Background/aim: The effects of pericardium 6 (P6) electrical stimulation in patients at risk of postoperative nausea and vomiting (PONV) following laparoscopic surgery were evaluated. Materials and methods:Eighty patients for laparoscopic surgery with at least one of the determined risks (nonsmoker, female, previous PONV/motion sickness, or postoperative opioid use) were randomized into either an active or sham group. At the end of surgery, Reletex electrical acustimulation was placed at the P6 acupoint. The active group had grade 3 strength and the sham group had inactivated electrodes covered by silicone. It was worn for 24 h following surgery. PONV scores were recorded. Results:The active group had significantly shorter durations of surgery and lower PONV incidence over 24 h (35.1% versus 64.9%, P = 0.024) and this was attributed to the lower incidence of nausea (31.4% versus 68.6%, P = 0.006). The overall incidence of vomiting was not significantly different between the groups, but it was higher in the sham group of patients with PONV risk score 3 (23.9%, P = 0.049). Conclusion:In patients at high risk for PONV, P6 acupoint electrical stimulation lowers the PONV incidence by reducing the nausea component. However, this reduction in nausea is not related to increasing PONV risk scores.

Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia.Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety score, level of sedation using the Bispectral Index and Observer's Assessment of Alertness and Sedation, hemodynamic stability, and overall patient's feedback on anxiolysis were assessed.Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 min after starting surgery. Difference in median anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion. Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the propofol group (45.20%). Conclusion:Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol during regional anesthesia.

The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

Pneumopericardium is a rare clinical presentation and is an unusual complication of tracheostomy. Its isolated presentation without associated air in other potential space such as mediastinum or pleura causes difficulty in diagnosis especially in patient with invasive ventilation. We report a case of 72-year-old lady who developed isolated pneumopericardium following tracheostomy. The progression into cardiac tamponade was halted by administration of fluid resuscitation and modifying ventilation mode to spontaneous setting. A flexometallic endotracheal tube was inserted through the tracheostomy stoma with the aid of fibre-optic scope while she was breathing spontaneously; and the cuff was inflated distal to the site of the tracheal wall injury. This technique successfully ceased the air leak across the injury. The endotracheal tube was changed to an adjustable flange tracheostomy tube size 8.5mm internal diameter once available and subsequent serial chest radiographs showed resolving pneumopericardium. Based on this case, we believed that a prompt diagnosis of isolated pneumopericardium may prevent its catastrophic progression into a fatal cardiac tamponade and thus, these rare findings were reported with the intention to raise awareness amongst clinicians.

INTRODUCTION: Laryngoscopy and endotracheal intubation is known to cause tachycardia and increase in blood pressure during general anaesthesia. This study was designed to assess if auricular acupressure has beneficial effects in attenuating the haemodynamic changes during laryngoscopy and intubation. Secondly, this study aimed to evaluate the effectiveness of auricular acupressure in reducing preoperative anxiety. MATERIALS AND METHODS: Eighty patients who were scheduled for surgery under general anaesthesia were randomised to receive either active auricular acupressure over bilateral Shen Men (Group A) or sham auricular acupressure (Group B). A total of three stimulations of auricular acupressure with ten minutes interval were performed before induction of anaesthesia. Haemodynamic parameters (heart rate and blood pressure) were recorded ten minutes after each stimulation, during laryngoscopy and intubation and every minute for ten minutes after intubation. Visual analogue scale for anxiety was documented before and at 30 minutes post first stimulation. RESULTS: The heart rate and mean arterial pressure were statistically higher in Group B comparing to Group A during intubation (p=0.043 and p=0.049 respectively). There was statistically significant reduction in blood pressure after intubation in both groups as compared to baseline (p<0.003 respectively). However, there was no significant difference when comparing both groups (p>0.05). There was no significant reduction of preoperative anxiety level in both groups after auricular acupressure (p=0.879). CONCLUSION: Auricular acupressure over bilateral Shen Men helped to attenuate the haemodynamic changes during intubation. However, it did not reduce preoperative anxiety.