scholarly journals Anesthetic management of an achondroplastic dwarf with difficult airway and kyphoscoliosis for total abdominal hysterectomy

2021 ◽  
Vol 8 (3) ◽  
pp. 475-478
Author(s):  
Tejaswini L Phalke ◽  
Jyoti P Deshpande ◽  
Jyoti H Kale ◽  
Madhavi R Godbole
Keyword(s):  
General Anesthesia ◽  
Difficult Airway ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Neurological Injury ◽  
Fiberoptic Intubation ◽  
Short Neck ◽  
Neck Movement ◽  
Neck Extension ◽  
Awake Fiberoptic Intubation

Achondroplasia is a common form of dwarfism and possesses multiple anesthetic challenges including securing of intravenous line, monitoring and calculating drug dosage, spine abnormality, difficulty in mask ventilation and endotracheal intubation, obesity, cardiopulmonary and neurological system abnormality. There is multiple systems involvement, therefore thorough preanesthetic check ups, investigations and planning for anesthesia is important. Here we came across 36 years old female patient, achondroplasic dwarf (height- 100cm) with thoracolumbar kyphoscoliosis, fused cervical spine, short neck and restricted neck movement with mild pulmonary restrictive disease for total abdominal hysterectomy. Patient also had complained of generalized weakness and fatigue. She had a limited neck extension and short neck possesses anticipated difficult intubation, therefore we planned awake fiberoptic intubation with smaller size endotracheal tube for airway management and general anesthesia in a patient with difficult airway and spine for total abdominal hysterectomy. As the spread of the drug in regional anesthesia is unpredicted, we planned general anesthesia with awake fiberoptic intubation to avoid the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to restricted neck movement.

scholarly journals Glucose, C-peptide and Cortisol Response To Surgery Under General Anesthesia In Diabetic Subjects with Treatment Variability

2009 ◽  
Vol 20 (1) ◽  
pp. 3-8
Author(s):  
K Sardar ◽  
UHS Khatun ◽  
L Ali ◽  
NN Chowdhury ◽  
KM Iqbal
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Plasma Glucose ◽  
Plasma Glucose Level ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cortisol Response ◽  
C Peptide ◽  
Type 2 Diabetic

Diabetic patients are considered to be at increased risk of perioperative morbidity and mortality because of the involvement of their vital organs and the autonomic nervous system in the natural course of the disease. Various aspects of anesthesia and surgery cause stress induced hemodynamic, endocrine and metabolic changes in type 2 diabetic subjects. The present study was designed to investigate the surgical stress response difference between the patients groups those who are treated with only insulin and with insulin-oral hypoglycaemic drugs combination before surgery. Stress response was measured with the changes of blood glucose, C-peptide and cortisol. A total number of 30 subjects who were admitted in BIRDEM hospital in fit physical condition (ASA Class I & II) were selected for the present study. Among them 15 patients were treated with only insulin and 15 patients were treated with insulin- OHA combination before surgery. All of the subjects were received total abdominal hysterectomy under general anesthesia. Three samples were collected from each subject. The first sample (control, PT0) was collected just before anesthesia; second sample (PT1) collected 10 minutes after incision and third sample (PT2) collected 10 minutes after extubation. Plasma glucose was measured by glucose oxidase method, serum C-peptide and cortisol by chemiluminescent based ELISA technique. The mean±SD age and BMI were 44±6 years and 24.4±3.0 kg/m2 respectively. In insulin treated group, the plasma glucose level was significantly higher in PT2 and it was about 147% whereas in insulin-OHA group, the plasma glucose level was significantly higher in both PT1 (111%) and PT2 (196%). The serum C-peptide values were decreasing tendency but not significant in both groups. The serum cortisol level was increased gradually and significantly higher in PT2 in both groups. The data suggest that a) insulin treatment alone is more effective than insulin-OHA combination to control blood glucose in type 2 diabetic subjects undergoing surgery under general anesthesia, b) lower abdominal surgery under general anesthesia in well controlled type 2 diabetic subjects is accompanied by a hyperglycemic response which results from rise of insulin antagonists like cortisol rather than fall of insulin secretion, but the two treatment modalities lead to similar cortisol response. Key words: General anesthesia, Serum glucose, cortisol, Total abdominal hysterectomy Journal of BSA, Vol. 20, No. 1, January 2007 p.3-8

scholarly journals Dexmedetomidine in the Management of Awake Fiberoptic Intubation

