Navigating Challenges During Airway Management and Anesthetic Considerations in a Patient with a Supraglottic Mass: Integrating Anesthesiologists and Otolaryngologist Expertise
Introduction: Managing patients undergoing head and neck surgeries necessitates meticulous evaluation, strategic planning, and collaborative efforts with surgical teams. This approach is crucial to mitigate perioperative complications and optimize patient safety.
Rationale: Expert navigation of the challenging airway in these patients, particularly in the perioperative period, is essential to significantly reduce the risks of morbidity and mortality associated with such complex conditions.
Patient Concerns and Diagnosis: The patient presented with a supraglottic mass extending into the epiglottis space, posing significant anesthetic challenges to airway management.
Outcomes: A surgical airway was established via tracheostomy. Postoperatively, the patient was monitored in the intensive care unit for further management and was subsequently discharged to commence chemoradiotherapy. The tracheostomy tube remained in place at the time of discharge.
Lessons: This case underscored our commitment to enhancing expertise in airway management for patients with oral cancer. Our experience contributes valuable insights to the evolving field of airway management in complex head and neck surgeries.
DOI: 10.29245/2768-5365/2023/1.1146 View / Download PdfEffectiveness of Intravenous Low-Dose Ketamine Versus Morphine for Procedural Burn Pain Management During Dressing Changes: A Randomized Clinical Trial
Background: There is limited literature on using low-dose intravenous ketamine as a single agent for procedural burn pain management during adult dressing changes.
Aims & Objectives: To determine the effectiveness of low-dose ketamine compared to morphine as a single analgesic agent in procedural burn pain management during dressing changes.
Materials & Methods: We performed an institutional review board-approved, randomized, prospective, double-blinded, controlled, non-inferiority trial. All adult patients 18 years and above scheduled for dressing change were screened. Patients who consented were randomized to receive low-dose ketamine infusion at 0.2mg/kg/hr. In the treatment group, morphine infusion at 0.1mg/kg/hr. In the control group. The primary endpoint was pain intensity, measured using a visual analog scale. Data were analyzed on an intention-to-treat (ITT) approach. Secondary endpoints included rescue analgesia requirements and the occurrence of adverse effects in both groups.
Results: 82 patients were enrolled (ketamine 41 vs. morphine 41). We compared VAS scores at
5-minute intervals during the dressing changes. Overall, pain scores are similar in both groups (p-value=0.595). The pain control was homogenous. However, the morphine group required more rescue analgesia throughout the dressing changes than the low-dose ketamine group (p=0.013 at T15, p<0.001 at T20, and p<0.001 at T30). The occurrence of side effects was similar in both groups.
Conclusion: This study suggests that low-dose ketamine provides as effective and more predictable procedural analgesia as morphine during dressing procedures for adult burn patients.
DOI: 10.29245/2768-5365/2024/1.1149 View / Download Pdf