Online ISSN: 2515-8260

Keywords : Intubation


Comparative study of midazolam and nalbuphine with midazolam and fentanyl for analgesic and sedative effect in patients undergoing awake fibre-optic intubation- Original research

Dr. Dharamveer Chandrakar, Dr. Liyakhat Ali, Dr. Sanjay Kumar Singh, Dr. Amiya Kumar Nayak, Dr. Alavala Vasavi Nikitha, Dr. Fawaz Abdul Hamid Baig

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 922-927

Aim: The purpose of the present study was to assess the comparison between midazolam-nalbuphine and midazolam-fentanyl combinations for analgesic as well as sedative effect in patients who have undergone fibre-optic intubation in awake state.
Methodology: 100 patients between the age of 20 and 60 yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score
Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F.
Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.

Comparison of Atracurium versus Cisatracurium Regarding Onset Time, Intubating Conditions and Haemodynamic Parameters and Duration of Action

Nikita Baser, Vijay kumar, Shilpa Sharda, Neetu Maurya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 132-137

Background:Endotracheal intubation is an integral part of the administration of general anesthesia during the surgery. Neuromuscular blocking agents facilitate general anaesthesia. cisatracurium having lack of histamine release, which provides better cardiovascular stability in comparison to atracurium. To compare of atracurium and cisatracurium onset time, intubation conditions, hemodynamics and duration of block.
Materials and Methods: The present study was a prospective randomize, conducted in the Department of Anaesthesia, Pacific medical college and hospital Udaipur, Rajasthan. Total 70 ASA Grade I/II patients in the age group of 18-60 years posted for elective surgery required general anesthesia were selected in this study.  Patients were divided into two groups of 35 each. Group A patients received atacurium 0.5 mg/kg as loading dose while Group B cisatracurium 0.2mg/kg, The onset time,intubating conditions hemodynamic parameters and duration of action were noted.
Results: Cisatracurium have rapid onset (p<0.001) and long duration of action (p<0.001) and stable mean arterial pressure (p<0.001) and better intubating conditions (p=0.04.).
Conclusion: Cisatracurium provides rapid onset, excellent intubating conditions, long duration of action and good haemodynamic stability in comparision to atracurium.

LARYNGOSCOPY INTUBATION AND EXTUBATION ARE AFFECTED BY MELATONIN: A PROSPECTIVE STUDY

Dr. Adithi Devi E, Dr. M Bhawathi, Dr. Pavani Kalyanam, Dr. PV Shiva

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3209-3216

Aim and objectives: Hypertension and increased heart rate are prevalent during laryngoscopy and tracheal intubation. Acute LV failure, dysrhythmias, IC haemorrhage, pulmonary edoema and myocardial infarction are all possible complications. Patients with hypertension had a heightened pressor response, despite being preoperatively normalized with anti-hypertensive medication. The purpose of this research is to see if melatonin is more effective than a placebo at reducing the Haemodynamic reactions to laryngoscopy and endotracheal intubation. Research into the effects of melatonin on extubation response and intraoperative hemostasis is also a goal.
Materials and Methods: This study took place between June 2020 and May 2022 at Public Sector Tertiary care center and the Government Ear, Nose, and Throat Hospital. There were a total of 60 participants in the study. They split up into pairs. Melatonin 6 mg capsules (Group M) and a placebo (Vitamin D3) were given to Group C, both to be taken 120 minutes before to surgery.
Results: The melatonin group had a considerably lower increase in HR compared to the control group during laryngoscopy and intubation (P0.0029). The melatonin group also had considerably decreased heart rate variability during and after extubation compared to the placebo group. After induction, during laryngoscopy and intubation, and for the first 10 minutes after tracheal intubation, systolic blood pressure was considerably lower in the melatonin group. Systolic blood pressure was considerably lower in the melatonin group after surgery. Compared to the placebo group, the SBP of those receiving melatonin prior to, during, and after extubation dropped dramatically. The melatonin group had lower diastolic blood pressure than the placebo group throughout laryngoscopy and intubation, as well as after 1 minute, 5 minutes, and 10 minutes post-intubation. The intraoperative DBP in the melatonin group was substantially lower. DBP was likewise considerably lower in the melatonin group after extubation. As a result, the melatonin group had considerably lower mean arterial pressure (MAP) during the intraoperative time. There was a huge discrepancy
between the groups during the extubation process and immediately afterward.
Conclusion: The results of the study show that the hemodynamic reactions to laryngoscopy, intubation, and extubation can be reduced by giving the patient 6 milligrammes of exogenous melatonin orally 120 minutes before intubation. In addition, it aids in keeping intraoperative hemodynamics steady.

