Fibreoptic intubation in ankylosing spondylitis patients

2021 ◽  
Vol 19 (1) ◽  
pp. 17-20
Author(s):  
Raghu K C ◽  
◽  
Nagesh R ◽  
Viswash G K ◽  
◽  
...  
Keyword(s):  
Spinal Cord ◽  
Ankylosing Spondylitis ◽  
Difficult Airway ◽  
Fibreoptic Intubation ◽  
Cardiovascular Complications ◽  
Inflammatory Disorder ◽  
Double Blind Study ◽  
Double Blind ◽  
Chronic Inflammatory Disorder ◽  
Group A

Background: Ankylosing spondylytes is a chronic inflammatory disorder characterized by inflammation in spines and spinal arthritis with a complex polygenic aetiology. The disease is more common in young males and risk factors include both genetic and environmental. Anesthesia management for ankylosing spondylitis is a challenge due to management of difficult airway, respiratory and cardiovascular complications, as well as the medications for disease and pain control. Both airway management and neuraxial access may prove to be difficult. Awake fibreoptic intubation is the safest option (²) in these patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a difficult airway. Methods: This is a Prospective Randomized Double-Blind Study conducted in Sri Sathya Sai Institute of Higher Medical Sciences; Total 70 Patients (Group A – 35, Group A – 35). All the subjects included after informed consent, blood samples and urine samples are collected from the all the subjects. Hb, RBCs, WBCs and Platelets was measured by laboratory standard methods. Along with Chest X- ray and ECG-for patients over 40 years of age. Results: This study was evaluated that in ankylosing spondylitis cases most of the physicians prefer to give general anaesthesia because to prevent trauma to the spinal cord but in these cases spine and surrounding tissues also it will involve at that time for maintain airway to the patient is challenge to the physicians by using fibreoptic intubation is good way to approach and maintain airway to the ankylosing patients. Conclusion: In this study suggest that in ankylosing spondylitis patients during surgery in place of tracheal intubation fibreoptic intubation is the best way to maintain airway to the patients and also we can prevent spinal cord damage.

The role of tolvaptan in prevention of hyponatremia in patients undergoing transurethral resection of prostate surgery- A randomized double blind study

2021 ◽  
Vol 8 (2) ◽  
pp. 321-325
Author(s):  
Dinesh Kumar Singh ◽  
B B Baj ◽  
Vipin Goyal
Keyword(s):  
Transurethral Resection ◽  
Blind Study ◽  
Transurethral Resection Of Prostate ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

The aim of our study to determine the role of tolvaptan in prevention of hyponatremia in transurethral resection of prostate surgery. This is randomized double-blind study conducted in 60 ASA grade status 1 and 2 patients age group between 45-80 yrs undergoing TURP under spinal anaesthesia in urology operation theatre in Mahatma Gandhi hospital Jaipur after receiving permission from hospital ethical committee. A detailed history, complete physical examination and routine investigation were done for all patients followed by informed written consent was obtained. Patients are randomly divided into 2 groups. In group A -30 patients who received orally tab tolvaptan 15 mg and group B-30 patients who received orally tab multivitamin 2 hrs before surgery after doing electrolytes of the patients in the morning. In both groups age (in yrs), wt (in kg), ASA grade, volume of irrigating fluid (in litres), volume of prostate resected (in gm) and duration of surgery (in minutes) all demographic and surgical details data were compared. Electrolytes were compared in both groups pre and post-operatively and statistical analysis was done.There was significant difference in post-operative sodium level between the two groups (A and B). The mean level of sodium significantly reduced post-operatively in group –B (control grp). The mean level of sodium significantly increased post-operatively in group –A (tolvaptan grp). We conclude single dose of tolvaptan -15 mg found to effective in prevention of hyponatremia in patients undergoing TURP.

