Pub Date : 2023-11-15DOI: 10.18231/j.ijca.2023.089
P. Ahluwalia, Simran Saroha
{"title":"Ultrasound-guided erector spinae plane block with graded epidural anesthesia for open cholecystectomy in geriatric patient","authors":"P. Ahluwalia, Simran Saroha","doi":"10.18231/j.ijca.2023.089","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.089","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139271998","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.073
Pooja Agrawal, Puneet Bhuwania
: The use of alpha 2 agonists are now becoming the standard of care pre-medication drug in paediatric patients to induce induction and reduce separation anxiety. A prospective, randomized, double-blind, controlled study was designed to assess and compare the effectiveness and safety of two different strengths of intranasal dexmedetomidine in children between the ages of 2 and 8.: Sixty children between ages 2-8 years and of ASA physical status I or II scheduled for elective surgery were randomly assigned to one of two groups. Group A received 1 µg/kg of intranasal dexmedetomidine while Group B received 2 µg/kg as pre-medication. Patients sedation status, behaviour (mask acceptance) and parental separation scores were assessed over 30 min as primary endpoints along with its effect on haemodynamic and respiratory parameters over the same duration as secondary endpoints.: 7.4% of children in group A while 96.5% of children in group B achieved a satisfactory sedation score, 11.1% of children in group A while 100% of children in group B achieved a satisfactory mask acceptance score and 7.4% of children in group A while 100% of children in group B achieved a satisfactory parent child separation score (p<0.001). We did not observe any clinically significant effects of dexmedetomidine on RR, SpO2, HR or MAP and no child required atropine or supplemental oxygen.: We conclude that 2µg/kg dose as compared to 1µg/kg offers multiple advantages of being good sedative, analgesic and anxiolytic in this age group when used as pre-medication.
{"title":"Comparative effectiveness of intranasal dexmedetomidine dosing as premedication in paediatric surgery: Randomized controlled trial","authors":"Pooja Agrawal, Puneet Bhuwania","doi":"10.18231/j.ijca.2023.073","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.073","url":null,"abstract":": The use of alpha 2 agonists are now becoming the standard of care pre-medication drug in paediatric patients to induce induction and reduce separation anxiety. A prospective, randomized, double-blind, controlled study was designed to assess and compare the effectiveness and safety of two different strengths of intranasal dexmedetomidine in children between the ages of 2 and 8.: Sixty children between ages 2-8 years and of ASA physical status I or II scheduled for elective surgery were randomly assigned to one of two groups. Group A received 1 µg/kg of intranasal dexmedetomidine while Group B received 2 µg/kg as pre-medication. Patients sedation status, behaviour (mask acceptance) and parental separation scores were assessed over 30 min as primary endpoints along with its effect on haemodynamic and respiratory parameters over the same duration as secondary endpoints.: 7.4% of children in group A while 96.5% of children in group B achieved a satisfactory sedation score, 11.1% of children in group A while 100% of children in group B achieved a satisfactory mask acceptance score and 7.4% of children in group A while 100% of children in group B achieved a satisfactory parent child separation score (p<0.001). We did not observe any clinically significant effects of dexmedetomidine on RR, SpO2, HR or MAP and no child required atropine or supplemental oxygen.: We conclude that 2µg/kg dose as compared to 1µg/kg offers multiple advantages of being good sedative, analgesic and anxiolytic in this age group when used as pre-medication.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274885","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.086
Shrishanth Murali Kallat, Manish Aggarwal, John M K
Diaphragmatic eventration is the abnormal elevation of the hemidiaphragm or part of it caused due to the lack of muscle or nerve function with normal anatomical attachments. Pneumothorax is a common occurrence during thoracoscopic approaches of diaphragmatic plication but a very rare complication in laparoscopic approaches.A 56-year-old male presented with complaints of pain in the left upper abdomen, bloating, and difficulty in breathing. He was diagnosed with idiopathic diaphragmatic eventration and was taken up for laparoscopic plication under American society of anaesthesiologists – physical status 1. Intra-op, he developed sudden onset increase in peak pressures with poor tidal volumes and desaturation. Examination revealed reduced breath sounds and movement of left side of chest, possibly a left sided pneumothorax. The placement of a left-sided intercostal chest drain led to improvements in ventilatory parameters.The patient was successfully extubated following the completion of surgery.: Pneumothorax is an established complication of laparoscopic surgery, with a reported incidence of 0.01%-0.4%. But early detection and diagnosis of a pneumothorax intraoperatively is difficult and often missed because of controlled ventilation and pneumoperitoneum. A high index of suspicion should be maintained for early diagnosis and management of such conditions.Intraoperative tension pneumothorax and its progression can have devastating consequences. A high index of suspicion, prompt recognition of the condition despite many factors that may mask the condition and prompt remediation leads to an effective management of such cases.
