Cm Of H2O Research Articles

Battle of the Gases: How Air and Nitrous Oxide Affect Endotracheal Tube Cuff Pressure During General Anesthesia.

Background Endotracheal tube (ETT) cuff pressure changes during general anesthesia. Endotracheal cuff pressure ideally should be maintained between 20 and 30 cm of H2O. Cuff pressure of less than 25 cm of H2O increases the chances of aspiration while pressure of more than 40 cm of H2O causes tracheal mucosa damage. The study aimed to monitor and compare variations of endotracheal cuff pressure during general anesthesia with oxygen-air or oxygen-nitrous oxide. Methods This prospective, randomized, double-blinded, observational study was conducted on 40 patients. After approval from the institutional ethics subcommittee, 40 patients of either gender, aged 18-60 years, belonging to ASA grades I and II, who were undergoing elective surgery under general anesthesia, were enrolled in this study. The patients were randomly divided into two groups, with 20 in each group. In Group A, oxygen-air and Group N, oxygen-nitrous oxide was used as a gaseous mixture in general anesthesia with ETT. The ETT cuff pressure was recorded with the help of a cuff manometer at intervals of five, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after intubation. If pressure was more than 40 cm of H2O, it was reduced to 25-30 cm of H2O. Data were collected and analyzed using methods described in Primer of Biostatistics by Stanton A. Glantz. Quantitative data were analyzed using the Student's t-test. Qualitative data were analyzed using the chi-square test. Results An increase in cuff pressure was noted more in Group N as compared to Group A. The pressure in the endotracheal cuff started to gradually increase after 30-40 minutes in Group N after intubation, while in Group A, there was no significant increase. The average number of times the cuff deflated was 0.2 ± 0.41 in Group A and 1.55 ± 0.51 in Group N, which was highly significant. Conclusion Changes in endotracheal cuff pressure were observed when using different gas mixtures for inflation. Specifically, cuff pressure increased with oxygen and nitrous oxide compared to oxygen with air. This suggests that anesthetic gas composition can impact cuff pressure, potentially affecting tracheal mucosal perfusion and patient safety. Therefore, regular monitoring and adjustment of cuff pressure is crucial, especially when using nitrous oxide, to prevent complications and ensure optimal patient care.

Assessment of childhood intracranial pressure: a comparative study of transcranial Doppler ultrasound indices and findings at ventriculoperitoneal shunt.

This study compares transcranial Doppler (TCD) Pulsatility Index (PI) and Resistivity Index (RI) with intra-operative CSF opening pressure measured by manometric technique during ventriculoperitoneal (V-P) shunt in children with hydrocephalus. It was a prospective, hospital-based study performed among patients diagnosed with hydrocephalus. Patients had TCD ultrasonography before V-P shunt. The TCD sonography was repeated within 1week post-op, and at 1month post-op. The PI and RI were retrieved after insonating the middle cerebral artery. Ventricular CSF opening pressure was measured. Associations between TCD indices and CSF pressure were determined using the t-test and the Wilcoxon rank /Mann-Whitney tests where the normality test failed. A p-value of < 0.05 was considered significant for associations. Fifty-two patients were enrolled with a mean age of 9.9 ± 11.5months. Of these, 41 (78.8%) were aged ≤ 12months. The mean CSF opening pressure was 21.4 ± 9.0. When raised, ICP was defined as opening pressure > 15cm of H2O, high PI (≥ 1.19), and high RI (> 0.8) diagnosed it with a sensitivity of 55% and 50%, respectively. The mean pre-operative PI (1.17 ± 0.56) reduced to 0.96 (Z = - 2.032, p = 0.042), while that of RI (0.66 ± 0.17) also decreased to 0.58 (t = 2.906, p = 0.044) after V-P shunt surgery. A strong positive correlation exists between a reduction in PI and RI after V-P shunt (r = 0.743, p = 0.014). Both PI and RI significantly decrease following V-P shunt, but a single reading has a poor sensitivity in predicting ICP.

