Indian Journal of Anaesthesia最新文献

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.

Background and aims: The dynamic needle tip positioning (DNTP) technique has recently been introduced, but the effectiveness of the DNTP and traditional palpation methods for radial artery cannulation remains unknown. Therefore, we conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) to compare the effectiveness and safety of ultrasound-guided DNTP and palpation techniques during radial artery cannulation in patients undergoing elective surgery.

Methods: We conducted a thorough search of electronic databases from inception through 31 January 2025 to identify relevant studies. We searched PubMed, Embase, Cochrane Library, and Web of Science and identify relevant studies. RCTs comparing US-guided DNTP versus the palpation method in all age groups requiring radial artery cannulation were included. The primary outcome was the first attempt success rate. Secondary outcomes included overall success rate, cannulation time, and incidence of complications. Statistical analysis was performed using RevMan software.

Results: A total of six studies with 388 participants were included. Our meta-analysis showed a higher first-pass success rate in the DNTP group compared to the palpation group (Risk Ratio = 1.44; 95% Confidence Interval: 1.19, 1.73). We also observed a higher overall success rate in the DNTP group. Cannulation times were similar between the two groups. Meta-analysis indicated a lower complication rate in the DNTP group compared to the palpation group.

Conclusion: This meta-analysis showed a higher first-pass success rate and overall success rate and fewer complications in the DNTP group compared to the traditional palpation group during radial artery cannulation. Additionally, there was no significant difference in cannulation time between the two groups.

Background and aims: Thoracic continuous spinal anaesthesia (TCSA) avoids airway instrumentation and mechanical ventilation and may provide better postoperative pulmonary outcomes compared to general anaesthesia (GA) with thoracic epidural analgesia (TEA) for patients requiring laparotomy. The study compared postoperative pulmonary functions and outcomes between these two anaesthesia techniques.

Methods: Sixty adults were randomly assigned to Group GA+TEA or Group TCSA. In Group GA+TEA, the TEA was secured through the T9-T10 level, followed by GA. A 25-G catheter was placed at the same level in Group TCSA, and they received all preservative-free drugs (0.5% plain bupivacaine with 0.25 mg/kg ketamine and 0.03 mg/kg midazolam) to achieve a sensory block from T4 to L1. The primary outcome assessed was peak expiratory flow rate (PEFR) over the 72 h postoperative period. The secondary outcomes assessed were breath-holding time (BHT), lung atelectasis, and change in transdiaphragmatic excursion. The two-sided Student t-test, Mann-Whitney test, and Chi-squared test were used to analyse the data.

Results: The PEFR was reduced in both groups from baseline (P < 0.001), with no difference between them (P = 0.498). However, Group TCSA showed significantly better outcomes concerning BHT on postoperative days (POD) 1 and 2 (P = 0.048 and P = 0.005, respectively), reduced lung atelectasis at 1 h postoperatively (P = 0.03), and greater diaphragmatic excursion at 1 h, POD 1 and 2 (P < 0.001).

Conclusion: In patients undergoing major abdominal surgery, the PEFRs during the postoperative period were comparable for GA with thoracic epidural versus thoracic continuous spinal anaesthesia.