2019 ◽  
Vol 13 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Aniello Alfieri ◽  
Maria B. Passavanti ◽  
Sveva Di Franco ◽  
Pasquale Sansone ◽  
Paola Vosa ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Practice Guidelines ◽  
Gold Standard ◽  
Fibreoptic Intubation ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Difficult Airway Management ◽  
Patient Discomfort ◽  
Awake Fiberoptic Intubation

Awake Fibreoptic Intubation (AFOI) is, nowadays, the gold standard in predicted difficult airway management. Numerous practice guidelines have been developed to assist clinicians facing with a difficult airway. If conducted without sedation, it is common that this procedure may lead to high patient discomfort and severe hemodynamic responses. Sedation is frequently used to make the process more tolerable to patients even if it is not always easy to strike a balance between patient comfort, safety, co-operation, and good intubating conditions. In the last years, many drugs and drug combinations have been described. This minireview aims to discuss the evidence supporting the use of Dexmedetomidine (DEX) in the AFOI management.

scholarly journals LOCALANAESTESIA FOR AWAKE FIBEROPTIC INTUBATION: A COMPARISON OF TWO TECHNIQUES- AIRWAY NERVE BLOCKS VS 'SPRAY AS YOU GO' TECHNIQUE

2020 ◽  
pp. 1-4
Author(s):  
Priyanka Mankar ◽  
Girish Saundattikar
Keyword(s):  
Difficult Airway ◽  
Local Anesthesia ◽  
Nerve Block ◽  
Superior Laryngeal Nerve ◽  
Fiberoptic Intubation ◽  
Intubation Time ◽  
Nerve Blocks ◽  
Intubating Conditions ◽  
Number Of Patients ◽  
Awake Fiberoptic Intubation

Background- Awake fiberoptic intubation is the recommended technique for anticipated difficult airway management which requires effective local anesthesia for patient's comfort and co-operation. In this study, we compared airway nerve blocks and “Spray as you go” technique for awake fiberoptic intubation in difficult airway patients. Method- Sixty adult patients with an anticipated difficult airway with Mallampati Class III and IV were selected and randomized into two groups for awake fiberoptic intubation. Each group receiving lignocaine as a local anesthetic with either of two different methods. Group A (n=30) via airway nerve blocks using transtracheal and superior laryngeal nerve block; and group B (n=30) via intubating fiberscope using ‘spray as you go’ technique. We compared two groups using the Number of attempts for intubation, Intubation time, Intubating conditions, Cough count, Hemodynamic response, Severity scale [patients comfort], and the additional required dose of lignocaine used. Descriptive statistics were done for all data. p-value<0.05 was considered statistically significant. The result- we found that airway nerve blocks provide better local anesthesia by providing good intubating conditions with less cough count, less intubation time, and better hemodynamic stability as compare to spray as you go group. None of the patients showed any evidence of lignocaine toxicity. But an additional dose of lignocaine used was significantly more number of patients in the spray as you go, group. However patient comfort and acceptance is equal in both groups as patient severity score was the same in both groups and all patients got successfully intubated in both the groups Conclusion- airway nerve block technique of local anesthesia is better than spray as you go method however spray as you go technique can be used in cases where airway blocks are not possible.

scholarly journals A PROSPECTIVE RANDOMIZED STUDY TO EVALUATE THE ANALGESIC AND SEDATIVE EFFECTS OF FENTANYL AND MIDAZOLAM TO NALBUPHINE AND MIDAZOLAM IN PATIENTS UNDERGOING AWAKE FIBEROPTIC

