Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

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Attenuation of Cardiovascular Response During Laryngoscopy and Endotracheal Intubation by Using Pethidine with Lignocaine

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v6i2.7274 ◽

1970 ◽

Vol 6 (2) ◽

pp. 40-43 ◽

Cited By ~ 1

Author(s):

MT Mollick ◽

MD Hossain ◽

NP Ali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Body Weight ◽

General Anaesthesia ◽

Endotracheal Intubation ◽

Cardiovascular Response ◽

Rate Pressure Product ◽

Group I ◽

Blood Pressures ◽

Group Ii

A prospective comparative study was done on lignocaine versus lignocaine with pethidine to observe the effect on cardiovascular response to laryngoscopy and endotracheal intubation. One hundred such elective surgical patients of active age group (16 - 60 years) having American Society of Anaesthesiologist (ASA) physical status I & II irrespective of surgical procedure were randomly assigned to one of the two groups of 50 each. Group I received injection lignocaine 1 mg/kg intravenously 02 minutes before induction of general anaesthesia. Patients in group II received injection pethidine 1 mg/kg body weight and injection lignocaine 1 mg/kg body weight intravenously 02 minutes before induction of general anaesthesia. Haemodynamic parameter i.e. blood pressures (systolic blood pressure, diastolic blood pressure and mean blood pressure), heart rate, rate pressure product were monitored after 1st, 3rd, 5th minutes following intubation. There were statistically significant (p<0.001) increase in blood pressures, heart rate and rate pressure product in group I i.e. pretreatment with 1 mg/kg body weight intravenous lignocaine and remained so after 5 minutes. On the other hand there were no statistically significant (p>0.05) increase in heart rate, blood pressures and rate pressure product in group II, where pretreatment done with pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight and the values returned control level before 5 minutes. The study showed that pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight pretreatment suppresses the cardiovascular response due to laryngoscopy and intubation. Key words: Cardiovascular response; laryngoscopy; lignocaine with pethidine. DOI: 10.3329/jafmc.v6i2.7274JAFMC Bangladesh. Vol 6, No 2 (December) 2010 pp.40-43

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The Effect of Propofol and Alfentanil on the Increase in Intraocular Pressure Due to Succinylcholine and Intubation

European Journal of Ophthalmology ◽

10.1177/112067210001000202 ◽

2000 ◽

Vol 10 (2) ◽

pp. 105-109 ◽

Cited By ~ 6

Author(s):

Z. Eti ◽

A. Yayci ◽

T. Umuroǧlu ◽

F.Y. Göǧüş ◽

N. Bozkurt

Keyword(s):

Intraocular Pressure ◽

Endotracheal Intubation ◽

Elective Surgery ◽

Muscle Relaxation ◽

Group Iv ◽

Vecuronium Bromide ◽

Group Iii ◽

Group I ◽

Thiopental Sodium ◽

Group Ii

Purpose The aim of this study was to evaluate the effects of propofol and alfentanil on the increase in intraocular pressure (IOP) due to succinylcholine and intubation, in comparison with thiopental sodium and vecuronium bromide. Methods Forty patients aged 20–50 years, scheduled for elective surgery requiring endotracheal intubation, were assigned to four groups of ten. General anesthesia was induced with 2.5 mg/kg propofol in Group I, 2.5 mg/kg propofol and 10 μg/kg alfentanil in Group II and 5 mg/kg thiopental in Groups III and IV; muscle relaxation was obtained with either 1.5 mg/kg succinylcholine (Group I, II and III) or 0.1 mg/kg vecuronium bromide (Group IV). In all patients mean arterial pressure, heart rate, oxygen saturation and IOP were recorded before (baseline) and after induction, after the muscle relaxant and after endotracheal intubation. Results Compared with their baseline values in Group I IOP decreased significantly after propofol (p<0.01) and increased significantly after intubation (p<0.01). In Group II IOP decreased significantly after propofol and alfentanyl (p<0.001), remained low after succinylcholine (p<0.01) and did not change after intubation. In Group III IOP decreased significantly after thiopental (p<0.001) and increased significantly after intubation (p<0.001). In Group IV it decreased significantly after thiopental (p<0.001), remained low after vecuronium (p<0.001) and increased significantly after intubation (p<0.05). Conclusions In all Groups, IOP did not increase significantly after succinylcholine, but only anesthesia induced with propofol and alfentanil prevented the increase in IOP due to intubation.

