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Introduction: The Skin-to-Epidural Space Distance (SESD) is likely to be different at two different parts of the spine in the same individual and also in the same part of the spine in two different individuals. The knowledge of the expected depth of the epidural space can be very useful in placing the epidural needle appropriately and avoiding unwanted dural puncture. Although many studies have been conducted to study the relation of lumbar SESD with various physical and anthropometric parameters, the literature on thoracic SESD is scant. Aim: To determine the correlation between SESD and Abdominal Girth (AG) in the mid-thoracic, lower thoracic, and lumbar regions of the spine in adult patients scheduled for elective surgical procedures. Materials and Methods: After obtaining Ethics Committee clearance (EC/NIMS/2671/2020, 51st ESGS No: 1082/2020), this prospective observational study was carried out at Nizam's Institute of Medical Sciences, Hyderabad, India, from October 2021 to February 2022. The study recruited 202 patients, and data from 194 patients was analysed. During the preoperative visit, all physical parameters, including AG, were noted. Using an 18G Tuohy needle, the epidural space was identified, and SESD was measured. Its correlation with AG, age, height, weight, and body mass index was studied. The data was analysed using the Statistical Pacakge for Social Sciences Software (SPSS) (2011, IBM, Armonk, NY, United States of America) version 20.0. Results: The mean SESD was 4.7±1.09 cm in the mid-thoracic region, 4.71±0.98 cm in the lower thoracic region, and 4.8±0.82 cm in the lumbar region. The correlation coefficient of SESD with AG was 0.42, 0.44, and 0.78 in the mid-thoracic, lower thoracic, and lumbar regions, respectively, and the significance level was <0.001 in all three regions. Body weight had a good correlation (r-values of 0.56, 0.66, 0.53 in mid-thoracic, lower thoracic, and lumbar areas, respectively, and p-value of <0.001 in all three anatomical regions of the spine) with SESD. All other physical parameters were correlated weakly with SESD. Conclusion: AG has a strong correlation with SESD in the lumbar area but a moderate correlation in the thoracic spine. SESD in the lumbar, mid, and lower thoracic regions have a good correlation with weight. [ABSTRACT FROM AUTHOR]

Byline: Archana. Pathy, Prachi. Kar, Ramachandran. Gopinath, Divya. Gubba, N. Rani, A. Kanimozhi Background and Aims: Preoperative risk stratification helps in better prognostication and allocation of resources. However, risk scoring [...]

Byline: Prachi. Kar, K. Sudheshna, Durga. Padmaja, Archana. Pathy, Ramachandran. Gopinath Background and Aims: Chronic post thoracotomy pain (CPTP) is a nagging complication and can affect quality of life (QOL). [...]

Background and Aims: The manipulation of urinary tract, the mandatory requirement of ureteral stenting, and bladder catheterization in patients undergoing percutaneous nephrolithotomy (PCNL) produces significant pain and dysuria postoperatively. The present study compared the efficacy of pregabalin with placebo in attenuation of these symptoms in patients undergoing PCNL. Material and Methods: This randomized controlled study was conducted in 110 patients of either sex, aged 18–65 years undergoing elective PCNL requiring nephrostomy tube under general anesthesia. Group G (n: 53) received pregabalin 150 mg and Group P received placebo (n: 49) orally 1 h before the anesthetic induction. All the patients received standard anesthetic protocol. Pain at the site of nephrostomy, instrumentation-induced dysuria (IID), anxiety, and sedation scores were recorded at 0 min, 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h postoperatively. Hemodynamics, total requirement of rescue analgesia, and incidence of any adverse effects were also noted. Results: Patients were demographically comparable between the two groups. There is no difference in nephrostomy site pain between the groups at different points of measurements. IID was less with pregabalin at 0 min, 15 min, 30 min, 1 h, and 2 h after extubation (P value < 0.05, 43% in Group G vs. 68% in group P). Severe urgency was seen in 4%, moderate in 31%, and mild in 33% of patients in placebo group. No patient in pregabalin had severe grade of instrumentation-induced dysuria score (P < 0.05). Patients in Group P required more rescue analgesic (P: 0.009). Anxiety scores, sedation scores, and hemodynamic parameters were comparable. Conclusion: A single dose of 150 mg pregabalin as oral premedication given 1 h before surgery reduced the incidence and intensity of IID compared to placebo in patients undergoing PCNL without significant adverse effects. [ABSTRACT FROM AUTHOR]

