An unexpected life-threatening persistent oxygen desaturation in a child after extubation.

Ureteroscopic nephrolithotripsy is now being preferred over percutaneous nephrolithotomy for removal of kidney stones in children. Here, in this report, we have discussed persistent oxygen desaturation immediately after extubation in a two-year-old child who underwent Ho-YAG (holmium-yttrium-aluminium garnet) laser ureteroscopic nephrolithotripsy. The child developed bilateral pleural effusion after nephrolithotripsy and required continuous oxygen supplementation to maintain oxygen saturation above 95%, followed by ultrasound-guided thoracentesis.

Relationship between difference of preoperative and cardiopulmonary bypass mean arterial pressure, and acute kidney injury in cardiac surgical patients undergoing valve surgery.

BACKGROUND: Modifiable and non-modifiable factors contribute to development and progression of acute kidney injury (AKI) during cardiac surgery. We hypothesized that, the difference between preoperative mean arterial pressure (MAP) and the average mean arterial pressure maintained on cardiopulmonary bypass (CPB) would be strongly predictive of AKI. We also measured plasma Neutrophil gelatinase-associated lipocalin (NGAL), to establish its association with cardiac surgery associated-AKI (CSA-AKI). METHODS: One hundred and twelve high-risk patients undergoing valve, and valve plus coronary artery bypass grafting (CABG) surgery under cardiopulmonary bypass (CPB) were included in this study. Delta mean arterial pressure (MAP) was calculated as the difference between the average of pre-operative and on-bypass MAP, and blood was sampled for NGAL levels, at baseline, and 6-h after CPB. Detailed data collection was done, tabulating most of the factors which might influence development of post-operative cardiac surgery associated-AKI (CSA-AKI). To define CSA-AKI within the first 24-h post-operatively, the Kidney Disease Improving Global Outcomes (KDIGO) classification was used. RESULTS: Out of 112 patients, 44 (39.3%) developed CSA-AKI postoperatively. With an ROC analysis cut-off of delta MAP of more than 25.67 mmHg, 46.4% patients developed post-operative AKI, and the average CPB flows which were 1.8 ± 0.2 were not contributory to the development of early CSA-AKI. In our study, ELISA test for human NGAL was performed on serum samples, and the estimated cut-off value of 1661 ng/mL was found to be significantly associated with early CSA-AKI. CONCLUSIONS: Delta MAP and CPB flows are not related to early post-surgical CSA-AKI in cases with prior high-risk elements. However, baseline serum NGAL, as well as its percent change during the early post-surgical period independently predicted the development of CSA-AKI. This implies that, there may be patients with a higher pre-operative preponderance to develop this complication, which could actually be delineated by the use of serum NGAL estimations at baseline.

A comparison of King vision video laryngoscope with CMAC D-blade in obese patients with anticipated difficult airway in tertiary hospital in India - Randomized control study.

BACKGROUND AND AIMS: This randomized control trial was conducted to compare two video laryngoscopes in obese patients with anticipated difficult airway. Video laryngoscopes have shown to be beneficial in many difficult airway scenarios including obesity. Many studies have shown that even though the glottic view is better, it takes longer to negotiate the endotracheal tube. We proposed to compare CMAC D-blade with King vision-channeled blade for intubating obese patients with anticipated airway difficulty. We hypothesized that channeled scope may be superior as once visualized, tube could be easily negotiated. This would be reflected by time taken for the glottis visualization, time taken for intubation, incidence of complications, and hemodynamic stability. MATERIAL AND METHODS: Sixty-three patients who fulfilled inclusion criteria were enrolled after informed consent. Based on the computer-generated randomization, they were assigned to group 1 (King vision laryngoscope - KVL) and group 2 (CMAC D-blade). All anesthetists who intubated, performed 20 intubations with both video laryngoscopes on manikin before performing the study case. The parameters analyzed were time to visualize the glottis, time to successful intubation, and intubation-related hemodynamic variations and complications. RESULTS: The mean time taken to visualize the glottis with KVL was 12.93 s compared to 10 s with CMAC D-blade (P value 0.12). Time taken to intubate was 50.04 s with KVL compared to CMAC D-blade which took 46.93 s (P value 0.64). KVL had a complication rate of 20.7% compared to 3.1% with CMAC D-blade (P value 0.04). CONCLUSION: There was no statistically significant difference in time to visualize the glottis and intubation between KVL and CMAC D-blade. But there was a high incidence of complications with KVL.