Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.
{"title":"The effect of hip shoulder width ratio and vertebral column length on sensory level in term participants posted for lower segment caesarean section under spinal anaesthesia in Indian population: A prospective observational study","authors":"Kiran Kishor Pisekar, Vaibhao Dongre, Sherin Rasalam, Supriya Chakravarthy, Pratik Shah","doi":"10.18231/j.ijca.2024.002","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.002","url":null,"abstract":"Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391674","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}
Balanced anaesthesia with intra-operative neuro monitoring (IONM) is an ideal choice for neurosurgeries wherein the functionalities of nerve has to be ascertained. The optimum goals during neurosurgeries include maintaining normothermia, hemodynamic parameters and blood loss. Neurophysiological monitoring consisting but not limited to evoked potentials originating from motor, somatosensory areas has become an indispensable tool in neurosurgeries to prevent nerve injuries and paralysis. This case describes the anaesthesia considerations in a case of laminectomy where IONM was used. The anaesthesiologist must have adequate knowledge regarding IONM to avoid interference and signal alteration due to anaesthesia. Hence, a proper teamwork is required between the anaesthesiologist, surgeon and neurophysiologist in order to provide a high-quality perioperative care and to detect and prevent neurological injuries.
{"title":"Intra-operative neurophysiological monitoring (IONM) & its role in neurosurgeries: An exceedingly essential monitoring technique","authors":"Praveen Ramasamy, Sathya Narayanan K, Premkumar Damodaran","doi":"10.18231/j.ijca.2024.017","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.017","url":null,"abstract":"Balanced anaesthesia with intra-operative neuro monitoring (IONM) is an ideal choice for neurosurgeries wherein the functionalities of nerve has to be ascertained. The optimum goals during neurosurgeries include maintaining normothermia, hemodynamic parameters and blood loss. Neurophysiological monitoring consisting but not limited to evoked potentials originating from motor, somatosensory areas has become an indispensable tool in neurosurgeries to prevent nerve injuries and paralysis. This case describes the anaesthesia considerations in a case of laminectomy where IONM was used. The anaesthesiologist must have adequate knowledge regarding IONM to avoid interference and signal alteration due to anaesthesia. Hence, a proper teamwork is required between the anaesthesiologist, surgeon and neurophysiologist in order to provide a high-quality perioperative care and to detect and prevent neurological injuries.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 86","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140392220","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.026
Anju Gupta, N. Gupta, Sandeep Diwan, Nitin Choudhary
{"title":"Comment on “Combined thoracic epidural anaesthesia and interscalene brachial plexus block for modified radical mastectomy in a high-risk patient”","authors":"Anju Gupta, N. Gupta, Sandeep Diwan, Nitin Choudhary","doi":"10.18231/j.ijca.2024.026","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.026","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391592","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.006
Namtip Triyasunant, P. Nivatpumin, Nutthakarn Luangpirom, Thanyarat Wongwananurak
Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p < 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p < 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.
文献中描述的对臼齿妊娠患者进行吸刮术的麻醉技术可分为全身麻醉和区域麻醉技术。本研究旨在报告影响在西里拉吉医院接受吸刮术的磨牙状妊娠患者选择麻醉技术决策的因素。本研究对2007年1月至2021年9月期间在西丽拉杰医院麻醉下接受吸刮术的双胎妊娠孕妇进行了回顾性病历审查。共有 244 名患者被诊断为磨牙妊娠，其中 110 名患者在考虑了纳入和排除标准后被纳入本研究进行分析。纳入患者的定量数据采用非配对t检验或曼惠尼U检验进行分析，定性数据则采用卡方检验进行分析。在接受吸刮术的磨牙妊娠患者中，全身麻醉是最受欢迎的麻醉技术（77.4%），其次是区域麻醉（11.3%）和静脉镇静（11.3%）。子宫增大≥16周的患者可能会使用全身麻醉，调整后的几率比为11.64（95% CI 1.08-125.72，P＜0.05）。子宫较大的患者β-hCG水平较高，会导致更严重的医疗并发症，如甲状腺功能亢进和妊娠剧吐（P < 0.05）。术中并发症，如子宫失弛缓（17.7%）、大出血（7.3%）和肺水肿（4.2%），仅限于接受全身麻醉的患者，但没有统计学意义。没有一名患者出现与麻醉相关的并发症。报告的术后严重并发症，如肺水肿（4.2%），需要术后插管并转入重症监护室，均发生在全身麻醉组。麻醉师建议合并疾病较多的患者接受全身麻醉。然而，子宫增大≥16周是影响麻醉师决定是否进行全身麻醉的唯一因素。
{"title":"Factors influencing decision-making for the anesthetic technique in molar pregnancy patients for suction curettage: A retrospective study","authors":"Namtip Triyasunant, P. Nivatpumin, Nutthakarn Luangpirom, Thanyarat Wongwananurak","doi":"10.18231/j.ijca.2024.006","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.006","url":null,"abstract":"Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p < 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p < 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391574","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 pilot questionnaire-based method was used to assess the qualitative data on work-related stress, family spending time and to evaluate the usefulness of this survey in managing their stress in their own feasible way among the anesthesiologists living in Tamil Nadu, Southern India.It