RESUMEN
Background: Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA). Methods: The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed. Results: Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications. Conclusion: SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.
RESUMEN
Background: The aim of the study is to compare intubating conditions and hemodynamic changes during awake fiber-optic intubation (AFOI) using midazolam and fentanyl versus dexmedetomidine in cases of difficult airway. Materials and Methods: A randomized prospective study was conducted in the department of oral and maxillofacial surgery, with a total of 60 patients, 18-55 years of age, ASA class I-II, of either sex with anticipated difficult airway planned for elective surgery. They were divided into two groups; group I patients received 1 µg/kg of dexmedetomidine and then an infusion of 0.5 to 0.7 µg/kg/hr of dexmedetomidine, whereas group II patients received 1 µg/kg of intra-venous (iv) fentanyl and 0.05 mg/kg of iv midazolam with additional doses of 0.02 mg/kg to achieve a Ramsay Sedation Scale score of ≥2. The ease of placement of the fiber-optic scope and the endotracheal tube and the patient's reaction to placement of the fiber-optic scope were assessed on a scale of 1-4 and were recorded as endoscopist satisfaction score and patient discomfort score, respectively. Results: The endoscopy time ranged from 2.66 ± 1.00 (group I) to 3.90 ± 0.96 (group II) minutes and was found to be statistically significant (p < 0.05). Also, the patient discomfort score was recorded during endoscopy (1-4) and ranged from 1.3 ± 0.53 (group I) and 2.33 ± 0.66 (group II) and was found to be statistically significant (p value < 0.05). Patients undergoing the procedure who received dexmedetomidine were thus more comfortable than those who received fentanyl and midazolam combination. Conclusion: Dexmedetomidine provided better intubating conditions, patient tolerance, higher endoscopist satisfaction, and reduced hemodynamic responses compared to fentanyl and midazolam combinations. Also, the major advantage of dexmeditomidine for preservation of airway with a lesser degree of respiratory depression allows for safer use of AFOI in cases of difficult airway.
RESUMEN
BACKGROUND: This study was designed to compare the prevention of emergence agitation (EA) of sevoflurane anesthesia by an intraoperative bolus or low-dose infusion of dexmedetomidine in pediatric patients undergoing lower abdominal surgeries. MATERIALS AND METHODS: Forty-eight patients, aged 2-12 years, undergoing lower abdominal surgeries with sevoflurane anesthesia were enrolled in this study. Patients were randomly assigned to receive either intravenous bolus over 10 min. 0.4 µg/kg dexmedetomidine (Group I, n = 24) or low-dose infusion 0.4 µg/kg/h of dexmedetomidine (Group II, n = 24) after intubation. Heart rate and mean arterial pressure were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, and Ramsay sedation scores (RSS) were recorded on arrival to the postanesthesia care unit and at 5, 10, 15, 30, 45, 60 min thereafter. Extubation time, emergence time, and time to reach Aldrete score ≥9 were recorded. RESULTS: OPS and PAED scores and percentage of patients with OPS ≥4 or PAED scale ≥10 were significantly higher in Group II as compared to Group I. RSS score, extubation time, emergence time, and time to reach Aldrete score ≥9 did not show any significant difference. CONCLUSION: Both bolus or low-dose infusion of dexmedetomidine was effective for the prevention of EA with sevoflurane anesthesia, but bolus dose of dexmedetomidine was more effective.
