Indian journal of anaesthesia
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Mostly, institutions in India have single post-anaesthesia care unit (PACU) which follows traditional time-based discharge (TBD) method. Recently, it has been classified into PACU Phase I and Phase II, and criteria-based discharge (CBD) method has been used. This study primarily compares CBD versus TBD methods in moving patients through PACU, and other non-clinical factors causing delay in shifting. ⋯ The study concluded that in patients undergoing ambulatory minor surgeries, discharge times based on Criterion Based Discharge scoring systems such as modified Aldrete's and White's-fast are significantly lower in PACU Phase I as compared to the traditional Time Based Discharge method.
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Post-operative pain after minimally invasive video-assisted thoracoscopic surgery (VATS) in adults is commonly managed with oral and parenteral opioids and invasive regional techniques such as thoracic epidural blockade. Emerging research has shown that the novel erector spinae plane (ESP) block, can be employed as a simple and safe alternative analgesic technique for acute post-surgical, post-traumatic and chronic neuropathic thoracic pain in adults. We illustrate this by presenting a paediatric case of VATS, in which an ESP block provided better analgesia, due to greater dermatomal coverage, as well as reduced side-effects when compared with a thoracic epidural that had previously been employed on the same patient for a similar procedure on the opposite side.
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Hypotension during propofol induction is a common problem. Perfusion index (PI), an indicator of systemic vascular resistance, is said to be predictive of hypotension following subarachnoid block. We hypothesised that PI can predict hypotension following propofol induction and a cut-off value beyond which hypotension is more common can be determined. ⋯ Perfusion index could predict hypotension following propofol induction, especially before endotracheal intubation, and had a very high negative predictive value.
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The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation (CVC) in view of an unpredictable success rate. There is an encouraging literature on the improved success rate of CVC through EJV with the inclusion of certain body manoeuvres. This prospective randomised controlled study was conducted with the aim of evaluating the efficacy of body manoeuvres in improving the success rate of CVC through EJV. ⋯ Inclusion of various body manoeuvres to Seldinger technique significantly improves the success rate of CVC through EJV.
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Apnoeic oxygenation during laryngoscopy has been emphasised in recent recommendations for airway management. We aimed to compare the effect of nasal oxygen supplementation on time for pulse oximeter oxygen saturation (SpO2) to fall from 100% to 92% (desaturation safety time), to assess the arterial oxygen partial pressures (PaO2) with and without nasal oxygen supplementation and the time for SpO2 to recover from 92% to 100% after initiation of ventilation. ⋯ Apnoeic oxygen supplementation at 10 L/min flow by nasal prong did not significantly prolong the apnoea desaturation safety periods or the PaO2 in our study.