Biomedical subjects

Mamta Pandey

Publications and source records attributed to Mamta Pandey.

3 recordsLinked to original sources

PubMed2006

Short thyromental distance: a predictor of difficult intubation or an indicator for small blade selection?

BACKGROUND: Short thyromental distance (TMD; < 5 cm) has been correlated with difficult direct laryngoscopic intubation in adult patients. The authors hypothesized that a smaller Macintosh curved blade (No. 2 MCB) would improve the predicted difficult laryngoscopy in short-TMD patients over that with a standard Macintosh curved blade (No. 3 MCB). METHODS: In a preliminary study of 11 consenting adults (7 females and 4 males), American Society of Anesthesiologists physical status I and TMD < or = 5 cm, lateral neck radiographs were recorded during laryngoscopy with a No. 2 and No. 3 MCB in sequential fashion. In a prospective clinical study, laryngoscopy and tracheal intubation were evaluated in 83 adult patients with TMD < or = 5 cm by randomly assigning them to two groups for the blade used at first intubation. Those who failed intubation with the first blade were switched to the alternate blade. In total 100 laryngoscopies and intubations were performed: the No. 2 MCB (n = 50) and the No. 3 MCB (n = 50). RESULTS: Lateral neck radiographs recorded at the best laryngeal view revealed that the tip of the No. 2 MCB was proximal to the hyoid body with the No. 2 MCB and distal to it with the No. 3 MCB. The intubation distance (C5 to blade tip) on neck radiographs with the No. 2 MCB was significantly greater than it was with the No. 3 MCB for similar anterior jaw displacement. In the clinical study, the laryngoscopic grade with the No. 2 blade was considered easy (median, 2B), better than the grade with the No. 3 MCB (median, 3). When the No. 2 MCB was used, external laryngeal pressure improved the laryngoscopic grade (1, full glottic view) in 46% of patients. In contrast, when the No. 3 MCB was used, pressure improved the grade in only 10% of the patients. Intubation time with the No. 2 MCB was significantly (P < 0.05) less than it was in patients with No. 3 MCB. Overall, 14 patients who failed intubation with the No. 3 MCB were switched to the No. 2 MCB, and intubation was successful with an easy laryngoscopic grade. Three patients who failed intubation with the No. 2 MCB were switched to the No. 3 MCB. CONCLUSIONS: The predicted difficult laryngoscopy and intubation with the use of the adult No. 3 MCB in standard adult patients with a TMD < or = 5 cm is significantly easier with use of the smaller No. 2 MCB.

Adolescent↗

PubMed2006

A mixture of organophosphate and pyrethroid intoxication requiring intensive care unit admission: a diagnostic dilemma and therapeutic approach.

The illegal mixing of organophosphates and pyrethroids in marketed agriculture insecticides is becoming prevalent in developing countries. Over a 12-mo period, 8 patients were admitted to the emergency department of a university hospital in Dharan, Nepal after ingestion of such a mixture with suicidal intent. All patients presented with a combination of miosis, bradycardia, tachypnea, and unconsciousness. The occurrence of both pupillary dilation after a small-dose infusion of atropine (0.08 to 0.2 mg/kg in 1-3 h) and seizures raised the possibility of pyrethroid poisoning. In each case, an examination of the insecticide container confirmed that it contained a mixture of organophosphate and pyrethroid. After seizure control, gastric lavage, respiratory support, hemodynamic stabilization and diuresis, seven of the patients recovered without neurological deficit. One patient suffered aspiration pneumonia and died. The early clinical picture after this mixed poisoning is based on the toxicity of organophosphates rather than pyrethroids. Because the patients responded to a small dose of atropine with mydriasis and tachycardia, it suggested a mixed poisoning. Early suspicion of mixed poisoning may have a significant prognostic impact.

Adult↗

PubMed2005

A randomized controlled double blind study on quick intubation regimen using vecuronium priming infusion technique with the use of patient controlled analgesia pump vs bolus priming technique.

BACKGROUND & OBJECTIVES: Priming principle is implied to hasten intubation with the use of vecuronium. Priming dose is usually injected by bolus and certain side effects have been observed due to acute rise in plasma levels after bolus injection. In the present study priming infusion regimen of vecuronium using patient controlled analgesia (PCA) pump was compared for the intubation dose onset, intubation, and the side effects with the usual bolus priming. METHODS: Adult ASA grade 1 patients of both sexes (n=112) were randomized into four groups of 28 patients each. In group 1 patients, vecuronium (10 microg/kg) was given bolus (30 sec). In group 2, priming infusion (5 microg/kg/min) regimen for vecuronium (1200 microg/kg) was used by setting up the background infusion rate (ml/h) at 1/4th of the patient body weight on PCA pump. Priming infusion for 3 min delivered the priming dose (15 microg/kg). In group 3, higher priming infusion (10 microg/kg/min) was given by setting up the PCA pump at the 1/2 the patient body weight for 1.5 min, to deliver same dose (15 microg/kg). In group 4, the priming infusion (10 microg/kg/min) for 2 min delivered higher priming dose (20 microg/kg). After induction of anaesthesia with fentanyl, propofol, the intubating dose of vecuronium (0.06 mg/kg) was injected by activating patient demand button and grading laryngoscopy/intubation after 1 min in each group. RESULTS: In demographically similar patients, the laryngoscopy/intubation was excellent in 53 per cent (group 3) and in 64 per cent patients (group 4) after 1 min of the intubation dose. While in bolus priming (group 1), 50 per cent patients developed ocular side-effects, none had it on priming infusion in groups 2 or 3. Only 2 patients complained of diplopia at the higher priming dose (20 microg/kg) (group 4). INTERPRETATION & CONCLUSION: PCA pump regimen for vecuronium priming infusion significantly shortened the onset of intubation. Side effects from the smaller priming dose by bolus were not seen in priming infusion regimen.

Aged↗