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Comparison of Intravenous Lignocaine and Dexmedetomidine for Prevention of Propofol Injection Pain

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/202 ◽

2021 ◽

Vol 10 (13) ◽

pp. 935-940

Author(s):

Akoijam Nikhil Singh ◽

Amol P. Singam

Keyword(s):

General Anaesthesia ◽

Elective Surgery ◽

Injection Pain ◽

P Value ◽

Chi Square ◽

Remarkable Effect ◽

Group I ◽

Group Ii ◽

Pre Treatment ◽

Sympatholytic Action

BACKGROUND This study was conducted to compare and evaluate the efficacy and safety of prior intravenous dexmedetomidine with intravenous lignocaine as pre-treatment for prevention of propofol injection pain. METHODS In this prospective, randomised and double blinded clinical study, a total of 200 patients aged between 18 and 70 years of American Society of Anaesthesiologists (ASA) grade I or II posted for elective surgery under general anaesthesia utilising propofol as the inducing agent, were randomly allocated into two groups of 100 patients each, using computer generated random number tables. Group I received intravenous lignocaine 0.2 mg / Kg and group II received intravenous dexmedetomidine 0.5 mcg / Kg respectively prior to administration of propofol (2 mg / Kg) for induction during general anaesthesia. Pain during propofol administration was assessed for each patient using the McCririck and Hunter scale. Peri-operative haemodynamic changes and side effects were noted. Data was analysed using chi-square test and a P-value < 0.05 was considered to be statistically significant. RESULTS A total of 200 patients (100 patients in lignocaine group and 100 patients in dexmedetomidine group) were studied. Statistically significant (P < 0.05) diminution in pain score was discovered to be higher in group II (dexmedetomidine) as compared to group I (lignocaine). 80 % in the dexmedetomidine group had no pain compared to 62 % of the patients in the lignocaine group which is statistically significant. Dexmedetomidine also had a more remarkable effect on the heart rate (10 minutes after intubation) compared to lignocaine, with P = 0.054 which is statistically significant. CONCLUSIONS Intravenous dexmedetomidine is a superior pre-medication compared to intravenous lignocaine in the prevention of pain following propofol administration. It also has additional properties of sedation, analgesia, anxiolysis and sympatholytic action making it a better alternative for the anaesthesiologist and the patient. KEY WORDS Analgesia, Anxiolysis, Pre-Treatment, General Anaesthesia, Sedation, Sympatholytic Action

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Effect of low-dose ketamine versus fentanyl on attenuating the haemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia: a prospective, double-blinded, randomised controlled trial

African Health Sciences ◽

10.4314/ahs.v19i3.51 ◽

2019 ◽

Vol 19 (3) ◽

pp. 2752-2763

Author(s):

Angela Ongewe ◽

Vitalis Mung’ayi ◽

Rajpreet Bal

Keyword(s):

