European Journal of Molecular & Clinical Medicine

Pulmonary complications have detrimental effect on the disease progression leading to increased hospitalization, postoperative morbidity and mortality. Aim: To find the incidence of postoperative pulmonary complications in patients undergoing elective intracranial surgery. Methods: This Prospective observational study was conducted from 2020- 2022 in Superspeciality hospital, Shireen Bagh, Srinagar over a period of 18 months after approval by Institutional Ethical Committee. All patients underwent questionnaire about the preoperative data including Age,  Sex,  Weight,  ASA physical state,  History of smoking,  Obstructive sleep apnea and  Snoring. All the intracranial procedures were performed under general anaesthesia. After the surgical procedure patients were shifted to Superspeciality ICU and were followed daily from immediate postoperative period until a new surgical intervention, hospital discharge or death. Results: Out of 132 study patients, 79 (59.8%) were diagnosed with Meningioma, 18 (13.6%) patients Glioma, 17 (12.9%) with Pituitary Macroadenoma, 6 (4.5%) with CP Angle Tumor, 5 (3.8%) with Medulloblastoma, 4 (3%) with Posterior Fossa Tumor and 3 (2.3%) with Astrocytoma. Postoperative Pulmonary Complications were observed in 31 (23.5%) patients. Most common complication was found out to be Atelectasis (17.4%) followed by Tracheobronchitis (6.8%) followed by Pneumonia (6.1%), followed by ARDS (4.5%) and Weaning Failure in 6 (4.5%) study participants. Total number of postoperative pulmonary complications observed were 52. the mean duration of stay in ICU of patients who had POPCs was much higher (4.65 days) as compared to those who did not have POPCs (1.83 days). Conclusion: In our study, given a modest sample size, the incidence of POPCS in patients undergoing elective craniotomies was 23.5% and we were able to identify certain risk factors of POPC in our population, however more replicative studies with a larger sample size are warranted to substantiate these findings so that future preventive strategies can be formulated.

Background: Emergence agitation has potential to harm both patients and caregivers. This is more often witnessed in patient undergoing otolaryngology operations under general anesthesia with volatile anesthetic used for maintenance.
Aim: We investigated the effects of intra-operative dexmedetomidine infusion on emergence agitation and quality of recovery after functional endoscopic sinus surgery in adult patients.
Materials and Methods: One hundred patients undergoing functional endoscopic sinus surgery were randomized into two groups. The dexmedetomidine group (Group D, n = 50) received dexmedetomidine infusion at a rate of 0.4 mcg/kg/hr from induction of anaesthesia until extubation, while the control group (Group C, n = 50) received volume-matched normal saline infusion as placebo. Propofol (2 mg/kg) and fentanyl (2 mcg/kg) were used for induction of anaesthesia, and sevoflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 hours after surgery.
Results: The incidence of agitation was lower in Group D than Group C (28 vs 56 %, P = 0.018). Mean arterial pressure and heart rate were more stable intra-operatively and during emergence in Group D than in Group C (P < 0.05). Time to extubation, nausea and vomiting, and pain scores were similar between the groups. Global QoR-40 score at 24 hours after surgery was higher in Group D (mean 174.7 ± 6.99) compared with Group C (mean 169.4 ± 9.91) (P < 0.05).
Conclusion: Intra-operative infusion of dexmedetomidine provided smooth and hemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

Background:  Laparoscopy has been used as a therapeutic as well as a diagnostic tool in pelvic and abdominal surgeries. Present study was aimed at to study correlation of acid base and blood gas changes during laparoscopy and effects of various insufflating agents comparing Carbon Dioxide with Nitrous Oxide at a tertiary care hospital. Material and Methods: Present study was hospital based, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. Results: We compared effects of pneumoperitoneal insufflating agents among 2 groups of 35 patients each as Group N (Nitrous oxide as the insufflating agent) versus Group C (carbon dioxide as the insufflating agent). The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet the increase in the tissue oxygen demand, it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in both the groups, with numerically high values in Group C. The PeCO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂. Though the rises of the PaCO2 and fall in pH were statistically significant, they did not reach hazardous level. Group N (14.28 %) had more incidences of nausea and vomiting as compared to Group C (5.71 %).
Conclusion: Nitrous oxide appears to be the most suitable insufflating agent, used to produce pneumoperitoneum as compared to carbon dioxide, with general anaesthesia for laparoscopic surgeries.

