Indian Journal of Anesthesia and Analgesia

Background: For the majority of endoscopic urological operations, spinal anesthesia is the recommended anesthetic approach because it offers enough muscle relaxation and efficient intraoperative analgesia. Hyperbaric 0.5% bupivacaine is widely used for subarachnoid block; however, higher doses may produce hypotension, prolonged motor blockade, and delayed recovery, particularly in elderly patients. It has been demonstrated that intrathecal fentanyl improves block quality, permits dose reduction, and increases the analgesic effectiveness of local anesthetics. Objective of the study: To assess the sensory block properties of intrathecal 0.5% hyperbaric bupivacaine (10 mg) and 0.5% hyperbaric bupivacaine (7.5 mg) in combination with 25 mcg of fentanyl in patients having endoscopic urological procedures. Methods: Forty ASA physical status I and II participants who were scheduled for elective endoscopic urological surgery under spinal anesthesia were included in this prospective observational study. Two groups of twenty participants each were formed. Group BF received 7.5 mg of 0.5% hyperbaric bupivacaine with 25 mcg of fentanyl intrathecally, while Group B received 10 mg of 0.5% hyperbaric bupivacaine. Time to commencement of sensory block, time to peak sensory block, and duration of sensory blockade were the main outcome measures. With statistical significance set at p < 0.05, the independent Student’s t-test was used for intergroup comparisons after data analysis using SPSS. Results: Participants in Group BF demonstrated a significantly faster onset of sensory blockade than those in Group B (3.40 ± 0.60 vs. 5.30 ± 0.57 minutes; p <0.001). Peak sensory block was also achieved earlier in Group BF (6.95 ± 0.89 vs. 7.85 ± 0.59 minutes; p < 0.001). In addition, the duration of sensory blockade was significantly longer in Group BF (214.50 ± 8.87 vs. 140.75 ± 4.94 minutes; p < 0.001). Conclusion: In comparison to conventional-dose hyperbaric bupivacaine alone, the addition of 25 mcg intrathecal fentanyl to low-dose hyperbaric bupivacaine produced a faster onset, earlier peak, and noticeably longer duration of sensory blockade. This combination may represent an effective spinal anesthetic technique for endoscopic urological procedures, particularly in elderly patients.

Background and Aims: Women recovering from breast cancer operations frequently report intense early pain, and inadequately controlled acute pain of this kind is known to predispose to a persistent postsurgical pain syndrome. Deposition of local anaesthetic within the pectoral fascial planes, described as the modified pectoral nerve (Pecs I and II) technique, has been advanced as a means of relieving pain after breast procedures that incorporate clearance of the axillary nodes. Our aim was to determine how well this ultrasound directed block controls pain in the first postoperative day, and to document its influence on circulatory variables and on the occurrence of adverse events. Methods: Sixty women of ASA physical status I or II, between 25 and 65 years of age and listed for breast surgery that included axillary clearance, were enrolled in this double blind, randomised, prospective comparison. One arm (Group A, n = 30) received a standard general anaesthetic without any regional supplementation, while the other (Group B, n = 30) received the same general anaesthetic together with an ultrasound directed modified Pecs block using 30 ml of bupivacaine 0.25 percent. How long and how effectively pain was controlled, graded on a visual analogue scale (VAS), served as the principal endpoint. Circulatory endpoints (mean arterial pressure and heart rate during and after operation), the need for supplementary analgesics, the level of sedation and any complications across 24 hours were recorded as additional outcomes. Results: At every recording point through the first 24 hours, pain scores were lower in the block arm than in the control arm (p less than 0.05). Fifteen minutes after operation, a pain score of zero was reported by 43.3 percent of the women who had received the block, whereas no control patient was pain free at that time. Far fewer patients in the block arm asked for supplementary analgesia (6.66 percent against 36.7 percent; p = 0.030). Mean arterial pressure, both during and after surgery, was lower in the block arm at the majority of time points, whereas differences in heart rate seldom reached significance. There were no complications attributable to the block, and sedation levels did not differ between the arms. Conclusion: When added to general anaesthesia for breast surgery that includes axillary clearance, the ultrasound directed modified Pecs block delivers good pain relief and lowers the demand for additional analgesics. It is therefore a worthwhile element of a multimodal analgesic plan for these patients.

Airway foreign bodies can be challenging for both the anesthesiologist and the surgeon, especially in children. Deep-seated foreign body extraction can be prolonged and difficult, requiring a still and bloodless field, in addition to concerns such as shared airway, ensuring adequate oxygenation and ventilation, and prevention of airway trauma. The perioperative management of pediatric airway foreign body can be mired by hypoxia, hypercarbia, foreign body dislodgements, barotrauma and airway trauma. We hereby present an interesting and novel method of administering jet ventilation to a child undergoing prolonged airway foreign body extraction by using an innovative airway connector adjunct for intermittent ventilation through the circuit connected to the jet ventilatorbronchoscope assembly with the adapter of airway exchange catheter.

