A comparative evaluation of fibreoptic bronchoscopy versus C-MAC® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients.

PURPOSE: Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS: We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS: The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION: Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION: CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.

RéSUMé: OBJECTIF: L'intubation nasotrachéale est nécessaire pour la chirurgie chez la patientèle atteinte de carcinome oropharyngé, mais elle peut être difficile en raison d'une anatomie déformée, d'une congestion des muqueuses et d'un risque accru de saignement. Dans ces cas, il est préférable d'utiliser une intubation nasotrachéale guidée par bronchoscopie flexible (BF), mais cette modalité a ses limites. Dans cette étude randomisée contrôlée, nous avons cherché à comparer la vidéolaryngoscopie guidée par lame D-BLADE C-MAC® (VL) (Karl Storz SE & Co. KG, Tuttlingen, Allemagne) à la BF pour réaliser l'intubation nasotrachéale sous anesthésie générale chez les patient·es ayant un carcinome oropharyngé. MéTHODE: Au total, nous avons randomisé 100 personnes atteintes d'un carcinome oropharyngé et présentant un indice de risque d'El-Ganzouri (EGRI) < 7 à bénéficier d'une intubation nasotrachéale sous anesthésie générale par BF (n = 50) ou par VL guidée par lame D-BLADE C-MAC (n = 50). Le critère d'évaluation principal était le temps d'intubation total. Nous avons également enregistré le temps écoulé jusqu'à la visualisation de la glotte, le score sur l'échelle de difficulté de l'intubation nasale (NIDS), le meilleur pourcentage de score d'ouverture de la glotte et les complications. RéSULTATS: La durée totale d'intubation médiane [écart interquartile (ÉIQ)] était plus courte avec la VL qu'avec la BF (durée totale d'intubation, 38 [26­43] sec vs 60 [52 à 65] secondes; différence, −20 sec [intervalle de confiance (IC) à 95 %, −27 à −11]; P < 0,001). De même, le temps médian [ÉIQ] jusqu'à la visualisation de la glotte était plus court avec la VL qu'avec la BF (8 [6­9] sec vs 22 [14 à 25] secondes; différence, −13 sec [IC 95 %, −17 à −10]; P < 0,001). Le score médian sur l'échelle NIDS était plus élevé avec la VL (différence, 2 [IC 95 %, 2 à 3]; P < 0,001). L'incidence des traumatismes des voies aériennes (deux cas avec la BF vs sept avec la VL; P = 0,30) et le mal de gorge postopératoire (dix cas dans les deux groupes; P = 0,56) étaient similaires. CONCLUSION: Par rapport à la BF, la VL guidée par lame D-BLADE C-MAC a réduit le temps total d'intubation nasale pour les personnes atteintes d'un carcinome oropharyngé, ce qui représente potentiellement une alternative acceptable dans certains cas. ENREGISTREMENT DE L'éTUDE: CTRI.nic.in (2018/11/0162830); première soumission le 8 novembre 2018.

Comparison of sedation efficacy of intravenous infusion of dexmedetomidine versus propofol in terms of opioid consumption in patients requiring postoperative mechanical ventilation after head and neck onco-surgeries - A randomized prospective study.

BACKGROUND: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. METHODS: After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2-4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient's satisfaction were noted. RESULTS: Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I (P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). CONCLUSION: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries.

Comparison of two different doses of hyperbaric bupivacaine for intracavitary radiotherapy in patients with carcinoma cervix - A randomized control trial.

Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double-blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 ± 32.4 minutes vs. Group II: 143.2 ± 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 ± 47.12 minutes versus Group II: 247.00 ± 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.

Comparison of two techniques (intermittent intravenous bolus morphine vs. morphine infusion) for analgesic titration in patients who had advanced cancer with severe pain: a prospective randomised study.