A Prospective Randomized Comparative Study of Hemodynamic Effects of Etomidate vs Propofol During Induction and Intubation Under General Anaesthesia

Sarpatwar Sailesh, Boini Chiranjeevi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4749-4756

Background:The aim of the study is to compare induction with etomidate and propofol
on hemodynamic response to laryngoscopy and intubation.
Materials and Methods: The study was conducted in 60 ASA I & II patients in the age
group of 18 to 60 years who were posted for elective surgeries under general
anaesthesia. Their baseline heart rate, systolic blood pressure, diastolic blood pressure,
SpO2 and ETCO2 were recorded. Both the groups were premedicated with iv
glycopyrrolate 5mcg/kg, iv midazolam 0.025mg/Kg, iv fentanyl 2mcg/Kg. Following
premedication, the above variables were again recorded. Group P patients were
induced with iv propofol at the dose of 2 mg/Kg and Group E patients received iv
etomidate at 0.4mg/Kg. In both the groups, Injection vecuronium was given at the dose
0.08mg/Kg and they were maintained with O2:N2O =33%:66% and Isoflurane 1% dial
concentration. Laryngoscopy was performed by trained anesthesiologists after 5 mins.
Duration of laryngoscopy was kept at a maximum of 10 seconds. Trachea was intubated
with appropriate size endotracheal tube. The variables (HR, SBP, DBP, MAP, SpO2)
were measured during induction, intubation and post intubation at intervals of 1,2,3,5
and 10 mins.
Results: On comparing the two groups, the following results were obtained – Age, Sex,
Weight and ASA status were comparable in both the groups. Propofol was found to
produce hypotension in more or less 20%- 30% of patients irrespective of the
underlying condition. Etomidate was found to maintain hemodynamic stability though
there were no significant difference in heart rate variability in both the groups during
laryngoscopy and intubation. Myoclonus was seen in 4 out of 30 patients induced with
Etomidate, pain on injection was more common with Propofol. Apnea occurred in 12
out of 30 patients induced with Etomidate,28 patients out of 30 in propofol group,
vomiting and nausea are more with Etomidate than propofol but the difference was
statistically insignificant.
Conclusion: As per the results of the study, Propofol produced more hemodynamic
changes than Etomidate. Thus, we conclude that Etomidate is more stable in terms of
hemodynamic stability.

Clinical and Etiological Profile of Mechanically Ventilated Patients Admitted in Paediatric Intensive Care at Tertiary Care Centre

Dr. Sunil Holikar, Dr. Swati Kagne, Dr. SambhajiChate, Dr. SagarMavale

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 554-561

Background:Mechanical Ventilation (MV) is frequently used as one of the most
frequent life-supportive technology in Pediatric Intensive Care Units (PICUs). The
present study was undertaken to assess the clinical and etiological profile and outcome
of mechanically ventilated patients admitted in PICU at Tertiary Care Centre.
Methods: A total 120 children of age >30 days and <12 years, who were ventilated in
PICU mechanically from September 2019 to October 2021 were included in the
study.The demographic, clinical and etiological profile, complications and outcomes
(Extubated and died) were recorded.
Results: The mean age of patients was 3.32±1.19 years with male predominance (55%).
The commonest cause for intubation was circulatory failure (42.5%) and commonest
clinical diagnosis was septic shock (27.5%). In 71.67% patients rapid sequence
intubation (RSI) was used. Size of ET was appropriate in 92.5% and type of ET was
uncuffed in 90%. 13(10.83%) patients required reintubation and 9(7.5%) patients done
tracheostomy. Out of 120 patients, 21(17.5%) required T piece, SIMV in 9.17%, CPAP
in 5.83% and no weaning methods in 67.5%. Majority of patients required inotropes
(80.83%) and raised intracranial pressure (ICP) was seen in 27(22.5%) patients.
Nosocomial pneumonia (15%) and obstructive emphysema (15%) were the commonest
complications. 25(20.83%) patients had culture positivity and K. Pneumoniae (6.67%)
was the commonest organism isolated, among 25 cases, 7 had multiple drug resistance
(MDR) (28%). Majority of patients died (62.50%) while 37.5% patients extubated.
Conclusion:Mortality was high, hence the patients requiring MV require better
primary care availability at periphery so that they can be managed well at tertiary level
centres.Also better infection control and respiratory disease control are required.