scholarly journals Use of Warm Local Anaesthetic Solution for Caudal Blocks

1992 ◽  
Vol 20 (4) ◽  
pp. 453-455 ◽  
Author(s):  
E. T. M. Lim ◽  
K. Y. Chong ◽  
B. Singh ◽  
W. Jong
Keyword(s):  
Adverse Effects ◽  
Local Anaesthetic ◽  
Room Temperature ◽  
Double Blind Study ◽  
Double Blind ◽  
Anaesthetic Solution ◽  
Group A ◽  
Group B ◽  
Local Anaesthetic Solution ◽  
Speed Of Onset

A double-blind study was undertaken to investigate the effect of prewarmed local anaesthetic solution on the latency of onset of caudal blocks. Forty-four (ASA I-II) patients were allocated into two equal groups. In Group A, the local anaesthetic solutions were injected at room temperature (25°C), while in Group B, they were injected at 37°C. All the caudal blocks were performed using 20 ml of lignocaine 1.5% with adrenaline 1:200,000. The speed of onset of perianal analgesia was found to be significantly faster (39%) with the prewarmed local anaesthetic solution (P < 0.05). No adverse effects were observed.

scholarly journals EMLA Cream Prior to Insertion of Elective Epidurals

1995 ◽  
Vol 23 (3) ◽  
pp. 339-341 ◽  
Author(s):  
J. A. Elson ◽  
M. J. Paech
Keyword(s):  
Elective Caesarean Section ◽  
Needle Insertion ◽  
Patient Comfort ◽  
Epidural Needle ◽  
Double Blind Study ◽  
Double Blind ◽  
Emla Cream ◽  
Skin Infiltration ◽  
Group A ◽  
Group B

A randomized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion. The patients were randomly allocated to one of three groups: Group A (EM/LIG) received EMLA and intradermal and subdermal 1% lignocaine infiltration, Group B (EM/SAL) EMLA and saline while Group C (PL/LIG) received placebo cream and 1% lignocaine. Assessments using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament. Skin changes under the applied cream and nursing rating of patients’ response were also noted. Statistical analyses were performed using Kruskal-Wallis and Fisher's Exact Tests. Groups were comparable for age, weight, parity and EMLA application time (interquartile range 105-150 minutes) There were significantly higher pain scores for skin infiltration in Group C (PL/LIG) (P<0.01) and for epidural needle insertion in Group B (EM/SAL) (P<0.05). We concluded that in this patient population, the application of EMLA cream for at least 90 minutes plus 1% lignocaine infiltration optimized patient comfort for epidural insertion.

scholarly journals A Double-Blind Randomized Prospective Study Comparing Ondansetron with Droperidol in the Prevention of Emesis following Strabismus Surgery

1995 ◽  
Vol 23 (4) ◽  
pp. 438-443 ◽  
Author(s):  
A. Davis ◽  
S. Krige ◽  
D. Moyes
Keyword(s):  
Recovery Time ◽  
Strabismus Surgery ◽  
Double Blind Study ◽  
Double Blind ◽  
Oral Fluids ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
To Receive ◽  
Mean Time

A prospective double-blind study was conducted to compare the anti-emetic efficacy of ondansetron and droperidol in preventing postoperative emesis following strabismus surgery. A sample size of 213 patients was divided into three equal groups to receive ondansetron 150 μg/kg (Group A), ondansetron 75 μg/kg (Group B), or droperidol 75 fig/kg (Group C). All patients received a standardized anaesthetic technique. All episodes of emesis, recovery time, and time to tolerating oral fluids were recorded. The incidence of emesis during 24 hours was Groups A and B 19.7%, and Group C 28.2%. The lower incidence of emesis recorded by the ondansetron groups compared with the droperidol group was not statistically significant. Ondansetron at 75 μg/kg was as effective as 150 μg/kg in reducing emesis when compared with droperidol. Mean time to discharge from the recovery room was 75.3 minutes (Group A), 44.4 minutes (Group B), and 41.0 minutes (Group C). The mean time to tolerating oral fluids was 356.5 minutes (Group A), 402.8 minutes (Group B), and 378.1 minutes (Group C). There was no statistical difference in discharge times from recovery or time to tolerating oral fluids in any of the three groups.