Comparison of incidence of sore throat with laryngeal mask airway Protector and laryngeal mask airway ProSeal: A randomised clinical trial.

Postoperative sore throat (POST) can be as high as 42% in supraglottic devices. LMA® Protector™ is a novel second-generation laryngeal mask airway (LMA) with Cuff Pilot™ technology that allows continuous cuff pressure monitoring. Elevated cuff pressure is a risk factor for POST in supraglottic devices, so we conducted this study to determine whether continuous cuff pressure monitoring can alleviate POST. This randomised double-blinded clinical trial compared the incidence of sore throat between LMA® Protector™ and LMA® ProSeal™ and was conducted in 118 patients scheduled for elective short surgical procedures. They were randomised to either LMA® Protector™ (Group PT) or LMA® ProSeal™ (Group P). The airway was secured with either of the two devices. The primary outcome was the incidence of sore throat at 1, 6, and 24 hours postoperatively and compared using the Chi-square test along with other parameters like first attempt success rate and blood staining of the device. The time taken for insertion and oropharyngeal seal pressure were compared using an independent t-test. The incidence of POST was low with Group PT (12%) compared to Group P (28.8%) (P = 0.005). The mean oropharyngeal seal pressure was significantly higher in Group PT than in Group P [33.72 (3.07) versus 27.72 (3.88) cm of H2O], P < 0.005. The first attempt success rate was 81.2% and 100% in LMA® Protector™ versus LMA® ProSeal™. LMA® Protector™ had a reduced incidence of POST compared to LMA ProSeal. However, a longer insertion time and difficult placement may be a concern.

Intracranial Hypertension Associated With Poly-Cranio-Radicular-Neuropathies: A Case Report and Review of the Literature.

We present the case of a gentleman who developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis in the context of severe intracranial hypertension. We reviewed the available cases in the literature to increase awareness of this rare clinical entity.Case Report:A 36-year-old man developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis. He had an extensive workup, only notable for severe intracranial hypertension, >55cm of H 2 O. No inflammatory features were present, and the patient responded to CSF diversion. Few similar cases are available in the literature, but all show markedly elevated intracranial pressure associated with extensive neuroaxis dysfunction. Similarly, these patients improved with CSF diversion but did not appear to respond to immune-based therapies. We term this extensive neuroaxis dysfunction intracranial hypertension associated with poly-cranio-radicular-neuropathy (IHP) and distinguish it from similar immune-mediated clinical presentations. Clinicians should be aware of the different etiologies of this potentially devastating clinical presentation to inform appropriate and timely treatment.

The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study.

Background and Objectives: The aim of this study was to examine whether the use of an alveolar recruitment maneuver (RM) leads to a significant increase in static lung compliance (Cstat) and an improvement in gas exchange in patients undergoing laparoscopic cholecystectomy. Material and Methods: A clinical prospective intervention study was conducted. Patients were divided into two groups according to their body mass index (BMI): normal-weight (group I) and pre-obese and obese grade I (group II). Lung mechanics were monitored (Cstat, dynamic compliance-Cdin, peak pressure-Ppeak, plateau pressure-Pplat, driving pressure-DP) alongside gas exchange, and hemodynamic changes (heart rate-HR, mean arterial pressure-MAP) at six time points: T1 (induction of anesthesia), T2 (formation of pneumoperitoneum), T3 (RM with a PEEP of 5 cm H2O), T4 (RM with a PEEP of 7 cm H2O), T5 (desufflation), and T6 (RM at the end). The RM was performed by increasing the peak pressure by +5 cm of H2O at an equal inspiration-to-expiration ratio (I/E = 1:1) and applying a PEEP of 5 and 7 cm of H2O. Results: Out of 96 patients, 33 belonged to group I and 63 to group II. An increase in Cstat values occurred after all three RMs. At each time point, the Cstat value was measured higher in group I than in group II. A higher increase in Cstat was observed in group II after the second and third RM. Cstat values were higher at the end of the surgical procedure compared to values after the induction of anesthesia. The RM led to a significant increase in PaO2 in both groups without changes in HR or MAP. Conclusions: During laparoscopic cholecystectomy, the application of RM leads to a significant increase in Cstat and an improvement in gas exchange. The prevention of atelectasis during anesthesia should be initiated immediately after the induction of anesthesia, using protective mechanical ventilation and RM.

