Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.043
Harika Erram, P. Varshney, Anshu Gupta
Enhanced recovery after surgery (ERAS) is a multidisciplinary approach, widely used in adults and children for improving patient care with reduced length of hospital stay and medical costs. However, it is poorly established and perceived as unimplementable in neonates. Recently, ERAS guidelines consisting of 17 recommendations for perioperative care in neonatal intestinal surgery are laid down by the ERAS society. To elicit the feasibility of implementing ERAS protocol, we did an observational pilot study in neonates undergoing intestinal surgery at a tertiary centre to know the number of recommendations from ERAS guidelines already being followed routinely.Data was collected for the neonates undergoing intestinal surgery for three months. All the relevant details were noted and analysed to find out the number of recommendations from ERAS guidelines already being implemented and the postoperative outcome of these neonates.Twelve neonates underwent intestinal surgery for obstruction and atresia during the study period. Eight out of 17 ERAS guidelines were already followed as a routine protocol in all these patients. Nine patients were extubated on table, one patient was extubated within 24 hours of surgery and two patients succumbed to death. Ten neonates were discharged from hospital within 6-8 days of surgery. Many recommendations from ERAS guidelines for neonatal intestinal surgery are already being followed routinely, suggesting that the implementation of complete ERAS protocol is easily possible, which may further improve the perioperative outcome with reduced length of hospital stay.
{"title":"Enhanced recovery after surgery (ERAS): A budding concept in neonatal intestinal surgery","authors":"Harika Erram, P. Varshney, Anshu Gupta","doi":"10.18231/j.ijca.2024.043","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.043","url":null,"abstract":"Enhanced recovery after surgery (ERAS) is a multidisciplinary approach, widely used in adults and children for improving patient care with reduced length of hospital stay and medical costs. However, it is poorly established and perceived as unimplementable in neonates. Recently, ERAS guidelines consisting of 17 recommendations for perioperative care in neonatal intestinal surgery are laid down by the ERAS society. To elicit the feasibility of implementing ERAS protocol, we did an observational pilot study in neonates undergoing intestinal surgery at a tertiary centre to know the number of recommendations from ERAS guidelines already being followed routinely.Data was collected for the neonates undergoing intestinal surgery for three months. All the relevant details were noted and analysed to find out the number of recommendations from ERAS guidelines already being implemented and the postoperative outcome of these neonates.Twelve neonates underwent intestinal surgery for obstruction and atresia during the study period. Eight out of 17 ERAS guidelines were already followed as a routine protocol in all these patients. Nine patients were extubated on table, one patient was extubated within 24 hours of surgery and two patients succumbed to death. Ten neonates were discharged from hospital within 6-8 days of surgery. Many recommendations from ERAS guidelines for neonatal intestinal surgery are already being followed routinely, suggesting that the implementation of complete ERAS protocol is easily possible, which may further improve the perioperative outcome with reduced length of hospital stay.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.041
Ankita Singh, Minati Choudhury, Sandeep Chauhan, A. Bisoi
Anterior mediastinal masses pose a serious challenge to anaesthetists and surgeons alike. It is sometimes associated with a severe cardiorespiratory compromise during surgery. The aim of this study was to evaluate the incidence of difficulty in airway management, intraoperative cardiorespiratory and postoperative complications in patients undergoing surgery for anterior mediastinal mass excision. We conducted a single centre-based retrospective observational study of the data of patients with anterior mediastinal mass who were treated surgically between February 2016 to January 2021. All the data of the patients were kept confidential. Data were collected from electronic medical records, operation theatre records, anaesthesia charts, intensive care unit (ICU) records, and discharge sheets. Demographic data, medical history, and preoperative imaging investigations were noted. The difficulty in airway management, amount of blood loss, blood transfusion, and other significant events during the intraoperative period were noted. In the postoperative period, the duration of mechanical ventilation, re-exploration, duration of ICU stay, hospital stay, and other complications were recorded. In our study, no patient suffered difficulty in intraoperative airway management(N=29). The intraoperative complication was seen in 13% of cases in the form of significant hemodynamic compromise. No patient underwent re-exploration. The mean blood loss during surgery was 455 ml. The mean duration of postoperative mechanical ventilation was 17 hours, and the ICU stay was 2.3 days. Postoperative complications were seen in 6% of cases (2 patients). Despite best management, some complications may happen in this subset of patients. A comprehensive multidisciplinary approach can minimize the risk of catastrophic hemodynamic and airway compromise during surgical excision.
