RESUMEN
Introduction: Most cardiac surgeries are performed through a median sternotomy, of which 49% of these patients experience severe pain at rest postoperatively and up to 78% on coughing and deep breathing. Regional thoracic wall blocks targeting thoracic nerve roots improve the analgesia quality and limit opioid use. Truncal blocks through the posterior approach can often be cumbersome in patients with multiple lines and catheters. Pecto-Intercostal Fascial Plane Block (PIFB) can be a convenient alternative for achieving comparable analgesia. Material and methods: The patients were randomly assigned to receive either an ultrasound-guided Pecto-Intercostal Fascial Plane Block (PIFB) or Erector Spinae Plane Block (ESPB). The outcomes measured and compared postoperative pain scores at rest and on deep breathing at 2, 6, 12, 24 h, total opioid (fentanyl) consumption in the postoperative period, time to rescue analgesia and total rescue analgesic doses required, between the two groups. Results: Data from 30 patients were analysed. Post-operative pain scores at rest and during deep breathing were found to be comparable in both groups. The total opioid consumed, time to rescue analgesia and total doses of rescue analgesia was not found to be statistically different in the two groups. Conclusions: PIFB was found to be comparable to ESPB in alleviating post-operative pain in patients who underwent cardiac surgeries through sternotomy. And it/PIFB can be a quicker alternative to posterior truncal blocks since it can be safely given in a supine position with an ultrasound.
RESUMEN
Floppy epiglottis in an adult is rare and often pathological. Airway obstruction caused by floppy epiglottis in an adult is rarely reported. Neck mass, however, can affect the airway in many ways; however, inducible upper airway obstruction by extra-laryngeal neck mass is hardly been reported. In most of the instances of inducible laryngeal obstruction, the tumor is found in and around the laryngeal inlet. Herein, we report such an unusual incident happened to a 40-year-old gentleman, a case of oral carcinoma for 3 months and a rapidly increasing swelling (6 × 5 cm) over the right side of the neck for 8 days. He presented to us for emergency tracheostomy with the feature of acute upper airway obstruction, unable to lie down; and having difficulty in breathing, desaturation, and chocking even in propped up position. The case highlights the importance of clinical findings and difficulties faced for airway management in such patients.
RESUMEN
Use of nitrous oxide (N2O) as an anaesthetic gas has been on contradicting views for various reasons; operating room (OR) pollution and occupational exposure is one of those controversies. The present pilot experiment was planned to analyze the anaesthesia gas waste at the machine end of scavenging outlet and calculate the probable portion of N2O in the OR air, which is likely to help us in informed decision making. Anaesthesia gas waste was sampled at the machine end of scavenging outlet and was connected directly and analyzed using a gas analyzer attached to Mindray A7 anaesthesia workstation. An assembly of L connector, sampling line, corrugated tube and endotracheal tube were used to perform the procedure. The measurements were taken at 600, 1200 and 1800 mL/minutes of fresh gas flow (FGF). A total of 15 paired readings from five general anaesthesia cases were taken. The N2O percentage in the anaesthesia waste gases with a FGF of 600, 1200 and 1800 mL was 3.4 ± 0.54, 8.2 ± 0.83 and 14.0 ± 0.70, respectively. On calculation, the likely concentration of N2O in OR with FGF of 600 mL/min is 0.576 ppm, which will lead to the time weighted average 4.6 ppm exposure per day in modular OR. Reducing FGF to 600 mL/min reduces the N2O concentration in OR by 75% as compared to the FGF of 1800 mL/min. The time weighted average exposure to N2O is far below the permissible limit in modular OR.