Indian Journal of Anaesthesia最新文献

Background and aims: Physical injuries during anaesthesia, while seemingly minor compared to other complications, can cause significant patient suffering and medico-legal consequences. This study aimed to determine the incidence and risk factors of physical injuries during anaesthesia in a large tertiary hospital to identify areas for improvement in patient safety.

Methods: A retrospective analysis of prospectively collected data in a high-volume tertiary hospital performing 25,000 surgeries annually was conducted from 2014-2019. All physical injury incidents during anaesthesia were categorised into six groups: airway injuries, eye injuries, non-regional nerve injuries, regional nerve injuries, pressure injuries, and vascular injuries. Risk factors and outcomes were analysed using Chi-square tests, with P < 0.05 considered significant.

Results: Among 161,645 anaesthetics, 246 physical injuries were reported (0.15% incidence). Pressure injuries were most common (36%), followed by airway injuries (35%), nerve injuries (14%), vascular injuries (12%), and eye injuries (3%). Physical injuries were twice as likely in patients with American Society of Anaesthesiologists Physical Status (ASA PS) ≥3 (0.28% vs 0.11%, P < 0.001) and four times more likely during after-hours procedures (0.53% vs 0.13%, P < 0.001). Overall, 60.3% required specialist review, 12.9% had temporary disabilities, and 0.73% had permanent disabilities. 31% of injuries were deemed preventable.

Conclusion: Physical injuries during anaesthesia occur in 15 per 10,000 cases, with higher ASA PS and after-hours procedures being significant risk factors. These findings support implementing enhanced protective protocols for high-risk patients and procedures to improve perioperative safety.

Background and aims: The use of supraglottic airway devices (SGADs) is still controversial in paediatric otorhinolaryngological surgeries. We conducted this review and analysis to compare SGADs to endotracheal tubes (ETTs) regarding the feasibility of their use in children.

Methods: Randomised controlled trials (RCTs) that compared SGADs versus ETTs in patients ≤18 years undergoing adenotonsillectomy surgery under general anaesthesia were searched from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase till November 2024 and re-examined on 31 August 2025. The primary outcome measure was conversion from SGAD to ETT, and other outcomes included comparison of perioperative respiratory adverse events, laryngospasm, and surgical time.

Results: Six trials (n = 750) were included in the analysis. The failure rate of SGAD was 6.5% [95% confidence interval (CI): 2.2, 0.9%, P = 0.001]. The odds ratio of developing [perioperative respiratory adverse event (PRAE) with SGAD was significantly less than the ETT odds ratio (OR) 0.55 (95% CI: 0.36, 0.82, P = 0.004)]. There was a statistically similar incidence of laryngospasm with OR 0.84 (95% CI: 0.39, 1.81). No difference was found in the operating times with a mean difference of 0.82 mins (95% CI: -2.08, 3.72). The level of evidence was graded as moderate to low.

Conclusion: SGADs are a feasible alternative to ETT in paediatric adenotonsillectomy with an anticipated failure rate of 6.5%. Larger and more rigorous RCTs are needed to establish the safety of these airway devices in terms of PRAE and efficacy in terms of duration of surgery in comparison to ETTs.

Background and aims: Patients undergoing oesophagectomies are at risk of intraoperative hypothermia. The study aims to determine the incidence of hypothermia during oesophagectomy surgeries.

Methods: This observational bidirectional study evaluated 266 adult patients (175 retrospective and 91 prospective) undergoing elective oesophagectomy at a tertiary care centre between 2019 and 2022. Intraoperative core temperature was monitored hourly using a nasopharyngeal probe. Postoperative complications were recorded until discharge. Logistic regression analysis assessed the association between the incidence of hypothermia and perioperative variables. Those factors found significant in the simple logistic regression were then subjected to multiple logistic regression. A goodness-of-fit and sensitivity analysis was performed.