Randomised Controlled Trial ◽

General Anaesthesia ◽

Endotracheal Intubation ◽

Low Dose ◽

Elective Surgery ◽

Controlled Trial ◽

Study Group ◽

Post Induction ◽

Randomised Controlled ◽

Double Blinded

Background: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. Current evidence is conflicting concerning the best agent and optimal dose for this purpose. In the majority of cases, fentanyl is widely utilized to attenuate haemodynamic responses. Ketamine, an established available drug, has been scarcely studied in this regard at low doses and against varying doses of other common agents.Objective: To compare the overall occurrence of hypertension and tachycardia immediately pre-intubation (post-induction) until 10 minutes post intubation between the study group receiving fentanyl at 1.0 µg/kg and the other receiving ketamine at 0.5 mg/kg, to compare the occurrence of post-induction hypotension and the occurrence of neuropsychiatric phenomena during emergence between the two groups.Methods: One hundred and eight ASA I and II patients aged 18-65 years scheduled for elective surgery under general anaesthesia were randomized into two groups: Control group: received fentanyl 1.0 µg/kg intravenously. Intervention group: received ketamine 0.5 mg/kg intravenously. General anaesthesia was standardized in both groups. The patients and physicians administering anaesthesia were blinded to the study. Haemodynamic responses were evaluated by determining heart rate and blood pressure immediately before laryngoscopy and at 2.5, 5, 7.5 and 10 minutes. Neuropsychiatric phenomena were assessed upon recovery from anaesthesia.Results: One hundred and eight ASA I and II patients scheduled to undergo elective surgery were included in this study, 54 participants (50%) in the fentanyl arm and 54 (50%) in the ketamine arm. Baseline demographic characteristics were similar between the groups. There were more hypertensive episodes in the ketamine arm (11%) compared to the fentanyl arm (1.85%), but not achieving statistical significance: Fisher’s exact test, p=0.06. There was no significant difference in the number of episodes of tachycardia between the Ketamine group 7/54 (13%) and the fentanyl group, 6/54 (11%); x2=0.05, p=0.82. Hypotensive episodes were more common in those who received Fentanyl, 41/54 (76%), compared to ketamine recipients, 21/54 (39%), X2=16.9, p<0.001. The use of Ketamine was associated with less episodes of hypotension, adjusted odds ratio = 0.18 (95% confidence interval 0.07, 0.45).Conclusion: We conclude, based upon findings in this study group, that there is no difference in the occurrence of hypertension with the use ketamine at 0.5 mg/kg in combination with Propofol at 2.0 mg/kg. In this regard, ketamine provides a viable alternative to fentanyl at 1.0 µg/kg for attenuating the pressor response to laryngoscopy and endotracheal intubation. Additionally, our results suggest that ketamine may protect against post-induction (pre-laryngoscopy) hypotension.Keywords: Low-dose ketamine, fentanyl, laryngoscopy, endotracheal, intubation, double-blinded, randomised controlled trial.

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Autologous Bone Marrow-Derived Chondrocytes for Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Advances in Orthopedics ◽

10.1155/2021/2146722 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Mir Sadat-Ali ◽

Abdallah S. AlOmran ◽

Sulaiman A. AlMousa ◽

Hasan N. AlSayed ◽

Khalid W. AlTabash ◽

...

Keyword(s):

Bone Marrow ◽

Short Form ◽

Controlled Trial ◽

Randomized Study ◽

Autologous Bone Marrow ◽

Functional Score ◽

Control Group ◽

Group I ◽

Autologous Bone ◽

Group Ii

Background and Objective. The aim of this study was to compare the effect of autologous bone marrow-derived chondrocytes (ABMDCs) with pharmacological management of osteoarthritis of knee (OAK) and assess the benefit of the two in the improvement of pain relief, functional betterment, and quality of life (QOL). Patients and Methods. A prospective, randomized study was undertaken in patients with OAK grades II and III of Kellgren–Lawrence grading (KLG) in two groups. Group I had 5 million of intra-articular ABMDC in the affected joint, and Group II continued the nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy as needed. Before the treatment, patients were meticulously examined and data were entered for age, sex, Body Mass Index (BMI), Visual Analogue Scale (VAS), Modified Knee Society Score-Short Form (MKSSSF), and QOL. Patients were followed up for 3, 12, and 24 months to assess efficacy, safety, and tolerability. To assess the cartilage regeneration of the damaged cartilage, magnetic resonance imaging (MRI) was used. Results. There were a total of 60 patients who were followed up. Three patients in Group II were removed from the analysis as they underwent total knee arthroplasty (TKA). A notably significant improvement was noticed in the ABMDC group on all scores of VAS and MKSSSF with P < 0.0001 . The control group continued to be dissatisfied with the treatment they were taking. Conclusions. This study reveals that a single injection of 5 million of ABMDC was efficient in reducing the symptoms, improving the functional score and betterment of QOL.

