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Background and Aims: Translaryngeal ultrasonography (TLUSG) for diagnosis of vocal cord palsy, a relatively new, safe and noninvasive bedside technique with minimal risk of respiratory infection transmission, has been effective in patients with thyroid disease. We studied its use as an alternative method to visual inspection by flexible laryngoscopy (FL) for vocal cord assessment in patients undergoing thoracic surgeries. Methods: After Institutional Ethics Committee approval and trial registration, in this single-arm, prospective study, the vocal cord function of 110 patients who underwent either total oesophagectomy or mediastinoscopy was assessed immediately after extubation by both FL and TLUSG. A follow-up assessment was done by laryngoscopy using Hopkin's endoscope (HL) and a repeat TLUSG. The primary outcome was the concordance between direct visualisation (FL or HL) and TLUSG. Results: Vocal cords were successfully visualised by TLUSG in 90% of male and all female patients. Findings of FL and TLUSG done at the first assessment matched in 89 (86.4%) out of 103 patients, and the degree of concordance was 0.69 (95% confidence interval [CI] =0.52-0.83). At the second assessment, HL and TLUSG findings matched in 83 (94.3%) out of 88 patients, and the degree of concordance was 0.89 (95% CI = 0.77-0.98). Conclusion: TLUSG is an effective noninvasive alternative to direct visualisation for vocal cord assessment in both male and female patients undergoing thoracic surgery.
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Objectives: Patients with brain tumors are prone to develop deep venous thrombosis (DVT) following neurosurgical excision of tumor. However, there is a deficiency of knowledge about the screening method, optimum frequency, and duration of the surveillance to diagnose DVT in the post-operative period. The primary objective was to find the incidence of DVT and associated risk factors. The secondary objectives were to find the optimum duration and frequency of surveillance venous ultrasonography (V-USG) in patients undergoing neurosurgery. Materials and Methods: Hundred consecutive adult patients undergoing neurosurgical excision of brain tumors were included after their consent, over a period of 2 years. The risk factors for DVT were assessed in all the patients preoperatively. All patients underwent surveillance duplex V-USG of the upper and lower limbs at pre-planned time intervals in the perioperative period, by experienced radiologists and anesthesiologists. The occurrence of DVT was noted using the objective criteria. The association between the perioperative variables and the incidence of DVT was assessed using univariate logistic regression analysis. Results: The most common prevalent risk factors were - malignancy (97%), major surgery (100%), and age >40 years (30%). Asymptomatic DVT was detected in the right femoral vein in one patient who underwent suboccipital craniotomy for high-grade medulloblastoma, on the 4th and 9th postoperative day, making the incidence of DVT 1%. The study found no association with perioperative risk factors and could not suggest the optimum duration and frequency of surveillance V-USG. Conclusion: A low incidence of DVT (1%) was detected in patients undergoing neurosurgeries for brain tumors. Prevalent thromboprophylaxis practices and a shorter period of post-operative surveillance could be the reasons for the low incidence of DVT.
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BACKGROUND AND AIMS: Baseline difference in the perfusion of two lungs is the cause of intra-operative shunt during one-lung ventilation (OLV). This study aimed to test the hypothesis that the gradient of end-tidal carbon dioxide (EtCO2) between two lungs in lateral position (D-EtCO2lateral) would predict the quantity of shunt and hence the drop in the oxygenation during OLV. METHODS: An observational study was conducted to include consecutive 70 patients undergoing thoracic surgery using a double-lumen tube in a lateral position. D-EtCO2lateral was calculated by subtracting EtCO2 from the non-dependent lung from that of the dependent lung when ventilation parameters are the same for each lung. Oxygenation was assessed by measuring PaO2/FiO2 ratios (P/F ratio) at 10, 20 and 40 min after OLV. Correlations between D-EtCO2lateral and P/F ratios were calculated. Receiver operating curves were analysed to test the ability of D-EtCO2lateral to identify patients with a P/F ratio of <100 during OLV. RESULTS: A moderate correlation was found between D-EtCO2lateral and P/F ratios at 10 and 20 min of OLV. Among lung resection cases (n = 61), correlation was moderate at 10 (r = 0.64), and 20 min (r = 0.65) (P < 0.001) and became weak at 40 min (r = 0.489, P < 0.001). Areas under curve for D-EtCO2lateral to predict the drop in P/F ratio <100 at 10, 20 and 40 min after OLV were 0.90 (cut-off: 2.5), 0.78 (cut-off: 3.5) and 0.78 (cut-off: 4.5), respectively. CONCLUSION: D-EtCO2lateral could predict the drop in oxygenation in the early part of OLV in lung resection surgeries.
