N. Kamenshchikov, E. A. Churilina, V. A. Korepanov, T. Rebrova, Irina V. Sukhodolo, B. N. Kozlov
Cardiopulmonary bypass (CPB) and circulatory arrest (CA) can induce intestinal injury and consequently lead to multiple organ dysfunction. Nitric oxide (NO) has protective effects, but its effect on the intestine has not been studied. The study aimed to investigate intestinal injury variables and prove the intestinal protective effects of exogenous nitric oxide when modelling CPB and CA in an experiment. The study was performed on sheep (n = 24). There were four groups: CPB, CPB + NO, CPB + CA and CPB + CA + NO. Sheep in NO groups received intraoperative inhalation of NO at a dose of 80 ppm. Groups without NO underwent CPB and CA without NO delivery. Defaecation rate, dynamics of intestinal fatty acid binding protein (i-FABP), coefficient of microviscosity and polarity in the areas of lipid–lipid and protein-lipid interactions of erythrocyte membranes were assessed. One hour after CPB, the intestinal tissue was collected and assessed for tissue concentrations of adenosine triphosphate (ATP) and lactate. The defaecation rate after CPB was higher in the CPB + NO group than in the CPB group. The concentration of i-FABP after CPB was lower in the CPB + NO and CPB + CA + NO groups than in the CPB and CPB + CA groups. Erythrocyte deformability before and after CPB revealed no significant dynamics in groups with NO. The ATP concentration 1 h after CPB was higher in the CPB + NO group than in the CPB group. The morphological picture in groups with NO was better. When modelling CPB and CA, NO had a positive effect on the functional and structural state of the intestine and also maintained erythrocyte deformability.
心肺旁路（CPB）和循环停止（CA）可诱发肠道损伤，从而导致多器官功能障碍。一氧化氮（NO）具有保护作用，但其对肠道的影响尚未得到研究。本研究旨在调查肠道损伤变量，并在模拟 CPB 和 CA 的实验中证明外源性一氧化氮对肠道的保护作用。 研究对象是绵羊（n = 24）。共分为四组：CPB组、CPB + NO组、CPB + CA组和CPB + CA + NO组。NO 组的绵羊在术中吸入剂量为 80 ppm 的 NO。无 NO 组进行 CPB 和 CA，不给予 NO。对排便率、肠道脂肪酸结合蛋白（i-FABP）的动态、红细胞膜脂-脂和蛋白-脂相互作用区域的微粘度系数和极性进行了评估。CPB 一小时后，收集肠道组织并评估组织中三磷酸腺苷（ATP）和乳酸的浓度。 CPB + NO 组 CPB 后的排便率高于 CPB 组。CPB + NO 组和 CPB + CA + NO 组 CPB 后 i-FABP 的浓度低于 CPB 组和 CPB + CA 组。CPB前后的红细胞变形性在NO组中没有发现明显的动态变化。CPB + NO 组 CPB 1 小时后的 ATP 浓度高于 CPB 组。NO组的形态学表现更好。 在模拟 CPB 和 CA 时，NO 对肠道的功能和结构状态有积极影响，还能保持红细胞的变形性。
{"title":"Effect of inhaled nitric oxide on intestinal integrity in cardiopulmonary bypass and circulatory arrest simulation: An experimental study","authors":"N. Kamenshchikov, E. A. Churilina, V. A. Korepanov, T. Rebrova, Irina V. Sukhodolo, B. N. Kozlov","doi":"10.4103/ija.ija_1267_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1267_23","url":null,"abstract":"\u0000 \u0000 Cardiopulmonary bypass (CPB) and circulatory arrest (CA) can induce intestinal injury and consequently lead to multiple organ dysfunction. Nitric oxide (NO) has protective effects, but its effect on the intestine has not been studied. The study aimed to investigate intestinal injury variables and prove the intestinal protective effects of exogenous nitric oxide when modelling CPB and CA in an experiment.\u0000 \u0000 \u0000 \u0000 The study was performed on sheep (n = 24). There were four groups: CPB, CPB + NO, CPB + CA and CPB + CA + NO. Sheep in NO groups received intraoperative inhalation of NO at a dose of 80 ppm. Groups without NO underwent CPB and CA without NO delivery. Defaecation rate, dynamics of intestinal fatty acid binding protein (i-FABP), coefficient of microviscosity and polarity in the areas of lipid–lipid and protein-lipid interactions of erythrocyte membranes were assessed. One hour after CPB, the intestinal tissue was collected and assessed for tissue concentrations of adenosine triphosphate (ATP) and lactate.\u0000 \u0000 \u0000 \u0000 The defaecation rate after CPB was higher in the CPB + NO group than in the CPB group. The concentration of i-FABP after CPB was lower in the CPB + NO and CPB + CA + NO groups than in the CPB and CPB + CA groups. Erythrocyte deformability before and after CPB revealed no significant dynamics in groups with NO. The ATP concentration 1 h after CPB was higher in the CPB + NO group than in the CPB group. The morphological picture in groups with NO was better.\u0000 \u0000 \u0000 \u0000 When modelling CPB and CA, NO had a positive effect on the functional and structural state of the intestine and also maintained erythrocyte deformability.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141371984","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}
{"title":"Regional analgesia and cancer outcomes: Our current understanding in 2024","authors":"V. Gottumukkala","doi":"10.4103/ija.ija_475_24","DOIUrl":"https://doi.org/10.4103/ija.ija_475_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141375261","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}
Ahmed Medhat Mohasseb, Mona G. Elebiedy, M. N. Mohammed
Opioid-sparing analgesia for acute postoperative pain after breast cancer surgery is crucial due to opioid-related side effects. The utilisation of erector spinae plane block and low-dose intravenous ketamine-dexmedetomidine are widely recognised as non-opioid analgesic methodologies. The objective of this study was to conduct a randomised trial to examine the analgesic efficacy of both approaches while minimising the use of opioids. Seventy-two female patients scheduled for unilateral modified radical mastectomy were recruited. They were allocated randomly to Group ESPB, which received ipsilateral ultrasound-guided erector spinae plane block by 20 mL bupivacaine 0.5% at the level of T5 after induction of general anaesthesia, and Group Ket-Dex, which received intravenous (IV) bolus 0.25 mg/kg of ketamine and 0.5 µg/kg of dexmedetomidine, followed by an IV infusion of 0.25 mg/kg of ketamine and 0.3 µg/kg of dexmedetomidine per hour. Total postoperative morphine consumption (24 h) was the primary outcome. The secondary outcomes were pain scores over 24 hours during rest, duration of analgesia, isoflurane consumption, time to awakening, postoperative nausea and vomiting (PONV), and postoperative serum cortisol level. The postoperative morphine consumption over 24-hour in Group ESPB was 3.26 mg (0–6.74) versus 2.35 mg (2.08–4.88) in Group Ket-Dex (P = 0.046). Group Ket-Dex had lower pain scores at rest, longer analgesia duration, longer awakening time, and lower postoperative serum cortisol levels. Intravenous low-dose ketamine-dexmedetomidine infusion intraoperatively with inhalational-based general anaesthesia provides superior opioid-sparing analgesia to that of ESPB in patients undergoing unilateral non-reconstructive modified radical mastectomy, with less postoperative opioid consumption and stress response.
