Indian Journal of Anaesthesia最新文献

Background and aims: Subclavian vein cannulation is a commonly performed procedure in the operating room. Ultrasound-guided supraclavicular subclavian vein cannulation can be done using either an in-plane or out-of-plane approach. This study compares the in-plane technique with a novel anterior out-of-plane technique. The primary objective of the study was to compare the first-pass success rate between the anterior out-of-plane technique approach and the in-plane approach for ultrasound-guided subclavian vein cannulation.

Methods: This single-centre, open-label, randomised controlled trial included 128 patients undergoing elective surgeries that required central vein cannulation. Patients were randomised to either the anterior out-of-plane or in-plane technique for ultrasound-guided subclavian central venous access. First-pass success rates, puncture and cannulation times, needle redirections, additional punctures, and complications were recorded and compared between groups. Continuous variables were analysed using independent-sample t-tests, and categorical variables with Chi-square tests. Normality was confirmed by the Shapiro-Wilk test; P values < 0.05 were considered statistically significant.

Results: Successful cannulation was achieved in 119 patients. The first-pass success rate was significantly higher with the anterior out-of-plane approach (95%) compared to the in-plane approach (77%) (P < 0.05). The out-of-plane approach demonstrated shorter puncture [9 (SD: 3) seconds] and cannulation times [148 (SD: 31) seconds) compared to the in-plane approach [17 (SD: 9) seconds and 185 (SD: 32) seconds, respectively]. Additionally, fewer needle redirections, punctures, and complications, including arterial punctures (1 vs 5), were observed with the out-of-plane approach.

Conclusion: Ultrasound-guided supraclavicular subclavian vein cannulation is more successful and efficient using this novel anterior out-of-plane approach compared to the standard in-plane approach.

Background and aims: Accurate assessment of anaesthesia depth in children is essential for individualised anaesthetic monitoring and remains a considerable challenge in clinical practice. The bispectral index (BIS), a widely used clinical tool for monitoring anaesthesia depth, has been subject to controversy regarding its effectiveness in improving recovery quality in children after anaesthesia. This meta-analysis aimed to compare the impact of BIS-guided anaesthesia versus traditional anaesthesia depth monitoring on postoperative recovery quality in children undergoing general anaesthesia.

Methods: A comprehensive search of databases, including PubMed, Cochrane Library, Embase, Web of Science, Scopus, and OVID, for articles published up to June 2024, updated in May 2025 was conducted. Randomised controlled trials comparing BIS-guided titration of anaesthetic agents to standard practice using haemodynamic parameters and clinical signs were analysed. Outcomes assessed included surgical duration, anaesthesia duration, end-tidal sevoflurane concentration, propofol consumption, first response time, eye-opening time, extubation time, post-anaesthesia emergence agitation scores, and post-anaesthesia care unit (PACU) stay duration.

Results: Compared to traditional anaesthesia depth monitoring, children monitored with BIS during anaesthesia maintenance had significantly lower end-tidal sevoflurane concentrations. In addition, BIS monitoring was associated with significantly shorter times for first response, eye-opening, extubation, and PACU stay. Other outcome measures did not show significant differences.

Conclusions: BIS monitoring in children undergoing general anaesthesia is associated with improved recovery quality, as evidenced by reduced times for first response, eye-opening, extubation, and PACU stay.