Comparison of I-gel and ProSeal laryngeal mask airway during volume controlled ventilation

Introduction: I-gel and the ProSeal laryngeal mask airway (PLMA) are two supra-glottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of I-gel compared with PLMA for airway maintenance in patients under general anesthesia with controlled ventilation. The aim of the study: To compare the supra-glottic airway devices, I-Gel and ProSeal Laryngeal mask airway with respect to Ease of insertion, Time taken for insertion, Airway leak pressure, Hemodynamic response during intubation. Materials and methods: A total number of, 40 patients were randomized into two groups of 20 each. After induction of anesthesia using a standardized protocol for all the patients, one of the supra-glottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion, airway leak pressure, hemodynamic changes, were noted. Results: There was no significant difference in the incidence of adverse effects in both the groups. One incidence of airway trauma was noted in I-gel group. No gastric insufflations and laryngo or bronchospasm in both groups. Conclusion: Based on the result of our study we conclude that I-gel had an acceptable airway leak pressure of 23 cm H2O when compared to ProSeal whose airway leak pressure is significantly higher i-e 29 cm H2O.Both the devices provided optimal oxygenation and no fall in saturation was observed in both the groups.

Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block

Introduction: Brachial plexus block is sole anesthesia for upper limb surgeries. Several techniques have been used to prolong the duration of regional anesthesia. The aim of the study: To compare the effectiveness of Clonidine as adjuvants to Ropivacaine in supraclavicular Brachial plexus block for prolonging the duration of motor blockade and prolonging the duration of analgesia. Materials and methods: 60 Patients of ASA grade I and II undergoing upper limb surgeries were randomly assigned into two groups R and RC. Surgery was done under the subclavian perivascular approach of supraclavicular brachial plexus block. The patients in group R received 25 ml at 0.75% Ropivacaine with 1 ml Normal saline. In a group RC received 25 ml at 0.75% Ropivacaine and 1 ml of (150 micrograms) clonidine. Parameters observed were a time of onset at the sensory block and motor block, duration of motor blockade, and sensory blockade, duration of postoperative analgesia, sedation score and side effects. Results: Addition of clonidine to Ropivacaine shows early onset of motor blockade compared to Ropivacaine alone. Addition of clonidine to local anesthetic solution significantly prolongs the duration of postoperative analgesia by 276 minutes compared to Ropivacaine alone. Addition of clonidine to Ropivacaine increased the duration of motor blockade by 132 minutes compared to Ropivacaine alone. S. Arul Rajan, N. Sathyan, T. Murugan. Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block. IAIM, 2018; 5(5): 33-37. Page 34 Conclusion: The addition of clonidine to the local anesthetic in supraclavicular brachial plexus produces the early onset of sensory and motor blockade and prolongs the duration of both sensory and motor blockade and postoperative analgesia, when compared to Ropivacaine alone.

Comparative study of lateral approach and subclavian perivascular approach of supraclavicular brachial plexus block using the peripheral nerve stimulators

Introduction: Supraclavicular Brachial plexus block is commonly used for upper limb surgeries. Supraclavicular block described as spinal of the arm because of the dense motor and sensory blocked below mid humerus. Advantages of the supraclavicular block are potent intraoperative and postoperative analgesia, reduction in stress response, reduction in opioid requirements and general anesthesia-related side effects. The Aim of the study: To evaluate the success rate as well as the quality of blockade and clinical efficacy of the Lateral approach compared with the Subclavian Perivascular approach of brachial plexus block for upper limb surgeries and both approach guided by peripheral nerve stimulators. Materials and methods: Sixty patients of ASA grade I and II of either sex undergoing upper limb surgeries were randomly allocated into two groups I and II. Each group comprises of 30 patients. Surgery was done under the Lateral approach of Brachial plexus Block in group I and under the subclavian perivascular approach of Brachial plexus block in group II. Results: Time to perform the block was shorter, Number of attempts was less and complications were less by the Lateral approach when compared to subclavian Perivascular approach. Conclusion: Supraclavicular block of brachial plexus by Lateral approach provides an adequate sensory blockade and motor blockade, with less time to perform block and reduced number of S. Arul Rajan, M. Bhavani, T. Murugan. Comparative study of lateral approach and subclavian perivascular approach of supraclavicular brachial plexus block using the peripheral nerve stimulators. IAIM, 2018; 5(5): 57-62. Page 58 attempts and good tourniquet tolerance, and high success rate and fewer complications when compared to subclavian perivascular approach.