Background and Aims: The Airtraq DL™ is a prototype channeled video laryngoscope, designed specifically for endobronchial intubation with a double-lumen tube (DLT). Evidence on its superiority over Macintosh laryngoscope for DLT placement in the difficult airway is limited. This study compared the efficacy of both these laryngoscopes in the simulated difficult airway. Methods: A prospective randomised controlled study was conducted on 52 patients undergoing elective thoracic surgery with lung isolation using a left-sided DLT. The patients were randomised into Airtraq DL™ group (group A) and Macintosh group (group M). The primary objective was to compare the time required for intubation, and the secondary objectives were to evaluate time to best glottic view, Cormack–Lehane (CL) grading, intubation difficulty score (IDS), manoeuvres, attempts at intubation, haemodynamic response and complications. Operating anaesthesiologists were also asked to grade the ease of laryngoscopy and intubation for both devices on a 4-point Likert scale. Results: The mean time to intubation was found to be lesser in group A than in group M (18 ± 6.91 s vs 25.48 ± 9.47 s, P = 0.003). Group A showed better CL grading (P ≤ 0.001), lesser requirement of manoeuvres (P = 0.02) and lower IDS (P = 0.003). Also, group A had significantly better Likert scale results as compared to group M. Conclusion: The Airtraq DL™ is superior to Macintosh laryngoscope as it requires lesser time for intubation and provides favourable intubating conditions (better CL grading, lesser manoeuvres, lower IDS and improved Likert scales) for double-lumen placement in the simulated difficult airway. [ABSTRACT FROM AUTHOR]

Byline: Prachi. Kar, Kanithi. Geeta, Ramachandran. Gopinath, Padmaja. Durga Background and Aims: Risk Stratification has an important place in cardiac surgery to identify high-risk cases and optimally allocate resources. Hence [...]

Byline: Prachi. Kar, Suresh. Chintha, Padmaja. Durga, Ramachandran. Gopinath Sir, Pectus carinatum is a chest wall deformity that occurs less frequently and surgical correction for this chest wall deformity is [...]

Byline: Prachi. Kar, Ramachandran. Gopinath, Padmaja. Durga, R. Kumar Introduction Hypertrophic cardiomyopathy (HCM) is an obstructive cardiac disorder which has autosomal inheritance and constrictive pericarditis (CP) is acquired in nature. [...]

Background: Thoracic epidural analgesia offers effective perioperative pain relief in patients undergoing thoracotomies apart from attenuating stress responses. It helps in fast tracking by facilitating early mobilization and improving respiratory function. Literature on high (T1-T2 level) thoracic segmental analgesia for thoracotomy is less.Aim: The aim of present study was to compare the ease of insertion, effect on pain relief in high (T1-T2 level) vs mid (T5-T6) approach of thoracic epidural.Setting and Design: The present study was a randomized control trial conducted at our institute.Materials and Methods: About 52 patients aged between 18-65 years scheduled for elective thoracotomies under general and thoracic epidural anesthesia were randomized into two groups. Intraoperatively ease of epidural insertion, extent of blockade, and postoperatively pain relief were assessed. Ropivacaine with fentanyl was used for epidural analgesia.Statistical Analysis: Data were presented as mean ± standard deviation and analyzed by the Student's t test, Chi-square test, and non-parametric test whereever applicable. A P value <0.05 was considered statistically significant.Results: We observed that high thoracic epidural anesthesia was easier to place (time taken 123.42 vs 303.08 s) P < 0.05, with less number of attempts (1.27 vs 1.92) P < 0.05. Extent of blockade, postoperative pain scores, rescue analgesia requirement, hemodynamics, and oxygenation were comparable.Conclusion: We conclude that high thoracic epidural is easier to insert, provides adequate pain relief, and stable hemodynamics with the advantage of patient comfort and safety. [ABSTRACT FROM AUTHOR]