OBJECTIVE: To compare the analgesic efficacy of two techniques of morphine titration (intermittent intravenous bolus vs infusion) by calculating rescue dosage in a day at 1 week after analgesic titration. METHODS: One hundred and forty cancer patients were randomised into two groups. In group 1, intravenous morphine 1.5 mg bolus given every 10 min until Numerical Rating Scale (NRS) pain score <4 is achieved. Total intravenous dose converted to oral dose (1:1) and administered every 4 hours. In group 2, intravenous bolus morphine 0.05 mg/kg body weight administered followed by 0.025 mg/kg/hour intravenous infusion. The NRS pain score was recorded every 10 min but infusion rate was titrated every 30 min if required. The infusion rate of morphine was doubled if the pain score was unchanged and increased to 50% when NRS was between 4 and baseline. If NRS<4, then infusion at same rate was continued. Once the NRS<4 for two consecutive hours, total intravenous dose for 24 hours was calculated and converted to oral morphine in a ratio of 1:3 and divided into six doses given over 24 hours. For rescue (pain score ≥4) analgesia, one-sixth of the total daily oral dose was prescribed. The primary outcome of this study was to note the number of rescue doses of oral morphine in a day at 1 week. RESULTS: The rescue dosage in a day at 1-week post discharge from the palliative care unit was significantly higher in group 1 as compared with group 2. CONCLUSION: Intravenous infusion morphine may be a better analgesic titration technique for analgesia in patients with advanced cancer. TRIAL REGISTRATION NUMBER: CTRI/2018/04/013369.

To compare clinical versus ultrasound assessment of correct placement of ProSeal Laryngeal mask airway (PLMA): a prospective randomized study.

Extraglottic airway devices (EAD) have revolutionized the perioperative airway management. The accuracy of clinical tests to identify malposition has been questioned by recent studies where fibreoptic evaluation identified various malpositions that were undiagnosed by a clinical test. Ultrasound (USG) has evolved to guide various airway interventions. However, USG is under-evaluated in the assessment of the EADs position. Our study aimed to compare clinical versus USG assessment of optimal placement of ProSeal laryngeal mask airway (PLMA). This randomized control trial was done in 212 consenting patients undergoing onco-surgery with PLMA as an airway device. Patients were randomized in Group CL (n-107) and US (n-105). Following primary assessment-using clinical tests and USG evaluation using a scoring system, fibreoptic evaluation of the placement of PLMA was done and then assessed for optimal position. The accuracy of each technique for optimal placement was compared statistically. We found that the sensitivity and specificity of the clinical evaluation were 98.77% and 34.62% with a diagnostic accuracy of 83.18% when compared with fibreoptic evaluation. While USG evaluation using the scoring system has sensitivity and specificity of 95.45% and 29.41% with a diagnostic accuracy of 84.76%. It was noted that USG assessment has a higher positive predictive value (87.5%) as compared to clinical assessment (82.47%). The incidence of rotation was higher in the clinical group. There was no difference in airway related morbidity. USG is comparable to clinical tests for evaluation of the optimal placement of PLMA. However, USG has various advantages over clinical assessment as it is quick and identifies the unacceptable placement of PLMA where the tip of PLMA may not lie over the tip of the esophagus, thereby, avoiding unnecessary mucosal injury during forceful or repeated attempts for gastric drainage tube insertion.Trial registration: Clinical Trials Registry (CTRI/2017/11/010359) dated 3rd November 2017.

Comparison of two forced air warming systems for prevention of intraoperative hypothermia in carcinoma colon patients: a prospective randomized study.

