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Aim: The aim of the present study was to assess the diaphragmatic and lung USG to predict the outcome of weaning process. Methods: The proposed study has been conducted on critically ill post-surgical patients on mechanical ventilation aged between 18-65 years, in intensive care unit of Department of Anaesthesiology and CCM, Nehru hospital, B.R.D. Medical College, Gorakhpur, Uttar Pradesh from December 2020 to November 2021. 110 patients were included in the study. Results: There was significant difference observed in failure rate of extubation among different age groups as age increases the rate of failure also increases significantly (p<0.0001). There was no significant difference observed in success rate of extubation across gender (success rate: male vs female: 88.2% vs 86.8%, p=0.839). Failure rate of extubation was significantly higher in those patients who had any comorbidities as compared to those who had no comorbidities. Mean LUS Score on CPAP was significantly lower in success group as compared to failure group. Mean LUS Score after extubation was significantly lower in success group as compared to failure group. Mean DTF on CPAP was significantly higher in success group as compared to failure group. Mean DTF on T piece was significantly higher in success group as compared to failure group. Mean DTF after Extubation was significantly higher in success group as compared to failure group. Likewise, Mean E on CPAP was significantly higher in success group as compared to failure group. Mean E on T piece was significantly higher in success group as compared to failure group. Mean E after extubation was significantly higher in success group as compared to failure group. Conclusion: The weaning outcome can be predicted by LUS score, diaphragmatic thickness fraction (DTF), diaphragmatic excursion (E) in mechanically ventilated patients. A value of LUS score on T-piece ≤10 predicts the successful weaning final outcome. A value of DTF on T-piece ≥31% predicts the successful weaning final outcome. Similarly, a value of E on Tpiece ≥18mm also predicts a successful weaning outcome. Increased rate of weaning failure observed in older age group, patients with co-morbidities and high SOFA score. Also prolonged duration of mechanical ventilation caused failure in weaning. [ABSTRACT FROM AUTHOR]

Background: Sub-arachnoid block is most commonly used technique in regional anaesthesia to conduct lower limb surgeries [1]. Wide variety of adjuvants have been used intrathecally to prolong post-operative analgesia. The aim of this study is to evaluate and compare the intra-operative block characteristics and duration of postoperative analgesia by using intrathecal dexmedetomidine (5μg) or nalbuphine(1mg) as an adjuvant to hyperbaric bupivacaine (12.5mg) in lower limb orthopedic surgeries. Aims and objectives: This study is used to compare the effects of dexmedetomedine and nalbuphine when given as an adjuvant to hyperbaric bupivacaine in sub-arachnoid block. Material and methods: This study was prospective, randomized, double-blind study. After obtaining ethical committees' clearance and informed consent, sixty patients of either sex, and ASA physical status I and II scheduled for sub-arachnoid block were included and categorized into two groups(n=30). Result: Addition of dexmedetomedine with hyperbaric bupivacaine intrathecally when compared with nalbuphine result in faster onset of both motor and sensory blockade, with statistically significant longer duration of post-operative analgesia. Conclusion: Both dexmedetomidine and nalbuphine can be used as adjuvant to hyperbaric bupivacaine in spinal anaesthesia but dexmedetomidine along with bupivacaine provide better quality of anaesthesia, and excellent post-operative analgesia when compared with nalbuphine. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Laparoscopic surgeries, despite being minimally invasive, is not popular as a day care surgery because of the post operative pain and requirement of intravenous analgesic drugs. The aim of this study is to compare the efficacy of intraperitoneal instillation of levobupivacaine alone versus levobupivacaine with different doses of dexmedetomidine for post operative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Prospective observational study. In the study, 100 patients, scheduled for elective laparoscopic cholecystectomy after getting informed and written consent were taken up and were randomised into 4 groups to receive either 50 ml of 0.25% levobupivacaine + 5ml normal saline [GROUP A], 50ml of 0.25% levobupivacaine + dexmedetomidine 0.5mcg/kg diluted in 5ml normal saline [GROUP B], 50ml of 0.25% levobupivacaine + dexmedetomidine 1mcg/kg diluted in 5ml normal saline [GROUP C], 50ml of 0.25% levobupivacaine + dexmedetomidine 1.5mcg/kg diluted in 5ml normal saline [GROUP D]. Study drug was instilled before the removal of the trocar at the end of the surgery. All the patients also received infiltration of 0.25% bupivacaine at the port sites. Post operative pain using NRS, time to first rescue analgesia and total