GMC Patiala Journal of Research and Medical Education

Comparison of Changes in Intracuff Pressure in Endotracheal tube and Laryngeal tube

Manpreet Singh Singh — 2025-04-26

Laryngeal tube is a supraglottic device that is used effectively for managing the airway either as rescue device or device through which intubation can be done. The present study was conducted to compare the changes in intracuff pressure in the patients with endotracheal tube (ETT) and laryngeal tube (LT). Also, postoperative complications (ST and PH) caused by changes in intracuff pressure of ETT and LT.

After approval from Institutional ethics committee, the authors randomly selected 60 patients scheduled for surgery under general anesthesia (expected to last maximum 2 hours) in supine position, belonging to either sex, aged 18-60 years and who belonged to ASA physical status I or II.

After exclusions and inclusions, the patients were divided into two groups, each comprising of 30 patients. In one group the trachea was intubated with appropriate sized ETT (ETT group) and cuff was inflated to a pressure of 24-25 cm H₂O; in the other group, the airway device used was LT (LT group) and cuff was inflated to a pressure of 60 cm H₂O using hand held cuff inflator with pressure gauge. All patients were premedicated with Inj. Glycopyrrolate, Inj. Fentanyl and Inj. Ondansetron. Anaesthesia was induced with Inj. Propofol 2-3 mg/ kg IV. Airway device was inserted after achieving neuromuscular blockade with inj. Vecuronium 0.1 mg/kg. Anaesthesia was maintained using O₂/N₂O/ Iso and Inj. Vecuronium for muscle paralysis. At the end of surgery, anaesthesia was reversed using appropriate doses of Neostigmine (50-70µg/kg) and Glycopyrrolate (10µg/kg).

Standard monitoring was instituted along with peak airway pressure and intracuff pressure of the respective airway used (measured every 15 min. starting from cuff inflation to 1 hour). Patients were also assessed for features of airway obstruction, gastric regurgitation and any evidence of airway / oropharyngeal trauma at the time of extubation (visual inspection of device for presence of blood and inspection of oral cavity for evidence of trauma); postoperatively for evidence of sore throat (ST), postoperative hoarseness (PH) and tongue numbness in PACU (2 hours) and in ward (1 day postoperatively). Appropriate statistical tests were applied.

The demographic profile was similar in both groups and all the patients in both the groups could be ventilated adequately with their respective airway device throughout the study period as indicated by end tidal CO₂ measurements, SPO2 ,Peak Airway pressures and Mean airway pressures at various points of times.The hemodynamics i.e. Heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure, Oxygen saturation and EtCO2 were also comparable (Table 2-7).

The peak airway pressures and mean airway pressures were comparable. In both the groups 3 patients had blood on the equipment as observed after extubation. No patient had dysphagia in any of the groups and 4 patients in each group had hoarseness in immediate postoperative period. Three patients had felt sore-throat in immediate postoperative and 2 hours in ETT group and 4 patients in LT group at immediate postoperative period and 2 patients after 2 hours.

It was concluded that both ETT and LT can be effective used for controlled ventilation, during general anaesthesia; the intracuff pressure increases in both these devices to similar levels and might contribute to LPM; the incidence of PH is decreased by use of LT instead of an ETT, hence LT can be an effective alternative to ETT.

Comparison of Open (Hasson's) Technique and Closed Entry Technique for Creation of Pneumoperitoneum in Laparoscopic Cholecystectomy

TEJINDER PAUL SINGH — 2025-04-26

Background Laparoscopic cholecystectomy has become the gold standard for treating benign gallbladder disease, where the creation of a pneumoperitoneum—an insufflation of the abdominal cavity with gas—is a critical prerequisite. The main objective of the present study was to compare the safety and efficacy of the Open (Hasson's) method and Closed (Veress Needle) method for creating a pneumoperitoneum in laparoscopic cholecystectomy and to determine safe practices for pneumoperitoneum creation with minimal complications and higher efficacy.

Methods This prospective, randomized clinical study was conducted on 50 patients divided into 2 groups having 25 patients each at Government Medical College, Rajindra Hospital, Patiala, Punjab (India) from May 2019 to December 2020, following ethical committee approval. Data was gathered by recording the time from abdominal incision to pneumoperitoneum creation and to close the wounds. Incidence of complications were noted during the procedure and during a three-month postoperative follow-up.