Oxiport laryngoscope blade versus miller laryngoscope blade for intubation in neonates and infants during general anesthesia

Dr Kapil Lamba

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 90-95

Aim: To compared the oxiport laryngoscope blade versus miller laryngoscope blade for
intubation in neonates and infants during general anesthesia.
Methods: This controlled interventional single-blind study conducted in the,
Department of Anesthesiology. 60 neonates/infants in groups of 30 each posted for
surgery in paediatric operation theatre over a period of 6 months were included in the
study. Full-term neonates and infants up to 6 months of age of either sex requiring
general anaesthesia with endotracheal intubation for elective as well as emergency
surgery were included in the study.
Results: Out of the 60 patients 30 patients in Miller group and 30 patients in Oxiport
group were included. Both groups were comparable with respect to age, sex, weight,
mean time to intubation (P = 0.61) and anaesthesiologist performing the laryngoscopy
(P = 0.69).Mean lowest SpO2 recorded was 97.21% ± 3.69% in Miller group and 99.77%
± 2.63% in Oxiport group. This difference was statistically significant (P = 0.039). The
incidence of mild desaturation (SpO2 up to 90%) was 86.67% in Miller group and
93.33% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85%
and 92.5%) was 3.33% in Miller group and 5% in Oxiport group. Incidence of severe
desaturation (SpO2<85%) was 16.67% in Miller group and 0 in Oxiport group.
Correlation between time to intubation and SpO2 in Miller group (Pearson’s R2 =
−0.14) was statistically not significant at P = 0.39. Correlation between time to
intubation and SpO2 in Oxiport group (Pearson’s R2 = −0.38) was statistically
significant at P = 0.001. Both groups were comparable with respect to the type of
surgery (abdominal, thoracic, miscellaneous) (P = 0.68). Abdominal surgeries were
associated with a higher number of severe desaturations (80%) compared to thoracic
(10%) and miscellaneous (10%) surgeries.
Conclusion: we concluded that the apnoeic laryngeal oxygen insufflation with Oxiport
laryngoscope blade decreased the incidence of severe desaturation while intubating
neonates and infants. This was easily done as it was non-cumbersome and did not
increase the overall cost of anaesthesia.

Effect of Bacteriophage and Sub-inhibitory concentration of Imipenemon Biofilm Production by Pseudomonas aeruginosa on Endotracheal tubing - An in-vitro model system

KENJAR, APOORVA; J, UDAYALAXMI; SUMAN, ETHEL; KOTIAN, SHASHIDHAR M; SAMSON, HARSHA PAUL

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1998-2008

Aim: To studybiofilm production by Pseudomonas aeruginosaon endotracheal tubing in the presence of bacteriophage and sub-inhibitory concentration of imipenem.Methods and Results: A total of 20 clinical isolates of P.aeruginosa obtained from endotracheal samples were taken for this study. Bacteriophages were obtained from sewage samples from sewage water treatment plant. Biofilm assay was performed by modified O’Toole and Kolter method wherein a piece of sterile 0.5cm2 ETTwas incorporated into the microtitre plate wells. Student’s unpaired t test, Kruskal Wallis, ANOVA and HSD Tukey’s test were used to analyse data with SPSS 17.0 software. P value of ˂0.05 was considered statistically significant.Of the 20 isolates, only four (20%) of the isolates were resistant to imipenem. In the presence of bacteriophage, the biofilm production was very less in comparison to biofilm production in the presence of sub-inhibitory concentration of imipenem or in plain broth (p = 0.004). Conclusions: Bacteriophages effectively reduced the biofilm production by P. aeruginosa on catheter tip. Significance and Impact:The present study demonstrates the effectiveness of using bacteriophage as a biofilm reducing agent. Further studies are required to prove the use of bacteriophage coated ETT to curb hospital acquired infections

