An innovative 'Prop technique' of mouth opening in post-COVID-19 mucormycosis maxillectomy: Finding a new way with minimal efforts.

General anaesthesia is associated with damage to teeth, particularly during laryngoscopy. Dental injury is more probable when pre-existing dental pathology or risk factors are present. Post-coronavirus disease -2019 mucormycosis is a rare, fulminant, lethal, angio-invasive, opportunistic fungal disease and is increasingly recognised in diabetic and immunocompromised patients. Since the flange of the laryngoscope blade appears to be the source of tooth injury, alternate methods of wide mouth opening during laryngoscopy should be examined, especially when mouth opening is limited. In this case series, we have studied 12 cases of maxillectomies with an aim to improve restricted mouth opening by using the 'Prop technique' resulting in a minimum hinging force of the flange of the blade on teeth. Preoperatively, patients were warned about the possibility of dental injuries during anaesthesia or surgery.

[To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine]. / Avaliação do efeito de dexmedetomidina na prevenção da dor relacionada à injeção de propofol e comparação com o efeito da injeção de lidocaína.

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2mcg/kg diluted in 5mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2mg/kg diluted in 5mL normal saline. IV line was secured with 20G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70mm Hg for 1min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10s. After 10s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine.

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2 mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2 mcg/kg diluted in 5 mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2mg/kg diluted in 5 mL normal saline. IV line was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70 mm Hg for 1 min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10s. After 10s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

Evaluation of bupivacaine-clonidine combination for unilateral spinal anesthesia in lower limb below-knee orthopedic surgery.

BACKGROUND AND OBJECTIVES: The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any. METHODS: Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally. RESULTS: The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly significant. CONCLUSION: Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in unilateral spinal anesthesia for lower limb below knee surgery.

To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine / Avaliação do efeito de dexmedetomidina na prevenção da dor relacionada à injeção de propofol e comparação com o efeito da injeção de lidocaína

BACKGROUND: Pain due to injection propofol is a common problem. Different methods are used to decrease the pain but with limited success. The objective of this study was to assess the effect of injection dexmedetomidine 0.2 mcg/kg for prevention of pain due to propofol injection and compare it with injection lignocaine 0.2 mg/kg. METHOD: After taking permission of the Institutional Ethical Committee, written informed consent was obtained from all patients, in a randomized prospective study. 60 American Society of Anesthesiology I and II patients of age range 20-60 years of either sex posted for elective surgeries under general anaesthesia were randomly allocated into two groups. Group I (dexmedetomidine group): Inj. dexmedetomidine 0.2 mcg/kg diluted in 5 mL normal saline and Group II (lignocaine group): Inj. lignocaine 0.2 mg/kg diluted in 5 mL normal saline. IV line was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet and inflated to 70 mm Hg for 1 min. Study drug was injected, tourniquet released and then 25% of the calculated dose of propofol was given intravenously over 10 s. After 10 s of injection, severity of pain was evaluated using McCrirrick and Hunter scale and then remaining propofol and neuromuscular blocking agent was given. Endotracheal intubation was done and anaesthesia was maintained on O2, N2O and isoflurane on intermittent positive pressure ventilation with Bain's circuit and inj. vecuronium was used as muscle relaxant. RESULTS: Demographic data showed that there was no statistically significant difference between the 2 groups. There was no statistically significant difference between 2 groups in respect to inj. propofol pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the two groups.

JUSTIFICATIVA E OBJETIVO: A dor relacionada à injeção de propofol é um problema comum. Métodos diferentes são usados para diminuí-la, mas com sucesso limitado. O objetivo deste estudo foi avaliar o efeito da dexmedetomidina (0,2 mcg kg-1) na prevenção da dor relacionada à injeção de propofol e compará-lo com lidocaína (0,2 mg kg-1). MÉTODO: Depois da permissão do Comitê de Ética Institucional, a assinatura do termo de consentimento informado foi obtida de todos os participantes deste estudo prospectivo e randomizado. Sessenta pacientes com estado físico ASA I-II, idades entre 20-60 anos, de ambos os sexos e programados para cirurgias eletivas sob anestesia geral foram randomicamente alocados em dois grupos: Grupo I (dexmedetomidina) recebeu injeção de dexmedetomidina (0,2 mcg kg-1) diluída em 5 mL de solução salina normal e Grupo II (lidocaína) recebeu injeção de lidocaína (0,2 mg kg-1) diluída em 5 mL de solução salina normal. O acesso IV foi obtido com uma cânula de calibre 20G e a oclusão venosa aplicada no antebraço com o uso de um torniquete pneumático e inflado a 70 mm Hg durante um minuto. Os medicamentos em estudo foram injetados, o torniquete foi liberado e, em seguida, 25% da dose calculada de propofol foi administrada por via intravenosa durante 10 segundos. Após 10 segundos de injeção, a intensidade da dor foi avaliada com o uso da escala de McCrirrick e Hunter e, em seguida, o restante do propofol e um agente bloqueador neuromuscular foram administrados. A intubação endotraqueal foi feita e a anestesia mantida com O2, N2O e isoflurano em ventilação com pressão positiva intermitente, com o circuito de Bain e uso de vecurônio como relaxante muscular. RESULTADOS: Os dados demográficos mostraram que não houve diferença estatisticamente significante entre os dois grupos. Não houve diferença estatisticamente significante entre os dois grupos em relação à dor relacionada à injeção de propofol. Não houve efeitos adversos, como edema, dor e pápula no local da injeção nos dois grupos.