Early versus Late Tracheostomy in a Suburban Population: Clinical Profile, Complications, and Outcomes

Arjun Panicker , Meenaxi Prashant Choudhary , Devipriya M — Thu, 02 Apr 2026 00:00:00 +0000

Background: Tracheostomy is one of the most frequently performed procedures in intensive care units (ICUs). Despite its common use, the optimal timing, patient selection, and impact on outcomes remain debated. There is limited data on tracheostomy practices in suburban Indian populations.

Aim: To study the clinical profile, indications, complications, and outcomes of tracheostomised patients in a suburban population.

Materials and Methods: This observational study included 50 patients who underwent surgical tracheostomy between January 2023 and January 2026 at Rajalakshmi Medical College, Sriperumbudur, Tamil Nadu, India. Data were collected on demographic profile, primary diagnosis, indication for tracheostomy, type and timing of procedure, duration of mechanical ventilation, ICU and hospital stay, complications, and outcomes at discharge and three months. Statistical analysis was performed using chi-square test, Student’s t‑test, and ANOVA; p<0.05 was considered significant.

Results: The mean age was 44.22±19.83 years, with male predominance (76%). Head trauma was the most common indication (58%). Early tracheostomy (≤7 days) was performed in 74% of patients and was associated with significantly shorter duration of mechanical ventilation (3.35±2.08 vs. 14.61±7.03 days), ICU stay (7.2±5.3 vs. 24.3±4.2 days), and hospital stay (24.97±19.59 vs. 41±15.36 days) compared to late tracheostomy (>7 days). Complication rates were lower in the early group (8.10% vs. 46.15%). At three months, 64.86% of early tracheostomy patients improved, whereas 61.53% of late tracheostomy patients expired (p=0.0001).

Conclusion: Early tracheostomy (≤7 days) is associated with reduced mechanical ventilation duration, shorter ICU and hospital stays, fewer complications, and improved three-month survival compared to late tracheostomy. In patients with an established need for prolonged airway support, earlier intervention is more rewarding than delayed management.

Keywords:

Comparative Efficacy of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Levobupivacaine versus Ropivacaine in Spinal Anaesthesia: A Randomized Controlled Trial

Atul Kumar Singh, Hari Sankar Prajapati, Rajeev Kumar Dubey, Arun Raj Pandey — Mon, 06 Apr 2026 00:00:00 +0000

Background and Aims: The selection of optimal local anaesthetic and adjuvant combinations in spinal anaesthesia significantly influences clinical outcomes, particularly regarding block characteristics, hemodynamic stability, and postoperative analgesia. The objective of our study was to compare the efficacy and safety of dexmedetomidine as an adjuvant to intrathecal hyperbaric levobupivacaine versus ropivacaine in adult patients undergoing elective surgery.

Methods: A prospective, randomized, single-blind study was conducted involving 60 adult patients (ASA I-II) scheduled for elective surgeries under spinal anaesthesia. Participants were randomly allocated to receive either levobupivacaine 15 mg plus dexmedetomidine 10 μg (Group L, n=30) or ropivacaine 15 mg plus dexmedetomidine 10 μg (Group R, n=30). Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes encompassed postoperative analgesia duration, hemodynamic parameters, and adverse events.

Results: Onset times for sensory (92.27±12.05 vs 93.57±11.16 seconds, p=0.666) and motor (326.93±19.03 vs 327.60±18.68 seconds, p=0.892) blocks were comparable between groups. Group R demonstrated significantly longer sensory block duration (334.83±18.73 vs 280.17±14.35 minutes, p=0.001) and postoperative analgesia (513.67±35.04 vs 416.50±37.65 minutes, p=0.001). Group L exhibited prolonged motor block duration (117.33±6.23 vs 111.47±5.88 minutes, p=0.001). Hemodynamic stability was maintained in both groups with minimal adverse events. Hypotension occurred in 16.7% of Group L and 20.0% of Group R patients (p=0.739), with no cases of bradycardia or other serious complications.

Conclusions: Both dexmedetomidine combinations provided safe and effective spinal anaesthesia with rapid onset characteristics. Ropivacaine-dexmedetomidine offers superior postoperative analgesia and sensory block duration, making it preferable for procedures requiring extended pain control. Levobupivacaine-dexmedetomidine provides longer motor blockade, suitable for surgeries demanding prolonged immobilization. The choice between combinations should be tailored to specific surgical requirements and patient recovery goals.

Keywords: Dexmedetomidine, Levobupivacaine, Ropivacaine, Spinal anaesthesia, Postoperative analgesia, Regional anaesthesia.

Current Clinical and Medical Education

Early versus Late Tracheostomy in a Suburban Population: Clinical Profile, Complications, and Outcomes

Comparative Efficacy of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Levobupivacaine versus Ropivacaine in Spinal Anaesthesia: A Randomized Controlled Trial