{"title":"Anterior mediastinal masses: A single centre-based retrospective study","authors":"Ankita Singh, Minati Choudhury, Sandeep Chauhan, A. Bisoi","doi":"10.18231/j.ijca.2024.041","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.041","url":null,"abstract":"Anterior mediastinal masses pose a serious challenge to anaesthetists and surgeons alike. It is sometimes associated with a severe cardiorespiratory compromise during surgery. The aim of this study was to evaluate the incidence of difficulty in airway management, intraoperative cardiorespiratory and postoperative complications in patients undergoing surgery for anterior mediastinal mass excision. We conducted a single centre-based retrospective observational study of the data of patients with anterior mediastinal mass who were treated surgically between February 2016 to January 2021. All the data of the patients were kept confidential. Data were collected from electronic medical records, operation theatre records, anaesthesia charts, intensive care unit (ICU) records, and discharge sheets. Demographic data, medical history, and preoperative imaging investigations were noted. The difficulty in airway management, amount of blood loss, blood transfusion, and other significant events during the intraoperative period were noted. In the postoperative period, the duration of mechanical ventilation, re-exploration, duration of ICU stay, hospital stay, and other complications were recorded. In our study, no patient suffered difficulty in intraoperative airway management(N=29). The intraoperative complication was seen in 13% of cases in the form of significant hemodynamic compromise. No patient underwent re-exploration. The mean blood loss during surgery was 455 ml. The mean duration of postoperative mechanical ventilation was 17 hours, and the ICU stay was 2.3 days. Postoperative complications were seen in 6% of cases (2 patients). Despite best management, some complications may happen in this subset of patients. A comprehensive multidisciplinary approach can minimize the risk of catastrophic hemodynamic and airway compromise during surgical excision.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"23 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.053
Lalit Gupta, Ripon Choudhary, Ridhima Sharma
{"title":"Artificial intelligence acquiescence as real-time guidance in USG peripheral nerve block-Need of the hour","authors":"Lalit Gupta, Ripon Choudhary, Ridhima Sharma","doi":"10.18231/j.ijca.2024.053","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.053","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"3 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.048
Poonam Singh, Shaista Jamil
Supraclavicular brachial plexus block (SBPB) is a commonly used regional anesthetic technique for upper limb surgeries in orthopaedic patients. It provides intraoperative anesthesia and postoperative analgesia. SBPB can be administered using either a landmark approach or ultrasound guidance (USG). The use of ultrasound has reduced the complications associated with the block by providing excellent real-time visualization of the pleura, vessels, and plexus in relation to needle insertion. However, complications can still arise even with USG-guided block if a large volume of local anesthetics is used. In fact, a large volume is not necessary when performing USG-guided blocks.We report a case of a 25-year-old male who presented with hoarseness of voice after receiving a USG-guided supraclavicular block (left side) due to recurrent laryngeal nerve (RLN) block. While RLN block is more common in interscalene blocks, it is a rare complication in SBPB, with very few reported cases of hoarseness of voice due to RLN block after SBPB.