was a cross-sectional, confidential survey conducted using a questionnaire method. It consisted of 15 questions under four headings prepared and handed over personally to 100 anesthesiologists who attended the State-level Anesthesiology Continuing medical education (CMEs), conducted in two districts of the southernmost part of Tamil Nadu. All the questions had a minimum of three multiple-choice options. They were subdivided into four sections: a) Questions on Demographic profile, b) Questions on assessment of time spent with family members: travel time, c) Questions on the assessment of personal time spent: hobbies, recreational activities, exercise, and habits of addiction d) Questions to assess the work pressure.Seventy anaesthesiologists (70%) responded to the survey. The mean age of the participants was 39.5(12.2) years. Among them, 14.3% (10) had diabetes, and 11.4% (8) had hypertension young. 24.3% (17) had>12 duty hours. Most of them spend (34.3%; 24) only 1-2 hours per day with family. Only 15.6% (5) exercise > 5 hours a week. Fifty percent of the participants were stressed during the first case of death on the table (DOT), only 17% handled with confidence and were not stressed, but 33% were stressed and did not sleep well for a few days. The overall stress levels were 61.4%. Forty-two percent (42.8%; 30) have addictive habits such as smoking and drinking alcohol. Our questionnaire-based study helped the responded Anaesthesiologists realize the amount of work-related stress, personal time, and family time is inadequate. At the end of the survey, most wanted to change their lifestyle and spend valuable family and me time for the rest of their life.
{"title":"The occupational stress and lifestyle of anesthesiologists living in the southern district of Tamil Nadu- A pilot questionnaire-based survey","authors":"Anitha Venugopal, Karthikeyan Venkatachalam, Amudha Rani","doi":"10.18231/j.ijca.2024.008","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.008","url":null,"abstract":"A pilot questionnaire-based method was used to assess the qualitative data on work-related stress, family spending time and to evaluate the usefulness of this survey in managing their stress in their own feasible way among the anesthesiologists living in Tamil Nadu, Southern India.It was a cross-sectional, confidential survey conducted using a questionnaire method. It consisted of 15 questions under four headings prepared and handed over personally to 100 anesthesiologists who attended the State-level Anesthesiology Continuing medical education (CMEs), conducted in two districts of the southernmost part of Tamil Nadu. All the questions had a minimum of three multiple-choice options. They were subdivided into four sections: a) Questions on Demographic profile, b) Questions on assessment of time spent with family members: travel time, c) Questions on the assessment of personal time spent: hobbies, recreational activities, exercise, and habits of addiction d) Questions to assess the work pressure.Seventy anaesthesiologists (70%) responded to the survey. The mean age of the participants was 39.5(12.2) years. Among them, 14.3% (10) had diabetes, and 11.4% (8) had hypertension young. 24.3% (17) had>12 duty hours. Most of them spend (34.3%; 24) only 1-2 hours per day with family. Only 15.6% (5) exercise > 5 hours a week. Fifty percent of the participants were stressed during the first case of death on the table (DOT), only 17% handled with confidence and were not stressed, but 33% were stressed and did not sleep well for a few days. The overall stress levels were 61.4%. Forty-two percent (42.8%; 30) have addictive habits such as smoking and drinking alcohol. Our questionnaire-based study helped the responded Anaesthesiologists realize the amount of work-related stress, personal time, and family time is inadequate. At the end of the survey, most wanted to change their lifestyle and spend valuable family and me time for the rest of their life. ","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391597","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}
Bystander CPR is an essential part of Out of Hospital Cardiac Arrest (OHCA). The Indian Society of Anaesthesiology Gujarat State Branch (ISAGSB) had embraced initiatives to teach Compression Only Life Support (COLS) to police personnel as they are likely to arrive before the emergency medical services in case of OHCA, thus increasing the chances of survival of victims. We evaluated the impact of one such training to 300 police men at our institute.: Participants were given a questionnaire in the pre and post training period and the impact of our training was evaluated in terms of attitude and knowledge by comparing the pre and post training scores.In both attitude and knowledge sections, there was a significant improvement in scores (p < 0.001). Marked percentage rise was also seen in the knowledge section with regards to the technique of COLS (<20% pre training to >80% post training). We conclude that raising awareness towards COLS and imparting proper training to first responders like police personnel can significantly improve the chances of survival.
