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Background and Aims: Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. Methods: A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. Results: In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. Conclusion: This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.
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Objectives Total intravenous anesthesia (TIVA) is used during surgery with intraoperative neurophysiological monitoring. Addition of adjuvant may minimize suppression of potentials by reducing doses of propofol. We studied the effect of addition of ketamine or dexmedetomidine to propofol-fentanyl-based TIVA on corticobulbar motor evoked potential (CoMEP) in patients undergoing posterior fossa surgeries. Materials and Methods Forty-two patients were assigned to three groups ( n = 14 each), Group S-saline, Group D-dexmedetomidine (0.25 µg/kg/h), and Group K-ketamine (0.25 mg/kg/h). Patients received propofol and fentanyl infusions along with study drugs. CoMEPs were recorded from muscles innervated by cranial nerves bilaterally at predefined intervals (T baseline , T 2 , T 3 , T 4 , and T 5 ). Effect on amplitude and latency of CoMEPs was assessed. Results A significant fall in CoMEP amplitude was observed across all analyzed muscles at time T 4 and T 5 in saline and dexmedetomidine group as compared with ketamine group, p -value less than 0.05. A significant increase in latency was observed at T4 and T5 among groups ( p -value, D vs. K = 0.239, D vs. S = 0.123, and K vs. S = 0.001). Conclusion Both ketamine and dexmedetomidine provide and allow effective recording of CoMEPs. Ketamine emerges as a better agent especially when prolonged surgical duration is expected as even propofol-fentanyl-based TIVA adversely affects CoMEPs when used for long duration.
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Background and Aims: Robotic surgeries often require a relatively long duration of pneumo-peritoneum and trendelenburg position which may accentuate changes in endo-tracheal tube (ETT) cuff pressure leading to pressure related complications. The aim of this study was to analyze changes in ETT cuff pressures during various stages of pneumo-peritoneum and surgical positioning and its correlation with airway pressure changes. Material and Methods: A prospective observational study was planned after approval of institutional review board on 60 patients undergoing elective robotic pelvic surgery requiring head down position. Baseline cuff pressure was adjusted to 25 cm H2O. ETT cuff pressure, peak airway pressure and end tidal CO2 (ETCO2) was measured at various time intervals before and after pneumo-peritoneum and head down. Ventilatory parameters were kept fixed after baseline setting. Those requiring any change were excluded. Pearson's coefficient was used for correlation and ANOVA for trend of parameters at different time intervals (P value <0.05 was considered significant). Results: Baseline cuff pressure after manual inflation was 46.2 ± 17.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (r = 0.4, P < 0.05). Serial measurements of ETT cuff pressure, peak airway pressure and ETCO2 were significantly increased compared to baseline (P < 0.05). Conclusion: Significant increases in ETT cuff pressure may be seen in robotic surgeries, with a positive correlation between change in cuff pressure and increase in airway pressures. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries.
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BACKGROUND: Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic. AIM: To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19. METHODS: The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips. RESULTS: Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student's t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient's airway. CONCLUSION: Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.
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INTRODUCTION: Exposure to biomass fuel (BMF) from traditional cookstoves inflicts an enormous burden of morbidities in women across the developing world. This study aims to assess the lung function and its association with the indoor air pollutants generated using BMF. MATERIALS AND METHODS: This cross-sectional study including 310 women was conducted in a rural village of India. Households were divided into two groups based on the cooking fuel, the BMF group and the liquefied petroleum gas (LPG) group. Information on respiratory symptoms and socioeconomic status was obtained using a standard questionnaire. Indoor air concentration for PM10and PM2.5was measured during cooking hours. Pulmonary function tests (PFTs) were conducted for the women inhabitants. RESULTS: On comparing the two groups, the concentration of PM10(890.26 ± 59.59 vs. 148.66 ± 31.97) µg/m3 and PM2.5(728.90 ± 50.20 vs. 99.76 ± 41.80) µg/m3 (P < 0.01) were higher in the group using BMF. The respiratory symptoms such as wheezing, dyspnea, chronic cough, and nocturnal cough, were significantly more common in the group using BMF. A significant difference was seen in the lung function indices between the two groups. A significant negative correlation of respiratory indices with duration of exposure and the particulate matter (PM) values suggested a greater decline on lung function among women exposed to increased concentrations of PM. On comparing participants with normal and abnormal PFT, it was seen that the use of BMF (odds ratio [OR] 8.01; 95% confidence interval [CI] 4.80, 13.36, P < 0.001) and the duration of exposure to BMF (OR 1.16; 95% CI 1.13, 1.20., P < 0.001) increased the odds of having an abnormal PFT. CONCLUSIONS: This study shows a high prevalence of respiratory symptoms and an abnormal pulmonary function in women exposed to BMF.