Comparison of Endotracheal Tube Cuff Pressure change between Supine prone and Supine – Knee Chest Position in Lumbar Disc Surgery

Background: In rare instances, massive over inflation of the cuff may lead to acute complications such as tracheal bleeding or rupture. This may be associated with post-operative complications like sore throat hoarseness of voice. The purpose of this study was to evaluate the ETT cuff pressure changes between supine to prone and supine to knee chest position in lumber disc surgery. Materials &amp; Methods: Sixty patients, aged between 18 to 60 years of either sex, belonging to American Society of Anaesthesiology (ASA) physical status I to II undergoing elective lumbar disc surgery under general anaesthesia either in prone position or in knee-chest position were considered for this study. The patients were randomly allocated into two groups of 30 patients each. Group “p” was undergone operation in prone position and group “k” undergone operation in knee-chest position. The patients were connected to standard monitoring system such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), pulse oxymeter, and capnometer. All patients were pre-medicated with inj. glycopyrrolate 0.2 mg and inj. fentanyl 2µg/kg iv 5-6 minutes before induction of anaesthesia and were pre-oxygenated with 100% oxygen for atleast 3 minutes. All the patients were induced with inj. propofol 2.5 mg/kg i.v. followed by inj. rocuronium at a dose of 1.2 mg/kg for facilitating tracheal intubation with reinforced ETT. The ETT size selected for men and women were 8.0-8.5 mm ID and 7.0- 7.5 mm ID (Mallinckrodt) respectively. Results: Group k patients showed higher cuff pressure change from 25 to 39.97cm of H2O compared to group p from 25 to 30.47 cm of H2O after change of position only. There was statistically significant different found between groups Sore throat was found significantly higher in group k compared to group p (20% vs 16.67%). Conclusion: The cuff pressure of the endotracheal tube should be monitored and managed properly after the position change from supine to prone and prone to knee chest position.

Clinical Performance of I-gel® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison.

Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.

COMPARATIVE EVALUATION OF INCIDENCE, SEVERITY, AND RELATION OF SORE THROAT AFTER ENDOTRACHEAL INTUBATION AT DIFFERENT CUFF PRESSURES

Objective: The primary objective of the study was to evaluate and compare the incidence, severity, and relation of sore throat after endotracheal intubation at different cuff pressures. The secondary objective of the present study was to evaluate whether regular monitoring of cuff pressure has any additional advantage during surgical procedures. Methods: Study design – A prospective, comparative, and randomized study. Group A – 25 female patients of age 20–35 where cuff pressure was kept at 15 cm H2O. Group B – 25 female patients of age 20–35 where cuff pressure was kept at 20 cm H2O. Group C – 25 female patients of age 20–35 where cuff pressure was kept at 25 cm H2O. Group D – 25 female patients of age 20–35 where cuff pressure was kept at 30 cm H2O. The patient was visited at 24 h, 48 h, and 72 h following extubation and enquired about the incidence of sore throat. Results: The incidence and severity of sore throat ranged from as low as 16% in group A to as high as 60% in group D at 24 h. Groups B and C showed incidences of 28% and 40%, respectively. The incidence of sore throat was found to be 12% in group A to as high as 40% in group D at 48 h postoperatively, which was further decreased to just one patient with a scratchy feeling in group A and three patients in group D at 72 h with incidence ranging from 4% to 12% only. Conclusion: As the cuff pressure goes on increasing, the incidence and severity of sore throat also increase, and cuff pressure should be monitored and regulated continuously. Moreover, the cuff pressure should not exceed 25 cm of H2O to minimize post-operative sore throat.

Clinical utility of i-gel® and BlockBuster™ supraglottic devices for airway management in postburn injury contracture neck patients under general anesthesia: A randomized controlled trial.

Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA). The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed. Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications. SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.

Anemia and idiopathic intracranial hypertension – A coincidence or a correlation

Idiopathic intracranial hypertension (IIH) is commonly seen in females of reproductive age (15–45 years). Here, we report a unique case of a 22-year-old female presenting with complaints of headache and vomiting with a history of polycystic ovarian syndrome for which she was on treatment. The patient had bilateral optic disc edema on fundus examination. Hematological investigations showed severe iron deficiency anemia with hemoglobin 3.7 g/dl. Lumbar puncture showed raised cerebrospinal fluid opening pressure of 270 cm of H2O. Magnetic resonance imaging brain showed partially empty sella and T2 hyperintensity in optic nerve canal, suggestive of IIH. The patient was treated subsequently with blood transfusion followed by iron therapy. After treatment, she showed drastic improvement with the resolution of papilledema and normalization of visual field analysis. Our findings emphasize the importance of hematological investigations and prompt treatment in IIH, which ensure a better prognosis by shortening the disease course.

Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children.

Infants and small children face changing boundary conditions when treated with a ventriculoperitoneal shunt (VPS) for hydrocephalus. There are no systematic data describing shunt drainage behavior and changes over time in a growing child. Using a child-adapted patient simulator, the authors investigated the drainage behaviors of fixed differential pressure (DP) valves and adjustable valves with devices for preventing overdrainage in children of different ages. Three miniNAV DP valves with a 10-cm H2O medium-pressure setting (MN10) and three adjustable proGAV2.0 valves with a 25-cm H2O gravitational unit (GU) at low 5-cm H2O opening pressure (PG5) and medium 10-cm H2O opening pressure (PG10) settings were each investigated with a hardware-in-the-loop test bed. This test bed consisted of a posture motion mechanism and two pressure compartments that mimicked intracranial and abdominal pressures and was used to test the VPS under realistic in vitro conditions. Body orientation and length were physically set according to the child's age. The software simulated the physiological situations of children aged 1, 5, and 10 years. All valves were tested according to these specifications, with 5 runs for 1 hour each in the horizontal, vertical, and horizontal positions. Intracranial pressure (ICP) and VPS flow were measured, and the respective cerebrospinal fluid volume changes and ICP set value were computed. The drainage parameters increased with age in all valves in the vertical position, with that of MN10 being pronounced in the 1-year-old simulation. The GU values in PG5 and PG10 substantially reduced drainage compared with MN10. PG10 prevented drainage in the 1-year-old and 5-year-old setups, but there was some drainage at physiological ICP in the 10-year-old setup. In contrast, MN10 produced the largest decreases in ICP across all ages and positions, and overdrainage resulted in insufficient ICP recovery in the subsequent horizontal position. ICP levels were mostly constant with PG10 at all ages. This study shows that unprotected DP valves may lead to overdrainage in infants, whereas low-pressure GU valves can prevent overdrainage through 5 years and medium-pressure GU valves admit physiological ICP through at least 10 years. Therefore, devices for preventing overdrainage should be included in the first implanted shunt, and opening pressure should be adjusted as the child grows.

A study on design, development, optimization and validation of product development framework for humidifier chamber

The upper airways of the patients under Mechanical Ventilation (MV) cannot humidify the inspired air by themselves, while heat and moisture exchange remain the most important criteria. Insufficient humidification leads to multiple issues while humidifiers, the devices used to add water molecules, gas and temperature, are used in MVs. There is a need exists to develop a new humidifier that can achieve 99% humidity, cost-effective, adheres to ISO standards and compact with controlled design. The aim of the current study is to develop an optimized product development framework for designing the humidifier chamber and to define the product testing guidelines for verification and validation of the humidification chamber. By following a step-wise methodology, the researchers compared the existing samples in the market, conducted CFD analysis for optimization, developed the prototype and framed the guidelines for testing and validation of the humidification chamber. The study found the optimum specifications given herewith as per the outcomes; Inlet/Outlet (mm) should be 22 M, Compressible volume should be 300 ml, Maximum water capacity should be 130 ml while maximum peak flow should be 180 L/min. Further, the resistance to flow should be 10 cm of H2O and the diameter of chassis should be 120 mm. With the humidification chamber being made up of PP, PVC, Silicone and AL, the optimum weight of the chamber should be 125.6 g.

