MATERIAL AND METHODS: A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications.
RESULTS: Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). There were no significant differences in other parameters.
CONCLUSIONS: The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.
CASE DESCRIPTION: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.
CONCLUSION: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.
METHODS:: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.
RESULTS:: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.
CONCLUSION:: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.
Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA.
Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: -0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle.
Conclusion: The 1 mL syringe with original 26G needle shows the best combination.
METHODS: We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions.
RESULTS: The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction.
CONCLUSION: We conclude that clavicle plating under WALANT is a good alternative option of anesthesia.
METHODS: Observational study conducted on 68 patients (1- 18 yrs.) with physical status of ASA II during methotrexate injection with MAC at the RSUP dr. Sardjito. The depth of anaesthesia was monitored with Observer's Alertness Assessment Sedation Scale (OAAS) every two minutes. Consciousness was defined as OAAS=5, or if there is volunteer movement of patients. The result was analysed and categorised according to age, sex, physical status, Body Mass Index (BMI) and anaesthesia's medication of patients.
RESULTS: Positive consciousness in paediatric patients based on OASS score at 2-minute and 4-minutes was 26.5% and 3.2% respectively, and was rescued by additional propofol 2mg/kg body weight.
CONCLUSION: The incidence of paediatric consciousness in patients during methotrexate injection with Monitored Anaesthesia Care (MAC) in the Sardjito General Hospital is 26.5% (2-minute after induction) and 3.2% (4-minute after induction), and this is considerably high thus needing futher prevention.