{"title":"An unusual case of hoarseness of voice after left supraclavicular brachial plexus block","authors":"Poonam Singh, Shaista Jamil","doi":"10.18231/j.ijca.2024.048","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.048","url":null,"abstract":"Supraclavicular brachial plexus block (SBPB) is a commonly used regional anesthetic technique for upper limb surgeries in orthopaedic patients. It provides intraoperative anesthesia and postoperative analgesia. SBPB can be administered using either a landmark approach or ultrasound guidance (USG). The use of ultrasound has reduced the complications associated with the block by providing excellent real-time visualization of the pleura, vessels, and plexus in relation to needle insertion. However, complications can still arise even with USG-guided block if a large volume of local anesthetics is used. In fact, a large volume is not necessary when performing USG-guided blocks.We report a case of a 25-year-old male who presented with hoarseness of voice after receiving a USG-guided supraclavicular block (left side) due to recurrent laryngeal nerve (RLN) block. While RLN block is more common in interscalene blocks, it is a rare complication in SBPB, with very few reported cases of hoarseness of voice due to RLN block after SBPB.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"1 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.047
Abinav Sarvesh S P S, S. Gaiwal, Nimitha Prasad
: Pulmonary alveolar proteinosis (PAP) is a very rare, life threatening, noninflammatory, diffuse lung disorder characterized by dense accumulation of lipo-proteinaceous material within the alveoli causing hypoxemia, restrictive lung disease leading to respiratory failure. Whole lung lavage (WLL) is considered as the treatment of choice which includes infusing warm saline in the lungs and draining it out with the lipo-porteinaceous materials thereby clearing the obstruction. WLL requires good team co-ordination between the anaesthesiologists, pulmonologists and physiotherapists. The procedural course is challenging in many aspects like hypoxaemia and hemodynamic fluctuations. Post procedure short term mechanical ventilation is commonly required.: A 45 year old female, diagnosed case of PAP presented with dyspnea at rest with increasing oxygen requirement. After clinical examination and investigations, due to severity of the disease, broncho-alveolar lavage (BAL) of left lung was planned with subsequent right lung BAL after few days. During the procedure, desaturation upto 78% was noted. With meticulous corrective measures, saturation picked up and the procedure was completed uneventfully. Post-operatively patient was mechanically ventilated and extubated after 32 hours.: WLL is the treatment of choice for PAP which involves multidisciplinary approach with mulitple challenges. Pre-oxygenation, adequate lung isolation with left sided double lumen tube (DLT), one lung ventilation with positive end expiratory pressure (PEEP), vigilant intra-operative monitoring, cautious use of positional manoeuvres and recruitment manoeuvres with a good teamwork is the key for successful outcome.
:肺泡蛋白沉积症（PAP）是一种非常罕见、危及生命的非炎症性弥漫性肺部疾病，其特点是肺泡内脂蛋白物质密集堆积，导致低氧血症和限制性肺病，进而引发呼吸衰竭。全肺灌洗（WLL）被认为是首选的治疗方法，包括在肺部注入温生理盐水，然后将其与脂蛋白物质一起排出，从而清除阻塞。WLL 需要麻醉师、肺病专家和物理治疗师之间良好的团队合作。手术过程在许多方面都具有挑战性，如低氧血症和血液动力学波动。术后通常需要短期机械通气：一名 45 岁的女性被诊断为 PAP 病例，她在休息时出现呼吸困难，且需氧量不断增加。经过临床检查和化验后，由于病情严重，计划进行左肺支气管肺泡灌洗（BAL），几天后再进行右肺 BAL。在手术过程中，发现饱和度降低到 78%。经过精心纠正，饱和度有所回升，手术顺利完成。术后患者接受了机械通气，32 小时后拔管：WLL是PAP的首选治疗方法，涉及多学科方法，面临多重挑战。术前吸氧、使用左侧双腔管（DLT）进行充分的肺隔离、使用呼气末正压（PEEP）进行单肺通气、术中密切监测、谨慎使用体位操作和招募操作以及良好的团队合作是取得成功的关键。
{"title":"Anesthetic management of broncho- alveolar lavage in pulmonary alveolar proteinosis: A case report","authors":"Abinav Sarvesh S P S, S. Gaiwal, Nimitha Prasad","doi":"10.18231/j.ijca.2024.047","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.047","url":null,"abstract":": Pulmonary alveolar proteinosis (PAP) is a very rare, life threatening, noninflammatory, diffuse lung disorder characterized by dense accumulation of lipo-proteinaceous material within the alveoli causing hypoxemia, restrictive lung disease leading to respiratory failure. Whole lung lavage (WLL) is considered as the treatment of choice which includes infusing warm saline in the lungs and draining it out with the lipo-porteinaceous materials thereby clearing the obstruction. WLL requires good team co-ordination between the anaesthesiologists, pulmonologists and physiotherapists. The procedural course is challenging in many aspects like hypoxaemia and hemodynamic fluctuations. Post procedure short term mechanical ventilation is commonly required.: A 45 year old female, diagnosed case of PAP presented with dyspnea at rest with increasing oxygen requirement. After clinical examination and investigations, due to severity of the disease, broncho-alveolar lavage (BAL) of left lung was planned with subsequent right lung BAL after few days. During the procedure, desaturation upto 78% was noted. With meticulous corrective measures, saturation picked up and the procedure was completed uneventfully. Post-operatively patient was mechanically ventilated and extubated after 32 hours.: WLL is the treatment of choice for PAP which involves multidisciplinary approach with mulitple challenges. Pre-oxygenation, adequate lung isolation with left sided double lumen tube (DLT), one lung ventilation with positive end expiratory pressure (PEEP), vigilant intra-operative monitoring, cautious use of positional manoeuvres and recruitment manoeuvres with a good teamwork is the key for successful outcome.