{"title":"Impact of compression only life (COLS) training to police personnel as first responder to cardiac arrest","authors":"Hetal Ashish Parikh, Chinar Nitin Patel, Anushri Ashish Parikh, Pranit Pankaj Mehta","doi":"10.18231/j.ijca.2024.011","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.011","url":null,"abstract":"Bystander CPR is an essential part of Out of Hospital Cardiac Arrest (OHCA). The Indian Society of Anaesthesiology Gujarat State Branch (ISAGSB) had embraced initiatives to teach Compression Only Life Support (COLS) to police personnel as they are likely to arrive before the emergency medical services in case of OHCA, thus increasing the chances of survival of victims. We evaluated the impact of one such training to 300 police men at our institute.: Participants were given a questionnaire in the pre and post training period and the impact of our training was evaluated in terms of attitude and knowledge by comparing the pre and post training scores.In both attitude and knowledge sections, there was a significant improvement in scores (p < 0.001). Marked percentage rise was also seen in the knowledge section with regards to the technique of COLS (<20% pre training to >80% post training). We conclude that raising awareness towards COLS and imparting proper training to first responders like police personnel can significantly improve the chances of survival.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391790","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.007
Prajna Jayaram, Pooja Rao K, Tamanna Ahmed, T. Tantry
: The fall in core body temperature and peripheral body temperature following the administration of anaesthetic agent has been studied and demonstrated so far, along with the comparison of the same parameters following induction with propofol in contrast to that with sevoflurane. But no study so far, has compared the effects of TCI-propofol based anaesthesia with that of sevoflurane based anaesthesia for induction and maintenance, on core and peripheral body temperature and the gradient of temperature between the agents. The studies conducted so far, has shown more fall in core and peripheral body temperature from their respective baseline values when propofol was used for induction of anaesthesia in comparison to the use of sevoflurane. A total of 60 adults were randomized into two groups of 30 each; Group 1 were induced with TCI- propofol at 8mcg/ml plasma concentration and maintaind with TCI-propofol at 2-3mcg/ml plasma concentration and 66% nitrous oxide and 33% oxygen gas mixture. Group 2 were induced with intravenous thiopentone at 3-5mg/kg body weight and maintained with 1-1.5MAC sevoflurane, 66% nitrous oxide and 33% oxygen gas mixture. Core body temperature was measured inserting the temperature probe into nasophraynx and peripheral temperature was measured with the temperature probe inserted onto thenar eminence of either hand. We observed that both anaesthetic agents have caused similar fall in core temperature. However, peripheral temperature fell more with sevoflurane compared to TCI-propofol. In parallel with these observations, the increase in temperature gradient was higher in magnitude for sevoflurane based anaesthesia. The core temperature was comparable between the groups from their respective baseline values. But, the fall in peripheral temperature was more in sevoflurane group, so was the temperature gradient. Thus, TCI-propofol when used in appropriate plasma concentration for induction and maintenance of anaesthesia causes less hypothermia in contrast to sevoflurane.
{"title":"Comparison of effect of inhaled anaesthetic (Sevoflurane) versus intravenous (Propofol) anaesthetic on core and peripheral body temperature during general anaesthesia: A randomised control study","authors":"Prajna Jayaram, Pooja Rao K, Tamanna Ahmed, T. Tantry","doi":"10.18231/j.ijca.2024.007","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.007","url":null,"abstract":": The fall in core body temperature and peripheral body temperature following the administration of anaesthetic agent has been studied and demonstrated so far, along with the comparison of the same parameters following induction with propofol in contrast to that with sevoflurane. But no study so far, has compared the effects of TCI-propofol based anaesthesia with that of sevoflurane based anaesthesia for induction and maintenance, on core and peripheral body temperature and the gradient of temperature between the agents. The studies conducted so far, has shown more fall in core and peripheral body temperature from their respective baseline values when propofol was used for induction of anaesthesia in comparison to the use of sevoflurane. A total of 60 adults were randomized into two groups of 30 each; Group 1 were induced with TCI- propofol at 8mcg/ml plasma concentration and maintaind with TCI-propofol at 2-3mcg/ml plasma concentration and 66% nitrous oxide and 33% oxygen gas mixture. Group 2 were induced with intravenous thiopentone at 3-5mg/kg body weight and maintained with 1-1.5MAC sevoflurane, 66% nitrous oxide and 33% oxygen gas mixture. Core body temperature was measured inserting the temperature probe into nasophraynx and peripheral temperature was measured with the temperature probe inserted onto thenar eminence of either hand. We observed that both anaesthetic agents have caused similar fall in core temperature. However, peripheral temperature fell more with sevoflurane compared to TCI-propofol. In parallel with these observations, the increase in temperature gradient was higher in magnitude for sevoflurane based anaesthesia. The core temperature was comparable between the groups from their respective baseline values. But, the fall in peripheral temperature was more in sevoflurane group, so was the temperature gradient. Thus, TCI-propofol when used in appropriate plasma concentration for induction and maintenance of anaesthesia causes less hypothermia in contrast to sevoflurane.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 65","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391921","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.024