Comparison of analgesic properties of perineural and systemic dexamethasone in patients undergoing upper limb surgeries under supraclavicular block

Introduction: Pain in the postoperative period is the distressing period after any surgeries particularly in the first 24 hours. Postoperative pain is associated with an increase in sympathetic activity leading to increases in heart rate, blood pressure, respiratory rate and even delirium and myocardial insults. Opioids and NSAIDS are very commonly used in the postoperative period in spite of their known adverse effects. So there is a need for a study to find a drug which prolongs the duration of analgesia in the postoperative period without many side effects so that usage of opioids and NSAIDS drugs in the first 24 hours can be decreased. The aim of the study: To compare during supraclavicular brachial plexus block, the single perioperative dose of intravenous Dexamethasone and perineural Dexamethasone effects on onset and duration of sensory and motor blockade ; quality of analgesia and reduction in the dose of opioids in first 24 hour. Materials and methods: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial. Totally 90 patients were recruited in the study patients undergoing upper limb surgeries under supraclavicular block at govt. Kilpauk medical college hospital and govt. Royapettah Hospital from Sathyan Natarajan, Karthikeyan G, Murugan T. Comparison of analgesic properties of perineural and systemic dexamethasone in patients undergoing upper limb surgeries under supraclavicular block. IAIM, 2017; 4(11): 220-228. Page 221 December 2015 to May 2016 were included in the study. After obtaining written informed consent patients were divided into three groups of 30 in each group. Group A local anesthetics and perineural dexamethasone Group B local anesthetics & intravenous dexamethasone, Group C local anesthetics only. Results: The Sensory and Motor block onset time between the intervention groups group A VS group B and group A VS group C were found to be statistically significant (p < 0.05) and the association between group B VS group c was found to be not statistically significant (p>0.05) as per unpaired t-test. The sensory & motor block duration time showed statistical significance in group A VS group C, group B VS group C (p < 0.05) but group A VS group B had no statistical significance( p > 0.05) as per unpaired t-test. The association of Visual Analog Scale between the intervention groups (group A Vs group C and group B VS group C) and VAS scores at 6, 12 and 24 hours postoperatively were found to be statistically significant since p < 0.05 as per unpaired t-test. The number of doses of opioid required in 24 hours was considered to be statistically significant since p < 0.05 as per unpaired t-test between the intervention groups (group A VS group C and group B VS group C). Conclusion: Systemic Dexamethasone is equally effective as perineural Dexamethasone in providing the significant duration of sensory, motor blockade and quality of analgesia. We come to a conclusion that Dexamethasone consistently decreases the postoperative pain scores and decrease the early & number of doses of opioid consumption (48 hours).

Antibacterial and antifungal activities of Actinobacteria isolated from Rathnagiri hills.

This study was performed to isolate actinomycete colonies having antibacterial and antifungal activity from soil samples. A total of 27 actinomycete colonies were isolated in pure culture from five soil samples using Starch casein agar medium. Entire isolates were screened for their antimicrobial activity by agar plug method against five each of human pathogenic bacteria and fungi. Of this, 7 strains inhibits B. substilis, 3 strains inhibits Klebseilla sp, 6 strains inhibits B. cerus, 5 strains inhibits S. aureus and only 2 strains inhibits E. coli. Incase of fungi all the actinobateria has moderate activity with less fungal strains, only 1 strain (RA 5) inhibits entire fungus except Penicillium sp. The metabolites from potent strain was produced by fermentation, separated by centrifugation, it was tested for their antimicrobial activity against the test bacterial and fungal strains by well diffusion and disc diffusion method. In this study, the metabolites from RA5 (identified as Streptomyces sp.) have showed good antibacterial and antifungal activity. Since many isolates showed inhibitory activity against indicator bacteria, it is suggestive that Rathnagiri hill’s soil could be an interesting source to explore for antibacterial secondary metabolites.