scholarly journals Effects of Catheter Tip Location on the Spread of Sensory Block Caused by a Continuous Thoracic Paravertebral Block: A Prospective, Randomized, Controlled, Double-Blind Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Takayuki Yoshida ◽  
Yoshiko Watanabe ◽  
Takeshi Hashimoto ◽  
Atsushi Ohta ◽  
Tatsuo Nakamoto
Keyword(s):  
Sensory Block ◽  
Paravertebral Block ◽  
Posterior Region ◽  
Anterior Region ◽  
Parietal Pleura ◽  
Double Blind Study ◽  
Paravertebral Space ◽  
Double Blind ◽  
Thoracic Paravertebral Block ◽  
Group A

Single injections in the anterior region of the thoracic paravertebral space (TPVS) have been reported to generate a multisegmental longitudinal spreading pattern more frequently than those in the posterior region of the TPVS. In this trial, we examined the hypothesis that a continuous thoracic paravertebral block (TPVB) administered through a catheter inserted into the anterior region of the TPVS allows a wider sensory block dispersion. Fifty consecutive patients undergoing video-assisted thoracic surgery were enrolled. Before the surgery, an infusion catheter was inserted into the TPVS through a needle placed adjacent to either the parietal pleura (group A) or internal intercostal membrane (group P) using an ultrasound-guided intercostal transverse approach according to a randomized allocation schedule. A chest radiograph was obtained postoperatively after injection of 10 mL of radiopaque dye through the catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the catheter, followed by commencement of continuous TPVB with 0.25% levobupivacaine at 8 mL/h. The primary outcome was the number of blocked dermatomes at 24 h after surgery. The secondary outcomes included radiopaque dye spreading patterns, the number of segments reached by the radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and pain scores. The median (interquartile range [range]) number of blocked dermatomes 24 h after surgery was 3 (2.75–4 [1–6]) in group A (n = 22) and 2 (1.5–3 [0–7]) in group P (n = 25; p = 0.037). No significant differences in the other outcomes were found between the groups. In conclusion, a continuous TPVB administered using a catheter supposedly inserted into the anterior region of the TPVS allows a wider sensory block dispersion than a catheter inserted into the posterior region of the TPVS. This trial is registered with the UMIN Clinical Trials Registry (UMIN000018578).

Clinical Efficacy of Etanercept Versus Sulfasalazine in Ankylosing Spondylitis Subjects with Peripheral Joint Involvement

2012 ◽  
Vol 39 (4) ◽  
pp. 836-840 ◽  
Author(s):  
JÜRGEN BRAUN ◽  
KAREL PAVELKA ◽  
CESAR RAMOS-REMUS ◽  
ALEKSANDAR DIMIC ◽  
BONNIE VLAHOS ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Missing Values ◽  
Human Tumor ◽  
Initial Therapy ◽  
Joint Involvement ◽  
Double Blind Study ◽  
Double Blind ◽  
Using Data ◽  
Current Guidelines ◽  
Necrosis Factor

Objective.Etanercept, a fully human tumor necrosis factor soluble receptor, is effective in treatment of ankylosing spondylitis (AS). Current guidelines suggest sulfasalazine (SSZ) treatment as initial therapy for the management of patients with AS with peripheral arthritis versus therapy with biologics. We compared the efficacy of etanercept with SSZ in patients with AS with peripheral joint involvement.Methods.The efficacy of etanercept 50 mg once weekly was compared with that of SSZ up to 3 g daily in subjects with ≥ 1 swollen peripheral joint at baseline, using data from a 16-week randomized double-blind study in subjects with AS. Efficacy was assessed by the Assessment in AS criteria and the Bath AS Disease Activity, Functional, and Metrology indices. The last observation carried forward method was used for imputation of missing values.Results.Of 566 subjects included in original study, 181 (etanercept 121; SSZ 60) had ≥ 1 swollen peripheral joint and 364 (etanercept 250; SSZ 124) had none at baseline. AS patients treated with etanercept showed significantly greater improvement than those treated with SSZ in all joint assessments regardless of swollen joint involvement.Conclusion.In this analysis, etanercept was significantly more effective than SSZ for management of patients with AS and peripheral joint involvement.

