No abstract

In patients undergoing ambulatory laparoscopic surgeries, Ryles tubes are required only for the purpose of intraoperative gastric decompression. Insertion of nasogastric tubes can lead to nasal trauma, and hence, oral tubes provide a feasible alternative. In contrast to the nasopharyngeal cavity, whose anatomical orientation allows ease of insertion into the esophagus, oral insertion of Ryles tube is difficult on account of a larger cavity and potential for coiling. Various aids are often used to ease the insertion of these orogastric tubes. One such aid is the use of an oral endotracheal tube (ETT). This case report aims to bring to light, and the inadvertent complications may occur with the improper use of these aids, which in our case, was the misplacement of the said oral ETT.

Context: Bleeding is of utmost concern in major orthopedic operations like total knee replacement, total hip replacement, and spine surgeries. Strategies to reduce blood loss must be employed to reduce allogeneic blood transfusion. Tranexamic acid (TAX) is an inexpensive synthetic derivative of the amino acid lysine. By attaching to lysine binding sites on plasminogen molecules it forms tranexamic acid-plasmin complex which has weaker fibrinolytic properties than plasmin alone. It also exhibits clot stabilizing and anti-inflammatory properties. When administered to surgical patients it can reduce blood loss and thus decrease transfusion requirements.Aim: This is a study to evaluate the efficacy and safety of tranexamic acid in reducing blood loss and need of postoperative blood transfusions following unilateral total knee replacement surgery in a tertiary care teaching hospital. Materials and methods:Sixty patients,18-70 years, American Society of Anesthesiology (ASA) statuses I and II undergoing unilateral total knee replacement under combined spinal-epidural anesthesia were enrolled in this prospective, randomized, double-blind study. Thirty patients each were randomly assigned to group T (TAX) and group C (control). Group T received intravenous tranexamic acid 10 mg/kg before tourniquet inflation followed by its infusion at 1 mg/kg/hour till skin closure. Group C received a similar amount of normal saline and served as the control group. The demographic data, duration of surgery, intraoperative vital parameters, intraoperative and postoperative blood loss, postoperative hemoglobin levels, quantity of blood transfusion required and a number of patients requiring blood transfusions and risk of the thromboembolic phenomenon were studied. Results:The mean (±SD) total blood loss was lower in the group receiving tranexamic acid (306.96 ± 75.23 mL) than in control group (543 ± 163.36 mL) which amounted to 43.47% less blood loss in the group receiving tranexamic acid. On an average control group required six times more blood transfusion than tranexamic acid group. Conclusion:Use of intravenous tranexamic acid is an effective and safe method to decrease blood loss in surgeries on the bone like total knee replacement.

Background: Pain on propofol injection is an unwanted effect which can lead to decreased patient satisfaction. Although many studies have shown that pre-treatment with lidocaine injection is effective in this pain, nevertheless, very few studies have been done  on different concentration and volume of lidocaine, effective of reducing pain significantly. Objective of the current study was to assess and compare the efficacy of intravenous lidocaine with  0.4% and 2% concentration in reducing the incidence and severity of propofol injection pain.Methods: A total of 126 American Society of Anesthesiologist grade I and II patients with age ≥18 years, scheduled for an elective surgery, were enrolled in the study. Patients were randomized into two equal groups of 63 each. Group A (n = 63) received pretreatment with 0.4% lidocaine and group B (n = 63) received 2% lidocaine. Propofol injection pain was measured by using Numeric Rating Scale (NRS) and Withdrawl Response Scale (WRS). Unpaired t test, ANOVA and Chi square test were used for statistical analysis.Results: A statistically significant decrease in the pain was recorded in group A (0.4% lidocaine) as compared to group B (2% lidocaine). Using NRS scale, 12% of patients in group A as compared to 33% patients of group B, experienced pain (p =0.02); while using WRS, 8% patients of group A as compared to 27% group B patients experienced pain (p= 0.04).Conclusions: The pain on injection of propofol is significantly decreased by the use of 0.4% lidocaine in comparison with 2% Lidocaine.

A 65-year-old male post-CABG surgery presented with history of ventricular storm refractory to antiarrhythmics and requiring multiple DC shocks. He got posted for VATs bilateral cardiac denervation for sympathetic remodulation. Patient was induced with high dose opioids and Etomidate and intubated with 37Fr left double lumen tube. A multidisciplinary approach was planned to tackle peri-operative cardiac event along with the placement of invasive monitors. Events that might lead to sympathetic overactivation because of laryngoscopy, pain, capnothorax, and surgical handling were kept in mind and avoided with optimum depth of anesthesia, analgesia, and pharmacological sympatholysis. There was no major cardiac event intraoperatively as well as in postoperative period.