{"title":"Pneumothorax during laparoscopic plication of diaphragmatic eventration: A case report","authors":"Shrishanth Murali Kallat, Manish Aggarwal, John M K","doi":"10.18231/j.ijca.2023.086","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.086","url":null,"abstract":"Diaphragmatic eventration is the abnormal elevation of the hemidiaphragm or part of it caused due to the lack of muscle or nerve function with normal anatomical attachments. Pneumothorax is a common occurrence during thoracoscopic approaches of diaphragmatic plication but a very rare complication in laparoscopic approaches.A 56-year-old male presented with complaints of pain in the left upper abdomen, bloating, and difficulty in breathing. He was diagnosed with idiopathic diaphragmatic eventration and was taken up for laparoscopic plication under American society of anaesthesiologists – physical status 1. Intra-op, he developed sudden onset increase in peak pressures with poor tidal volumes and desaturation. Examination revealed reduced breath sounds and movement of left side of chest, possibly a left sided pneumothorax. The placement of a left-sided intercostal chest drain led to improvements in ventilatory parameters.The patient was successfully extubated following the completion of surgery.: Pneumothorax is an established complication of laparoscopic surgery, with a reported incidence of 0.01%-0.4%. But early detection and diagnosis of a pneumothorax intraoperatively is difficult and often missed because of controlled ventilation and pneumoperitoneum. A high index of suspicion should be maintained for early diagnosis and management of such conditions.Intraoperative tension pneumothorax and its progression can have devastating consequences. A high index of suspicion, prompt recognition of the condition despite many factors that may mask the condition and prompt remediation leads to an effective management of such cases.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273432","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.076
Sakhi Sachin Sardeshpande, Shubhada Deshmukh
The use of Ketamine, an NMDA receptor antagonist, in sub-anesthetic doses for analgesia is increasingly being administered in inpatient settings with acute pain service guidance and in outpatient settings under a variety of models. At sub-anesthetic doses, ketamine possesses centrally mediated analgesic properties with minimal effects on consciousness and cognition.In this study we have compared the efficacy of IV low-dose Ketamine as an adjunct to conventional systemic analgesia to examine preventive effect on post-operative pain and opioid consumption in patients undergoing laparotomies.The study was carried out on 50 patients, 25 patients received a pre-incisional IV bolus of 0.15 mg/kg of Ketamine,10 mins before the incision followed by IV infusion of 2mcg/kg/min continued for 24 hours postoperatively in addition to systemic analgesia (Group K)and 25 Patients received IV bolus of Normal Saline 10 min before the incision, followed by an IV infusion of normal saline (Group C) till 24 hours post-op and systemic analgesia alone. Saline bolus and infusion were given at equivalent volume/rate of the study group. The analgesic efficacy was judged by NRS (Numeric Pain Rating Scale), Time to first rescue analgesia (TFA) and Total opioid consumption (Tramadol in mg) in 24 hours. Ketamine related side effects were also recorded.Patients in the Ketamine group had significantly lower Mean total opioid consumption (88.04 ± 29.07 mg vs. 210 ± 23.93 mg)and Numerical pain Rating Scale (NRS) (3.13 +0.34 vs. 4.44+ 0.77). Time to first rescue analgesia was significantly delayed in Ketamine group as compared to Control group (20.65 ± 9.2 mins vs. 5.4 ± 5.38 mins). Ramsay Sedation scores (RSS) were significantly higher in the Ketamine group (2.4 +0.76vs. 1.52 +0.51)in the immediate post-operative period. There were no demonstrable side-effects related to Ketamine in Group K.Pre-emptive IV low-dose Ketamine is an effective adjunct to systemic analgesia in abdominal surgeries as it significantly prolongs the time to first rescue analgesia (TFA), reduces mean total analgesic requirement and lowers pain scores (NRS) in the post-operative period with negligible side effects.