scholarly journals The Effect of Use of Anidulafungin on Failure of Weaning Due to Ventilator-associated Pneumonia which Complicate Contused Lungs

2018 ◽  
Vol 12 (1) ◽  
pp. 73-84
Author(s):  
Mohamed Gaber Ibrahium Mostafa Allam
Keyword(s):  
Broad Spectrum ◽  
Antifungal Drugs ◽  
Lung Contusion ◽  
Prolonged Treatment ◽  
Double Blind Study ◽  
Ventilator Associated Pneumonia ◽  
Double Blind ◽  
Broad Spectrum Antibiotics ◽  
Group A ◽  
Group B

Introduction:Failure of weaning is considered one of the most difficult challenges facing any intensivist especially in the devitalized lung due to infected lung contusion. Unsatisfactory results with prolonged treatment with the proper broad-spectrum antibiotics raise the point of exclusion of candidemia or suspected pulmonary candidiasis which is considered a major problem not only because of increasing rate (2-10 per 1000 ICU admission) but also because of difficult diagnosis. Patients with failure of weaning due to unresolved VAP after receiving broad-spectrum antibiotics for more than 10 days especially in preexisting severe lung contusion should be put on empirical systemic antifungal. Echinocandins are a new class of antifungal drugs used as a reliable class for empirical systemic antifungal treatment.Aim of Work:The study aims to evaluate and compare the effect of the use of anidulafungin on weaning from the ventilator due VAP which complicates traumatized contused lungs after 2 weeks from ventilation.Patients and Methods:This was a prospective double-blind study done on 200 patients admitted to King Abdulaziz Specialized Hospital, Taif, KSA between March 2015 and August 2018 in surgical ICU with the failure of weaning due to Ventilator Associated Pneumonia (VAP) complicate contused lungs. Group (A) 100 patients started on antibiotics regimen according to qualitative culture for 2 weeks while group (B) 100 patients received anidulafungin with the antibiotics regimen.In this study, diagnosis of lung contusion was made by Computerized Axial Tomography (CT) chest while both VAP was diagnosed by a modified Clinical Pulmonary Infection Score (CPIS). A score of 6 or more was considered VAP.Results:Comparing the data of the patients in the 3 studied periods (1st5 days, 2nd5 days and last 4 days) controlled tracheal secretion was recorded in 15, 38 and 46 patients in group A respectively in the 3 studied periods compared to 28, 75 and 83 in group B. Less parenchymatous lung infiltration in the chest X-ray found was in 12, 40 and 48 patients in group A compared to 24, 88 and 91 patients in group B. Improvement of the hypoxic index in 48, 76 and 85 patients in group A was compared to 66, 90 and 98 patients in B. Normalization of temperature in 16, 36 and 54 patients in group A while 40, 76 and 90 patients in B and reduction of total leucocytic count in 18, 35 and 57 patients in group A while 38, 70 and 87 patients in group B were observed. There were 15 out of 98 patients in Group A not weaned while only 5 out of 100 patients in group B failed to be weaned from mechanical ventilation within the study period (2 weeks).Conclusion:The use of anidulafungin with proper antibiotics in patients with failure of weaning due to VAP complicate contused lung efficiently treated VAP and reduced the morbidity by accelerating the weaning from the ventilator compared to the use of proper antibiotics alone.

scholarly journals Comparison of Intrathecal Fentanyl and Butorphanol as an Adjuvant to Intrathecal Bupivacaine 0.5% in Infraumbilical Surgeries- A Randomised Double Blind Study