Hypothermia is common occurrence in patients undergoing colonic surgeries. We hypothesized that the underbody forced air warming blankets will be better than conventional over-body forced air warming blankets for prevention of hypothermia during laparoscopic colon surgeries. After ethics approval, sixty patients undergoing elective laparoscopic colon surgeries were randomly divided into two groups to receive warming by underbody forced air warming blanket (n = 30) or over-body forced air warming blanket (n = 30). In the operating room, epidural catheter was inserted and thereafter warming was started with the forced air warmer with temperature set at 44 °C. Intraoperatively core temperature (using nasopharyngeal probe), vitals, incidence of postoperative shivering and time to reach Aldrete Score of 10 in the postoperative period were recorded. The core temperature was higher with an underbody blanket at 60 min (36.1 ± 0.5 °C vs. 35.7 ± 0.5 °C, P = 0.005), 90 min (35.9 ± 0.5 °C vs. 35.6 ± 0.5 °C, P = 0.009), 120 min (35.9 ± 0.5 °C vs. 35.5 ± 0.4 °C, P = 0.007), and 150 min (35.9 ± 0.5 °C vs. 35.6 ± 0.4 °C, P = 0.011). In the post anesthesia care unit, the time to reach an Aldrete score of 10 was also less in the underbody blanket group (14.3 ± 2.5 min vs. 16.8 ± 3.6 min) (P = 0.003). However, there were no clinically meaningful differences in any outcome. Underbody and over-body blankets were comparably effective in preventing hypothermia in patients undergoing laparoscopic colorectal surgery under general anaesthesia.Trial registration CTRI (2019/06/019,576). Date of Registration: June 2019, Prospectively registered.

Telemedicine as an Acceptable Model of Care in Advanced stage Cancer Patients in the Era of Coronavirus Disease 2019 - An Observational Study in a Tertiary Care Centre.

OBJECTIVES: The availability of routine care for patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has become challenging, and the use of telemedicine can be promising in this area. The objective of the study is to evaluate the feasibility of telemedicine-based palliative interventions in cancer patients. MATERIALS AND METHODS: This retrospective study was conducted in a tertiary care centre with 547 follow-up patients who used palliative medicine teleconsultation services. The following data were retrieved from the records: Patient's reason for the call, the main barriers to a hospital visit, the assistance given to them by the physician on the call and the patients' satisfaction with the service on a 4-point scale. The data were analysed using percentages for categorical variables and mean/standard deviation for quantitative variables. RESULTS: Out of the 547 patients, 462 (84.46%) utilised voice calling service, and the major reason for not visiting the hospital were cited to be fear of contracting COVID-19 (37.3%), inability to attend due to health constraints (7.13%) and issues with transportation (48.8%). The majority of the calls (63.62%) calls were regarding uncontrolled symptoms of the primary diseases. A total of 402 (73.49%) patients were very satisfied, and a total of 399 (72.94%) decided to continue to use this medium in the future as well. CONCLUSION: Telemedicine is a good modality for the assessment of chronic pain and providing symptomatic supportive care in patients with cancer in the COIVD-19 pandemic.

Comparative evaluation of glidescope videolaryngosocope and conventional macintosh laryngoscope for nasotracheal intubation in patients undergoing oropharyngeal cancer surgeries: A prospective randomized study.

Background and Aims: Nasotracheal intubation in oropharyngeal cancer patients is challenging owing to anatomical alterations. Various videolaryngoscopes have been compared to conventional laryngoscope and also amongst each other in different clinical scenarios; the supremacy of videolaryngoscopes over conventional laryngoscope in oropharyngeal cancer patients is yet to be established. We compared the efficacy of glidescope videolaryngoscopes and Macintosh laryngoscope for nasotracheal intubation in patients posted for routine oropharyngeal cancer. Material and Methods: 120 ASA I and II oropharyngeal cancer patients scheduled for elective surgery were randomized to undergo nasotracheal intubation after induction of general anesthesia with glide scope video laryngoscope (Group GVL, N = 60) or Macintosh laryngoscope (Group L, N = 60) as per group allocation. Time to glottic view, total intubation time (primary objective), hemodynamic fluctuations, and additional manoeuvres to aid intubation were recorded. Results: Time to visualize the glottic opening (9.20 ± 4.6 sec vs 14.8 ± 6.3 sec) (P = 0.000) and the total intubation time was significantly less in group GVL (35.6 ± 9.57 sec vs 42.2 ± 11 sec) (P = 0.001). Glidescope videolaryngosocpe provided better glottic views and resulted in significantly fewer manoeuvres to facilitate NTI (P = 0.009). The median numeric rating scale (NRS), hemodynamic parameters and complications were similar in both the groups. Conclusion: Glidescope videolaryngosocpe is better than conventional Macintosh laryngoscope for intubation times and need of manoeuvres to facilitate intubation and should be a preferred device for NTI in patients with oropharyngeal cancer.