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"8 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A defect in the septum between the left and right atrium is known as atrial septal defect which is a congenital heart disease. The defect causes shunting of blood from left to right side of the heart, increasing the blood flow through the lungs. Small atrial septal defects may be found incidentally and never cause a major concern. Larger defects may damage the heart and also the lungs. The use of combined spinal and epidural technique in a patient with ASD can maintain hemodynamic stability, provide perioperative analgesia and also avoid the hemodynamic perturbations associated with general anaesthesia in a patient with severe pulmonary hypertension.
{"title":"A case report on the use of combined spinal epidural technique in the anaesthetic care of a patient with a large ASD and severe pulmonary hypertension","authors":"Gade Sandeep, Jitendra Kushwaha, Jitendra Kalbande, Nimisha Cherunghattil","doi":"10.18231/j.ijca.2024.045","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.045","url":null,"abstract":"A defect in the septum between the left and right atrium is known as atrial septal defect which is a congenital heart disease. The defect causes shunting of blood from left to right side of the heart, increasing the blood flow through the lungs. Small atrial septal defects may be found incidentally and never cause a major concern. Larger defects may damage the heart and also the lungs. The use of combined spinal and epidural technique in a patient with ASD can maintain hemodynamic stability, provide perioperative analgesia and also avoid the hemodynamic perturbations associated with general anaesthesia in a patient with severe pulmonary hypertension.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postoperative alopecia of beard after spine surgery in the prone position","authors":"Deepak Ganjigere Palaksha, Binesh Badyal, Kapil Jain","doi":"10.18231/j.ijca.2024.052","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.052","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"9 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.035
K. G. Sambandam, B. R. Karthekeyan, Shruthi Shree, Saranya Nagalingam, Kiran Muthu Rajah, Ashok Gnanachandran
This study aimed to investigate the hypothesis that minimally invasive coronary artery bypass grafting (CABG) induces fewer hemodynamic alterations compared to conventional approaches, attributing this to reduced heart rotation during grafting. Given the critical role of hemodynamic stability in patient outcomes and the growing popularity of minimally invasive CABG, we sought to assess and compare the hemodynamic responses during left anterior descending artery grafting. This randomized controlled trial was conducted at a tertiary center, enrolling a total of 60 patients, with 30 in each group. Parameters such as heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and perfusion index (PI) were measured at baseline, after octopus stabilization prior to grafting, at 3 minutes during grafting, and at the end of grafting. Additionally, serum lactate levels were assessed at baseline and upon completion of grafting. The baseline HR was comparable between the groups. However, the trends in HR revealed a significant increase in the conventional group after octopus stabilization (P value = 0.0038), at 3 minutes post-initiation of grafting (p < 0.001), and at the completion of grafting (P value = 0.001). MAP and CVP remained comparable at all time points. Notably, PI showed a significant increase in the conventional group during positioning (after octopus stabilization), at 3 minutes post-initiation of grafting, and at the completion of grafting. There were no significant differences in lactate levels between the groups. Despite no significant differences in MAP, CVP, and lactate levels, our findings highlight significant disparities in HR and PI between the two groups. We conclude that the observed variations in heart rate may be attributed to minimal positional changes in the minimally invasive approach compared to the conventional approach.
