Online ISSN: 2515-8260

Keywords : Intubation


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.

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.

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

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.