Smartphone-Based Telemedicine Service at Palliative Care Unit during Nationwide Lockdown: Our Initial Experience at a Tertiary Care Cancer Hospital.

BACKGROUND AND AIMS: With the COVID-19 pandemic, lockdown, and fear from contagion, the advantages of telemedicine are clearly outweighing the setbacks by minimizing the need for individuals to visit health-care facilities. Our study aims to assess how palliative medicine physicians could follow up on cancer patients and barriers they faced, discuss their results, and evaluate their treatment response with the help of telemedicine. MATERIALS AND METHODS: We conducted a prospective analysis of the smartphone-based telemedicine service at our palliative care (PC) unit from March 25, 2020, to May 13, 2020. We recorded the patient's reason for call, main barriers to a hospital visit, and the assistance given to them by the physician on call. Each caller was asked to measure his/her satisfaction with the service on a 4-point scale. RESULTS: Out of 314 patients, 143 (45.54%) belonged to Delhi and 171 (54.46%) belonged to other states. 157 patients sought help for symptom management; 86 patients needed to restock their opioid medications. Seventy-one patients required information regarding their oncological treatments requiring consultation from other departments. Titration of oral opioids and medication prescription (n = 129), contact details of other PC units at their native state for opioid procurement (n = 55), and attachment to our community-based PC service (n = 22) were main modes of management. Fifty-six patients were very satisfied and 152 patients were satisfied with the service. CONCLUSION: Telemedicine is the future of health-care delivery systems. In PC, we deal with immunocompromised debilitated cancer patients and telemedicine is immensely helpful for us to provide holistic integrated care to these patients who are unable to visit hospitals regularly.

Ultrasound-Guided Glossopharyngeal Nerve Block at Pharyngeal Wall Level in a Patient with Carcinoma Tongue.

Glossopharyngeal nerve (GPN) block is used for pain management in patients' head and neck malignancy. The GPN is a mixed nerve containing both motor and sensory fibers. The usual approaches for GPN blocks are usually topical, intraoral, or peristyloid. Topical anesthesia may be difficult in patients with limited mouth opening or when there is inflammation in the area of interest. Intraoral and peristyloid approaches have risk of inadvertent neurovascular injection. The intraoral technique may lead to long-lasting oropharyngeal discomfort. Hence, GPN block is done at the pharyngeal wall level for pain relief.

Cancer Care Delivery Challenges Amidst Coronavirus Disease - 19 (COVID-19) Outbreak: Specific Precautions for Cancer Patients and Cancer Care Providers to Prevent Spread.

Coronavirus outbreak has affected thousands of people in at least 186 countries which has affected the cancer care delivery system apart from affecting the overall health system. Cancer patients are more susceptible to coronavirus infection than individuals without cancer as they are in an immunosuppressive state because of the malignancy and anticancer treatment. Oncologists should be more attentive to detect coronavirus infection early, as any type of advanced cancer is at much higher risk for unfavorable outcomes. Oncology communities must ensure that cancer patients should spend more time at home and less time out in the community. Oncologists and other health care professionals involved in cancer care have a critical opportunity to communicate to their patients to pass on right information regarding practice modifications in view of COVID-19 outbreaks. Countries must isolate, test, treat and trace to control the coronavirus pandemic. There is a paucity of information on novel coronavirus infection and its impact on cancer patients and cancer care providers. To date, there is no scientific guideline regarding management of cancer patients in a background of coronavirus outbreak.
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Sexual Dysfunction in Carcinoma Cervix: Assessment in Post Treated Cases by LENTSOMA Scale.