{"title":"Hemodynamic comparison between minimally invasive and conventional approaches in off-pump coronary artery bypass grafting: A randomized controlled trial","authors":"K. G. Sambandam, B. R. Karthekeyan, Shruthi Shree, Saranya Nagalingam, Kiran Muthu Rajah, Ashok Gnanachandran","doi":"10.18231/j.ijca.2024.035","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.035","url":null,"abstract":"This study aimed to investigate the hypothesis that minimally invasive coronary artery bypass grafting (CABG) induces fewer hemodynamic alterations compared to conventional approaches, attributing this to reduced heart rotation during grafting. Given the critical role of hemodynamic stability in patient outcomes and the growing popularity of minimally invasive CABG, we sought to assess and compare the hemodynamic responses during left anterior descending artery grafting. This randomized controlled trial was conducted at a tertiary center, enrolling a total of 60 patients, with 30 in each group. Parameters such as heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and perfusion index (PI) were measured at baseline, after octopus stabilization prior to grafting, at 3 minutes during grafting, and at the end of grafting. Additionally, serum lactate levels were assessed at baseline and upon completion of grafting. The baseline HR was comparable between the groups. However, the trends in HR revealed a significant increase in the conventional group after octopus stabilization (P value = 0.0038), at 3 minutes post-initiation of grafting (p < 0.001), and at the completion of grafting (P value = 0.001). MAP and CVP remained comparable at all time points. Notably, PI showed a significant increase in the conventional group during positioning (after octopus stabilization), at 3 minutes post-initiation of grafting, and at the completion of grafting. There were no significant differences in lactate levels between the groups. Despite no significant differences in MAP, CVP, and lactate levels, our findings highlight significant disparities in HR and PI between the two groups. We conclude that the observed variations in heart rate may be attributed to minimal positional changes in the minimally invasive approach compared to the conventional approach.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.036
Amit Pravin Chauhan, Aarjuv Majmundar, S. Lakhani, Jitendra Lakhani
Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.
尽管近年来临床医学不断进步，但 CAP 导致的死亡率却相对保持不变。因此，早期识别并送入重症监护室在 CAP 的治疗中起着至关重要的作用。PSI/PORT（肺炎严重程度指数/肺炎患者结局研究小组）评分和 CURB-65（意识模糊、尿毒症、呼吸频率、血压、年龄大于 65 岁）是临床医生广泛使用的两种严重程度评估评分，用于区分高危和低危患者。本研究旨在比较这两个评分对入住重症监护病房和死亡率的预测价值。计算 CURB-65 和 PSI 所需的信息是通过仔细询问病史、评估患者和进行必要的检查提取的。共对 131 名入院患者进行了 CURB-65 和 PSI 评分。根据仔细的临床评估和主治医生的判断，60 名患者入住重症监护室，71 名患者入住内科病房。在入住重症监护室的 60 名患者中，有 23 人死亡。PSI/PORT 评分（AUC 0.9605；95% CI 0.9277-0.9933）和 CURB-65 评分（AUC 0.9694；95% CI 0.9368-1.9714）预测入住 ICU 的能力几乎相似。PSI/PORT 评分（AUC 0.9196；95% CI 0.8670-0.9722）和 CURB-65 评分（AUC 0.9214 95% CI 0.8696-0.9732）预测死亡率的能力几乎相似。与 PSI/PORT 评分相比，我们发现 CURB-65 评分在预测本院 CAP 患者入住 ICU 的情况方面与 PSI/PORT 评分几乎相似，而在预测社区获得性肺炎患者的死亡率方面，CURB-65 和 PSI/PORT 评分似乎具有相似的特异性和敏感性。考虑到简便性，CURB-65 评分可能比 PSI/PORT 评分更受青睐。不过，要了解印度的具体情况，还需要进行更大规模的研究。尽管最近医学领域取得了进步，但 CAP 导致的死亡率仍然相对较低。因此，早期诊断和入住重症监护室并接受标准治疗在 CAP 患者的管理中起着关键作用。PSI/PORT 评分和 CURB-65 评分这两种评分系统被广泛用于区分低风险和高风险患者。我们进行了这项研究，以比较这两种评分对入住重症监护室和死亡率的预测价值。
{"title":"A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital","authors":"Amit Pravin Chauhan, Aarjuv Majmundar, S. Lakhani, Jitendra Lakhani","doi":"10.18231/j.ijca.2024.036","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.036","url":null,"abstract":"Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141335901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.18231/j.ijca.2024.029
N. Kamble, M. Gajbhare, Pranjal Rajendra Pimparkar, M. Gaikwad
