Anesthesia, essays and researches
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Awake fiberoptic intubation (AFOI) is the gold standard technique for managing patients with anticipated difficult airway. Conscious sedation is desirable, not only to make the procedure more tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Ideal sedation regime for AFOI should provide comfort, cooperation, hemodynamic stability, and amnesia along with maintenance of spontaneous respiration. Several sedative agents have been assessed over the past two decades for this purpose but α2 agonists appear to be the favorable choice owing to its sedative, analgesic, amnestic, and sympatholytic properties along with good hemodynamic profile. ⋯ Patients who received α2 agonist were calmer and cooperative with less pain and discomfort than the patients who received midazolam. Dexmedetomidine allows better endurance, stable hemodynamics, and patent airway as compared to clonidine.
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Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects. ⋯ NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.
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Adductor canal block is a regional anesthetic block procedure commonly employed for knee surgeries. This study aims at locating the adductor canal precisely which will be of great use for the surgeons operating on knee. ⋯ This study suggests that a point more than 3 cm below the midpoint of thigh will be the ideal location for the approach of adductor canal block.
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Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the opioids and general anesthetics' needs. This study compared the erector spinae plane (ESP) block and the pectoral plane (PECS) block effects on the opioid consumption postoperatively, stress response, fentanyl needs intraoperatively, pain scores, and incidence of complications in female patients subjected to MRM surgery. ⋯ The current study demonstrated that PECS block provides better quality of analgesia than ESP block in patients subjected to MRM operations.
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The biggest anesthetic challenge in infants with thoracolumbar /sacral meningomyelocele is securing the airway. For securing the airway, most of the anesthesiologist's practices supine position with doughnut or head ring placed around the swelling to prevent rupture, which has got disadvantages like risk of rupture, infection and damage to neural structure. Left lateral position has been recommended previously for tracheal intubation in post-tonsillectomy hemorrhage. Several studies have shown successful ventilation in lateral position using laryngeal mask airway and intubation using video laryngoscopes. ⋯ Anesthesiologist should pay more attention to the safety and quality of mask ventilation, laryngoscopy and intubation in meningomylocele infants. Both supine and lateral position were comparable.