngoscopy. A combination of tests has higher sensitivity and specificity with better discriminative power. Therefore indices should be used in combination in the preoperative airway assessment of adult patients.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Transcoccygeal neurolytic ganglion impar block for perineal pain: A case series.
Chronic perineal pain (CPP) is a poorly localized pain. Its etiology may be benign or malignant. The ganglion impar is a solitary retroperitoneal structure at sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. CPP has been effectively managed by ganglion impar block. Here, we describe a case series of neurolytic ganglion impar block by transcoccygeal approach, analyzing its safety and efficacy. ⋯ Transcoccygeal ganglion impar block may offer a safe and effective treatment option for CPP as compared to opioids. This approach for neurolysis of the ganglion impar may be recommended in view of the direct course, appreciable end point, and smaller volume of neurolytic requirement.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Effect of spinal flexion and extension in the lateral decubitus position on the unilaterality of spinal anesthesia using hyperbaric bupivacaine.
Many unilateral lower limb orthopedic surgeries are conducted under unilateral spinal anesthesia with full flexion of spine and immediate extension after local anesthetic administration into the subarachnoid space. Studies have shown that extension of the spine in lateral decubitous position makes cauda equina to sink to the dependent side due to gravity. Continuous flexion of the spine causes sunken cauda equina to be suspended in the middle of the subarachnoid space increasing the possibility of unilateralization of the block. Hence, this study was carried out to assess the effect of flexion and extension in lateral decubitus position in unilateral spinal anesthesia. ⋯ Maintaining flexion of the spinal column for 15 min increases the likelihood of unilateral spinal block compared with extension of the spinal column during lateral decubitus positioning.
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J Anaesthesiol Clin Pharmacol · Jul 2018
An observational study to evaluate the effect of different epidural analgesia regimens on dynamic pain scores in patients receiving epidural analgesia for postoperative pain relief after elective gynecological surgery.
The primary measure of efficacy of any analgesic regimen is pain relief, but it is important to measure dynamic pain relief rather than pain relief at rest. Epidural analgesia is an effective technique for postoperative analgesia. The drug combinations given therein (local anesthetics with adjuvants such as opioids/alpha-2 agonists), however, remain a personal choice. The aim of this study was to evaluate dynamic pain scores in patients receiving different epidural analgesia regimens for postoperative pain relief after elective gynecological surgery used in our institution. ⋯ Combination of clonidine 2 μg/mL to 0.125% bupivacaine @ 5 mL/h in combined spinal epidural provides better postoperative analgesia as compared to combination of bupivacaine with opioids with greater patient satisfaction and significantly reduced side effects.