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   Table of Contents - Current issue
Coverpage
September-December 2016
Volume 10 | Issue 3
Page Nos. 45-68

Online since Friday, February 17, 2017

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ORIGINAL ARTICLES  

Licorice versus ketamine gargle for postoperative sore throat due to insertion of a double-lumen endobronchial tube Highly accessed article p. 45
Ahmed Nabil Ibrahim, Sherif Anis
DOI:10.4103/1687-9090.200283  
Background Postoperative sore throat (POST) is common after tracheal intubation, especially with double-lumen endobronchial tube (DLT). Licorice has many uses such as dental hygiene and in sore throat. Ketamine gargle is a newly proposed adjunct for reducing the incidence of POST in anesthesia. The aim of this study was to determine the efficacy of licorice and ketamine gargles in patients undergoing the insertion of DLT in preventing POST within 24 h. Methods This prospective, randomized, double-blind study included 90 patients undergoing thoracic surgery requiring DLT for one-lung ventilation. Patients were randomized to three groups (n=30) and were asked to gargle for 1 min to 15 min before operations. Group A received ketamine gargle (0.5 mg/kg ketamine in 30 ml of dextrose water 20%), group B received licorice gargle (500 mg licorice powder in 30 ml of dextrose water 20%), and group C (the control group) received 30 ml of dextrose water 20% gargle. Assessment of patients for the incidence and the severity of POST and any side effect was carried out in the recovery room. Sore throat (yes/no) and severity of its pain measured using visual analogue scale were recorded at baseline in the recovery room and then at 2, 4, and 24 h after operation with a specified questionnaire. Results The incidence of sore throat was significantly higher in group C at all time points in comparison with the other two groups. There was a marked decrease in the incidence of sore throat in groups A and B, with no significant difference between them. The severity of POST pain was significantly higher in group C when compared with the other two groups, with no significant difference between them and with no complications. Conclusion Ketamine and licorice gargles decrease the incidence and severity of sore throat occurring postoperatively due to DLT intubation, with no significant differences between them.
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The role of dexmedetomidine in fast-track extubation for closed congenital heart surgery in children: a randomized double-blinded placebo-controlled trial p. 50
Passaint H Fahim, Mai A Madkour
DOI:10.4103/1687-9090.200281  
Background The definition of early extubation is not well-established; some authors extended its time to 24 h postoperatively. In our study, we tried to extubate the patients by the end of the surgery. We investigated the role of dexmedetomidine use during induction of anesthesia in the improvement of outcomes with fast-track extubation in children undergoing cardiac surgery. We assumed that the use of dexmedetomidine will help in extubating the patients at the end of operation with decreased use of inhalational anesthetic and fentanyl, thus improving oxygenation and decreasing the need for analgesia postoperatively. Patients and methods A study was conducted in a population of 84 pediatric patients scheduled for closed congenital heart surgery. Patients were randomly allocated to two groups: group D (42 patients), which received a single dose of dexmedetomidine 0.4 mg/kg over 10 min in the induction of anesthesia, and group C (42 patients), which received normal saline. Both groups were compared in relation to percentage of extubated patients by the end of the surgery as primary outcome. Hemodynamics (mean arterial blood pressure and heart rate), sevoflurane consumption, fentanyl consumption, incidence of postoperative infection, and length of ICU stay were recorded. Arterial blood gases were analyzed before extubation and in the ICU 1 and 3 h after transfer to the ICU. Results Compared with the control group, group D showed lower intraoperative sevoflurane and fentanyl consumption (14.2±2.9 vs. 37.8±24.1, P<0.01; 48±12.5 vs. 85.2±43.2, P<0.01). The blood pressure at T1 and T2 showed a statistically significant decrease compared with baseline (P=0.05 and 0.01, respectively) and heart rate showed a significant decrease (P=0.05) at T1 and (P<0.01) at T2. Group D showed a higher incidence of successful extubation (64 vs. 26.7%, P=0.04) and higher pO2 after extubation (82±28.45 vs. 68±0.23, P=0.04). The length of ICU stay was lower in group D (1.8±0.8) compared with 5.5±3.2 in the control group (P<0.01), and the incidence of postoperative infections was lower in group D compared with group C (29.4 vs. 65.2%, P=0.04). Conclusion Adding dexmedetomidine as an adjuvant to induction of anesthesia in children undergoing congenital heart surgery improved the success of extubation, the oxygenation, and decreased the length of hospital stay.
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CASE REPORTS Top

Intraoperative ventilation strategy in a patient with empyema thoracis complicated by bronchopleural fistula p. 57
Soma Bhattacharya, Prakash K Dubey, Rupam Kumari
DOI:10.4103/1687-9090.200284  
Bronchopleural fistulae (BPF) are communications between the bronchioles of the respiratory tract and pleural space. No consensus has been established for the management of BPF due to varied presentation. We report the successful use of one lung ventilation with left sided double lumen tube in a patient with BPF following recurrent thoracic empyema, posted for decortications & repair under general anaesthesia. This case was unique as the patient had restrictive lung disease on the left side due to fibrosis of pleural space and mediastinum following tuberculosis. There were features of obstructive lung disease on the right side due to compensatory emphysema. We had to work up an individualised ventilatory strategy focussed on the better lung to cater to the unique need of our patient that turned out to be safe & effective. Lung protective ventilatory strategy along with proper postoperative management helped in early recovery of the patient.
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Pulmonary endarterectomy under intermittent deep hypothermic circulatory arrest p. 60
Shilpa Tiwari, Rajnish K Jain, Yogesh Niwariya, Sarika Katiyar
DOI:10.4103/1687-9090.200282  
Chronic thromboembolic pulmonary hypertension occurs in very few patients after acute embolism, and pulmonary thromboendarterectomy is the main and curative treatment. Here we have a patient with a chronic thrombus in the pulmonary artery that required thromboendarterectomy with deep hypothermic circulatory arrest.
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Role of transesophageal echocardiography for intraoperative decision-making in double-chamber right ventricle with ventricular septal defect and absent pulmonary valve p. 64
Neeti Makhija, Ira Dhawan, Ajay K Jha, Sachin Talwar
DOI:10.4103/1687-9090.200285  
Absent pulmonary valve is a variant of tetralogy of Fallot, characterized by small or rudimentary, stenotic or regurgitant pulmonary valve with dilated pulmonary artery. It is uncommonly associated with double-chamber right ventricle. We hereby report a case with preoperative diagnosis of ventricular septal defect with pulmonary stenosis based on routine transthoracic echocardiography. Intraoperatively, transesophageal echocardiography showed a rare combination of double-chamber right ventricle in association with ventricular septal defect and absent pulmonary valve, which was confirmed during surgery.
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INVITED COMMENTARY Top

Invited commentary on intraoperative ventilation strategy in a patient with empyema thoracis complicated by bronchopleural fistula p. 67
Jamshid Ali
DOI:10.4103/1687-9090.200286  
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