Results More time was taken to achieve pneumoperitoneum and to close the port site wounds in case of Closed method of pneumoperitoneum creation, however there was no significant difference in intra-operative or post-operative complications between the two groups.

Conclusion This study indicates that both the open (Hasson’s) and closed (Veress needle) techniques are effective and safe for pneumoperitoneum creation in laparoscopic cholecystectomy, with the open technique offering a slight advantage in terms of reduced procedure time and minimal complications. Further large-scale studies may be needed to confirm these findings and provide additional insights into technique optimization.

A STUDY TO EVALUATE CAUSES AND RISK FACTORS OF STILL BIRTHS IN A TERTIARY CARE HOSPITAL

Nancy — 2025-04-26

INTRODUCTION: The ICD 10 defines foetal death as death prior to complete expulsion of foetus from its mother irrespective of gestational age^. But WHO defines still births as baby born with no signs of life at or after 28 weeks of gestation or if weight is >1000 gm when gestation age is not available. The still births are a major contributor to perinatal mortality. So, to reduce the perinatal mortality, reduction of still births is necessary and for this better understanding of aetiology of still births is important.

MATERIAL AND METHODS A prospective study was done in the Department of Obstetrics and Gynaecology in collaboration with the Department of Pathology at Government Medical College and Rajindra Hospital Patiala during 2021-22. Review of antenatal records; maternal investigations was done and delivered foetuses were examined after delivery. For every case proforma was filled and the cause of still birth was identified and classified under ReCoDe system of still birth classification.

RESULTS: In our study, still birth rate was 40.54/1000 live births. According to ReCoDe classification, maternal causes were observed in 53/227 (23.34%), foetal cause in 38/227 (16.74%) and placental and cord origin were suspected in 50/227 (22.02%) and 6/227 (2.64%) cases respectively and Amniotic fluid in 11 cases (4.84%). In 21/227 (9.25%) cases the reason for still birth was unknown and unclassifiable. Hypertension was seen to be the most common cause 44/227 (19.38%) among maternal causes. Among the foetal causes FGR was most common 37/227 (16.29%) followed by extreme prematurity 36/227 (15.85%)

CONCLUSION: A significant proportion of still births is preventable by adequate and quality antenatal care.

Bone metastasis from endometrioid ovarian carcinoma: a case study and literature review

Monika Garg — 2025-04-26

Abstract

Ovarian epithelial malignancy rarely metastasize to the skeletal system. They usually spread by direct extension , transcoelemic spread and by lymphatic channel. Hematogenous spread is rare and late occurance. Metastasis to bone from these tumours is rare. (0.1- 0.12%) and is reported in a few series. A 75 year old post menopausal lady presented in surgery department with chief complaints of swelling and pain over left thigh since 2 months. Swelling appeared 5 months back , it was drained at that time, but recurred 1 month back. Grossly we received skin covered biopsy, partly solid and partly cystic in multiple pieces measuring 12x11.5x 2.5 cm. external surface of skin was ulcerated and cut surface showed necrotic areas. Two bony pieces were received separately. Section from bony pieces showed deposits of tumour cells amongst normal bony trabeculae. Diagnosis of bony metastasis from unknown primary was made and clinicians were informed to search for primary in ovary, breast, GIT etc. serum CA 125 levels were increased to 230 U/ml.

Coexistent Cellulitis and Myositis Presenting with Left Iliac Fossa Pain: A Case Report

NAVNEETH SANKAR S — 2025-04-26

Cellulitis is a bacterial skin infection affecting the dermis and subcutaneous tissues, while myositis is characterized by skeletal muscle inflammation. These are two different conditions which often occur independently. Their co-occurrence, however, poses diagnostic challenges due to overlapping symptoms and potential systemic complications. This report highlights the case of a 65-year-old female presenting with cellulitis and myositis. This case shows the diagnostic complexities which can occur and emphasizes the importance of a multidisciplinary approach.