氯胺酮是一种 NMDA 受体拮抗剂，以亚麻醉剂量用于镇痛的情况越来越多，在急性疼痛服务指导下的住院环境和各种模式的门诊环境中都在使用氯胺酮。在这项研究中，我们比较了静脉注射低剂量氯胺酮作为常规全身镇痛的辅助药物的疗效，以检查对开腹手术患者术后疼痛和阿片类药物消耗的预防效果。研究对象为50名患者，其中25名患者在手术前10分钟静脉注射0.15毫克/千克氯胺酮，随后静脉输注2毫克/千克/分钟，持续至术后24小时，同时进行全身镇痛（K组）；25名患者在手术前10分钟静脉注射生理盐水，随后静脉输注生理盐水（C组），直至术后24小时，同时仅进行全身镇痛。生理盐水注射和输注的量/速度与研究组相同。镇痛效果通过 NRS（数字疼痛评分量表）、首次抢救镇痛时间（TFA）和 24 小时内阿片类药物总消耗量（曲马多，毫克）来判断。氯胺酮组患者的平均阿片类药物总用量（88.04 ± 29.07 毫克 vs 210 ± 23.93 毫克）和数字疼痛评分量表（NRS）（3.13 + 0.34 vs 4.44+ 0.77）均明显低于氯胺酮组。与对照组相比，氯胺酮组首次镇痛抢救时间明显延迟（20.65 ± 9.2 分钟 vs. 5.4 ± 5.38 分钟）。术后初期，氯胺酮组的拉姆塞镇静评分（RSS）明显高于对照组（2.4 +0.76 vs. 1.52 +0.51）。在腹部手术中，抢先静脉注射低剂量氯胺酮是全身镇痛的有效辅助手段，因为它能明显延长首次镇痛抢救时间（TFA），减少平均镇痛剂总需求量，降低术后疼痛评分（NRS），而且副作用微乎其微。
{"title":"Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study","authors":"Sakhi Sachin Sardeshpande, Shubhada Deshmukh","doi":"10.18231/j.ijca.2023.076","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.076","url":null,"abstract":"The use of Ketamine, an NMDA receptor antagonist, in sub-anesthetic doses for analgesia is increasingly being administered in inpatient settings with acute pain service guidance and in outpatient settings under a variety of models. At sub-anesthetic doses, ketamine possesses centrally mediated analgesic properties with minimal effects on consciousness and cognition.In this study we have compared the efficacy of IV low-dose Ketamine as an adjunct to conventional systemic analgesia to examine preventive effect on post-operative pain and opioid consumption in patients undergoing laparotomies.The study was carried out on 50 patients, 25 patients received a pre-incisional IV bolus of 0.15 mg/kg of Ketamine,10 mins before the incision followed by IV infusion of 2mcg/kg/min continued for 24 hours postoperatively in addition to systemic analgesia (Group K)and 25 Patients received IV bolus of Normal Saline 10 min before the incision, followed by an IV infusion of normal saline (Group C) till 24 hours post-op and systemic analgesia alone. Saline bolus and infusion were given at equivalent volume/rate of the study group. The analgesic efficacy was judged by NRS (Numeric Pain Rating Scale), Time to first rescue analgesia (TFA) and Total opioid consumption (Tramadol in mg) in 24 hours. Ketamine related side effects were also recorded.Patients in the Ketamine group had significantly lower Mean total opioid consumption (88.04 ± 29.07 mg vs. 210 ± 23.93 mg)and Numerical pain Rating Scale (NRS) (3.13 +0.34 vs. 4.44+ 0.77). Time to first rescue analgesia was significantly delayed in Ketamine group as compared to Control group (20.65 ± 9.2 mins vs. 5.4 ± 5.38 mins). Ramsay Sedation scores (RSS) were significantly higher in the Ketamine group (2.4 +0.76vs. 1.52 +0.51)in the immediate post-operative period. There were no demonstrable side-effects related to Ketamine in Group K.Pre-emptive IV low-dose Ketamine is an effective adjunct to systemic analgesia in abdominal surgeries as it significantly prolongs the time to first rescue analgesia (TFA), reduces mean total analgesic requirement and lowers pain scores (NRS) in the post-operative period with negligible side effects.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"2022 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273511","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.075
Neenu Susan Paul, Valsamma Abraham, Dootika Liddle
: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I & II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.