analgesic requirement of the patients amongst all the four groups was observed and compared. RESULTS: The mean NRS was found to be significantly lesser in Groups C & D as compared to Groups A & B. Inj. Fentanyl [1-2mcg/kg] was used as rescue analgesia for patients with NRS>4. Patients belonging to Group A received rescue analgesia earlier and higher as compared with Group B. Patients belonging to Group C & D did not require any rescue analgesia. CONCLUSION: The addition of dexmedetomidine to levobupivacaine for intraperitoneal instillation was found to be more efficacious for post operative analgesia and 1mcg/kg of dexmedetomidine can be used as optimal adjuvant dose with levobupivacaine in patients undergoing laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: The duration and quality of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics. The aim of the study is to compare the efficacy of dexmeditomedine and clonidine as adjuvant to levobupivacaine for epidural anesthesia in lower abdominal and lower limb surgeries. MATERIAL AND METHODS: This Prospective comparative study was done to assess the efficacy and clinical profile of two a2 adrenergic agonists - clonidine and dexmedetomidine administered epidurally in combination with intrathecal 0.5%levobupivacaine. 60 adult patients ASA Class I and II undergoing lower abdomen and lower limb surgery were randomly assigned into two groups, to receive either epidural dexmedetomidine (1.5μg/kg) or clonidine (2 μg/kg) with 0.5% isobaric levobupivacaine. RESULTS: Based on the VAS score of the patients and time taken for rescue analgesia, it was found that better post-operative analgesia was provided for longer duration by dexmedetomidine than clonidine. Though no significant differences have been observed based on the hemodynamic parameters between both the groups of the patients, dexmedetomidine has shown beteer hemodynamic stability as compared to clonidine. CONCLUSION: It can be concluded that in patients undergoing lower abdominal and lower limb surgeries, administration of epidural anaesthesia with 0.5% of Levobupivacaine with dexmedetomidine provided better and longer post-operative analgesia as compared to clonidine. [ABSTRACT FROM AUTHOR]

Introduction: The safety margin of tracheal tube cuff pressure lies between excessive and insufficient pressure. Specifically, insufficient pressure can lead to air leakage, which lessens the effect of mechanical ventilation and results in the leakage of inhalation anesthetics, while excessive pressure can cause serious injury and affect blood flow to the tracheal mucosa, resulting in cough, hoarseness of voice prolonged intubation may cause tracheal stenosis, fistula, or tracheal rupture. Movement of the head and neck and the resulting displacement of the tracheal tube can alter cuff pressure. Material and Methods: We collect this sample size by using purposive sampling method. We select the individual who full fill the inclusion criteria and also give consent for participating in study. Result: In this study 59 (59%) female and 41 (41%) males. This study shows that 20 to 30 ET Cuff Pressure after change in Head and Neck Position in 41 (41%) cases and above 30 ET Cuff Pressure after change in Head and Neck Position in 59 (59%). Conclusion: It has been observed that change in average ETT cuff pressure was in between 6 cm of H2O after every 15 minutes interval, and every time when the ETT cuff pressure was found to be more than 25 cm of H2O, we reduced to within normal limits (25 cm of H2O) with the help of digital manometer. On the basis of the present study we arrived to the following conclusion that repeated reducing of ETT cuff pressure to within normal range (25 cm of H2O) lead to lesser complication of sore throat and hoarseness of voice as compared to the previous studies done for the same. Hence we can conclude that, ETT cuff pressure measuring manometer - (AG Cuffill) is an important tool to regulate ETT cuff pressure during intraoperative period, and it also helps to reduce post-operative complications like sore throat and hoarseness of voice. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is one of the most common major surgeries performed in gynaecology. post operative pain is an inevitable consequence of surgical incision involving full thickness of abdominal wall given in abdominal hysterectomy. Conventional method of pain management includes use of intravenous and oral NSAIDS and opioid. Use of Intrathecal opioid and epidural analgesia has been explored for post operative management. Regional anaesthesia gives a new ray of hope for post operative pain management. The aim of our study to compare the efficacy of bilateral Quadratus Lumborum block (QLB) and erector spinae plane block (ESPB) for post operative analgesia in total abdominal hysterectomy. Material and Method: This Prospective observational study was carried out among 60 patients, which scheduled for elective surgery after getting approval from ethical committee and informed written consent from all patients, the prospective observational study was conducted on adult patients of either sex satisfying