Anesthesia, essays and researches
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Awake fibreoptic nasotracheal intubation is an effective technique for the management of patients with difficult airways. Adequate sedation with effective topicalization of the airway is important to overcome discomfort and achieve intubation successfully. ⋯ Fentanyl-midazolam and dexmedetomidine-midazolam are both effective for awake fiberoptic intubation under topical anesthesia. Dexmedetomidine allows better endurance and more stable hemodynamics.
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For an outpatient surgery, an ideal anesthetic drug should have a faster onset and shorter duration of action and minimal side effects. Although Bupivacaine is a drug of choice in spinal anesthesia but is not suitable for ambulatory surgeries. We aimed to compare 1% 2-chloroprocaine (2-CP) which is considered to be a short-acting agent with 0.5% hyperbaric bupivacaine as a spinal anesthetic agent in ambulatory surgeries. ⋯ We concluded that 2-CP can be used for spinal anesthesia in shorter duration surgeries with early recovery from anesthesia and hence early discharge from the hospital.
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Videolaryngoscopy is a newly developed technique to improve tracheal intubation success. It was made to bypass the need of directly visualising the glottic inlet. These devices are advantageous as there is no need of aligning the laryngeal, pharyngeal and oral axes for a clear view, thus making intubation easier and faster. ⋯ Although duration of laryngoscopy was significantly shorter in McGrath as compared to Truview video laryngoscope and Macintosh laryngoscope but the duration of intubation was comparable between the three groups. Both these video laryngoscopes performed significantly better than Macintosh laryngoscope with respect to laryngoscopic view, requirement of optimization manoeuvre and need for second attempt for intubation.
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The ultrasound (US)-guided erector spinae plane (ESP) block and oblique subcostal transversus abdominis plane (OSTAP) block are used to decrease postoperative pain and subsequently opioids consumption. ⋯ Bilateral US-guided ESP block was found to be as effective as bilateral US OSTAP block. There was more decrease in intraoperative rescue fentanyl, PACU morphine analgesia, 24-h morphine, and pain assessment score in both groups than the control port-site infiltration group.Clinical trial registration number: NCT03398564.
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Supraclavicular brachial plexus block offers good operating conditions with limited postoperative analgesia. Magnesium sulfate (MgSO4) and ketamine block peripheral nociception mediated via N-methyl-D-aspartate receptors. ⋯ The addition of MgSO4 to ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia. MgSO4 improves the quality of postoperative analgesia with lesser incidence of side effects when compared to ketamine.