EFFECT OF ORAL PREGABALIN AND ORAL CLONIDINE FOR ATTENUATION OF HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION: PROSPECTIVE OBSERVATIONAL STUDY

Dr Farheen Arief, Dr Mubasher Ahmad Bhat, Dr Azhar Hussain Mir, Dr Aabid Hassan, Dr Razia Bano

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 5785-5799

Laryngoscopy and endotracheal intubation are an integral part of an anaesthesiologist’s contribution to patient care and are regarded as one of the core skills of anesthesiologist. A number of pharmacological measures have been used to attenuate the hemodynamic stress response associated with larngoscopy and intubation. Aim: To evaluate the effect of oral Clonidine 300 mcg vs oral Pregabalin 75 mg premedication in attenuating the hemodynamic response following laryngoscopy. Methods: The study was designed as a hospital-based prospective observational  trial involving 120 patients of ASA physical status I of either sex scheduled to undergo elective general surgical procedures under general anaesthesia. The patients were randomly allocated to three equal groups of 40 each by means of a computer-generated table of random numbers. The Heart Rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure values, and arrhythmias (if any) were recorded. Statistical testing was conducted with the statistical package for the social science system (SPSS) version 17.0. Continuous variables were presented as mean±SD or median (IQR) for non-normally distributed data. Categorical variables were expressed as frequencies and percentages. Results:  The heart rate increased by 27.7% 1 min after direct laryngoscopy and endotracheal intubation compared to baseline value in the placebo group (p<0.01). A similar increase in pregabalin group was 29.9% and in clonidine group was 12.7%. The mean arterial pressure increased by 28.5% in placebo group while it increased by 26.6% in pregabalin group and only by 11.17% in clonidine group compared to baseline values during laryngoscopy and intubation. Attenuation of mean arterial pressure is significant in clonidine group as compared to both pregabalin and placebo groups (p<0.01). With regard to arrhythmia, which was our secondary objective, it was observed that none of the patients who participated in our study developed arrhythmias, either at induction or anytime later during the surgeries. Conclusion: Oral clonidine (300µg) given 120 min before induction was effective in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation. There was no statistically significant difference between placebo and pregabalin groups.

ANAESTHETIC AND PERIOPERATIVE CONSIDERATIONS IN ORAL AND MAXILLOFACIAL SURGERY

Dr. Chandhini Asokan; Dr. Vijay Ebenezer; Dr. Balakrishnan Ramalingam

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 1844-1853

Airway management is a significant worry in patients with maxillofacial injury, on the grounds that an undermined airway route may prompt demise. There are numerous alternatives accessible, every one has specific signs. As a rule, endotracheal intubation is normally not a feasible choice, but rather nasotracheal intubation and tracheotomies can be performed. These two techniques are known to have difficulties. Two options that can be picked are the submental and submandibular intubation procedures.

Ease of Intubation While Using Macintosh and (Mccoy’s Type) Laryngoscope Blade Undergoing with Anaesthesiology

N.V. Kanase; Saudamini Gandhi; Saurabh R Todi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 70-73

Various anesthesia devices have been designed to overcome the difficult airway scenario in anesthesia practice. The ease of intubation, timing, and hemodynamic variability between the two groups during intubation are considered as primary results compare. The study was conducted in two groups, each group set aside of 65 patients, named Group A and Group B with normal physical status I-II to endothelial intubation. Determined to perform surgery under anesthesia by consent. This includes simple rigid laryngoscopes for complex fiber-optic incubating devices; However, there is weak evidence to support the superiority of one device over another. McCoy’s blade shows overall minimal haemodynamic response and provides better glottic view and ease of intubation as compared to Macintosh blade.