{"title":"A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions","authors":"Neenu Susan Paul, Valsamma Abraham, Dootika Liddle","doi":"10.18231/j.ijca.2023.075","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.075","url":null,"abstract":": A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I & II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139272335","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.084
Sinchu Mary Babu, Alex Francisco Nicholas, R. Devaprasath
We present a case of an open hernia repair for an obstructed Umbilical Hernia for a 77-year-old male patient categorized as ASA 4E with multiple comorbidities under Bilateral Rectus Sheath Block.A bilateral rectus sheath block was performed under real-time ultrasonographic guidance. He is a known case of coronary artery disease and double vessel disease and was on dual antiplatelet therapy. Due to the patient’s significant perioperative risks, the surgery was performed under ultrasonography-guided bilateral rectus sheath block. The patient tolerated the surgery well, with minimal further sedation.
{"title":"Obstructed umbilical hernia repair under bilateral rectus sheath block for a high-risk patient: A case report","authors":"Sinchu Mary Babu, Alex Francisco Nicholas, R. Devaprasath","doi":"10.18231/j.ijca.2023.084","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.084","url":null,"abstract":"We present a case of an open hernia repair for an obstructed Umbilical Hernia for a 77-year-old male patient categorized as ASA 4E with multiple comorbidities under Bilateral Rectus Sheath Block.A bilateral rectus sheath block was performed under real-time ultrasonographic guidance. He is a known case of coronary artery disease and double vessel disease and was on dual antiplatelet therapy. Due to the patient’s significant perioperative risks, the surgery was performed under ultrasonography-guided bilateral rectus sheath block. The patient tolerated the surgery well, with minimal further sedation.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275045","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.072
S. J. L. Flower, Alex Francisco Nicholas, R. Devaprasath
Transversus abdominis plane (TAP) block is a successful postoperative analgesia technique in laparoscopic surgeries. This study compared the analgesic efficacy of 0.25% bupivacaine and 0.375% Ropivacaine in TAP block as post-operative analgesia for upper abdomen laparoscopic surgeries.: This randomized, double-blinded comparative study was conducted at the Dr Jeyasekharan Medical Trust and Nursing Home for 18 months. Seventy-one consenting adult patients undergoing upper abdominal laparoscopic surgeries qualifying the inclusion criteria to undergo Bilateral Subcostal TAP Block were included. The patient was labelled group A or B according to a computer-generated randomization list. TAP block was administered using 30 ml (15 ml on each side) of 0.25% bupivacaine (A) or 0.375% ropivacaine (B). Similar premedication and induction were given to all patients. : Among 71 patients in group A, males were 5 (14.7%), and females were 29 (85.3%). In group B, males were 7 (18.9%), and female was 30 (81.1%). There is no significant difference in gender, age, and BMI between groups. The mean duration of analgesia with 0.375% ropivacaine (10.21±3.36 hrs.) was significantly higher than 0.25% bupivacaine (6.38±2.03 hrs.). In the first 24 hours postoperatively, the mean total tramadol consumption was 147.06±11.94 mg in group A and 117.57±31.11 mg in group B, which is statistically significant.: This study concludes that 0.375% 30ml ropivacaine given as a TAP block under ultrasound guidance significantly prolonged the post-operative analgesia duration compared to 0.25% 30ml bupivacaine.