Comparison of Normal Saline and Alkalinized 2% Lignocaine to Reduce Emergence Phenomenon and Post-Intubation Morbidities: A Prospective, Double-Blind, Randomized Study.

Endotracheal intubation for airway management in general anesthesia is associated with post-intubation morbidities due to tracheal mucosa injury caused by endotracheal tube (ETT) cuff. Nitrous oxide (N2O) diffuses into tracheal tube cuffs filled with air. The rate of diffusion of N2O through the membrane is proportional to its concentration gradient. High-volume low-pressure cuffs expand with only a slight increase in pressure until fully inflated. At this point, owing to the inelasticity of the material, the cuff pressure rises rapidly. This increased pressure can damage the tracheal mucosa. This phenomenon can be avoided, if we inflate the cuff with either a liquid or a gas mixture identical to the inspired gas and monitor the cuff pressure and volume at regular intervals. When lignocaine is used to inflate the ETT cuff, it diffuses to the underlying tracheal mucosa. Thus reducing local irritation and inflammation of the airway through its local anesthetic action. Alkalinization of lignocaine increases its rate of diffusion across the ETT cuff. It also reduces the dose of local anesthetic required to achieve the desired result. We sought to determine the benefits of filling the ETT cuff with alkalinized lignocaine 2% over normal saline, to prevent ETT-induced emergence phenomenon and reduce the incidence of post-intubation morbidities like sore throat, hoarseness, and nausea. This prospective, randomized, double-blind, and comparative study was done at a multispecialty hospital. A total of 120 individuals ofAmerican Society of Anesthesiologists (ASA) physical status 1 and 2, posted for surgery under general anesthesia, were randomly selected and divided into two groups: alkalinized 2% lignocaine group (group L) and normal saline group (group S). After induction of general anesthesia, the airway was secured with appropriate-sized ETT. The ETT cuff was inflated with either of the study media. Continuous cuff pressure monitoring was done to keep cuff pressure below 30 centimeters of water (cm of H2O), at all times. At extubation, the response was evaluated in terms of percentage change in heart rate (HR) and blood pressure from baseline, coughing, bucking, and restlessness. All the surgeries lasted more than two hours. Post-operatively, the patients were evaluated for sore throat and hoarseness, at regular intervals of up to 24 hours. ETT cuff pressure was initially less in group S, which rose to a significantly higher level at extubation, compared to group L (p <0.001). At extubation, there was a significant increase in HR and systolic blood pressure (SBP) from baseline, in group S than in group L (p <0.001 and p=0.001, respectively).The incidence of cough and restlessness was less in group L, compared to group S (p<0.001 and p=0.002, respectively). Mean extubation time and emergence time was more in group S than in group L (p<0.001). Post-operatively, the incidence and severity of sore throat were significantly higher in group S than in group L (p<0.001). Meanwhile, the incidence of hoarseness and nausea was comparable in the two groups. Continuous ETT cuff pressure monitoring helps to keep cuff pressure below tracheal mucosa capillary occlusion pressure. Filling the ETT cuff with alkalinized lignocaine further reduces extubation response and post-intubation morbidities.

Simple CPAP (SIMPAP) for Neonatal Transport—Device Development and Proof of Concept Study

