Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 74
Filtrar
1.
Paediatr Anaesth ; 31(12): 1304-1309, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34555230

RESUMO

BACKGROUND: Accurate insertion depth of endotracheal tube (ETT) in children has been predicted using the demographic variables, such as age, weight, and height. Middle finger length showed good correlation with ETT depth measurement in children aged 4-14 years. AIMS: The primary objective was to correlate the actual ETT insertion depth with the depth derived from middle finger length, age, weight, and height formulae in children aged 1-4 years. The secondary objective was to find the most accurate formula for prediction of ETT insertion depth. METHODS: This prospective parallel group study was done in 50 american society of anesthesiologists 1 or 2 children aged 1-4 years undergoing elective surgery under general anesthesia. Children with difficult airway, finger anomalies, or syndromic associations were excluded. Age, weight, height, and middle finger length of all children were measured. Depth of orally inserted uncuffed ETT and tracheal length was measured by fiberoptic bronchoscopy. The actual ETT depth was correlated with the depth calculated from different formulae. RESULTS: The mean middle finger length was 4.42 ± 0.50 cm, age was 2.64 ± 1.07 years, weight was 12.28 ± 2.84 kg, and height was 82.89 ± 16.23 cm. The mean tracheal length was 6.42 ± 0.96 cm. The mean depth of ETT was actual depth (12.89 ± 1.09 cm), middle finger depth (13.23 ± 1.53cm; p = .001; 95%CI 0.12-0.50), age-based depth 1(3.31 ± 0.53 cm; 95%CI 0.37-1.44; p = .001), weight-based depth (14.14 ± 1.42 cm; 95% CI 0.10-0.51; p = .004), and height-based depth (13.73 ± 0.94 cm; 95% CI 0.15-0.77; p = .004). Middle finger length and age-based formulae showed higher number of accurate placements (58% each). Weight- (74%) and height (64%)-derived formulae gave a higher number of distal ETT placements. CONCLUSION: Formulas based on the demographic variables and middle finger length showed good correlation with the actual ETT depth in children aged 1-4 years. The percentage of accurate ETT depth placements was higher with middle finger length and age-based formulae.

2.
J Anaesthesiol Clin Pharmacol ; 37(2): 226-230, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34349371

RESUMO

Background and Aims: Accurate measurement of intraocular pressure (IOP) under anaesthesia is essential for diagnosis and further management of pediatric glaucoma patients. However, depth of anaesthesia and use of airway device like laryngeal mask airway (LMA) or endotracheal tube can influence IOP values measured. We planned this study to compare change of IOP with facemask or LMA. Change of IOP at varying depth of anaesthesia was also assessed. Material and Methods: After Institutional ethical clearance and informed parental consent, 89 children of glaucoma aged 0-12 years were included in this prospective randomized controlled trial. The children were randomized to facemask (Group M) and LMA (Group L). Sevoflurane was the sole general anaesthetic used in both the groups and IOP were recorded after induction, at BIS 40-60, after LMA insertion (Group L), at BIS 60-80 and BIS more than 80. Results: The IOP values did not differ significantly between the groups at BIS 40-60 and at BIS 60-80. Moreover, pre and post LMA insertion IOP values were also comparable in Gr L (p = 0.11). However, significant increase in IOP values were observed with increasing BIS values within each group. The mean IOP in Group M at BIS 40-60 was 13.41 ± 4.04 as compared to 14.18 ± 3.64 at BIS 60-80 (p = 0.003). There was a similar pattern observed in Group L, where mean IOP at BIS 40-60 & BIS 60-80 was 14.13 ± 4.90 and 15.52 ± 4.57 respectively (p < 0.001). Conclusion: Either facemask or classic LMA can be safely used as per anaesthesiologist's preference without any significant effect on IOP. BIS monitoring may be used during IOP measurement in paediatric glaucoma suspects for accurate assessment of IOP.

3.
Anesth Pain Med ; 11(2): e113750, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34336627

RESUMO

Schizophrenia is ranked among the top 10 global burdens of disease. About 1% of people meet the diagnostic criteria for this disorder over their lifetime. Schizophrenic patients can develop cataract, particularly related to age and medications, requiring surgery and anesthesia. Many concerning factors, including cognitive function, anxiety, behavioral issues, poor cooperation and paroxysmal movements, may lead to general anesthesia as the default method. Antipsychotic agents should be continued during the perioperative period if possible. Topical/regional anesthesia is suitable in most schizophrenic patients undergoing cataract surgery. It reduces potential drug interactions and many postoperative complications; however, appropriate patient selection is paramount to its success. General anesthesia remains the primary technique for patients who are considered unsuitable for the topical/regional technique. Early involvement of a psychiatrist in the perioperative period, especially for patients requiring general anesthesia, is beneficial but often under-utilized. This narrative review summarizes the anesthetic considerations for cataract surgery in patients with schizophrenia.