腹横肌平面（TAP）阻滞是腹腔镜手术中一种成功的术后镇痛技术。这项研究比较了 0.25% 布比卡因和 0.375% 罗哌卡因在上腹部腹腔镜手术中作为术后镇痛的 TAP 阻滞的镇痛效果：这项随机、双盲比较研究在杰亚瑟卡兰博士医疗信托和疗养院进行，为期 18 个月。71名同意接受上腹部腹腔镜手术的成年患者符合双侧肋下TAP阻滞的纳入标准。根据计算机生成的随机名单，患者被分为 A 组或 B 组。TAP阻滞使用30毫升（每侧15毫升）0.25%布比卡因（A组）或0.375%罗哌卡因（B组）。所有患者的术前用药和诱导均相似。 A 组 71 名患者中，男性 5 名（14.7%），女性 29 名（85.3%）。B 组中，男性 7 人（18.9%），女性 30 人（81.1%）。各组之间在性别、年龄和体重指数方面没有明显差异。0.375% 罗哌卡因的平均镇痛时间（10.21±3.36 小时）明显高于 0.25% 布比卡因（6.38±2.03 小时）。术后 24 小时内，A 组和 B 组的曲马多总用量分别为（147.06±11.94）毫克和（117.57±31.11）毫克，差异有统计学意义：本研究得出结论：与 0.25% 30 毫升布比卡因相比，在超声引导下给予 0.375% 30 毫升罗哌卡因作为 TAP 阻滞可明显延长术后镇痛时间。
{"title":"A randomized comparative study of transversus abdominis plane block (tap) with 0.25% bupivacaine and 0.375% ropivacaine in the duration of post-operative analgesia in upper abdominal laparoscopic surgeries","authors":"S. J. L. Flower, Alex Francisco Nicholas, R. Devaprasath","doi":"10.18231/j.ijca.2023.072","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.072","url":null,"abstract":"Transversus abdominis plane (TAP) block is a successful postoperative analgesia technique in laparoscopic surgeries. This study compared the analgesic efficacy of 0.25% bupivacaine and 0.375% Ropivacaine in TAP block as post-operative analgesia for upper abdomen laparoscopic surgeries.: This randomized, double-blinded comparative study was conducted at the Dr Jeyasekharan Medical Trust and Nursing Home for 18 months. Seventy-one consenting adult patients undergoing upper abdominal laparoscopic surgeries qualifying the inclusion criteria to undergo Bilateral Subcostal TAP Block were included. The patient was labelled group A or B according to a computer-generated randomization list. TAP block was administered using 30 ml (15 ml on each side) of 0.25% bupivacaine (A) or 0.375% ropivacaine (B). Similar premedication and induction were given to all patients. : Among 71 patients in group A, males were 5 (14.7%), and females were 29 (85.3%). In group B, males were 7 (18.9%), and female was 30 (81.1%). There is no significant difference in gender, age, and BMI between groups. The mean duration of analgesia with 0.375% ropivacaine (10.21±3.36 hrs.) was significantly higher than 0.25% bupivacaine (6.38±2.03 hrs.). In the first 24 hours postoperatively, the mean total tramadol consumption was 147.06±11.94 mg in group A and 117.57±31.11 mg in group B, which is statistically significant.: This study concludes that 0.375% 30ml ropivacaine given as a TAP block under ultrasound guidance significantly prolonged the post-operative analgesia duration compared to 0.25% 30ml bupivacaine.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"18 7-8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275183","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 : 2023-11-15DOI: 10.18231/j.ijca.2023.077
S. Gandotra, Slomi Gupta
Anesthesiology is well positioned to benefit from applications of artificial intelligence on multiple elements such as monitoring the depth of anesthesia, control of anesthetic machine functions, ultrasound guidance for procedures and diagnosis, adverse event prediction, pain assessment and management, and optimising the operating room workflow. The ethical concerns can arise from multiple aspects of AI research and deployment such as the nature and source of the data, data collection methodologies, AI models design, output interpretation and inappropriate use. AI solution can have the unintended consequences like perpetuation of systematic biases and discrimination towards under-represented sections of society. There could be conflicts about data protection, intellectual property rights and economic gains. Also, the research must be transparent and solutions feasible. The clinician’s role is ever changing in this landscape. We will discuss the broad ethical frameworks that are applicable to developing and using AI in medicine.
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Airway management has always been the main stay of concern for all Anaesthetists especially when it is an undiagnosed difficult one. Our main stay of the article is to be prepared with all forms of equipment for any and all difficult airways, difficult airway can turn into a nightmare for any anaesthesiologist. Vallecular or aryepiglottic fold cysts are often asymptomatic and harmless as long as they do not cause airway narrowing.To discover a vallecular or aryepiglottic fold cyst after induction of anesthesia on direct laryngoscopy is a potentially life-threatening problem as it involves a challenge for the anaesthesiologist. This report describes the management of a patient with an asymptomatic vallecular cyst that was discovered during inability to ventilate after proseal insertion and visualised with laryngoscopy, prior to which the patient did not present with any airway symptoms even after anesthesia induction and muscle relaxant.