2020 ◽  
Author(s):  
Sandip Roy Basunia ◽  
Prosenjit Mukherjee ◽  
Md Bakir Hossain Munshi
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Controlled Trial ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

Introduction: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like Butorphanol and Fentanyl allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Aim: To compare the safety and efficacy of Butorphanol and Fentanyl combined with bupivacaine for spinal anaesthesia in infraumbilical surgeries. Materials and Methods: The present study was a randomised controlled trial in which 110, ASA I and II patients of either sex who underwent elective infraumbilical surgeries under spinal anaesthesia were selected. Patients were allocated randomly into two groups A (n=55) and B (n=55). Group A (F) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with fentanyl 25 microgram (0.5 mL) to make it total 3.5 mL. Group B (B) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with butorphanol 250 microgram (0.25 mL) and Normal Saline (NS) 0.25 mL to make it total 3.5 mL. Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed at preset intervals. Chi-square test or Fischer’s-exact test were used and a p-value ≤0.05 was considered as statistically significant. Results: Mean of two segment sensory regression time of Group A was 41.94±1.73 minutes and Group B was 50.56±4.43 minutes (p<0.0001). Time to onset of motor block in Group A was 5.28±.32 minutes and Group B was 5.27±.32 minutes (p=0.96). Mean duration of motor block in Group A was 81.23±4.87 minutes and Group B was 109.83±2.61 minutes (p<0.0001). Time to rescue analgesic was 289.27±7.37 minutes in Group A and 378.41±10.25 minutes in Group B (p<0.0001). HR, SBP and DBP were comparable among the groups. Conclusion: Intrathecal bupivacaine-butorphanol mixture was clinically better as it provided longer duration of analgesia with lesser incidences of pruritus and nausea/vomiting compared to intrathecal fentanyl-bupivacaine mixture.

scholarly journals A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Trishala Jain ◽  
Jaipal .
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Institutional Ethics ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj.  3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally.  Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.

scholarly journals EFFICACY OF TAP BLOCK AND PLACEBO FOR PAIN IN PATIENTS UNDERGOING CSECTION SURGERY

2021 ◽  
Vol 71 (1) ◽  
pp. 266-69
Author(s):  
Usman Khalid ◽  
Kaukab Majeed ◽  
Maihmoona Yasmeen ◽  
Khalid Mehmood ◽  
Muhammad Ali Muazzam ◽  
...  
Keyword(s):  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Military Hospital ◽  
P Value ◽  
Double Blind Study ◽  
Transversus Abdominis Plane ◽  
Double Blind ◽  
Cross Sectional ◽  
Group A ◽  
Group B

Objective: To compare efficacy of transversus abdominis plane block and placebo for pain in patients undergoing C-section surgery. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital Quetta, from Apr toOct 2018. Methodology: A sample size of 200 patients calculated by WHO calculator undergoing Elective C-section andof age 20-40 year were randomized in a double blind study to undergo transversus abdominis plane block orplacebo group in two equal groups. Group A received block as placebo and group B with Bupivacaine. Resultsrecorded and analysed there-after for conclusion. Results: The mean age of patients in group A was 29.98 ± 5.18 years and in group B was 29.68 ± 5.43 years (pvalue ≤0.01). Majority of the patients 141 (70.50%) were between 31 to 40 years of age. Out of 200 patients, 108 (54.0%) were ASA I and 92 (46.0%) were ASA II (p-value ≤0.01). Mean body mass index was 25.20 ± 2.28 kg/m2 (p-value ≤0.01). Meantime for the first analgesia in the patients undergoing elective C-section in group A (placebo group) was 4.96 ± 1.44 hours while in group B (transversus abdominis plane block group) was 11.24 ± 1.83 hours (p-value ≤0.01). Conclusion: This study concluded that meantime for the first analgesia was found longer in TransversusAbdominis plane block for post-operative pain management in patients undergoing elective C-section.

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