Objective: To develop a low-cost, easy to use CPAP device with a simple patient interface—SIMPAP. Design: This was an in vitro experimental study. SIMPAP was designed and developed over three iterations to be able to use in clinical studies. SIMPAP consists of intersecting cylinders with each opening performing a designated function. One of the openings serves as an extremely short expiratory limb that is fitted with a calibrated occlusion. This results in a nonrebreathing system that generates predetermined pressure against which the baby has to exhale. Main Outcome Measure: To analyze the pressures generated by the initial prototypes of the SIMPAP device. Results: Four SIMPAP bodies and four pressure relief valves were tested with different combinations as four exercises. Mean (–2Sd to +2SD) pressure generated at a flow rate of 1 liter was 3.4 (2.2-4.7) cm of H2O and at 2 liters per min flow was 5.7 (4.8-6.6) cm of H2O. The 95% limit of agreement between exercises 1 and 2 was –0.4 to +1 cm of H2O, and between exercises 1 and 3 and 1 and 4 was –1 to +1 cm of H2O across the pressure range. Conclusion: SIMPAP can deliver therapeutic CPAP at low gas flow rates. Further clinical studies are warranted to establish the efficacy and safety of this new device on neonates.

COMPARISON OF I-GEL WITH PROSEAL LMA IN ADULT PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANAESTHESIA WITHOUT PARALYSIS

Comparison Of I-gel With Proseal Lma In Adult Patients Undergoing Elective Surgical Procedures Under General Anaesthesia Without Paralysis Objective: Supraglottic airway devices (SADs) have been widely used as an alternative to tracheal intubation during general anaesthesia. They are easily inserted, better tolerated, with fewer hemodynamic changes. This study compares the efcacy of two supraglottic devices (LMA Proseal and I-gel) in elective surgical procedure under general anaesthesia without paralysis. Material and Method: A prospective randomized study was conducted on 40 patients who were posted for elective short surgical procedures under general anaesthesia. They were randomly divided into two groups of 20 patients each, Group I (I-gel) and Group P (PLMA). All the patients were induced with general anaesthesia and the planned SAD was inserted with head in neutral position. Ease of insertion, number of insertion attempts, oropharyngeal seal pressure and incidence of adverse effects were assessed. Results: I-gel was signicantly easier to insert than Proseal (P &lt; 0.05). The mean time for insertion was more with Group P (40.8±09.61 secs) than with Group I (29.63±08.13 secs). Although the airway sealing pressure was signicantly higher with Group P (26.63±1.31 cm of H2O), the airway sealing pressure of Group I (20.97 ± 2.14 cm of H2O) was within normal limit. The success rate of rst attempt insertion was more with Group I. There was no evidence of airway trauma, regurgitation, and aspiration. Sore throat was signicantly more evident in Group P. Conclusion: I-Gel is better supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence, I-gel is better alternative than Proseal LMA.

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE

Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study.

Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10-cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2-10 years, undergoing LAP were randomized to receive PEEP of 5- or 10-cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.

Implementation of Early Rehabilitation in Severe COVID-19 Respiratory Failure: A Scoping Review.

PubMed, EMBASE, and CINAHL databases were searched from January 1, 2020, through April 1, 2022. Selected studies included individuals hospitalized with severe COVID-19 and provided objective criteria for clinical decision making for mobility interventions. A total of 1464 publications were assessed for eligibility and data extraction. The PRISMA-ScR Checklist and established guidelines for reporting for scoping reviews were followed. Twelve articles met inclusion criteria: 5 CPGs and 7 implementation articles. Objective clinical criteria and guidelines for implementation of early rehabilitation demonstrated variable agreement across systems. No significant adverse events were reported. Sixty percent (3/5) of CPGs restrict mobility for individuals requiring ventilatory support of more than 60% Fio2 (fraction of inspired oxygen) and/or positive end-expiratory pressure (PEEP) greater than 10-cm H2O (positive end-expiratory pressure). Preliminary evidence from implementation studies may suggest that some individuals with COVID-19 requiring enhanced ventilatory support outside of established parameters may be able to safely participate in mobility-related interventions, though further research is needed to determine safety and feasibility to guide clinical decision making.

