Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

Background

Prehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations.

Methods

This prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded.

Results

Differences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better.

Conclusion

Considering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

Comparative evaluation of effects of intrapleural block with adjuvants on analgesia and pulmonary function after intercostal drainage: A pilot study

Background

Inter-costal chest drain (ICD) used for varied thoracic pathologies causes continuous pain and irritation of the pleura, which limits respiratory efforts and impairs ventilatory function. Intrapleural block deposits local anaesthetic between the layers of pleura and may improve ventilatory function especially in non surgical patients.

Methods

Twenty eight ASA I-III patients treated with ICD, who could perform incentive spirometry, were included for study. They were randomized to 'Group C' (control group); 'Group B' (Bupivacaine); 'Group M' (Bupivacaine + Morphine) and 'Group D' (Bupivacaine + Dexmedetomidine). The drugs were administered via the ICD itself and clamped thereafter for 15 min. The success of the block was assessed by time for first analgesic demand, maximum inspiratory volume generated and Numerical Rating Scale score for pain; by patients.

Results

Effective analgesia was observed in Group B, M and D. Addition of an adjuvant significantly prolonged time for rescue analgesic demand. Patients who received local anaesthetic alone or with an adjuvant had significantly improved maximal inspiratory volume and required lesser rescue analgesics. No significant complications were observed in any group. Pain relief in post-surgical patients using intraplural block is masked by systemic analgesics. However its application in patients with ICD for non surgical indications was explored in this study and was found to improve patient comfort and ventilation.

Conclusion

Intra-pleural blockade is safe and effective in relieving the constant pleural irritation and pain of ICD, thus enabling the patient to improve ventilatory effort and faster recovery of respiratory function.

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

BACKGROUND

Intravenous regional anaesthesia (IVRA) has been successfully used as a sole technique for forearm fractures and has high success rates. However, it is uncomfortable for the patient when the fresh fracture is manipulated for conduct of IVRA. Haematoma block (HB) has also been demonstrated as an effective anaesthetic technique for treatment of radial fractures in the ER. Unfortunately, HB does not provide muscular relaxation and may not be sufficient for operative intervention.

METHODS

An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.

RESULTS

100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery.

CONCLUSION

The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications.

Assessment of clonal fidelity of Tylophora indica (Burm. f.) Merrill "in vitro" plantlets by ISSR molecular markers

Tylophora indica Burm F. Merrill. is widely used against various diseases owing to the presence an array of medicinally important secondary metabolites. Its stem is bitter, stomachic, stimulates bile secretion, enriches the blood and cures diseases like diabetes, fever, flatulence, hypertension, jaundice, leucorrhoea, urinary disease and upper respiratory tract infection. It is neglected for tissue culture work because of deciduous nature of climbing shrub, facing problems for micropropagation. Hence, in vitro regeneration of complete plantlets was done through indirect organogenesis in Tylophora indica. Calli were produced from in vivo leaves of T. indica on MS medium supplemented with 6-Benzylaminopurine (BAP: 2.0 mg l(-1)) and Indole-3-butyric acid (IBA: 0.5 mg l(-1)). The multiple shoots (12.00 ± 1.50) emerged and elongated on MS medium fortified with Thidiazuron (TDZ: 0.1 mg l(-1)). They were rooted on half strength MS medium having IBA (0.5 mg l(-1)) (7.75 ± 0.25) after 20 days of sub-culturing followed by hardening and acclimatization. During indirect regeneration of plants, chances of somaclonal variations may arise. These variations should be identified to produce true to type plants. Plantlets raised through tissue culture were used to validate the clonal fidelity through Inter simple sequence repeat markers (ISSR). Clonal fidelity is a major consideration in commercial micropropagation using in vitro tissue culture methods. During the study, total 71 clear and distinct bands were produced using 6 primers. The banding pattern of each primer was uniform and comparable to mother plant and showed about 93% homology using un-weighted pair group method with arithmetic averaging (UPGMA). ISSR analysis confirmed the genetic stability of in vitro raised plants.

Role of gray scale and color Doppler in differentiating benign from malignant ovarian masses

Objectives:

To evaluate prospectively the relative usefulness of color Doppler and gray scale sonography in differentiating benign from malignant ovarian masses and evaluation of scoring systems Sassone and Alcazar for differentiating benign from malignant ovarian masses.

Methods:

Study was conducted during the period of Jan 2006 to Oct 2007 in department of obstetrics and gynaecology, New civil Hospital, Surat. The study was conducted mainly with the help of department of radio-diagnosis. The study include 100 patient clinically suspected to have ovarian neoplasm and referred to department of radio-diagnosis where evaluation with Ultrasonography and Doppler was done. The efficacy of scoring systems were evaluated by histopathological examination of mass or fine needle aspiration cytology or presence of malignant cells in ascetic fluid.

Results:

Sassone's scoring system was able to identify 72 out of 78 benign masses and 18 out of 22 malignant masses.where as Alcazar system with use of colour Doppler was able to identify 75 out of 78 benign and 21 out of 22 malignant ovarian masses. Sensitivity and specificity of sassone is 81.8%,92.3% respectively, where as that of Alcazar is 95.5%, 96.2% respectively.