Results: The incidence of intraoperative hypothermia (core temperature <36°C) was 90.6% [95% confidence interval (CI): 87, 94]. Nearly 60% of patients were found to be hypothermic before the surgery began. The incidence of clinically significant hypothermia (CSH) (core temperature <35°C) was 32.3% (95% CI: 30, 40). The perioperative factors significantly and independently associated with intraoperative hypothermia were preoperative significant weight loss [odds ratio (OR): 2.03, 95% CI: 1.17, 3.52, P = 0.012] and intraoperative requirement of vasopressors (OR: 2.76, 95% CI: 1.10, 6.93, P = 0.030). We found no association between intraoperative hypothermia and postoperative complications.

Conclusion: The study recorded a high incidence of intraoperative hypothermia during oesophagectomy surgeries. Hypothermia began in the preoperative period for nearly two-thirds of patients. Factors associated with CSH included preoperative significant weight loss and the intraoperative need for vasopressors. No significant association was found with postoperative complications and discharge.

Background and aims: The sniffing position is required for direct laryngoscopy to align the oropharyngeal-laryngeal axis in the line of sight. However, videolaryngoscope (VL)-guided intubation may not need a sniffing position. This meta-analysis compared intubation using VL in the sniffing position versus ramped or head-elevated positions.

Methods: This prospective systematic review and meta-analysis included randomised controlled trials comparing VL in a ramped or head-elevated position with the sniffing position in adult patients undergoing endotracheal intubation. The primary outcome was time for intubation. The secondary outcomes included the first attempt success and the glottic view during intubation. Trial sequential analysis (TSA) was conducted for the primary outcome.

Results: This review adhered to the PRISMA 2020 guidelines. Four studies were included, with 341 patients (173 in the ramped and 168 in the sniffing position). The pooled data showed that intubation time was comparable in the ramped as well as in the sniffing position [standard mean difference: -0.74; 95% confidence interval (CI): -1.59, 0.11; P = 0.089; I ² = 92.4%; prediction interval = -3.59, 2.11]. Similarly, no significant difference in first attempt success rate between the two groups [risk ratio (RR): 1.03; 95% CI: 0.95, 1.12; P = 0.368; I ² = 33.1%]. The comparison of the good glottic view showed a pooled RR of 1.14; 95% CI: 0.61, 2.12; and P = 0.461. TSA showed an adequate sample for the primary outcome.

Conclusion: The current meta-analysis suggests that during VL, the intubation time, first-attempt success, and glottic view were comparable in both ramped and sniffing positions. However, high heterogeneity makes the results less robust.

Background and aims: Evidence is inconclusive regarding the role of magnesium sulphate (MgSO₄) on the onset of sensory block in brachial plexus blocks (BPBs). A meta-analysis was conducted to assess the impact of adding MgSO₄ to local anaesthetics (LA) used in BPBs on the onset time of sensory block.

Methods: Medline, Embase, Google Scholar, and bibliography searches were consulted to identify randomised clinical trials using MgSO₄ versus control in BPBs. The primary outcome was the onset of sensory block. The secondary outcomes measured were duration of sensory and motor block, as well as the duration of analgesia. Continuous data were expressed as standard mean difference (SMD) with 95% confidence intervals (CI) and analysed using a random-effects model. Subgroup analysis was also performed based on magnesium dose. Study quality was assessed using a JADAD scoring system.

Results: Thirty-two studies were included in this study. MgSO₄ led to a quicker onset of sensory block (n = 1768; N = 28; SMD = -1.00; 95% CI: -1.46, -0.55; P < 0.0001). MgSO₄ also led to a quicker onset of motor block (n = 1768; N = 28; SMD = -1.15; 95% CI: -1.62, -0.68; P < 0.00001), and prolonged duration of analgesic effect (n = 1368; N = 21; SMD = 4.22; 95% CI: 3.36, 5.08; P < 0.00001). Subgroup analysis showed that MgSO₄ doses of >200 mg compared to ≤200 mg prolonged the duration of sensory block (MD = 179.00 min vs 144.31 min) and motor block (MD = 145.26 min vs 116.52 min). It also showed that MgSO₄ >200 mg led to a longer duration of analgesia compared to MgSO₄ ≤200 mg (MD = 231.65 min vs 173.58 min).

Conclusion: Using MgSO₄ as an adjunct to LA in BPBs leads to a faster onset of sensory block. MgSO₄ also prolongs the duration of analgesia, with optimal doses likely being ≤200 mg.