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Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure

Nephron ◽

10.1159/000513168 ◽

2021 ◽

pp. 1-7

Author(s):

Alexander E. Lubennikov ◽

Nicolay V. Petrovskii ◽

German E. Krupinov ◽

Evgeniy M. Shilov ◽

Roman N. Trushkin ◽

...

Keyword(s):

Kidney Disease ◽

Large Bowel ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

Bowel Injury ◽

Polycystic Kidney ◽

Group I ◽

Group Ii ◽

Autosomal Dominant Polycystic Kidney ◽

End Stage

Background: In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. Patients and Methods: This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). Results: Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. Conclusion: The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

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RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

10.36106/ijar/7213765 ◽

2021 ◽

pp. 51-54

Author(s):

Md. Shafiqur Rahman ◽

Sanjeeb Bhakta Bista ◽

Md. Sayedul Islam ◽

A. S. M. Shafiul Azam ◽

Md. Shamim Hossain ◽

...

Keyword(s):

Bladder Cancer ◽

Recurrence Rate ◽

Transurethral Resection ◽

Tumor Recurrence ◽

Controlled Trial ◽

Intravesical Therapy ◽

Newly Diagnosed ◽

Group I ◽

Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

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To Compare Frequency of Sore Throat in Early Postop period in General Anesthesia and Endotracheal Intubation for Abdominal Surgeries who are given Dexamethasone and Normal Saline

10.53350/pjmhs211561227 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1227-1229

Author(s):

R. Farooqi ◽

T. Iqbal ◽

M. S. Mehmood ◽

Z. Y. Bhatti ◽

F. Liaquat

Keyword(s):

General Anesthesia ◽

Sore Throat ◽

Endotracheal Intubation ◽

Normal Saline ◽

Controlled Study ◽

Control Group ◽

Chi Square ◽

Group I ◽

Chi Square Test ◽

Group Ii

Aim: To Compare frequency of sore throat in early post operative period among patients undergoing general anaesthesia and endotracheal intubation for abdominal surgeries who are given dexamethasone and normal saline. Study Design: Randomized controlled study Setting: Department of Anesthesia/ ICU, Sheikh Zayed Hospital, Lahore Duration of study: Six months i.e. 25-09-2009 to 25-03-2010. Methodology: 120 patients undergoing elective general surgery on abdomen were selected. They were divided into two groups. Group I received dexamethasone 8mg (2ml) I/V pre-operatively and group II received 2ml normal saline I/V pre-operatively. Chi square test was used. Visual analogue (VAS) scale was used for recording sore throat. The VAS score ≤4 was considered as no sore throat and VAS scores>4 were considered as the sore throat. Results: Frequency of post-operative sore throat after the first 24 hours following GA and endotracheal intubation was lower in group (I) as compared to the control group (II). Eleven (20%) patients with dexamethasone had post-operative sore throat compared to thirty one (56.3%) patients in control group. (p<0.01). Conclusion: Pre-operative use of dexamethasone was associated with decreased incidence of post-operative sore throat. Keywords: Visual analogue scale (VAS), Post-operative sore throat, general anesthesia

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Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v18i1.4038 ◽

2009 ◽

pp. 38-44

Author(s):

Md Maqsud Isa ◽

Rubina Yasmin ◽

Nur Syeeda ◽

Suraiya Enam ◽

Md Manowarul Isiam ◽

...

