Introduction: Neonates and infants are more prone to desaturation during the apnoeic period of laryngoscopy and intubation. Various options exist to reduce this risk beyond conventional preoxygenation. Aim: To assess whether continuous apnoeic oxygenation via nasal prongs during intubation can extend the safe apnoea period compared to standard management with preoxygenation alone. Materials and Methods: A randomised controlled, two-group parallel clinical study was conducted at the Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India, from July 2019 to November 2020. The study involved 63 infants aged one day to six months undergoing elective or emergency surgeries under general anaesthesia. Preoxygenation via a mask was followed by sevoflurane induction and vecuronium-induced muscle relaxation. Conventional laryngoscopy and intubation were performed in 32 infants in Group-C (Control group), while 31 infants in Group-O (Apnoeic Oxygenation group) also received oxygen (O2 ) via nasal prongs at 4 L/min in addition to preoxygenation. The primary outcome parameter was the time taken for desaturation by 1%. The time taken to desaturate by 2%, 3%, 4%, and 5%, as well as their incidences, lowest observed saturation, safe apnoea period, and Heart Rate (HR) trends, were also noted. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and OpenEpi version 3.01. Results: Demographic and clinical parameters were comparable between the groups. The mean time for 1% desaturation was 18.33±4.3 seconds in Group-C, while all Group-O cases maintained 100% saturation during the study period. No significant difference was found in the safe apnoea period between the groups (p=0.503). The average lowest O2 saturation observed in Group-C was 98.81±1.28%, while it was 100% in Group-O. Only one infant in Group-C showed desaturation down to 95%. Both groups exhibited similar HR trends. Conclusion: Apnoeic oxygenation by nasal prongs in healthy infants helps prolong the time to desaturation and can be beneficial for those at risk of desaturation and hypoxia.
Introduction: Hypotension after Subarachnoid Block (SAB) can affect mother and foetus and can be prevented by prophylactic use of vasopressors. Phenylephrine (PE) has been a popular and effective drug as prophylaxis against hypotension. Norepinephrine (NE) is recently tried for this purpose. Aim: To compare PE infusion with NE infusion prophylactically against SAB induced hypotension during Lower Segment Cesarean Section (LSCS). Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesiology at a Tertiary Care Hospital, Ballari, Karnataka, India. The duration of the study was 12 months, from December 2018 to November 2019. A total of 156 primigravida and multigravida with singleton term pregnancy, posted for caesarean section under SAB received prophylactic infusions of either NE 5 μg/minute (group NE) or PE 50 μg/minute (group PE) immediately after SAB till end of the surgery. The primary outcome of the study was to assess the incidence of hypotension. The secondary outcomes included incidence of nausea, vomiting, hypertension, tachycardia, bradycardia and the neonatal outcomes. Related categorical and numerical variables were subjected to suitable statistical tests and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of the study participants of group NE was 24.47±2.52 years and group PE was 23.91±2.63 years, respectively. The age, parity and surgical duration was comparable between the groups. The incidence of hypotension was 17.9% in group NE and 26.8% in group PE (p-value=0.182). No significant differences in total doses of vasopressors used were noted. The incidence of bradycardia in group NE was 3.8% and 21.8% in the group PE (p=0.053). No adverse events or neonatal outcomes were observed. Conclusion: The incidence of hypotension and the total dose of vasopressors administered were similar in the two groups receiving prophylactic infusion doses (NE or PE). Incidence of bradycardia was greater in the parturients receiving PE infusion.
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