Indian Journal of Anaesthesia最新文献

Background and aims: Postoperative delirium (POD) and postoperative neurocognitive dysfunction (POND) are common neurological complications after general anaesthesia. This study aimed to evaluate the effect of perioperative ketamine or esketamine on POD and POND.

Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for randomised controlled trials investigating perioperative use of ketamine or esketamine versus placebo or no treatment. The primary outcomes included the incidence of POD and POND. Secondary outcomes included postoperative nausea and vomiting, pain scores, length of hospital stay, extubation time, and psychological adverse effects. The pooled estimates were quantified using odds ratios (ORs) and 95% confidence intervals (CIs), and between-study variability was quantified by the I² index, and sensitivity, subgroup analyses, and meta-regression were used to explore effect modifiers.

Results: Sixteen studies (2536 patients) demonstrated that ketamine significantly reduced POD risk (OR = 0.62, 95% CI: 0.42, 0.92; I² =51%), while seven studies (453 patients) showed no significant effect on POND (OR = 0.41, 95% CI: 0.14, 1.21; I² =74%). (es)ketamine administration was associated with increased psychological adverse effects (OR = 1.72, 95% CI: 1.24, 2.37; I² =0%). Subgroup analyses revealed that esketamine reduced delirium risk (OR = 0.68, 95% CI: 0.47, 0.98), whereas ketamine prevented neurocognitive disorder (OR = 0.35, 95% CI: 0.20, 0.61). No significant differences were observed in secondary outcomes including nausea/vomiting, pain intensity, hospital stay, or extubation time.

Conclusion: Perioperative (es)ketamine significantly reduces POD risk but not POND. Subgroup analyses reveal esketamine excels in delirium prevention, while racemic ketamine shows better cognitive protection.

Background and aims: The sacral multifidus plane block (SMPB) is an emerging regional anaesthesia technique targeting the dorsal rami of sacral spinal nerves, with potential applications in lower limb, pelvic, and perineal surgeries. Evidence from randomised controlled trials (RCTs) has not been systematically synthesised.

Methods: We conducted a systematic review and meta-analysis following the PRISMA 2020 guidelines, and the study was registered prospectively in PROSPERO. PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov were searched (January 2019-May 2025) for RCTs comparing SMPB with other regional techniques or no block. The primary outcome was time to rescue analgesia. Secondary outcomes included 24-h opioid consumption, postoperative pain scores, patient satisfaction, and adverse events. Data were pooled using a random-effects model; trial sequential analysis (TSA) and GRADE assessment were performed.

Results: Twelve RCTs (n = 768; 348 received SMPB) were included. SMPB significantly prolonged time to first rescue analgesia, reduced 24-h opioid consumption, and lowered pain scores at rest and movement during the first postoperative day, particularly during the intermediate (6-12 h) and late (24 h) postoperative periods. Patient satisfaction was generally higher with SMPB, correlating with improved analgesia and reduced opioid use. TSA confirmed the robustness of findings for time to rescue analgesia and opioid consumption, although the required sample size was not reached. No serious block-related complications were reported.

Conclusions: SMPB appears to be a safe, effective regional anaesthesia technique, offering opioid-sparing benefits, prolonged analgesia, and high patient satisfaction. However, current evidence is limited by small sample sizes, methodological heterogeneity, and potential publication bias.

Background and aims: Mechanical power (MP) is the energy transferred to the respiratory system and the lung during mechanical ventilation. The interaction between the anatomical and physiological characteristics of the lung parenchyma and the MP transferred to it during ventilation determines the extent of lung injury. This study aims to assess the association between MP and the development of postoperative pulmonary complications (PPCs) within the first seven postoperative days in adult patients receiving mechanical ventilation during major abdominal onco-surgery.

Methods: After obtaining approval from the institutional ethics committee, written informed consent was obtained from all participants. Patients aged 18-80 years undergoing major abdominal onco-surgery under general anaesthesia with mechanical ventilation for more than 3 hours were included in the study. Intraoperative ventilatory parameters were recorded. Predictors for the development of respiratory complications during the first seven days postoperatively were analysed using logistic regression.