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BACKGROUND: Inter-costal chest drain (ICD) used for varied thoracic pathologies causes continuous pain and irritation of the pleura, which limits respiratory efforts and impairs ventilatory function. Intrapleural block deposits local anaesthetic between the layers of pleura and may improve ventilatory function especially in non surgical patients. METHODS: Twenty eight ASA I-III patients treated with ICD, who could perform incentive spirometry, were included for study. They were randomized to 'Group C' (control group); 'Group B' (Bupivacaine); 'Group M' (Bupivacaine + Morphine) and 'Group D' (Bupivacaine + Dexmedetomidine). The drugs were administered via the ICD itself and clamped thereafter for 15 min. The success of the block was assessed by time for first analgesic demand, maximum inspiratory volume generated and Numerical Rating Scale score for pain; by patients. RESULTS: Effective analgesia was observed in Group B, M and D. Addition of an adjuvant significantly prolonged time for rescue analgesic demand. Patients who received local anaesthetic alone or with an adjuvant had significantly improved maximal inspiratory volume and required lesser rescue analgesics. No significant complications were observed in any group. Pain relief in post-surgical patients using intraplural block is masked by systemic analgesics. However its application in patients with ICD for non surgical indications was explored in this study and was found to improve patient comfort and ventilation. CONCLUSION: Intra-pleural blockade is safe and effective in relieving the constant pleural irritation and pain of ICD, thus enabling the patient to improve ventilatory effort and faster recovery of respiratory function.
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CONTEXT: Acute Physiology and Chronic Health Evaluation (APACHE) III and Simplified Acute Physiology Score (SAPS) II are frequently used to predict the outcome of Intensive Care Unit (ICU) patients of sepsis. AIM: The aim of the study was to compare the predictability of outcome with APACHE III and SAPS II score in ICU patients of sepsis, severe sepsis, and septic shock and the 28-day mortality. SETTINGS AND DESIGN: This study was an observational, prospective cohort study. MATERIALS AND METHODS: A total of 100 consecutive patients of sepsis were studied over 20 months. The worst physiological and biochemical parameters during the first 24 h were recorded for the scores and the patient's 28-day outcome followed up. STATISTICAL ANALYSIS USED: Continuous data were expressed as mean ± standard deviation or median. Receivers operating characteristic (ROC) curve was used to find the cutoff value, area under the curve, sensitivity and specificity of APACHE III score, and SAPS II score. Binary logistic regression with response variable as the outcome was utilized. P < 0.05 was considered statistically significant. RESULTS: The mean APACHE III score in the survivor group was 66.49 ± 18.56 as opposed to 80.67 ± 19.03 for nonsurvivors. The mean SAPS II score for the survivor group was 43.32 ± 13.02 as against the nonsurvivor group at 51.92 ± 12.34. The area under the ROC curve for APACHE III was 0.711 with 95% confidence interval as against 0.686 for SAPS II. The best cutoff value obtained for mortality prediction using the ROC curve was 69 for APACHE III while that for SAPS II was 49. CONCLUSIONS: APACHE III was found to be a better predictor of mortality as compared to SAPS II though the margin of difference in mortality prediction was not high.