Fibreoptic intubation in ankylosing spondylitis patients

Background: Ankylosing spondylytes is a chronic inflammatory disorder characterized by inflammation in spines and spinal arthritis with a complex polygenic aetiology. The disease is more common in young males and risk factors include both genetic and environmental. Anesthesia management for ankylosing spondylitis is a challenge due to management of difficult airway, respiratory and cardiovascular complications, as well as the medications for disease and pain control. Both airway management and neuraxial access may prove to be difficult. Awake fibreoptic intubation is the safest option (²) in these patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a difficult airway. Methods: This is a Prospective Randomized Double-Blind Study conducted in Sri Sathya Sai Institute of Higher Medical Sciences; Total 70 Patients (Group A – 35, Group A – 35). All the subjects included after informed consent, blood samples and urine samples are collected from the all the subjects. Hb, RBCs, WBCs and Platelets was measured by laboratory standard methods. Along with Chest X- ray and ECG-for patients over 40 years of age. Results: This study was evaluated that in ankylosing spondylitis cases most of the physicians prefer to give general anaesthesia because to prevent trauma to the spinal cord but in these cases spine and surrounding tissues also it will involve at that time for maintain airway to the patient is challenge to the physicians by using fibreoptic intubation is good way to approach and maintain airway to the ankylosing patients. Conclusion: In this study suggest that in ankylosing spondylitis patients during surgery in place of tracheal intubation fibreoptic intubation is the best way to maintain airway to the patients and also we can prevent spinal cord damage.

Comparative study of hemodynamic effects, quality of extubation and emergence - agitation response of the patients with dexmedetomidine versus lignocaine during and following the endotracheal extubation

Background: Endotracheal extubation is the translaryngeal removal of a tube from the trachea via the nose or mouth. It is associated with hemodynamic changes because of reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation. Various drugs and techniques have been tried to attenuate the airway and stress responses during tracheal extubation. In present study, we have compared the effects of dexmedetomidine and intravenous lignocaine on the hemodynamic and recovery profiles during endotracheal extubation. Material and Methods: Present study was prospective randomised comparative study, conducted in patients from age group of 18-45 years, ASA grade I/II, scheduled for elective abdominal surgeries. The patients were categorised into two different groups using the sealed envelope method as Group D and group L. Results: In present study, patients were divided in following 2 groups with 50 patients in each group as group D (Dexmedetomidine) and group L (Lignocaine). Age, gender, mean BMI were comparable in both groups and difference was not significant statistically. The difference between mean heart rate, systolic BP, diastolic BP and mean arterial BP during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant. In Dexmedetomidine group, 12% of the patients had no cough during extubation, 72% of the patients had smooth extubation with minimal cough while in Lignocaine group, 22% of the patients had smooth extubation with minimal cough, 74 % of the patients had moderate cough during extubation. Statistical analysis of the Emergence agitation score shows better results in group D. Conclusion: Administration of Dexmedetomidine before tracheal extubation was more effective in maintaining the hemodynamic stability, facilitated smooth tracheal extubation and had a better quality of recovery as compared to Lignocaine.