Spindle cell tumor as nasal mass-A rare case report

Balwinder Singh Tiwana — 2025-04-26

_{We present a rare case of spindle cell tumor manifesting as a nasal mass. Due to its uncommon location, diagnosis was challenging. Radiological imaging aided detection. Surgical excision and histopathological examination confirmed the diagnosis.}

ANESTHETIC MANAGEMENT OF LARGE MULTINODULAR GOITRE POSTED FOR TOTAL THYROIDECTOMY : A CASE REPORT

Veena Chatrath — 2025-04-26

The multinodular goitre presents as a swelling of neck and when it is enlarged enough it can distort the airways, produce pressure symptoms leading to a difficult airway. We are presenting case of successful anesthetic management in a woman with enlarged neck mass posted for total thyroidectomy.

CLINICAL PROFILE OF CHILDREN WITH SNAKE BITE IN A TERTIARY CARE CENTER

Kashish Singla — 2025-04-26

Background: Snake bite is a major public health problem which leads to significant mortality and morbidity. Its incidence is more in rural India. The clinical profile of the snake bite depends on the various factors such as the type of snake , time of arrival in to the hospital and time of the bite (daytime or nighttime)

Methods: This is a Crossectional observational study conducted in a tertiary care hospital GMC Patiala Punjab from a period of January 2023 to September 2023 on children aged 1 month to 18 years presenting with the history of snake bite and fang marks or swelling at the site or in altered sensorium or with multiorgan involvement were included in the study. The subjects were enrolled in to the study after getting their written consent . The history , physical examination , demographic profile , relevant investigations and outcomes of the patient were analyzed.

Results: In our study total 50 patients were enrolled out of which 28 (56%) were males while 36(72%) were females. 2 (4%) in the age group of less than 1 year, 8(16%) in the age group between 1 year to 5 year,5 (10%) in the age group of between 5 years to 10 years,25 (50%) in the age group between 10 and 15 years and 10(20%) more than 15 years. 36 (72% )of the children were from rural areas while 14(28%) were from urban areas. Mean duration of arrival to the hospital was 2 hours.28(56%) cases presented with neurological dysfunction while 2 (4% )presents with disseminated intravascular coagulation while 15(30%) suffered from shock

As per labs severe anemia was present in 12(24%) and deranged LFT observed in 10(20%) and 15(30%) suffered from prerenal AKI.Mean duration of stay at hospital was 9±1 day

Overall mortality was 5(10%) however absolute mortality was observed in <1 year age group

Conclusion: Snake bite remains a major health problem in India. In our study it was concluded that time of arrival to the hospital , type of the snake and age of the patients are the major factors which influence the final outcome of the patient

Keywords

Snakebite, antisnake venom, Multiorgan failure

STRESS AND MENTAL FATIGUE IN THE MEDICAL PROFESSION

Editor — 2025-04-26

Stress and burnout are quite prevalent phenomena among health professionals. As these professionals have a fundamental role in patient care it is imperative that they feel well physically and psychologically, so as to fulfill their functions well as caregivers. In this way, it becomes important to act in the relationship between the individual and the problem, improving the skills of encouraging using his social and personal resources to obtain control over the circumstance inducer of stress.

MANAGEMENT OF TUBERCULOSIS IN INDIA - NTEP GUIDELINES

Tejinder Singh — 2025-04-26

The year 2019 saw an estimate by WHO that 10 million fresh cases of TB emerged globally, with a staggering 97% of them emerging in low- & middle-income countries.^[1] Among these cases, 57% were seen in men, 32% in women, and the remaining 11% in children. Shockingly, approximately 1.4 million fatalities were recorded due to TB that year, including around 0.21 million among individuals co-infected with HIV. In India, the burden of tuberculosis infection (TBI) is believed to be the highest globally, with an estimated range of 35-400 million individuals living with TBI. Of these numbers, roughly 2.6 million are reported as tuberculosis (TB) cases annually. TB ranks as the 13th leading cause of death on a global scale and continues to plague HIV-infected individuals. Management, diagnosis quality, and treatment services for tuberculosis under the program are provided free of charge nationwide with the vision of achieving a TB-free India by 2025. The typical drug regimen for Tuberculosis includes an intensive two-month phase followed by a four-month continuation phase. However, the duration of treatment may vary based on severity/organ involvement, necessitating tailored regimens in certain cases such as those involving pregnant women or issues with liver or kidney function as per NTEP guidelines.