Anesthesia, essays and researches
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A double-blinded, prospective, and randomized study was designed to determine the efficacy and tolerability of intravenous (IV) magnesium sulfate (MgSO4) to facilitate fiberoptic bronchoscopic (FOB) nasotracheal intubations. ⋯ Intravenous MgSO4 improved awaken FOB intubation without adverse hemodynamic or respiratory effects.
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Pain experienced following laparotomy is largely due to abdominal wall incision. Effective mitigation of this pain is vital to improve patient satisfaction and for early ambulation. We evaluated the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia, as a component of multimodal analgesia. ⋯ TAP block is an effective component of the multimodal analgesia regimen for reducing postoperative pain and opioid requirement after emergency laparotomy.
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Midazolam and clonidine are preferred premedicants whose effects are not restricted to the preoperative period. In addition, these premedicants significantly modulate not only the intraoperative requirements of the anesthetic agents, but also the postoperative outcome. We aim to compare the efficacy of both the agents in view of premedication, induction characteristics, hemodynamic changes and postoperative complications utilizing bispectral index (BIS) using propofol anesthesia. ⋯ Both clonidine and midazolam contributed equally in lowering propofol consumption. Reduction in the induction dosage of propofol and hemodynamic variations were also observed to be similar with the use of midazolam or clonidine as premedicants. Both provide a beneficial effect in relation to recovery and less postoperative complications. However clonidine premedication was found to be more effective in preventing post operative shivering and can be recommended in routine practice.
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Ketamine was introduced commercially in 1970 with the manufacturer's description as a "rapidly acting, nonbarbiturate general anesthetic" and a suggestion that it would be useful for short procedures. With the help of its old unique pharmacological properties and newly found beneficial clinical properties, ketamine has survived the strong winds of time, and it currently has a wide variety of clinical applications. ⋯ The present article attempts to review the current useful applications of ketamine in anesthesia, pain and critical care. It is based on scientific evidence gathered from textbooks, journals, and electronic databases.
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Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia. There are divided opinions regarding ease of intubation in obese patients. Moreover, the definition of difficult intubation is not uniform; hence we have use the Intubation Difficulty Scale (IDS) to find the incidence of difficult intubation in obese patients. ⋯ Obese patients are difficult to mask ventilate and intubate. During intubation of obese patients who is more than 40 years age and SMD <12.5 cm, it is preferable to have a second skilled anesthesiologist.