Conclusion:

Using both gray scale and colour Doppler in differentiating benign from malignant ovariam masses is giving results with more accuracy and Alcazar system is better performing than sassone's scoring systems.

Small cell carcinoma of the gall bladder: case report and review of literature

Small cell carcinoma of the gall bladder is a very rare tumor. The neoplasm is highly lethal, metastasizes early, and may cause death shortly after diagnosis. Here we report a 56 year old male with small cell carcinoma of the gall bladder metastatic to the liver. He attained partial remission with 5 fluouracil, cisplatin based chemotherapy. However, the disease progressed after 3 months and salvage chemotherapy with docetaxel and caboplatin failed to produce any tumour response. He succumbed to the illness 13 months after cholecystectomy.

Ride vibration on tractor-implement system

India is the largest manufacturer of tractors in the world. They are used for primary and secondary tillage operations and as a means of transportation. Vibration in tractor driving can cause deafness and disorders of the spinal column and stomach. The effect of implements on tractor ride is not well understood in India. The present study was undertaken to quantify ride vibration of a low horsepower tractor-implement system. Tractor ride vibration levels have been measured at the person-seat interface along three mutually perpendicular axes, longitudinal, lateral and vertical, under different operating conditions. It was observed that the acceleration levels increased as forward speed of travel increased under most of the operating conditions. There was no conclusive difference in measured acceleration levels on a tar-macadam road and a farm road during transport mode. The measured ride vibration levels under different operating conditions were evaluated as per ISO 2631/1 (1985), Geneva, and BS 6841 (1987), London, standards. On the basis of this study, it is concluded that the exposure time for the tractor operator should not exceed 2.5 h during ploughing and harrowing operations. Increasing exposure time may cause severe discomfort, pain and injury.

Sarcoma-like nodule in ovarian mucinous tumour (a case report)

Sarcoma-like mural nodule, a morphologically benign epulis-like tumour with osteoid formation in the wall of mucinous tumour of borderline malignancy is described. The pattern simulated those of malignant giant cell tumour of soft part and was considered to be a reactive process that has no effect on the prognosis of the patient. This case, second to be reported from India and is in addition to the other thirteen cases reviewed. The case under report had in addition osteoid-formation which have not been reported in the literature.

Fine needle aspiration biopsy--a critical investigation in thyrotoxicosis

Four hundred and fifty two patients having clinical features of thyrotoxicosis have been studied for their hormonal (T4, T3 and TSH) content, I131 uptake levels and FNAB at repeated intervals. Four hundred and twenty seven had presented with diffuse enlargement and rest 25 cases with nodular enlargements. Of the primary hyperthyroidism cases 342 (82.4%) were of Grave's disease without exophthalmos and 73 (17.6%) with exophthalmos. T4, T3 and I131 uptake levels have correlated well with the degree of morphological changes as observed on FNAB. Degree of nuclear pleomorphism has correlated well with the duration of disease. Critical evaluation of morphological changes on FNAB has been done in all cases of primary hyperthyroidism being treated with neomercazole and radioactive iodine therapy. Treatment with neomercazole had shown, good correlation between time lag and the retrogressive changes. This was not so in cases treated with radioactive iodine therapy. Various known complications of radioactive treatment e.g. development of hypothyroidism, refractory and recurrent hyperthyroidism, exacerbation of the disease, radiation thyroiditis, and severe degree of dysplastic changes could be demonstrated in some cases on serial aspirations.

Lupus nephritis--light, electron and immunofluorescent microscopy (a clinicopathological study)

Kidney biopsy specimens from nine patients of systemic lupus erythematosus were studied for the purpose of correlating the findings of light and electron microscopy and immunofluorescent studies with the kidney functions and the presence of proteinuria. Morphologically, three were mesangiocapillary glomerulonephritis, three mesangioproliferative glomerulonephritis and one membranous nephropathy. Subendothelial deposits were observed in eight cases, subepithelial deposits in seven cases and mesangial deposits in eight cases. Four cases with massive subendothelial deposits had massive proteinuria and decrease in renal functions. Most of the patients with mild subendothelial deposits were considered to be useful in assessing the prognosis and severity of lupus nephropathy, in addition to the morphologic types of lesions, as mesangial pattern had shown insignificant proteinuria. Study of semithin sections by light microscopy could demonstrate the deposits which were observed on electron microscopy and immuno-fluorescent microscopy.

Multiple Keratoacanthoma

A rare case of multiple keratoacanthoma involving the right lower limb is reported along with brif review of literature.

Study of the Skin in the Viciniw of Well Merginated Lesions of TT and BT Leprosy

Well-defined margin in a patch of leprosy indicates good cell mediated immunity (CMI) and containment of the disease process within the lesion. A study was hence undertaken to ascertain if histological changes in well marginated lesion are confined to the involved area alone or extend into the surrounding normal looking skin.