Paediatric patient posted for meningomyelocele repair poses a challenge for anaesthesiologists in terms of IV cannulation, Airway access, positioning; anaesthesia management focuses on protecting the spinal sac during positioning, managing potential respiratory issues, preventing hypothermia, controlling fluid balance and monitoring for CSF leaks and blood loss. Our patient was 6 months old, 5kgs with full term normal delivery with other investigations within normal limits. Securing an IV cannulation was difficult, Positioned with cotton padding for the meningomyelocele; and premedicated with Inj Atropine 0.1 mg; Inj Fentanyl 10 mic gm and Induced with Sevoflurane and Intubated under Inj Suxamethonium 10 mg with 4.0 mm ETT and Fixed at 11 cm. Maintained with O 2, N2O, Inj Atracurium & Isoflurane. Patient was carefully proned with padding and support for head and neck. HR, SPO2, ETCO2, NIBP were monitored and Fluid managed with Isolyte-P. Uneventfully extubated after reversing the NMB with Inj Neostigmine and Ing Atropine and shifted to recovery.A multidisciplinary approach to paediatric anaesthetic management with trained anaesthetist securing IV cannulation, Airway access and care in positioning was helpful in a successful outcome.

Introduction: Endotracheal tube (ETT) cuff integrity is essential for effective ventilation, prevention of aspiration, and maintenance of airway pressures during general anaesthesia. Although ETT cuff–related complications are uncommon, cuff herniation or structural failure can result in significant air leaks, inadequate ventilation, and hypoventilation Case Report: A 54-year-old female (ASA physical status I) was scheduled for elective lumbar decompression at L4–L5 and L5–S1 levels under general anaesthesia. Preoperative evaluation revealed no significant comorbidities, normal airway assessment, and unremarkable laboratory investigations. After standard monitoring was established, general anaesthesia was induced uneventfully. Tracheal intubation was performed using a standard-sized cuffed ETT, and correct placement was confirmed by bilateral chest auscultation, and appropriate airway pressures. The cuff was inflated to achieve an adequate seal, and the patient was mechanically ventilated with stable tidal volumes and normal peak airway pressures. The patient was then carefully positioned prone. Soon after prone positioning, a progressive reduction in delivered tidal volumes accompanied by a significant ventilatory leak was observed. Peak airway pressures remained low, and capnography showed reduced end-tidal carbon dioxide values. Circuit disconnection, ventilator malfunction, and tube displacement were systematically excluded. Additional cuff inflation was attempted but failed to resolve the leak. Given the persistent ventilatory compromise and restricted airway access in the prone position, the decision was made to return the patient to the supine position. Direct laryngoscopy revealed herniation of the ETT cuff proximal to the vocal cords. The tube was immediately replaced with a new cuffed ETT. Following re-intubation, normal tidal volumes, airway pressures, and capnography were restored. The patient was repositioned prone, and the remainder of the surgery proceeded uneventfully. Extubation was smooth, and the postoperative course was unremarkable. Conclusion: Endotracheal tube cuff herniation, though uncommon, should be considered when sudden ventilatory leaks or reduced tidal volumes occur intraoperatively, particularly during prone-position spine surgeries. Early recognition, prompt airway reassessment, and immediate replacement of the ETT are crucial to ensure patient safety and prevent hypoxia-related complications.

Central fever is a non-infectious, neurogenic hyperthermia arising from thalamic injury. It complicates the clinical course of patients in neurointensive care units by closely mimicking infectious sepsis, often leading to diagnostic dilemmas and the inappropriate overuse of broad-spectrum antimicrobials.The underlying mechanism involves the disruption of hypothalamic thermoregulatory pathways and secondary neuroinflammation. Emerging advanced neuromonitoring techniques further assist in differentiating autonomic dysregulation from infection. We present the clinical course of two neurocritically ill patients who developed refractory central fever. The report discusses successful resolution of fever in these patients. Maintaining a high clinical suspicion for central fever following the systematic exclusion of sepsis is paramount. Prompt intervention with targeted therapies like diclofenac rapidly controls temperature, safeguards the brain from secondary metabolic stress, and prevents antimicrobial abuse.

Access of airway can pose a problem with cleft palate. Patient was hyperthyroid also on medications posted for Abdominal hysterectomy. Her T4 was high, anxious and with tachycardia. Planned for General anaesthesia with Endotracheal intubation. Premedicated with Inj Glycopyrrolate, Inj Midazolam, Inj Fentanyl; induced with Inj Propofol and Intubated with Inj Suxamethonium with Video Laryngoscope. Intraoperative tachycardia was treated with Ing Lignocaine and Extubated uneventfully after reversing neuromuscular blockade. Proper planning for airway management and treating hyperthyroidism for our patient with cleft palate and hyperthyroidism turned out with a successful anaesthesia management.