Context: Choosing appropriate-size double-lumen tube (DLT) has always been a challenge as it depends on existing guidelines based on gender, height, tracheal diameter (TD), or personal experience. However, there are no Indian data to match these recommendations.Aim: To find out whether the size of DLT used correlates with height, weight, TD, or left main stem bronchus diameter (LMBD). We also documented clinical consequences of any of our current practice.Setting and Design: Single-center observational pilot study.Subjects and Methods: Prospective, observational study of 41 patients requiring one-lung ventilation with left-side DLT. The choice of DLT was entirely on the discretion of anesthesiologist in charge of the case. Data were collected for TD, LMBD, height, weight, age, sex, and amount of air used in the tracheal and bronchial cuff. Any intraoperative complications and difficulty in isolation were also noted.Statistical Analysis: The statistical analysis was done with the National Council of Statistical Software version 11.Results: Average TD and LMBD were 16.5 ± 0.9 and 10.7 ± 0.8 mm for males and 14.2 ± 1.1 and 9.4 ± 1.1 mm for females, respectively. There was a weak correlation between DLT size and height (R2 = 0.0694), TD (R2 = 0.3396), and LMBD (R2 = 0.2382) in the case of males. For females, the correlation between DLT size and height (R2 = 0.2656), TD (R2 = 0.5302), and LMBD (R2 = 0.5003) was slightly better.Conclusion: Although there was a weak correlation between DLT size and height, TD, and LMBD, the overall intraoperative outcome and lung isolation were good. [ABSTRACT FROM AUTHOR]

Introducton: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy. Aim: The current study sought to identify a clinically relevant cut off value of eGFR for identifying thoracotomy patients at higher risk for MACCE. Materials and Methods: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=60-89.9; Stage 3a, eGFR=45-59.9; Stage 3b, eGFR=30-44.9; Stage 4, eGFR=15-29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality. Results: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR. It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001).The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR. Conclusion: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial. [ABSTRACT FROM AUTHOR]

Background and Aims: The Airtraq DL ™ is a prototype channeled video laryngoscope, designed specifically for endobronchial intubation with a double-lumen tube (DLT). Evidence on its superiority over Macintosh laryngoscope for DLT placement in the difficult airway is limited. This study compared the efficacy of both these laryngoscopes in the simulated difficult airway., Methods: A prospective randomised controlled study was conducted on 52 patients undergoing elective thoracic surgery with lung isolation using a left-sided DLT. The patients were randomised into Airtraq DL ™ group (group A) and Macintosh group (group M). The primary objective was to compare the time required for intubation, and the secondary objectives were to evaluate time to best glottic view, Cormack-Lehane (CL) grading, intubation difficulty score (IDS), manoeuvres, attempts at intubation, haemodynamic response and complications. Operating anaesthesiologists were also asked to grade the ease of laryngoscopy and intubation for both devices on a 4-point Likert scale., Results: The mean time to intubation was found to be lesser in group A than in group M (18 ± 6.91 s vs 25.48 ± 9.47 s, P = 0.003). Group A showed better CL grading ( P ≤ 0.001), lesser requirement of manoeuvres ( P = 0.02) and lower IDS ( P = 0.003). Also, group A had significantly better Likert scale results as compared to group M., Conclusion: The Airtraq DL ™ is superior to Macintosh laryngoscope as it requires lesser time for intubation and provides favourable intubating conditions (better CL grading, lesser manoeuvres, lower IDS and improved Likert scales) for double-lumen placement in the simulated difficult airway., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Anaesthesia.)