Pregnancy-induced hypertension constitutes a significant cause of morbidity and mortality in developing nations and complicates about 6-8% of pregnancies. Severe preeclampsia poses a serious dilemma for the anaesthesiologist, especially in emergencies, with respect to difficulty in endotracheal intubation and exaggerated haemodynamic responses due to anaesthetic procedures.
Objective: This study aimed to observe intra-operative haemodynamic, anaesthesia parameters, maternal and foetal complications and indications of the need for postoperative critical care. Methods: This study included 145 patients with severe pre-eclampsia who underwent emergency caesarean section. Out of 145 patients, 103 patients were administered spinal anaesthesia (SA), and 42 patients received general anaesthesia (GA) based on the consent of the patient, fasting status of the patient, maternal and foetal distress and active respiratory tract infection (RTI). Patients were categorised into two groups: those who received SA as Group S and those who received GA as Group G.
Results: The Mean intra-operative SBP in group S and group G was 129.8±14.23 mmHg and 136.5±17.25 mmHg respectively, with statistically significant differences (p-value of 0.017). Mean intra-operative DBP group S and group G were 79.1±12.64mmHg and 85.4±15.38mmHg, respectively, with statistically significant differences (p-value of 0.012). The most common maternal complication among group S was headache (6.8%), and among the group G was pulmonary oedema (8.3%) (p<0.001). 74.8% of patients in group S and 31% in group G were complications-free (p<0.001). Out of 103 patients in group S, nine (8.7%) were admitted to ICU and 19 (45.2%) out of 42 patients in group G. The difference was statistically significant (p-value< 0.001).
Conclusion: Spinal anaesthesia is a safer alternative to general anaesthesia in severe preeclampsia, with less postoperative morbidity and mortality for mothers and babies. These findings agreed with many previous studies worldwide.

BACKGROUND:
Preoperative management of the patient is the liability of a medical attendance. An understanding of risk factors before general anaesthesia [GA] is an important factor for preoperative management.The present study was aimed at assessing the airway of patients undergoing oral surgical procedures under general anaesthesia in our institution.
 
MATERIAL AND METHODS:
The study was performed under a university setting where all the data of patients who underwent oral and maxillofacial surgical procedure under general anaesthesia.The collected data was compiled, reviewed , tabulated and entered in SPSS software and statistically analysed.
 
RESULTS:
55% of the patients were males and the rest (45%) were females. Airway assessment in patients according to mallampati classification revealed that 57% were of class I, 38% were of class II , 3% were of class III and less than 1% were class IV. Patients who underwent FMR (40%) and cleft lip/palate (14%) had class I airway. Patients who underwent ORIF and enucleation both had class I (19.5%), class II (3.5%) airways and class I (4%), class II (1%) airways respectively. Patients who underwent orthognathic surgery had class I (11%) and class II (3.5%) airways. Patients undergoing TMJ surgery including ankylosis release, surgery for Oral submucous fibrosis had predominantly class III (1%) and class IV (2.5%) airways. Difficult airways (class III, Class IV) were present in patients undergoing procedures like TMJ ankylosis release, and surgery for oral submucous fibrosis.The association between the mallampati classification and the treatment [oral and maxillofacial surgical procedures] done under GA was statistically significant with p=0.025 (p<0.05) [chi square test].
 
CONCLUSION:
Assessing airway is crucial before any surgical treatment. The modified Mallampati test is easy to perform, more accurate and is commonly used to assess the airway of patients undergoing oral and maxillofacial procedures under general anesthesia. Complications might not occur if the pre operative assessment of the airway of the patient is done properly using this classification, and the surgery is planned accordingly.

Background: The main aim of our study was to compare the intraoperative and postoperative outcomes of general anaesthesia and epidural anaesthesia in single level lumbar microdiscectomies.
Methods & materials: 40 ASA I and II, both male and female patients, posted for single level lumbar microdiscectomies were chosen for the study. Group GA underwent the operation under general anaesthesia and group EA underwent the surgery under epidural anaesthesia. Patients were observed in the recovery room for 24hrs.
Conclusion: Epidural anaesthesia may be used as an alternative to general anaesthesia in single level lumbar microdiscectomies.

Background: Laparoscopy involves the visualization of abdominal and pelvic organs after creating an artificial pneumoperitoneum. Present study was aimed at to study effects of various insufflating agents during general anaesthesia and correlation of acid base and blood gas changes during laparoscopy to determine ideal insufflating agent amongst CO₂, O₂ and N₂O at a tertiary hospital. Material and Methods:  Present study was single-center, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/ II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. 105 patients were divided in three groups of 35 patients each as Group- I (oxygen as the insufflating agent), Group II (Nitrous oxide as the insufflating agent) & Group III (carbon dioxide as the insufflating agent).Results: Mean age, body weight & types of procedures were comparable among all groups & no significant statistical difference was noted. The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet in increased the tissue oxygen demand it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in all the three groups, with a numerically high value in Group III. The PECO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂.  Though the rise of the PaCO₂& fall in pH was statistically significant, they did not reach hazardous level. The Group I had the highest incidence of nausea and vomiting (88.57 %) followed by Group II (14.28 %). Conclusion:         Nitrous oxide appears to be the most suitable amongst the three gases; Oxygen, Nitrous oxide and carbon dioxide, with general anaesthesia.

