Comparison of Upper Lip Bite Test with Modified Mallampati Score in Predicting Difficult Intubation

Background and Aims: Identifying a patient with a difficult airway is important in planning anaesthetic management so that endotracheal intubation can be achieved safely. This study aims to compare modified Mallampati score with Upper Lip Bite Test to predict difficult intubation using intubation difficulty scale. Materials and methods: A prospective study was carried on 104 patients, both sexes aged between 18 to 60 years scheduled for elective surgeries under general anaesthesia fulfilling inclusion and exclusion criteria. Patient airway was evaluated by MMT and ULBT preoperatively. Predictors of difficult endotracheal intubation were assigned to MMT class III and IV, ULBT class III. After premedication and induction laryngoscopy was performed. After successful intubation Intubation difficulty score was noted down based on the sum of seven assessing parameters. A score >5 was considered difficult intubation. Results: The incidence of difficult intubation in the study was 10.6% (i.e. 11 out of 104 patients). In this study ULBT had a higher sensitivity (90.9% v/s 18.20%), specificity (95.7% v/s 75.3%) PPV (71.4% v/s 8%) and NPV (98.9% v/s 88.6%) than that of MMT Conclusion: Upper lip bite test is better at predicting difficult intubation with higher accuracy when compared to Modified Mallampati test. Both the tests are good predictors of easy intubation. Keywords: Upper Lip Bite Test (ULBT), Modified Mallampati test (MMT), Intubation Difficulty scale (IDS), airway assessment. Difficult intubation prediction, Difficult airway

Comprehensive Analysis of Perioperative Anaesthesia Concerns in Covid Associated Mucormycosis: A Retrospective Study of Surgical Patients

Background: Data regarding sudden surge of mucormycosis cases with COVID-19 outbreak and its impact on anaesthesia management are lacking. This retrospective study was designed to analyze the number and characteristics of patients posted for mucormycosis surgery in COVID19 pandemic while emphasizing upon the anaesthesia concerns. Methods: Data was collected from all patients who were admitted with mucormycosis in our institute from the year 2020 onwards. Further analysis of patients who were surgically treated was carried out in terms of demographic characteristics, association with COVID19 and perioperative course of mucormycosis and anaesthetic management. All statistical analyses were performed with the Statistical package for social sciences (SPSS) version 25·0 software. Results: We report an incidence of 30 operated patients of the average age 52.60 years with mucormycosis from August 2020 to May 2021. Diabetes as a comorbidity was common (86.90%). Previous infection with COVID-19 was observed in 29 (96.60%) out of which 80% patients had residual pulmonary involvement. Concomitant medical therapy with Amphotericin B was received by 90% patients and subsequently 70% had deranged renal profile. While 20 % patients had compromised airway, 60 % required blood transfusion and 76.6% patients were electively ventilated while 1 patient (3.3%) succumbed amounting to a survival rate of 96.6%. Conclusion: To conclude elderly male diabetic patients with history of COVID19 infection is the most vulnerable population for developing mucormycosis. Airway management, glycemic control, concomitant Amphotericin B therapy and intraoperative bleeding are the major challenges for anaesthesiologist along with an element of post Covid respiratory compromise.

Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery

Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information to guide perioperative evaluation and management of these patients. Yet, a satisfactory outcome is feasible by focusing on elaborate disease-adapted anaesthetic management of this complex disease with a multidisciplinary approach. The cornerstone of the peri-anaesthetic management of patients with PH is preservation of right ventricular (RV) function with attention on maintaining RV preload, contractility and limiting increase in RV afterload at each stage of the patient's perioperative care. Pre-anaesthetic evaluation, choice of anaesthetic agents, proper fluid management, appropriate ventilation, correction of hypoxia, hypercarbia, acid–base balance and pain control are paramount in this regard. Essentially, the perioperative management of PH patients is intricate and multifaceted. Unfortunately, a comprehensive evidence-based guideline is lacking to navigate us through this complex process. We conducted a literature review on patients with PH with a focus on the perioperative evaluation and suggest management algorithms for these patients during non-cardiac, non-obstetric surgery.

Anaesthetic Management of Left Temporal Glioma Undergoing Awake Craniotomy

For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.

Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy

Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity. Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable. Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Anaesthetic management in COVID-19 parturients scheduled for caesarean delivery - a comparison with non-COVID-19 parturients

Background: Data regarding outcomes after anaesthesia in COVID-19 parturients is scanty. There is hardly any information about the length of hospital stay in COVID-19 parturients who undergo caesarean delivery (CD) as compared to non-COVID-19 parturients.Methods: An observational study of COVID-19 parturients undergoing CD was conducted. Age and CD indication matched non COVID-19 parturients were taken as controls. The length of hospital stay along with maternal and neonatal outcomes were studied.Results: A total of 45 COVID-19 parturients and an equal number of non-COVID-19 parturients were studied. The length of hospital stay was significantly longer in COVID-19 parturients as compared to non-COVID-19 parturients (4.3±1.6 days versus 3.3±0.6 days, p=0.02). One COVID-19 parturient developed severe disease and expired. Apart from this case, the maternal and neonatal outcomes were comparable between the two groups. Mild thrombocytopenia was seen in COVID-19 parturients. One neonate had a positive reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on first day of life.Conclusions: COVID-19 parturients who undergo CD have a longer length of hospital stay than non-COVID-19 parturients. Severe disease is likely to be associated with longer length of hospital stay. Intraoperative hypotension, maternal and neonatal outcome is not significantly different between COVID-19 and non COVID-19 although mild thrombocytopenia is seen in COVID-19 parturients. While vertical transmission of SARS-CoV-2 may be possible, more data is needed regarding vertical transmission is needed.