2021 ◽  
Vol 9 (09) ◽  
pp. 530-538
Author(s):  
Akshat Taneja ◽  
◽  
Akash Gupta ◽  
Malti Agrawal ◽  
Upasana Asooja ◽  
...  
Keyword(s):  
Difficult Airway ◽  
Pressor Response ◽  
Randomized Study ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Intubation Attempt ◽  
Intubation Time ◽  
Intubating Conditions ◽  
Sedative Effects ◽  
Awake Fiberoptic Intubation

Background- Awake nasal or oral flexible fiberoptic intubation (AFOI) is technique of choice in known or anticipated difficult airway . The main aim was to have calm and cooperative patient who can follow verbal commands while maintaining adequate oxygenation . In our study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubationmore tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Material and Methods– A prospective, randomized comparison study among patients between the age of 18 and 60yrs of either sex, with anticipated difficult airway . We compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubation. The primary objectives of our study were to observe the level of sedation, intubation score and OAS score after completion of procedure. The secondary objectives included assessment of patient comfort, intubation time, hemodynamic changes and complications. Results – We found that comfort score and intubation time were significant lesser in Group which received fentanyl and midazolam than Group which received nalbuphine and midazolam . (p<0.05). The intubation attempt was similar in both groups (P>0.05). Conclusion– we concluded that both regimens used in this study provided comparable intubating conditions, better sedation and analgesia was observed in group fentanyl for airway procedure events. Our study concluded fentanyl to be the drug of choice for blunting of pressor response in such patients.

scholarly journals ¿Son los videolaringoscopios una alternativa al fibrobroncoscopio en la intubación del paciente despierto?

2020 ◽  
Vol 12 (6) ◽  
pp. 1
Author(s):  
Mónica San Juan Álvarez ◽  
Juan José Correa Barrera ◽  
Marta Chacón Castillo ◽  
Concepción Rodríguez Bertos
Keyword(s):  
Airway Obstruction ◽  
Difficult Airway ◽  
Fibreoptic Bronchoscopy ◽  
Fiberoptic Intubation ◽  
Awake Patient ◽  
Alternative Option ◽  
Number Of Patients ◽  
Awake Fiberoptic Intubation ◽  
Excessive Sedation ◽  
Regular Practice

La intubación del paciente despierto con fibrobroncoscopio es la técnica más ampliamente utilizada ante la presencia de una vía aérea difícil conocida. Sin embargo, hay varias razones que limitan su ejecución. La mayoría de los anestesiólogos están de acuerdo en que el fibrobroncoscopio constituye un reto en cuanto a su aprendizaje. Además, una vez aprendida esta habilidad, requiere una práctica regular para su mantenimiento. La hiperreactividad de la vía aérea por una anestesia tópica inadecuada, el exceso de sedación y agitación, la hemorragia nasal, y en algunos casos, la progresión de una obstrucción parcial existente la vía aérea hasta una total, han sido comunicados como riesgos de la técnica. Los videolaringoscopios pueden ser una solución ante una vía aérea difícil prevista. Su uso se está extendiendo ampliamente porque son dispositivos fáciles de manejar, económicos y versátiles, permitiendo su utilización en un mayor número y variedad de pacientes. ABSTRACT Are videolaryngoscopy  an alternative option to fibreoptic bronchoscopy in awake patient intubation? Awake fiberoptic intubation is the most widely used approach in the management of the known difficult airway. However, there are several problems that limit this technique. Most anesthesiologists agree on the challenging nature of fiberoptic intubation training. The maintenance of this skill requires regular practice. Among the known risks of this technique are airway hiperreactivity due to inadequate topic anesthesia, excessive sedation or agitation, nasal hemorrhage and, in some cases, progression from partial to complete airway obstruction. Vídeolaryngoscopy can be an alternate option in the management of known difficult airway. These devices are becoming widely used because they are easy to use, inexpensive and versatile, and thus they can be used in a wider variety and number of patients.    

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