Annals of Anesthesiology and Critical Care

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Background: One of the concerns of the anesthetists in performing surgical procedures is hemodynamic changes after laryngoscopy and tracheal tube intubation. In these cases, stress response with the release of catecholamines leads to increased blood pressure and heart rate in patientswhoare prone to cardiovascular disease and cerebral events, leading to the life-threatening risks.

Objectives: Endotracheal Intubation (ETT) is one of the most stress response techniques for airway management. Here, wecompare the effects of tree devices including ETT, laryngeal mask airway (LMA) classic, and I-gel with each other.

Methods: The present study investigated the hemodynamic changes in patients undergoing elective cataract surgery after the intubation of an endotracheal tube. This clinical trial study was conducted on 75 patients with ASA class I or II in both genders and in the age group of 50 - 65 years old. The effects of LMA Classic™ and I-gel were also investigated. In this study, patients’ vital signs such as pulse rate, systolic blood pressure, and diastolic blood pressure were measured and recorded at times before insertion of the airway devices, one, two, and five minutes after the insertion.

Results and Conclusions: Before the start of the operation, there was no significant difference between the groups in terms of hemodynamic parameters. Immediately before inserting ETT, LMA, or I-gel, the heart rate and systolic and diastolic blood pressure increased significantly in all groups. Our results generally showed that the hemodynamic changes due to the I-gel insertion compared to the tracheal tube and LMA Classic™ insertion followed minor adjustments. In a comparison between the insertion of the endotracheal tube and LMA Classic™, the use of the LMA Classic™ was associated with more stability

Background: This study aimed at determining the effects of implementation of “early mobilization protocol” on incidence of cognitive dysfunction after cardiac surgery.

Methods: In a randomized controlled trial, 80 adult patients, who had undergone elective cardiac surgery were randomly assigned to intervention (early mobilization protocol; n = 40) and control (routine physical therapy; n = 40) groups. Early mobilization was initiated from the first post-op morning and continued until discharge from the ICU. Cognitive dysfunction was assessed by the mini mental state examination (MMSE) questionnaire. The MMSE questionnaire was completed at three occasions for every patient: one day before surgery, second post-op day, and at the time of discharge from the intensive care unit (ICU).

Results: Preoperative cognitive status had no difference between the two groups (P = 0.310). Post-op cognitive dysfunction was significantly more commonly reported in the control group. The MMSE scores were higher in early mobilized patients compared to the control group on the first post-op day (median: 28; inter quartile range: 26 to 30 versus median: 25; IQR: 22 to 27; p = 0.001) and at the time of discharge from the ICU (median: 29; IQR: 28 to 30 versus median: 26; IQR: 25 to 28; p = 0.001). In multivariate analysis, duration of tracheal intubation and “early mobilization protocol” had significant effects on patients’ length of ICU stay.

Conclusions: Implementation of early mobilization protocol has positive effects on cognitive outcome and ICU stay after cardiac surgery.

Anesthesia for parturients with pulmonary arterial hypertension (PAH) is challenging. Successful management of anesthesia in PAH parturients during labor requires an interdisciplinary approach and a multidisciplinary team. During parturition, neuraxial anesthesia can be a safe and reasonable choice in this group of patients. Choosing the safest anesthesia method is always a challenge in this scenario. In a case report study, the current researchers used management of anesthesia with neuraxial block and preserving afterload and meticulous control of pulmonary hypertension

Background: Extracorporeal Shockwave Lithotripsy (ESWL) is a safe and noninvasive management for upper urinary tract calculi. It is potentially a painful procedure. There are different analgesic agents for pain relief during ESWL. Successful treatment depends on good management of pain. Therefore, a standard protocol is needed for administering an analgesic agent. This study was designed to compare the efficacy and side effects of paracetamol and fentanyl for pain control during extracorporeal shock wave lithotripsy.

Methods: In this randomized clinical trial, 102 patients with upper urinary tract stones undergoing SWL were randomly divided to two groups. Group P received 15 mg/kg of paracetamol 10 minutes before the procedure, and group F received 1 _g/kg intravenous fentanyl three minutes before the procedure. Pain scores were assessed with the 10-score linear Visual Analogue pain Scale (VAS). The VAS scores, systolic and diastolic blood pressure, and peripheral oxygen saturation were recorded before the procedure and every 10 minutes during the ESWL. Side effects (nausea and vomiting) and satisfaction scores were recorded.

Results: There were no statistically significant differences in VAS scores between the two groups, except for those at 30 minutes, at which group P showed a higher VAS value. There were less supplemental analgesia requirement and side effects in the P group compared with fentanyl.

Conclusions: This study showed that paracetamol could be an effective and safe alternative analgesic for pain control during ESWL.

Background and Objectives: Central neuraxial blocks are the preferred technique for anesthesia for lower segment caesarean section. Local anesthesia drugs have been routinely used for spinal anesthesia to compare various block characteristics and hemodynamic changes in patients undergoing lower segment caesarean section using hyperbaric bupivacaine and isobaric levobupivacaine.

Methods: After Institutional ethical committee approval, 100 patients scheduled for elective lower segment caesarean section were randomized into Group L and Group B. Group L (N = 50) received 2.5mL(12.5mg)0.5% isobaric levo-bupivacaine and Group B (N = 50) received 2.5 mL (12.5 mg) 0.5% hyperbaric bupivacaine as intra-thecal drugs for spinal anesthesia. The present study was conducted in Operation theaters and the Post-operative ward of LLRM medical college, Meerut. Difference in characteristics of onset of block, regression of block, hemodynamic profile, and side effects were recorded between groups.

Results: Group L, in comparison to Group B, showed prolonged duration of sensory block (P = 0.01) with lesser duration of motor block (P = 0.0002). Hemodynamically hypotension was statistically significant in the bupivacaine group (P = 0.016).

Conclusions: The current study validates that both isobaric levo-bupivacaine and hyperbaric bupivacaine in spinal anesthesia provide effective surgical anesthesia for lower segment caesarean section. Levo-bupivacaine can be a better alternative to bupivacaine in terms of reduced motor block time and a longer sensory block time with lesser incidence of hypotension and better hemodynamic stability.