Cancer is emerging as a significant global public health concern. Worldwide, the incidence of cancer is predicted to increase by 50% by the year 2030. Over 80% of patients will need anaesthetic care and services for perioperative and periprocedural care, as well as for other non-cancer-related procedures. It is estimated that by 2030, over 45 million surgical procedures will be needed globally for cancer control alone. Immunosuppressed patients with cancer represent a unique subset of the population who are at a heightened risk of developing severe infections due to neutropenia, lymphopenia, and immune impairment. The complex nature of the deranged immunologic profiles, compounded by using immune-altering therapies (e.g. corticosteroids, cytotoxic drugs, and immunotherapy) during the perioperative period and after the index surgical procedure, increases the risk of various complications and unfavourable cancer-related outcomes. Therefore, understanding and addressing the unique needs of cancer patients with immune compromise is crucial for improving their prognosis and overall survival rates.

Background and aims: Effective postoperative pain management is pivotal not only for alleviating discomfort but also for enhancing overall patient satisfaction and recovery. This systematic review aims to investigate various factors influencing patient satisfaction due to the postoperative pain management offered.

Methods: Using relevant keywords, we searched PubMed, Scopus, and the Cochrane database after registering the protocol in PROSPERO. A qualitative systematic review was planned using the Appraisal Tool for Cross-Sectional Studies (AXIS tool) to assess the risk of bias (RoB). Thereafter, a quantitative meta-analysis of the transformed proportions was performed using an inverse-variance random-effects model, and a Freeman-Tukey double arcsine transformation was applied to all reported proportions.

Results: From the 1234 articles available after the database search, 21 articles comprising 7289 patients met the inclusion criteria. Among the 21 studies, 12 (57.14%) had a moderate RoB, while nine (42.85%) had a low RoB. The random effects model, using the inverse variance method and the Freeman-Tukey double arcsine transformation, revealed a summarised proportion of 0.8 (95% confidence interval: 0.74,0.85), with significant heterogeneity (P < 0.01 and I² statistic of 97%). The various factors influencing postoperative patient satisfaction were summarised.

Conclusions: Based on the results from this systematic review and meta-analysis, we conclude that the majority of the patients are satisfied with the postoperative pain management offered (a summarised proportion of 0.8 or 80%). Further studies need to be done to find out optimal strategies to improve patient satisfaction undergoing various surgeries. Having robust perioperative pain management policies and an audit of patient satisfaction for pain management could help in improving institutional practices.

Background and aims: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic hyperplasia. However, the systemic absorption of irrigation fluids, such as glycine or saline, may affect coagulation. Glycine is associated with dilutional coagulopathy and electrolyte imbalance, while saline offers better stability. Conventional coagulation tests may miss early changes; rotational thromboelastometry (ROTEM) offers dynamic assessment. This study compared the coagulation effects of glycine and saline irrigation using ROTEM to inform safer irrigant selection during TURP.

Methods: In this study, 80 males (50-70 years) undergoing TURP were administered glycine (Group G, n = 40) or saline (Group S, n = 40). Coagulation was evaluated pre- and postoperatively via ROTEM (INTEM, EXTEM, and FIBTEM) and conventional tests (haemoglobin, platelets, prothrombin time, and electrolytes). Statistics included t-tests, Mann-Whitney U, and Chi-square (P < 0.05 significant).

Results: Glycine significantly prolonged mean INTEM clotting time (CT): 176.05 [standard deviation (SD): 52.97] [95% confidence interval (CI): 160.48, 191.63)] versus 152.58 (SD: 25.23) (95% CI: 144.47, 160.68) (P = 0.013), and reduced mean maximum clot firmness: 55.85 (SD: 15.29) versus 62.73 (SD: 8.60) (P = 0.015). FIBTEM CT and clot formation time were also prolonged in the glycine group (P = 0.013 and P = 0.023, respectively). Postoperative haemoglobin and platelet counts declined in both groups, more so in the glycine group. One patient (2.5%) in Group G developed TUR syndrome.

Conclusion: Glycine impairs intrinsic coagulation and fibrin polymerisation more than saline. Saline offers better coagulation profiles. ROTEM-guided protocols may optimise perioperative haemostatic management, especially in high-risk patients.