Results: The cut-off value for intraoperative MP obtained from the receiver operator curve [area under the curve: (AUC)=0.927;P = 0.01; 95% confidence interval (CI)=0.89,0.97] was 9.5 J/min with a sensitivity of 87% and specificity of 83%. MP was found to have a statistically significant association with postoperative respiratory failure, with an odds ratio (OR) of 3.22. For each 1-J/min rise in intraoperative MP, the risk of developing respiratory failure postoperatively increases by 3.2 times. MP of ventilation was found to have an independent association with the development of postoperative RF.

Conclusion: Our study explored the relationship between MP applied to the lungs intraoperatively and the development of RF postoperatively. Our findings suggest that intraoperative MP is a strong, independent predictor of postoperative respiratory failure.

Background and aims: Catheter-related bladder discomfort (CRBD) is a frequent and distressing complication following urological procedures such as transurethral resection of the prostate (TURP). Melatonin may reduce CRBD. This study aimed to evaluate the efficacy of pre-emptive oral melatonin in reducing CRBD in patients undergoing TURP.

Methods: Seventy male patients aged 40-65 years scheduled for TURP under spinal anaesthesia were enroled in this randomised controlled trial. Group M received oral melatonin 5 mg the night before and the morning of surgery, while Group C received oral vitamin C 5 mg as a placebo. CRBD incidence and severity were assessed at 0, 2, 8, 12, and 24 h postoperatively. Sedation using the Ramsay sedation scale (RSS), patient satisfaction scale (PSS), surgeon satisfaction scale (SSS), and need for rescue analgesia was assessed. Statistical tests were two-tailed with a significance level set at P < 0.05.

Results: The incidence of CRBD was significantly reduced at 24 h in Group M as compared to Group C (P = 0.001, Absolute risk reduction = 48.57%, Relative risk reduction = 45.1%, Number needed to treat = 2.06). Similarly, the incidences were also reduced at 2, 8, and 12 h (P = 0.005, P = 0.004, and P < 0.001, respectively). No significant differences in sedation levels, PSS, SSS, and RSS were noted between the groups. The need for paracetamol in the postoperative period was significantly higher in Group C than in Group M (P = 0.0006).

Conclusion: Preemptive oral melatonin effectively reduces the incidence and severity of postoperative CRBD in patients undergoing TURP.

Background and aims: The Basic Cardiopulmonary Life Support (BCLS) guidelines have been developed to describe stepwise management of cardiac arrest victims. During the training of healthcare workers in BCLS, their retention of knowledge was assessed using a questionnaire. We describe the process of developing and validating this questionnaire to ensure that participants' knowledge is reliably measured.

Methods: Based on a comprehensive literature review, 16 questions were prepared by six subject experts with mutual consensus. Face validity was done by 15 participants, both qualitatively and quantitatively. The questionnaire was sent to 10 experts for content validity, who graded the questions on four attributes: relevance, clarity, simplicity, and ambiguity. The responses were collected, and item-level and scale-level average content validity indices (I-CVI and S-CVI/Ave) were calculated, along with modified kappa statistics. I-CVI > 0.79 and S-CVI/Ave > 0.9 were considered acceptable.

Results: Face validity resulted in minor language changes in three questions, and all questions were retained. In terms of content validity, the S-CVI/Ave scores were 0.99, 0.97, and 0.99. 0.97 for relevance, clarity, simplicity, and ambiguity, respectively. One question had I-CVI < 0.79 and was revised. Minor revisions and reframing of questions were done according to the experts' suggestions. All the questions demonstrated excellent kappa agreement, and the final questionnaire consisted of 16 questions.

Conclusion: The questionnaire designed to assess the knowledge level of participants and retention of this knowledge after BCLS training in healthcare workers met the face and content validity criteria. This validated questionnaire can also be used to assess participants after BCLS training.