Evaluation of perfusion index as a predictor of successful caudal block in pediatric patients: A prospective randomized study.

Background and Aims: Caudal block is among the most widely administered regional anesthesia in pediatric patients. The clinical signs and objective assessments are not fast and reliable enough to provide a good feedback. Perfusion index (PI) is considered as a sensitive marker to assess the efficacy of caudal block. We aim to assess PI as an indicator for success of caudal block in pediatric patients. Material and Methods: Sixty pediatric patients scheduled for elective surgery of lower abdomen and below were included. Patients were randomly allocated into two groups (n = 30): Group 1 received caudal block after general anesthesia and Group 2 only received general anesthesia. PI, heart rate, mean arterial pressure, and anal sphincter tone (AST) were recorded at 5, 10, 15, and 20 min following induction of anesthesia. Results: A persistent increase in the PI value was observed in Group 1 starting from 5 min till 20 min, as compared to Group 2, at all the time intervals. When mean PI was statistically compared between both the groups, it was found to be highly significant (P = 0.001). Group 1 patients have progressive laxity of AST which was found to be significantly different from Group 2 (P < 0.001). Conclusion: We have found that both PI and AST are good indicators for assessing success of caudal block onset in pediatric patients but AST took slightly longer time (~20 mins). Therefore, we conclude that PI is simple, economical, and noninvasive monitor that predicts the caudal onset much earlier than AST.

Evaluation of the three different doses of cisatracurium during general anaesthesia: A prospective randomized study.

Background and Aims: The present study was conducted to determine the optimal dose of cisatracurium for intubating conditions and onset and offset of neuromuscular blockade. Data in Indian population are scarce, and hence, the present study was planned to evaluate different doses of cisatracurium. Material and Methods: The prospective randomized double-blind study was conducted on 180 patients of either sex in the age group of 20-60 yrs., having physical status class I to III, scheduled for surgery under general anesthesia. After exclusion 154 patients were randomly divided into three groups comprising 52, 51, and 51, respectively, in Group A, Group B, and group C. They received 0.1 mgkg-1, 0.2 mgkg-1, and 0.3 mgkg-1 of cisatracurium, respectively, to facilitate endotracheal intubation. Time of onset, intubating conditions, hemodynamic parameters, signs of histamine release, and recovery time were noted. Results: Mean time to onset was maximum in group A (4.37 ± 0.48 minutes) and minimum in group C (2.33 ± 0.43 minutes). Intubating conditions were found excellent in 88% patients in group. Change in HR was found to be non-significant at all time periods, but decrease in MAP was found between 2 and 10 minutes in group C. Duration of action was longest in group C. Conclusion: We conclude that cisatracurium in dose of 0.2 mgkg-1 and 0.3 mgkg-1 provides good-to-excellent intubating conditions within less than 3 minutes.

Guiding Flexible-Tipped Bougie Under Videolaryngoscopy: An Alternative to Fiberoptic Nasotracheal Intubation in Maxillofacial Surgeries.

BACKGROUND: Maxillofacial surgeries are known to have difficulty in airway management due to anatomical and functional reasons. Tumors of maxillofacial region and diseases of TM joint limit mouth opening as well as airway space. Various methods have been tried with success for nasotracheal intubation including fiberoptic-aided as well as blind nasal and light-guided intubation. Video laryngoscopy-assisted intubation uses visualization of glottis without the need of alignment of all the three axes of airway. PURPOSE: Video laryngoscopy is being considered to increase the success rate in various different setups including critical care, pre-hospital and operating rooms. Flexible-tipped bougie guided by a video laryngoscope was used in patients with limited airway space undergoing maxillofacial surgery. METHODS: In present study, airway of five patients posted for various maxillofacial surgeries was secured by passing flexible-tipped bougie through the nasopharyngeal airway and, once under the view of a McGrath videolaryngoscope, was advanced toward the glottis; the rotation of the bougie with the required flexion of the tip helped a quick redirection of bougie to enter the larynx at an angle. RESULTS: Our experience of five cases with anticipated difficult intubation normally judged to be manageable with fiberoptic bronchoscopic intubation were managed without awake fiberoptic bronchoscopy using flexible-tipped bougie under vision of videolaryngoscopy. All patients were successfully managed with this technique. CONCLUSION: Flexible-tipped bougie could take the direction toward glottis under a videolaryngoscope in an anticipated difficult airway, making a place for airway management in patients with limited mouth opening.

Dexmedetomidine Supported Office Based Genioplasty: A Pilot Study.

INTRODUCTION: Despite the availability of wide variety of pharmacological agents for dental procedural sedation, there has always been a continuous search for newer sedative agents. Dexmedetomidine is a newer sedative agent for provision of short-term sedation (<24 h) in adult patients in the intensive care unit setting. It is a selective α2 adrenergic receptor agonist. The reports on off-label use of this drug in a variety of settings for invasive and non invasive procedural sedation have provided encouraging results. MATERIAL AND METHODS: The present paper reports a pilot study observing clinical efficacy of the newer drug dexmedetomidine in patients undergoing office based sliding genioplasty for correction of facial asymmetry. Subjects were sedated with dexmedetomidine with a loading dose of 0.5 mcg/kg over 10 min followed by a continuous infusion dose of 0.1 mcg/kg/h, the recovery process was observed for 60 min after the dexmedetomidine infusion was stopped. The patients were observed pre operatively, intra operatively (every 10 min) and postoperatively for the following parameters-oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), and Ramsay sedation score (RSS), respiratory rate, pain scale.

Use of i-gel in magnetic resonance imaging.

Anesthesia for magnetic resonance imaging (MRI) requires special equipment that can be used in the presence of a magnetic field. Endotracheal tube and various laryngeal mask airway devices have a variable quantity of ferromagnetic material in the pilot balloon that could reduce image quality and result in artifacts. The i-gel is a reliable, easily inserted airway device, and causes minimal interference in image quality. We used i-gel in 10 anaesthetized adult patients undergoing MRI. The quality of image, evidence of airway, tongue, and dental trauma were assessed throughout the procedure. All scans were diagnostically adequate. Therefore, we concluded that i-gel causes the least ferromagnetic interference compared with other devices and improves the quality of imaging and produces minimal artifact while scanning.

Chordal transfer in rheumatic mitral regurgitation: early experience.

Chordal transfer and chordal replacement techniques have been quite successful for repair of anterior mitral leaflet prolapse in degenerative disease, but largely unexplored in rheumatic patients. To extend the scope of valve repair, we assessed the chordal transfer technique for correction of anterior mitral leaflet prolapse in 57 patients with rheumatic mitral regurgitation, who were treated between October 2008 and March 2010. There were 36 women and 21 men with a mean age of 25 ± 7.4 years. Normal chordae and a strip of leaflet tissue were transferred from the posterior leaflet to the free edge of the anterior leaflet; the posterior leaflet was repaired in the same manner as after quadrangular resection. Additional procedures were commissurotomy in 19 patients, aortic valve replacement in 1, tricuspid repair in 5, and cryo maze operations in 21. There was no hospital mortality. One (1.7%) patient had acute renal failure but recovered fully. There was moderate regurgitation in one patient who had undergone simultaneous aortic valve replacement. At a mean follow-up of 6.2 ± 2 months, 56/57 (98.2%) patients were asymptomatic with no significant mitral regurgitation.