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Background and objectivesPropofol-based sedation is one of the most commonly used methods for endoscopic retrograde cholangiopancreatography (ERCP). The commonest complications during ERCP are in the form of adverse cardiopulmonary events as a result of sedation. Etomidate has a more stable cardiovascular and respiratory profile than propofol and has been used for sedation in simple gastrointestinal endoscopy but has not been studied for procedural sedation in ERCP. The objective of the present study was to compare the safety and feasibility of etomidate and propofol for sedation during ERCP procedures. MethodsThis single-center, randomized trial included 100 American Society of Anesthesiologists (ASA) physical status class I to II patients who were scheduled for ERCP. All patients received midazolam 0.02 mg/kg, lignocaine (2%) 1 mg/kg, and fentanyl 1 µg/kg intravenously, followed by etomidate or propofol according to the group allocation. The primary outcome was to compare the mean arterial pressure (MAP) at various timepoints between the two groups and secondary outcomes were to compare oxygen saturation, induction and recovery times, and adverse events. Transient hypotension was defined as any decrease in MAP below 60 mmHg or 20% below the baseline. Transient hypoxia was defined as desaturation (saturation of peripheral oxygen (SpO2) <92%) lasting for more than 10 seconds requiring airway intervention. ResultsFifty patients were enrolled in each group (Group E: etomidate and Group P: propofol). Transient hypotension occurred in eight (16%) patients in Group P, and two (4%) patients in Group E (P= 0.045). Baseline MAP was comparable between the two groups but was significantly lower in Group P at three timepoints during the study. Nine (18 %) patients in Group P had a transient hypoxic episode, compared to none in Group E (p= 0.006). The induction and recovery times were similar in the two groups. ConclusionsEtomidate offers better hemodynamic and respiratory stability than propofol and can be recommended for use during ERCP in ASA I/II patients.

Background: The severe acute respiratory syndrome coronavirus-2-2019 pandemic has posed significant challenges and barrier devices such as aerosol/intubation box, intubation tent, and intubation screen have been widely used during endotracheal intubation by the clinicians without any definite proven benefit. The initial experience at our institute with the intubation box posed some difficulties leading to failed intubations. Hence, as an alternative, we switched to a transparent plastic intubation screen that is likely to provide better vision and space during intubation. We evaluated the impact of intubation box and plastic screen on intubations in this simulation-based crossover study. Materials and Methods: Ten anesthesiologists performed 90 intubations in an operating room on a Laerdal® adult airway management trainer. Each participant performed 9 intubations, 3 without any barrier and 3 each with intubation box and plastic screen. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. Results: Intubation time with no barrier was significantly shorter than with the intubation box (median interquartile range [IQR]: 25 [22–28] vs. 40 [30–51] s, P < 0.001) and with the screen (median [IQR] 29 [25–35] s, P = 0.015). The intubation time was significantly lesser with the screen compared to the box (P = 0.023). The first-pass success was 86.66%, 96.66%, and 100% in the box, screen, and no barrier groups, respectively. Conclusion: In comparison to an intubation box, the transparent plastic screen decreases intubation times and has greater operator comfort. These devices require further evaluation for patient safety.

A bstract One of the damage control strategies used to avoid or treat abdominal compartment syndrome is “open abdomen (OA),” where the facial edges and the skin is left open, exposing the abdominal viscera. Although it reduces the mortality both in trauma and non-trauma abdominal complications, it does create a significant challenge in an intensive care setting, as it has physiological consequences that need early recognition and prompt treatment both in the intensive care unit and in the operating room. The article aims to review literature on “open abdomen,” describe the challenges in such cases, and proposes a guideline for the intensivist in managing a patient with an OA. How to cite this article: Mitra LG, Saluja V, Dhingra U. Open Abdomen in a Critically Ill Patient. Indian J Crit Care Med 2020;24(Suppl 4):S193–S200.