Treatment for cervical cancer consists of hysterectomy, radiotherapy, chemotherapy and targeted therapy in different combination based on stage at presentation. However, late consequences of such radical treatments are known but not many Indian studies have reported it. Quality of life and impact on sexual health has become an important issue in view of long survival of cervical cancer patients. LENTSOMA scale is one such scale validated for scoring radiotherapy related morbidity. However, there is need for a comprehensive scale covering all aspects of physical and psychological disruptions to provide complete recovery and rehabilitation. The study was prospective and patients who were treated for cervical cancer on follow up were included in this study. A total of 85 patients, who were treated with surgery, radiotherapy, chemotherapy alone or in combination, comprising of stage I to stage IV disease, participated in this study. Findings of this study showed that pain during intercourse and altered sexual life were reported by 32.9% and 25.9% patients respectively whereas 24.7% found it problematic and in 22.3% patients, alteration in interest in sex were reported. Vaginal stenosis was seen in 75.29% of patients after treatment with decreased frequency of intercourse after treatment was seen in 16.4 % of patients. Combination of surgery and radiotherapy in cervical cancer patients caused more sexual dysfunction and dissatisfaction, especially in lower age group. Treatment morbidity in term of sexual function was more with advanced stage disease and with the patients on longer follow up. Sexual function is an important aspect of quality of life but there is no single self-report measure in routine clinical follow up use which is brief, easy to complete and incorporates all (physical, psychological, emotional) aspects of sexual health for people affected by cancer.
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Comparison of analgesic efficacy of ultrasound-guided thoracic paravertebral block versus surgeon-guided serratus anterior plane block for acute postoperative pain in patients undergoing thoracotomy for lung surgery-A prospective randomized study.

CONTEXT: Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications. AIMS: We have compared total morphine consumption in 24 hours following thoracotomy. SETTINGS AND DESIGN: This prospective randomized pilot study involved 50 patients undergoing elective thoracotomy for lung surgery at AIIMS, New Delhi. PATIENTS AND METHODS: Fifty patients undergoing elective thoracotomy were randomly allocated into two groups. In Group I patients, ultrasound (USG)-guided paravertebral catheter was inserted preoperatively and in Group II patients, serratus anterior plane (SAP) catheter was inserted by the surgeon before closure. Ropivacaine bolus (group I: 0.2% 0.1 ml/kg and group II: 0.375% 0.4 ml/kg) was given before extubation, followed by its continuous infusion for 24 hours. If the numerical rating scale (NRS) was >3, then patients were given intravenous (i.v.) morphine 3 mg. Total 24-hour morphine consumption, duration of effective analgesia, hemodynamic parameters, side effects, and overall patient satisfaction were recorded. STATISTICAL ANALYSIS USED: T-test was used to compare the parametric values in both the groups, whereas the Mann-Whitney U-test was performed to compare the nonparametric values. RESULTS: Postoperative morphine requirement in the ParaVertebral Block (PVB) group (8.65 ± 4.27 mg) was less as compared to the SAP group (11.87 ± 6.22 mg) but that was not statistically significant (p 0.052). Postoperative pain scores at rest and on movement, patient satisfaction, and incidence of chronic post-thoracotomy pain were comparable in both the groups. CONCLUSION: SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.

Comparative evaluation of forced air warming and infusion of amino acid-enriched solution on intraoperative hypothermia in patients undergoing head and neck cancer surgeries: A prospective randomised study.