4.
6.
Saudi J Anaesth ; 14(1): 15-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998014

RESUMO

Background: Anesthesia trainee may initially take longer time to intubate and unintentionally place the endotracheal tube (ETT) in the esophagus. The present study determined if ultrasound is the fastest method of confirmation of correct placement of ETT compared to capnography, and chest auscultation in trainees. Methods: First year anesthesia residents performed intubation in 120 patients recruited after ethical clearance and informed consent. Time to visualize flutter in trachea, double trachea sign, time to appearance of first and sixth capnography, and time to execute chest auscultation was noted. Results: Ultrasonography was statistically fastest method to determine endotracheal intubation (36.50 ± 15.14 seconds) vs unilateral chest auscultation (50.29 ± 15.50 seconds) vs bilateral chest auscultation (51.90 ± 15.98 seconds) vs capnography first waveform (53.57 ± 15.97 seconds) vs capnography sixth waveform (61.67 ± 15.88 seconds). Conclusion: When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign.

10.
Indian J Anaesth ; 63(6): 485-490, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263301

RESUMO

Background and Aims: In children, entropy-guided titration of isoflurane and sevoflurane leads to faster recovery after anaesthesia. However, role of entropy in recovery following desflurane anaesthesia is not known. Hence, we compared laryngeal mask airway (LMA) removal time and desflurane consumption with entropy and minimal alveolar concentration-guided titration in children given low-flow desflurane anaesthesia. Methods: After ethics committee approval and parental consent, 80 American Society of Anesthesiologists grade I-II children, age 2-14 years, undergoing elective ophthalmic surgery were randomised into entropy and minimal alveolar concentration-guided groups. After LMA insertion, anaesthesia was maintained using oxygen, air (FiO2 0.5) and desflurane using low fresh gas flow of 0.75 L/min. In the entropy-guided group, desflurane was titrated to maintain state entropy between 40 and 60. In the minimal alveolar concentration-guided group, desflurane was titrated to maintain a minimal alveolar concentration between 1 and 1.3. We recorded LMA removal time (from switching off desflurane at the end of surgery till removal of LMA), haemodynamic parameters, uptake and consumption of desflurane between the groups. Results: LMA removal time was significantly decreased in the entropy-guided group in comparison to the minimal alveolar concentration-guided group (4.34 ± 2.03 vs 8.8 ± 2.33 min) (P < 0.0001). Consumption of desflurane was significantly less in the entropy-guided group compared with the minimal alveolar concentration-guided group (18.7 ± 5.07 vs 25.3 ± 8.11 mL) (P < 0.0001). Conclusion: Entropy-guided low-flow desflurane anaesthesia is associated with faster LMA removal and reduced consumption of desflurane in children undergoing ophthalmic surgery.

11.
Indian J Ophthalmol ; 67(6): 903-907, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124512

RESUMO

Purpose: Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP. Methods: In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status. Results: The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20-68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease. Conclusion: ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.


Assuntos
Retinopatia da Prematuridade/cirurgia , Acuidade Visual , Cirurgia Vitreorretiniana/métodos , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Indian J Anaesth ; 63(4): 284-288, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000892

RESUMO

Background and Aims: The preterm and ex-preterm babies form a separate group among the paediatric population with unique airway anatomy. The utility of C-MAC® Video laryngoscope (VL) for routine intubation of preterm babies has not been evaluated. The purpose of this study is to report the performance of C-MAC® VL Miller blade size-0 for endotracheal intubation in preterm babies at our institute. Methods: After Institute Ethics Committee approval, a retrospective study was designed to evaluate the performance of C-MAC® VL for intubation in preterm and ex-preterm babies. The medical files, and video recordings of preterm babies up to 60 weeks of post-gestational age who had undergone surgery for retinopathy of prematurity from January 2014 to April 2016 were reviewed. All babies were intubated with C-MAC® Miller blade size-0. Demographic parameters, time to best glottic view (TTGV), time to intubate (TTI), ease and number of intubation attempts were assessed. Episodes of desaturation and complications related to intubation were recorded. Results: Data of 37 preterm and ex-preterm babies were analysed. The mean age and weight at the time of surgery were 40.5 (±4.9) weeks and 2532 (±879) grams respectively. The median TTGV and TTI were 11.0 and 22.0 seconds. A total of 32 babies (86.5%) were intubated on initial attempt and five were intubated on second attempt. Stylet was used to facilitate intubation in all infants. There was no incidence of desaturation, mucosal injury or bleeding. Conclusion: C-MAC video laryngoscope Miller blade size 0 is suitable for endotracheal intubation in preterm and ex-preterm infants.

13.
Paediatr Anaesth ; 29(4): 304-309, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30614138

RESUMO

BACKGROUND: Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low-fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions. METHODS: After institutional ethical committee approval, 50 children, aged 1-5 years, undergoing ophthalmic procedures under general anesthesia, were randomized into two groups-standard induction (Group S) and low-flow induction (Group L). A pediatric circle system with 1 L reservoir bag was primed with 8% sevoflurane in oxygen at 6 L min-1 for 30 seconds before beginning induction. In Group S, fresh gas flow was maintained at 6 L min-1 until the end of induction. In Group L, fresh gas flow was reduced to 1 L min-1 after applying facemask (time = T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone, and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA-Classic™ (T3). Heart rate and endtidal sevoflurane concentration were measured at each of the above time points, and at 15 seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded. RESULTS: Sevoflurane consumption was significantly lower in Group L (4.17 ± 0.70 mL) compared to Group S (8.96 ± 1.11 mL) (mean difference 4.79 [95% CI = 4.25-5.33] mL; P < 0.001). Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia, or need for rescue propofol. CONCLUSION: Induction of anesthesia with sevoflurane using low-fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.