Brachial plexus block via supraclavicular approach performed with the help of ultrasound assistance, is a promising anaesthetic alternative for upper limb surgery, when compared with general anaesthesia. It provides good surgical anaesthesia and better post-operative analgesia. We compared the anaesthetic and analgesic efficacy of two additives, nalbuphine and tramadol with 0.375% ropivacaine.A double-blind, cross-sectional study, performed prospectively on 82 patients who were randomly assigned into Group N (41) and Group T (41). Patients were posted for surgical procedure of upper limb under supraclavicular brachial plexus block. Group N received inj. Ropivacaine 0.375% 25 ml plus 1ml (10 mg) of Nalbuphine plus 1ml of normal saline. Patients in Group T received inj. Ropivacaine 0.375% 25 ml with Inj. Tramadol 2 ml (100 mg). Total volume was 27 ml in both groups. Duration of postoperative analgesia was the primary outcome of our study. The secondary outcomes were the sensory and motor block characteristics (onset and duration), change in hemodynamic parameters and side effects.A statistically significant difference was noted in the duration of postoperative analgesia [Group N: 648.27 (± 124.69) minutes, Group T: 514.73 (± 43.15) minutes; P <0.001]. In terms of onset of both sensory and motor block no statistically significant difference was noted. A significant difference was noted in duration of sensory block (Group N: 545.85 ± 118.13 min; Group T: 416.71 ± 50.43 min; P <0.001). The mean duration of motor block was 482.93 ± 120.07 min in nalbuphine group and 356.59 ± 43.74 min in tramadol group; P <0.001.Nalbuphine 10mg is a better adjuvant to 0.375% ropivacaine when compared with tramadol 100 mg. It prolongs the duration of sensory block and motor block and increases the duration of analgesia postoperatively.
{"title":"Comparative study of tramadol and nalbuphine as an adjuvant to ropivacaine in supraclavicular block: A cross sectional observational study","authors":"N. Kamble, M. Gajbhare, Pranjal Rajendra Pimparkar, M. Gaikwad","doi":"10.18231/j.ijca.2024.029","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.029","url":null,"abstract":"Brachial plexus block via supraclavicular approach performed with the help of ultrasound assistance, is a promising anaesthetic alternative for upper limb surgery, when compared with general anaesthesia. It provides good surgical anaesthesia and better post-operative analgesia. We compared the anaesthetic and analgesic efficacy of two additives, nalbuphine and tramadol with 0.375% ropivacaine.A double-blind, cross-sectional study, performed prospectively on 82 patients who were randomly assigned into Group N (41) and Group T (41). Patients were posted for surgical procedure of upper limb under supraclavicular brachial plexus block. Group N received inj. Ropivacaine 0.375% 25 ml plus 1ml (10 mg) of Nalbuphine plus 1ml of normal saline. Patients in Group T received inj. Ropivacaine 0.375% 25 ml with Inj. Tramadol 2 ml (100 mg). Total volume was 27 ml in both groups. Duration of postoperative analgesia was the primary outcome of our study. The secondary outcomes were the sensory and motor block characteristics (onset and duration), change in hemodynamic parameters and side effects.A statistically significant difference was noted in the duration of postoperative analgesia [Group N: 648.27 (± 124.69) minutes, Group T: 514.73 (± 43.15) minutes; P <0.001]. In terms of onset of both sensory and motor block no statistically significant difference was noted. A significant difference was noted in duration of sensory block (Group N: 545.85 ± 118.13 min; Group T: 416.71 ± 50.43 min; P <0.001). The mean duration of motor block was 482.93 ± 120.07 min in nalbuphine group and 356.59 ± 43.74 min in tramadol group; P <0.001.Nalbuphine 10mg is a better adjuvant to 0.375% ropivacaine when compared with tramadol 100 mg. It prolongs the duration of sensory block and motor block and increases the duration of analgesia postoperatively.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"3 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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