Image Quality of Abdominal Ultrasonography After Esophagogastroduodenoscopy is Preserved by Using Carbon Dioxide Insufflation

Because bowel gas deteriorates the image quality of abdominal ultrasonography (AUS), it is common to perform AUS prior to esophagogastroduodenoscopy (EGD). This one-way order limits the availability of examination appointments. To evaluate whether EGD using insufflation of carbon dioxide (CO2), which is rapidly absorbed by the gastrointestinal mucosa, preserves the image quality of AUS performed subsequently, we designed a non-inferiority test in which each subject underwent AUS, EGD with CO2 insufflation, and a second AUS. All saved AUS moving images were randomized and evaluated using a four-point Likert scale that divides the depiction rate by 25%. Sample size was calculated to be 26 and 30 subjects were enrolled. The mean and 95% confidence interval (CI) of the image quality score at pre- and post-EGD AUS were 3.54 [3.48–3.60] and 3.46 [3.39–3.52], respectively. The difference in the means was 0.08, corresponding to a 2% depiction rate. The effect size was 0.172. The image quality of post-EGD AUS was not inferior, as demonstrated by the 97.5% CI of the difference, which did not cross the non-inferiority margin of –0.40 corresponding to depiction rate of –10%. Because EGD using CO2 insufflation does not appreciably deteriorate the image quality of AUS performed subsequently, it is permissible to perform EGD prior to AUS.

Ventilatory performance of AMBU® AuraGain™ and LMA® Supreme™ in laparoscopic surgery: A randomised controlled trial

The Ambu® AuraGain™ (Ambu A/S, Ballerup, Denmark) is a newer phthalate-free, single-use supraglottic device with the advantage of a facility for tracheal intubation if necessary intraoperatively. We compared the oropharyngeal leak pressures and other performance variables between the AMBU AuraGain and the LMA® Supreme™ (Teleflex Medical, Athlone, Co. Westmeath, Ireland) in patients undergoing laparoscopic cholecystectomy and preperitoneoscopic inguinal herniorrhaphy with carbon dioxide insufflation under controlled ventilation. We recruited 120 American Society of Anesthesiologists physical status class I–3 patients between the ages of 21 and 80 years undergoing laparoscopic cholecystectomy or preperitoneoscopic inguinal herniorrhaphy into this single-centre randomised controlled trial. The primary outcome measure was the oropharyngeal leak pressures. Secondary outcomes included insertion parameters, ventilatory characteristics and postoperative sequelae. The AuraGain had slightly but significantly higher oropharyngeal leak pressures than the LMA Supreme (mean (standard deviation) 26.1 (6.9) versus 21.4 (4.7) cmH2O, P < 0.010). The overall insertion success of the AuraGain was comparable to the LMA Supreme (AuraGain 58/60 (96.7%); LMA Supreme 56/59 (94.9%), P = 0.679). The AuraGain was deemed more difficult to insert than the LMA Supreme, with 26/60 (43.3%) of AuraGain insertions graded easy versus 48/59 (81.4%) of LMA Supreme, P < 0.001. The mean time to insertion of the AuraGain was slightly longer than the LMA Supreme, 32.2 (10.5) versus 28.3 (12.0) s, P < 0.001. Intraoperative device failure occurred following carbon dioxide insufflation in one AuraGain and three LMA Supremes, bringing the perioperative success rate of AuraGain and LMA Supreme to 95% and 89.8%, respectively, P = 0.322. No cases of regurgitation and aspiration occurred, and minor postoperative complications were similar. The AuraGain exhibited higher oropharyngeal leak pressures than the LMA Supreme, but was slightly more difficult to insert. The higher oropharyngeal leak pressures suggest that ventilation might be less affected by high peak inspiratory pressures when using the AuraGain than the LMA Supreme.

Effects of Intramuscular Dexmedetomidine as Premedication in Elective Laparoscopic Surgeries - A Prospective Randomized Controlled Study in Trichy, Tamilnadu

BACKGROUND The major concern of laparoscopic surgery is intra-operative hypercapnia induced stress response such as increase in heart rate (HR), increase in blood pressure (BP), increased stress hormones. The major concern of anaesthetist is to reduce stress response perioperatively. Drugs like clonidine, dexmedetomidine, nitroglycerine and esmolol are used to control the hemodynamic response associated with pneumoperitoneum in laparoscopic surgeries. Dexmedetomidine has been found to have hemodynamic stability with good analgesic effect. Dexmedetomidine is a highly selective α2 agonist with sedative, analgesic and sympatholytic properties. Here in this prospective randomized controlled study, we evaluate the effects of intramuscular dexmedetomidine as a premedication in laparoscopic cholecystectomy METHODS This is a randomized controlled study. Forty patients aged 20 to 50 years, both sexes, with American society of anaesthesiology (ASA) grade I & II planned for elective laparoscopic cholecystectomy were randomly assigned into two groups, Group DS : (N - 20) Received 2 mcg/kg of dexmedetomidine with normal saline (total 2 ml) Group CS : (N - 20) Received 2 ml of normal saline as intramuscular injection in the deltoid region 60 minutes before induction. We compared the hemodynamic parameters like pulse rate, mean arterial pressure (MAP) in baseline, preinduction, during intubation, before and after carbon dioxide insufflation, post extubation, visual analog score (VAS) and the analgesic requirements in both groups RESULTS Compared to control group, intramuscular dexmedetomidine group had statistically significant reduction in pulse rate, mean arterial pressure perioperatively during intubation, before and after carbon dioxide insufflation, during surgery and post extubation (P < 0.001) and also found to decrease the analgesic requirement post operatively CONCLUSIONS 2 mcg/kg intramuscular dexmedetomidine premedication produces better hemodynamic stability, reduced perioperative analgesic requirement and hence could be a better alternative to other premedicant agents. KEYWORDS Dexmedetomidine, IM Premedication, Laparoscopy, Stress Response