Assuntos
Anestesia por Inalação/métodos , Anestésicos Inalatórios/administração & dosagem , Sevoflurano/administração & dosagem , Anestesia por Inalação/economia , Anestésicos Inalatórios/economia , Pré-Escolar , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lactente , Máscaras Laríngeas , Procedimentos Cirúrgicos Oftalmológicos , Propofol/administração & dosagem , Sevoflurano/economia
14.
J Anaesthesiol Clin Pharmacol ; 35(4): 509-514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31920236

RESUMO

Background and Aims: CMAC video laryngoscope size 2 D-Blade has been recently introduced for management of pediatric difficult airway. Our primary outcome was to compare glottic view, intubation time, and ease of intubation with the size 2 Macintosh versus D-Blade of C-MAC video laryngoscope in simulated cervical injury in children. Material and Methods: This randomized crossover study was conducted in a tertiary care hospital of Northern India. Forty children of 4-14 years of age were enrolled in this study. After induction of anesthesia, video laryngoscopy was performed either with size 2 CMAC Macintosh (group M) or D-Blade (group D) with manual in-line stabilization. After removal of the first blade, second video laryngoscopy was performed with the alternative blade. Endotracheal intubation was done with the second laryngoscopy. Best glottic view, time for best glottic view, and difficulty in blade insertion were recorded during both the video laryngoscopies. During second video laryngoscopy, difficulty of tube insertion and time for intubation were noted. Results: The glottic view grade was significantly better in group D compared with the group M (P = 0.0002). Insertion of D-Blade was more difficult than Macintosh blade (P = 0.0007). There was no statistical difference in terms of time for best glottic view in group M and group D (13.40 ± 4.90 vs 13.62 ± 5.60 s) and endotracheal tube insertion time (24.80 ± 7.90 vs 27.90 ± 10.90 s), respectively. Number of intubation attempts was similar in both the groups. Conclusions: Size 2 D-Blade of C-MAC video laryngoscope provided a better glottic view in children with simulated cervical spine injury as compared with CMAC Macintosh blade. Success of intubation, intubation time, and ease of intubation were comparable with both the blades.

15.
Intractable Rare Dis Res ; 8(4): 286-288, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31890459

RESUMO

Airway management in a child with hunter syndrome is a challenge to the anesthetists. Various methods to achieve this are reported in literature. Here we describe another method in a three year old male child posted for adenotonsillectomy and myringotomy. After check videolaryngoscopy with C Mac blade size 2, vocal cords were not visible even with various monoevres. Thus a larger blade size 3 was used to place it under the epiglottis after which posterior part of vocal cords became visible and bougie guided endotracheal intubation was successful. Thus we recommend that in a child with hunter syndrome if vocal cords are not visible, a larger blade can be utilized to place under the epiglottis to visualize the vocal cords for successful endotracheal intubation.

19.
J Pediatr Ophthalmol Strabismus ; 55(6): 397-402, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30452766

RESUMO

PURPOSE: To review systemic associations of childhood glaucoma. METHODS: Patients younger than 15 years and diagnosed as having glaucoma were divided into four groups: isolated primary congenital glaucoma, glaucoma with other congenital ocular anomalies, congenital glaucoma with known systemic diseases, and secondary glaucoma. Prevalence and type of systemic associations in each group were studied. RESULTS: A retrospective analysis of 371 patients diagnosed as having glaucoma was done. In the primary congenital glaucoma group, 13 of 218 (5.9%) patients had an associated systemic illness: congenital heart disease and global developmental delay were the most common systemic manifestations. In the congenital ocular anomalies group, 10 of 63 (15.8%) patients had an associated systemic illness. Axenfeld-Reiger syndrome, aniridia, and Peters' anomaly frequently had systemic comorbidities with congenital heart disease. In the known systemic diseases group, all 18 (100%) patients had systemic manifestations of an associated syndrome: Sturge-Weber and Down syndrome were the most frequent. In the secondary glaucoma group, 9 of 72 (12.5%) patients had systemic involvement, which was often seen as the most common cause after congenital cataract surgery. These children had congenital heart disease and global developmental delay as a consequence of congenital rubella and congenital cytomegalovirus infection. CONCLUSIONS: The study found that 12.9% of patients with childhood glaucoma had an associated systemic abnormality. Patients with congenital glaucoma and other ocular anomalies have a three times higher risk of an underlying systemic anomaly than patients with isolated primary congenital glaucoma. A team comprising an ophthalmologist, pediatrician, and anesthesiologist is recommended to treat these cases. [J Pediatr Ophthalmol Strabismus. 2018;55(6):397-402.].


Assuntos
Anormalidades Congênitas/epidemiologia , Glaucoma , Criança , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Saúde Global , Humanos , Morbidade/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...