inclusion criteria. In our study patients were randomized into 2 groups (30 patient in each group), group QLB (spinal anaesthesia + USG guided bilateral QL3 block) and group ESPB (spinal anaesthesia + USG guided bilateral ESPB block). Post operative pain using NRS, time for first rescue analgesia and total analgesic requirement of the patient amongst all two groups were observed and compared. Result: The mean NRS on rest and movement both were found to be significantly less in QLB group than ESPB group. Injection fentanyl was used as rescue analgesia for patients with NRS > 4. Patients belonging to group ESPB received rescue analgesia faster and significantly higher amount as compared with group QLB. Conclusion: It can be concluded that patient undergoing total abdominal hysterectomy surgery Quadratus lumborum block and erector spinae plane block, both are effective but Quadratus lumborum block is more effective in decreasing postoperative pain and post operative analgesic consumption and lead to greater patient satisfaction, without any serious side effect oral hemodynamic instability. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Endotracheal intubation is the first step to maintain the patency of airway during general anaesthesia. Problem with the airway management constitutes 17% of anaesthesia closed claim, most common being difficult intubation which is almost 5%. The aim of this study is to compare the time, ease, numbers of attempts taken, switching between the laryngoscopes if facing any difficulty during endotracheal intubation while using Macintosh laryngoscope, KingVision laryngoscope, Anaesthetics video laryngoscope. MATERIAL AND METHODS: In this Prospective observational study Ninety patients, scheduled for elective surgery after getting approval from ethical committee and informed written consent from all patients, the prospective observational study was conducted on adult patients of either sex satisfying inclusion criteria. In our study patients were randomized into 3 groups (30 patients in each group), patient who got intubated with Macintosh laryngoscope (Group M), patient who got intubated with KingVision video laryngoscope (Group K), patient who got intubated with Anaesthetics video laryngoscope (Group A). All the three groups were compared for time, ease and attempts to successful endotracheal intubation while using Macintosh laryngoscope, KingVision laryngoscope, Anaesthetics video laryngoscope. RESULTS: The mean time taken has been found to be significantly lesser in Group A as compared to Group M and Group K. The intubation difficulty score was found statistical insignificant in all the three groups (p value: 0.956). The comparison between Mallampati score and Cormack-Lehane grading was significant in Group A (p value <0.001) and Group K (p value< 0.033). CONCLUSION: It can be concluded that Anaesthetic video laryngoscope is better when considering the intubation time (takes lesser time for intubation), number of attempts (takes lesser number of attempts for intubation) and stylet used (less stylet used in case of Anaesthetic video Laryngoscope). [ABSTRACT FROM AUTHOR]

Background: Epidural volume extension (EVE) is claimed to increase the block height and decrease the dose requirement for intrathecal drug. However, almost all studies have been done in obstetric population and none actually compares the effect of additional drugs added to epidural volume., Materials and Methods: Seventy-five (ASA I and II) patients scheduled for lower abdominal surgery were randomly divided into three groups. All groups received intrathecal 10 mg bupivacaine; two groups received additional 10 ml of normal saline epidurally with 25 mg tramadol or 25 mg of fentanyl. Groups were than compared for maximal block height, rate of sensory block regression to T10, and motor block regression to Bromage scale of 0. Time to first analgesia and adverse effects were also compared among the three groups., Materials and Methods: Seventy-five (ASA I and II) patients scheduled for lower abdominal surgery were randomly divided into three groups. All groups received intrathecal 10 mg bupivacaine; two groups received additional 10 ml of normal saline epidurally with 25 mg tramadol or 25 mg of fentanyl. Groups were than compared for maximal block height, rate of sensory block regression to T10, and motor block regression to Bromage scale of 0. Time to first analgesia and adverse effects were also compared among the three groups., Results: Groups with EVE had statistically significant higher block height, with a significant faster regression that the control group. However, both fentanyl and tramadol groups were inseparable in respect to motor or sensory block regression. Fentanyl group had maximal time to first analgesia, followed by tramadol and control groups. Hemodynamic alterations were also more common in EVE groups., Conclusion: EVE can increase the block height significantly, but it seems to be limited only to the physical property of additional volume in epidural space and fentanyl or tramadol do not seem to differ in their ability to alter block properties.