Keyword(s):

Oxygen Saturation ◽

General Anaesthesia ◽

Local Anaesthetic ◽

Local Infiltration ◽

Group I ◽

Mean Pressure ◽

Recovery Status ◽

Group Ii ◽

Operative Recovery ◽

Group 1

This prospective clinical study was carried out in the dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU. Dhaka during the period of January 04 to September 04. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain or express their pain and to improve post operative recovery status and associated response by reducing the immediate post operative pain with simple local anaesthetic infiltration. The children scheduled for elective herniotomy operation through a hernial incision under general anaesthesia were recruited in this study. Immediate recovery status in children was compared with preemptive (group-1 and without preemptive (group-II) local infiltration of 0.25% bupivacaine in herniotomy operation. No. of patients was 20 in each group. Pulse, systolic, diastolic and mean pressure, oxygen saturation, pain (scored by TPPPS), anaesthetic recovery (scored by steward recovery system) and mental status if the children were observed postoperatively at different time interval up to one hour. Pulse, systolic, diastolic, mean pressure were stable in group-1 then group-II. Oxygen saturation in both the groups were in clinically acceptable range but in group-11 5 mins after extubation fall more than that of group- l and statistically significant. Pain score (TPPPS) in group-1 was lower all the time period but in group-II the score was high, all the children required rescue pethidine within 10 mins after extubation, mean dose reqd, in group-II was 23.6+3.6mg. Steward recovery score in both group was not significant at early period but after 10 mins. P value become significant The mental state of group-I was calm & quite only 3 were excited, on the other hand in group-11 all children were excited & irritable and required rescue pethidine. So preemptive local infiltration of 0.25 bupivacaine improved the recovery status in children by reducing the immediate postoperative pain and there by decrease in postoperative morbidity. Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.38-44

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Clinic Results of Intraductal Meibomian Gland Probing Combined Intense Pulsed Light in Treating Patients With Refractory Obstructive Meibomian Gland Dysfunction: A Randomized Controlled Trial

10.21203/rs.2.4294/v1 ◽

2019 ◽

Author(s):

Xiaodan Huang ◽

Qiyu Qin ◽

Linping Wang ◽

Jiao Zheng ◽

Lin Lin ◽

...

Keyword(s):

Controlled Trial ◽

Symptom Relief ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Group I ◽

Final Treatment ◽

Group Ii ◽

Better Than

Abstract Background: To optimize therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their effect and reduce their limitations. Methods: This randomized, assessor blind study include 45 patients (90 eyes) with refractory o-MGD. They were divided into 3 groups by allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time) and MGP combined IPL (group III, MGP at first then an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade and lid margin finding results were assessed at baseline, 3 weeks after final treatment in group I and III, 3 and 12 weeks after MGP in group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected in all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction and Kruskal-Wallis tests were used for data analysis. Results: In 3 groups, all above indexes improved significantly after treatment (all P＜0.01). MGP-IPL was better than IPL and MPG in posttreatment SPEED, TBUT, meibum grade, lid telangiectasia (all P＜0.05/3). Besides, the MGP-IPL was better than IPL in lid tenderness and better than MGP in orifices abnormality (all P＜0.05/3 ). Six months later, the SPEED in MGP-IPL was also significantly lower than other groups (all P＜0.05/3). And no patients in MGP-IPL group revealed the need to be treated again, while 35.7% or 20% of patients with IPL or MGP need retreatment. Conclusions: Compared with single IPL or MGP, the combination of MGP and IPL demonstrated the most efficient results in relieving all signs and symptoms and can help patients attain the most lasting symptom relief. Trial registration: http://clinicaltrials.gov, ChiCTR1900021273 (retrospectively registered 09 February 2019). Funding: This work was supported by the National Natural Science Foundation of China: [grant numbers: 81870624; 81700802]; Major Science and Technology Projects of Zhejiang Province [grant numbers: 2017C03046].

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