ANALYSIS OF THE BASKA MASK VERSUS PROSEAL LARYNGEAL MASK AIRWAY SEALING PRESSURE IN PATIENTS POSTED FOR LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

Background: Airway management by anaesthesiologist has come a long way from the invention of endotracheal intubation. Invention of supraglottic airway devices (SAD) provided alternative airway, without hazards of direct laryngoscopy and intubation. First generation SAD was considered airway tubes, and hence modications were made to them. PLMA (Proseal laryngeal mask airway) is a second generation SAD which has a gastric port along with the airway tube. BASKA mask is a novel 3rd generation SAD. We designed this study to compare the clinical efcacy of BASKA mask and PLMA for time for insertion, ease of insertion, airway sealing pressure and complications in anaesthetised patients undergoing positive pressure ventilation under general anaesthesia. The present randomi Methodology: zed control trial was conducted in 60 ASA-1 and ASA-2, aged between 18-60 years posted for elective laparoscopic surgeries under general anaesthesia. Patients were allocated into two equal groups, Group B-BASKA mask (n=30) and Group P- PLMA (n=30). All the data Collected were analysed. The demographic data, duration of insertion and airway sealing pressure were analysed using unpaired't' test. In our study we observed that, BASKA mask took lesser time to ins Results: ert in comparison to PLMA, the mean duration of insertion was 16.77±2.14 sec in BASKA Mask and 25.40±3.04 sec in PLMA Group. This difference was statistically signicant (p &lt; 0.0001). The Mean airway sealing pressure was 33±2.31 cm of H2O in BASKA mask group and 27.00±1.84 cm of H2O in PLMA Group, after 5 min of insertion and 31.33±2.06 cm of H20 in BASKA Mask and 26.90±1.79 cm of H2O in PLMA Group after 5 min of pneumoperitoneum. The airway sealing pressure was more in BASKA group which was statistically signicant both after 5 min insertion and 5 min of pneumoperitoneum. There were no signicant mean airway sealing pressures between 5 min after insertion and 5 min after pneumoperitoneum in both the groups. The ease of insertion was more in BASKA mask but it was statistically insignicant. The Laryngopharyngeal morbidity score between these groups were statistically insignicant. To conclude, we observed that BASKA mask took lesser time to insert Conclusion: than PLMA in anaesthetized paralysed adult patients. Mean airway sealing pressure was higher in BASKA mask than PLMA. The ease of insertion was more in BASKA mask but it was statistically insignicant. The LPM score between these groups were statistically insignicant.

Comparison of the clinical performance of I-Gel and ambu aura gain-supra-glottic airway devices in paediatric patients under controlled ventilation

: I-Gel and Ambu Aura Gain are two novel second generation supra-glottic airway devices available for airway management and can be used safely and effectively in paediatric patients under controlled ventilation with adequate airway seal. The aim of our study was to compare efficacy of I-Gel and Ambu Aura Gain in providing safe and adequate airway seal in paediatric patients under controlled ventilation. A prospective, randomized, single blind clinical study was carried out on total 60 paediatric patients with ASA grade I &amp; II, 3-10 years age, undergoing surgery under general anaesthesia. The patients were randomly assigned into Group I (I-Gel) (n=30) and Group-A (Ambu Aura Gain) (n=30) using randomizer software. I-Gel was inserted using “finger technique” and Ambu Aura Gain with simple insertion technique. We assessed effective airway insertion time, time required for insertion of the device, ease and number of attempts for airway and gastric tube insertion, oropharyngeal leak pressure, haemodynamic parameters and complications. Statistical analysis was done using the MedCalc software, student’s paired t- test, unpaired t-test and chi-square test. Effective airway insertion time (p=0.1671), ease and numer of airway insertion attempts were comparable amongst both groups. Oropharyngeal leak pressure was significantly higher in group I (22.366±1.4735 of H2O) than in group A (20.8±1.01 cm of H2O), p value = 0.0001. Airway seal of Ambu Aura Gain is lesser compared to I-Gel. I-Gel can be used with better safety and efficacy for controlled ventilation in paediatric patients. I-Gel provides higher oropharyngeal seal pressure, which gives higher safety against risk of aspiration and air leak than Ambu Aura Gain, yet oropharyngeal seal pressure of Ambu Aura Gain is adequate that it allows its use during controlled ventilation under general anaesthesia. Hence, both devices can be used alternatively.