The prospective randomized open controlled study was done to compare tracheal extubation response following nitroglycerine (NTG) sublingual spray in hypertensive patients

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.

Introduction: Cholecystectomy is performed either as an open or a laparoscopic route. Despite of a number of peri-operative and post-operative benefits of laparoscopic cholecystectomy, the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Therefore, this study was conducted to compare the effectiveness of SA for open cholecystectomy versus GA with respect to reducing post operative pain, analgesia requirement, respiratory complications and length of hospital stay.
Materials and Methodology: One hundred and forty patients were allocated randomly into two groups—SA group (spinal anaesthesia group, n = 70) and GA group (general anaesthesia group, n =70). And the two groups were divided as SA group underwent open cholecystectomy under spinal anaesthesia whereas GA group had undergone it under general anaesthesia.
Results: Out of all the 140 patients, 70 patients were allotted in each group, there were 120 females (85.85%) and 20 males (14.17%). Their age mostly ranged between 18 – 70 years, with a mean of 42.35 ± 12.66 years. There was no statistically significant difference between both the study groups with respect to age, sex distribution, body mass index (BMI) and ASA physical status. Intra-operatively, bradycardia and hypotension were more common in the SA group. Bradycardia less than 50/ min in 12 patients (16.66%) were treated by atropine 0.6mg IV. Bradycardia was the only side effect noted in both groups.
Conclusion: Since the conventional use of general anaesthesia in open cholecystectomy, this study displays that spinal anaesthesia is also a recommended alternative. It is therefore safe and more effective than general anaesthesia in providing prolonged post-operative pain-free interval, less analgesic/ opioid requirement and no reported respiratory problems.

Supraglottic Airway devices (SAD) have now become a fundamental tool for ventilation, oxygenation and delivery of anaesthetic gases in modern anaesthesiology. The advent of newer generation of SADs has resulted in their extended use. Baska mask and I Gel being newer generation SADs are vastly being used due to their specific designs for ease of securing the airway, better ventilation and higher patient safety. After institutional ethical committee clearance, a prospective randomized comparative study was conducted. 60 patients of age group 18-60 years of ASA grade I and II undergoing elective surgeries under GA were included. Patients were randomized into 2 groups, Group B (Baska mask group) and Group I (I Gel group) with 30 patients in each group. The ease of insertion (p value 0.035), insertion attempts (p value 0.04) and the time taken for insertion (p value <0.001) were significantly better with I Gel compared to Baska mask. Both the groups were comparable in terms of postoperative pharyngolaryngeal morbidities.

Laparoscopy has revolutionised surgery and management of the patient with marked decrease in morbidity and post-operative complications. Initially, these procedures were done using only General Anaesthesia. However, now with the introduction of Spinal anaesthesia and after learning its advantages, surgeons are slowly beginning to gravitate towards this mode of anaesthesia. Sixty three patients who were admitted in the hospital for appendicitis participated in this Randomized controlled trial conducted in a tertiary care hospital in India. Thirty three patients were randomly included in Group A (undergoing laparoscopic surgery under Spinal Anaesthesia) and thirty patients in Group B (undergoing laparoscopic surgery under General Anaesthesia). The mean values of Systolic and diastolic pressure was found to be significantly higher in patients who were administered General anaesthesia and no change in the respiratory functions was observed following administration of either Spinal or General anaesthesia. Laparoscopic surgery under Spinal anaesthesia is a viable and safe alternative as compared to General anaesthesia. The recovery rates and the satisfaction reported by patients is also better. Spinal anaesthesia also helps in maintaining better haemodynamic stabilization.

Aim: Purpose of our research was to assess the preference of pediatric dentists to carry out
treatment with either conscious sedation or with general anesthesia.
Methodology: 50 children were selected for your study who did not have any previous
medical conditions. Patients requiring complete dental treatment were treated under GA,
those requiring one or two procedures were under conscious sedation. The two groups of
patients were evaluated in terms of vital signs, duration of the treatment procedure, patient
behavior, recovery time and comfort experienced by the dentists and the anesthesiologists.
Results: Dentists in sedation group were anxious, uncomfortable and restless during
implementation of dental treatment. During dental procedure under sedation, some
interruption has been noted in few cases such as vomiting during the procedure (3 cases).
Those who vomited, during the procedure, their heads were turned to one side, the
procedure was discontinued immediately (to prevent aspiration), and the patients were
referred for treatment under GA.
Conclusion: Dental treatment under CS can be successful with little or no complications if
the cases are well selected by qualified trained dentist.