Ruma Thakuria, Dhatri Jonna, P. Talawar
{"title":"Challenging airway complicated with esophageal perforation: Concerns for anaesthesiologist","authors":"Ruma Thakuria, Dhatri Jonna, P. Talawar","doi":"10.18231/j.ijca.2024.024","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.024","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140392465","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.009
Govind Shaji, Gayatri Mishra
The incidence of residual neuromuscular paralysis (RNMB) with Train of four ratio<0.9 remains as high as 16% in PACU even after administration of reversal when neuromuscular monitoring is not done. Reversal with standard dose of neostigmine and extubation are done based on the clinical signs. We observed the clinical signs of neuromuscular recovery and correlated with neuromuscular monitoring to assess the degree of residual blockade in the post-operative period.100 Patients posted for surgery under general anaesthesia with endotracheal tube intubation and controlled ventilation were enrolled for the study after obtaining human ethical approval. Standard anaesthesia technique using morphine, propofol, vecuronium, isoflurane with low flow anaesthesia were administered for all patients. TOF was noted at the end of surgical procedure when patient resumed spontaneous respiration, during extubation, and at 15 minutes interval for one hour in the postoperative period. Hemodynamics were observed including respiratory rate. Overall 32 percent of patients had residual paralysis. 27% at 15 min, 26% at 30min, 6% at 45min and 3% at one hour in the postoperative period showed RNMB. Subgroup analysis showed that at the time administration of reversal 72 patients had (TOFR>0.4) and 28 had (TOFR<.0.4), showed significant difference in improvement in TOFR between 2 subgroups before reversal, immediate extubation and 15 min post extubation (p=0.00,0.001,0.003,) respectively. Clinical findings of neuromuscular reversal is not foolproof for complete recovery and standard dose neostigmine given during shallow block will accentuate the residual neuromuscular paralysis.
残余神经肌肉麻痹（RNMB）的发生率（Train of four ratio0.4）和 28 例（TOFR<.0.4）显示，在逆转前、立即拔管和拔管后 15 分钟这两个亚组之间，TOFR 的改善程度存在显著差异（P=0.00,0.001,0.003,）。神经肌肉逆转的临床结果并不能保证完全恢复，在浅阻滞期间给予标准剂量的新斯的明会加重残余的神经肌肉麻痹。
{"title":"Clinical assessment of recovery from neuromuscular blockers, is it a safe practise - An observational study","authors":"Govind Shaji, Gayatri Mishra","doi":"10.18231/j.ijca.2024.009","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.009","url":null,"abstract":"The incidence of residual neuromuscular paralysis (RNMB) with Train of four ratio<0.9 remains as high as 16% in PACU even after administration of reversal when neuromuscular monitoring is not done. Reversal with standard dose of neostigmine and extubation are done based on the clinical signs. We observed the clinical signs of neuromuscular recovery and correlated with neuromuscular monitoring to assess the degree of residual blockade in the post-operative period.100 Patients posted for surgery under general anaesthesia with endotracheal tube intubation and controlled ventilation were enrolled for the study after obtaining human ethical approval. Standard anaesthesia technique using morphine, propofol, vecuronium, isoflurane with low flow anaesthesia were administered for all patients. TOF was noted at the end of surgical procedure when patient resumed spontaneous respiration, during extubation, and at 15 minutes interval for one hour in the postoperative period. Hemodynamics were observed including respiratory rate. Overall 32 percent of patients had residual paralysis. 27% at 15 min, 26% at 30min, 6% at 45min and 3% at one hour in the postoperative period showed RNMB. Subgroup analysis showed that at the time administration of reversal 72 patients had (TOFR>0.4) and 28 had (TOFR<.0.4), showed significant difference in improvement in TOFR between 2 subgroups before reversal, immediate extubation and 15 min post extubation (p=0.00,0.001,0.003,) respectively. Clinical findings of neuromuscular reversal is not foolproof for complete recovery and standard dose neostigmine given during shallow block will accentuate the residual neuromuscular paralysis.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391531","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 : 2024-03-15DOI: 10.18231/j.ijca.2024.015
Shashidhar Dabbeghatta
: The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.
{"title":"A retrospective review of effectiveness of ERAS post-operative pain protocol in hip replacement surgeries under general anaesthesia at a tertiary orthopaedic hospital","authors":"Shashidhar Dabbeghatta","doi":"10.18231/j.ijca.2024.015","DOIUrl":"https://doi.org/10.18231/j.ijca.2024.015","url":null,"abstract":": The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":" 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391547","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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