Comparison of weight-based and pinna size method for ProSeal laryngeal mask airway size selection in children receiving general anesthesia: A randomized clinical study.

Background and Aims: Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size-based method is a promising new technique for accurate size selection. Material and Methods: A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures. Results: A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups (P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively (P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y (P = 0.180). The two groups were comparable as per the number of attempts needed for insertion (P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups. Conclusions: Pinna size-based estimation of LMA size is an effective alternative method to weight-based selection.

Cardiopulmonary Exercise Testing as a Predictor of Postoperative Outcome in Patients Undergoing Oesophageal Cancer Surgery Following Neoadjuvant Chemotherapy.

OBJECTIVE: Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients' exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing. METHODS: Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality. RESULTS: Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1 ) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1 ) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1 ) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1 ) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade ≥3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1 ) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1 Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.

Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study.

BACKGROUND AND AIMS: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. METHODS: Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann-Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. RESULTS: Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h (P < 0.001). CONCLUSION: Type-1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.

Anesthetic Management of a Patient with Dilated Cardiomyopathy and End-stage Renal Disease for Emergency Strangulated Hernia Repair Surgery.

Dilated cardiomyopathy (DCMP) is a myocardial disease associated with dilatation of one or both the ventricles, impaired myocardial contractility, decreased cardiac output, and increased ventricular filling pressures. Patients with end-stage renal disease are dependent on renal replacement therapy to survive and often manifest with a variety of pathological organ dysfunction. We present a case of DCMP and chronic kidney disease posted for emergency reduction of strangulated umbilical hernia under general plus epidural anesthesia.