{"title":"Unexpected challenge: Proseal insertion and intubation complicated by undiagnosed aryepiglottic fold cyst","authors":"Krishan Yogesh Sawhney, Sabih Ahmad, Aakash Agarwal","doi":"10.18231/j.ijca.2023.078","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.078","url":null,"abstract":"Airway management has always been the main stay of concern for all Anaesthetists especially when it is an undiagnosed difficult one. Our main stay of the article is to be prepared with all forms of equipment for any and all difficult airways, difficult airway can turn into a nightmare for any anaesthesiologist. Vallecular or aryepiglottic fold cysts are often asymptomatic and harmless as long as they do not cause airway narrowing.To discover a vallecular or aryepiglottic fold cyst after induction of anesthesia on direct laryngoscopy is a potentially life-threatening problem as it involves a challenge for the anaesthesiologist. This report describes the management of a patient with an asymptomatic vallecular cyst that was discovered during inability to ventilate after proseal insertion and visualised with laryngoscopy, prior to which the patient did not present with any airway symptoms even after anesthesia induction and muscle relaxant.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"25 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274978","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}
: Cardiovascular autonomic neuropathy (CAN) is one of the least frequently diagnosed and the most clinically significant complications of Diabetes mellitus (DM). Impaired heart rate variability (HRV) is the earliest indicator of CAN. Peri-operative hemodynamic instability is a major concern during general anaesthesia (GA) in patients with autonomic dysfunction. Purpose of this study was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients pre-operatively and to study the haemodynamic responses of these patients during induction.: The primary objective was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients preoperatively. Secondary objective was to study hemodynamic responses of these patients during induction of GA.: We included 68 patients (34 diabetics- group D and 34 non-diabetics- group N) aged between 30 to 65 years, with American society of anaesthesiologists (ASA) physical status 1 and 2 undergoing elective surgeries under GA. All the eligible patients underwent HRV evaluation for 10 minutes on the previous day of surgery and the time & frequency domain variables were evaluated. The hemodynamic parameters were recorded at pre-induction, post-induction, post-intubation and for every 3 minutes thereafter for 15 minutes and analysed.: The diabetics had a significantly lower total power (TP) with p-value 0.003. The post- induction mean arterial pressures (MAP) were comparatively lower in diabetics and the difference was significant at 12 minutes post intubation (p= 0.04). The lower trends in heart rate (HR) were comparatively more in diabetics rather than non-diabetics (p= 0.06) and the ephedrine usage was also higher in diabetics (p= 0.07). The measurement of HRV is a simple tool to evaluate the peri-operative risks in patients with suspected cardiovascular autonomic neuropathy.
{"title":"Pre-operative screening of diabetic patients for heart rate variability and their hemodynamic responses during induction of general anaesthesia","authors":"Geetha Lakshminarasimhaiah, Nithya Dinesh, Arun Kumar, Smita Musti, Ridhi Rao, Ayesha Sabha Khavas","doi":"10.18231/j.ijca.2023.071","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.071","url":null,"abstract":": Cardiovascular autonomic neuropathy (CAN) is one of the least frequently diagnosed and the most clinically significant complications of Diabetes mellitus (DM). Impaired heart rate variability (HRV) is the earliest indicator of CAN. Peri-operative hemodynamic instability is a major concern during general anaesthesia (GA) in patients with autonomic dysfunction. Purpose of this study was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients pre-operatively and to study the haemodynamic responses of these patients during induction.: The primary objective was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients preoperatively. Secondary objective was to study hemodynamic responses of these patients during induction of GA.: We included 68 patients (34 diabetics- group D and 34 non-diabetics- group N) aged between 30 to 65 years, with American society of anaesthesiologists (ASA) physical status 1 and 2 undergoing elective surgeries under GA. All the eligible patients underwent HRV evaluation for 10 minutes on the previous day of surgery and the time & frequency domain variables were evaluated. The hemodynamic parameters were recorded at pre-induction, post-induction, post-intubation and for every 3 minutes thereafter for 15 minutes and analysed.: The diabetics had a significantly lower total power (TP) with p-value 0.003. The post- induction mean arterial pressures (MAP) were comparatively lower in diabetics and the difference was significant at 12 minutes post intubation (p= 0.04). The lower trends in heart rate (HR) were comparatively more in diabetics rather than non-diabetics (p= 0.06) and the ephedrine usage was also higher in diabetics (p= 0.07). The measurement of HRV is a simple tool to evaluate the peri-operative risks in patients with suspected cardiovascular autonomic neuropathy.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"23 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275573","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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