BACKGROUND: Inadvertent core hypothermia is a common occurrence during general anaesthesia. Forced air warming (FAW) is the most effective perianaesthetic warming system, but it may lead to thermal discomfort. Amino acids (AAs) have been used to prevent hypothermia, but no study has compared the effect of AA infusion with FAW systems. We have conducted this study to compare the effects of external heating (FAW system) and internal heat generation (AA infusion) in preventing hypothermia during anaesthesia. METHODS: After institutional review board approval, 80 American Society of Anesthesiologists Grade I/II adult patients admitted for head and neck cancer surgeries lasting more than 2 h under general anaesthesia were included. The patients were randomly divided into two groups using computer-generated codes to receive AA infusion at 3 mL/kg/h, Group AA (N = 40), or normal saline at 3 mL/kg/h with FAW, Group FA (N = 40) till the end of surgery. Standard anaesthetic technique and monitoring was used in all the patients. RESULTS: The baseline mean temperature in both the groups was comparable. The core temperature was similar in the two groups at 30 min (35.6 ± 0.54 vs 35.5 ± 0.54), 60 min (35.5 ± 0.63 vs 35.3 ± 0.60), 90 min (35.5 ± 0.79 vs 35.2 ± 0.66), 120 min (35.6 ± 0.93 vs 35.2 ± 0.78), 150 min (35.7 ± 0.88 vs 35.3 ± 0.89) and 180 min (35.8 ± 1.01 vs 35.3 ± 0.95) in Groups FA and AA, respectively (P > 0.05). However, the core temperature was significantly higher in Group FA at 210 min (35.8 ± 1.0 vs 35.3 ± 0.85; P = 0.01), 240 min (35.9 ± 1.0 vs 35.4 ± 0.90; (P = 0.001), 270 min (35.9 ± 1.12 vs 35.6 ± 0.97; P = 0.002) and 300 min (36.0 ± 1.12 vs 35.6 ± 1.02; P = 0.002), respectively. Clinically relevant hypothermia (at least one measurement <35.5°C) was comparable between the two groups. CONCLUSION: The AA infusion can be used as an alternative to FAW in preventing intraoperative hypothermia under general anaesthesia especially in places where FAW system is unavailable.

A Case Report of Surgical Entrapment and Catheter Embolization: A Rare Complication of Peripherally Inserted Central Catheters.

Peripherally inserted central catheters (PICCs) are a feasible alternative to conventional central venous access. PICCs are often used perioperatively for central venous pressure monitoring and administration of vasoactive drugs especially in cancer patients. Catheter breakage and embolization are rare but potentially fatal complications, and most of the reported literature pertains to pediatric patients after medium- to long-term use. In this report, we describe a rare scenario of catheter breakage, entrapment, and embolization in a patient caused by inadvertent surgical clip and suture placement.

Anesthetic implications in hyperthermic intraperitoneal chemotherapy.

Patients with peritoneal carcinomatosis were considered incurable with dismal survival rates till hyperthermic intraperitoneal chemotherapy after optimal cytoreductive surgery evolved. Perioperative management for these procedures is complex and involves an optimal cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. In this article we highlight the perioperative concerns in these patients including anesthetic challenges, such as optimal fluid management, maintaining blood pressure, control of body temperature, coagulation and electrolyte derangement and renal toxicity of chemotherapeutic drugs. We have also discussed the postoperative problems and their management.

Central Venous Catheter as Peritoneal Indwelling Catheter for the Management of Recurrent Malignant Ascites: A Case Series.

BACKGROUND: Malignant ascites is an accumulation of fluid in the peritoneal cavity due to the manifestation of terminal metastatic malignancies. Accumulation of ascitic fluid could cause abdominal distention, early satiety, and shortness of breath. The onset and progression of these symptoms are not only distressing but also cause deterioration of the quality of life. Malignant ascites is associated with poor prognosis with anticipated life expectancy ranging from 1 to 4 months. Therapeutic paracentesis is the mainstay of palliation for malignant ascites. It only provides a temporary relief of symptoms, ascites re-accumulates, and paracentesis has to be repeated. OBJECTIVES: The aim of this case series was to evaluate our experiences when treating malignant ascites with placement of central venous catheter in the peritoneal cavity, with special emphasis on patient satisfaction, comfort of caregiver, technical success, and adverse events. METHODS: Five patients with advanced disease and recurrent malignant ascites who required multiple paracentesis were selected for placement of 7-FG triple-port Central venous catheter in the peritoneal cavity. Maximum fluids that can be tapped were removed in ward. Patients and their relatives were assessed for satisfaction with the procedure. RESULTS: Out of 5 patients, 3 were female and 2 male (age between 46 and 62 years). Two patients had carcinoma gallbladder and one each of carcinoma ovary, breast, and prostate. All patients were followed up till 1 month from catheter placement. Patients and their relatives were well satisfied in terms of frequent hospital visit for paracentesis. CONCLUSION: In summary, we suggest that central venous catheter may be used as indwelling peritoneal catheter for the symptom management of recurrent malignant ascites. It provides a relatively safe and cost-effective alternative to serial large-volume paracentesis that requires multiple hospital admissions.