{"title":"A randomised comparative study of erector spinae plane block versus low-dose ketamine-dexmedetomidine intravenous infusion as intraoperative opioid-free analgesia for modified radical mastectomy","authors":"Ahmed Medhat Mohasseb, Mona G. Elebiedy, M. N. Mohammed","doi":"10.4103/ija.ija_1167_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1167_23","url":null,"abstract":"\u0000 \u0000 Opioid-sparing analgesia for acute postoperative pain after breast cancer surgery is crucial due to opioid-related side effects. The utilisation of erector spinae plane block and low-dose intravenous ketamine-dexmedetomidine are widely recognised as non-opioid analgesic methodologies. The objective of this study was to conduct a randomised trial to examine the analgesic efficacy of both approaches while minimising the use of opioids.\u0000 \u0000 \u0000 \u0000 Seventy-two female patients scheduled for unilateral modified radical mastectomy were recruited. They were allocated randomly to Group ESPB, which received ipsilateral ultrasound-guided erector spinae plane block by 20 mL bupivacaine 0.5% at the level of T5 after induction of general anaesthesia, and Group Ket-Dex, which received intravenous (IV) bolus 0.25 mg/kg of ketamine and 0.5 µg/kg of dexmedetomidine, followed by an IV infusion of 0.25 mg/kg of ketamine and 0.3 µg/kg of dexmedetomidine per hour. Total postoperative morphine consumption (24 h) was the primary outcome. The secondary outcomes were pain scores over 24 hours during rest, duration of analgesia, isoflurane consumption, time to awakening, postoperative nausea and vomiting (PONV), and postoperative serum cortisol level.\u0000 \u0000 \u0000 \u0000 The postoperative morphine consumption over 24-hour in Group ESPB was 3.26 mg (0–6.74) versus 2.35 mg (2.08–4.88) in Group Ket-Dex (P = 0.046). Group Ket-Dex had lower pain scores at rest, longer analgesia duration, longer awakening time, and lower postoperative serum cortisol levels.\u0000 \u0000 \u0000 \u0000 Intravenous low-dose ketamine-dexmedetomidine infusion intraoperatively with inhalational-based general anaesthesia provides superior opioid-sparing analgesia to that of ESPB in patients undergoing unilateral non-reconstructive modified radical mastectomy, with less postoperative opioid consumption and stress response.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141373877","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}
K. Jangra, A. Gandhi, Nitasha Mishra, M. A. Shamim, B. Padhi
Goal-directed fluid therapy (GDFT) has conflicting evidence regarding outcomes in neurosurgical patients. This meta-analysis aimed to compare the effect of GDFT and conventional fluid therapy on various perioperative outcomes in patients undergoing neurosurgical procedures. A comprehensive literature search was conducted using PubMed, EMBASE, Scopus, ProQuest, Web of Science, EBSCOhost, Cochrane and preprint servers. The search was conducted up until 16 October 2023, following PROSPERO registration. The search strategy included terms related to GDFT, neurosurgery and perioperative outcomes. Only randomised controlled trials involving adult humans and comparing GDFT with standard/liberal/traditional/restricted fluid therapy were included. The studies were evaluated for risk of bias (RoB), and pooled estimates of the outcomes were measured in terms of risk ratio (RR) and mean difference (MD). No statistically significant difference was observed in neurological outcomes between GDFT and conventional fluid therapy [RR with 95% confidence interval (CI) was 1.10 (0.69, 1.75), two studies, 90 patients, low certainty of evidence using GRADEpro]. GDFT reduced postoperative complications [RR = 0.67 (0.54, 0.82), six studies, 392 participants] and intensive care unit (ICU) and hospital stay [MD (95% CI) were -1.65 (-3.02, -0.28) and -0.94 (-1.47, -0.42), respectively] with high certainty of evidence. The pulmonary complications were significantly lower in the GDFT group [RR (95% CI) = 0.55 (0.38, 0.79), seven studies, 442 patients, high certainty of evidence]. Other outcomes, including total intraoperative fluids administered and blood loss, were comparable in GDFT and conventional therapy groups [MD (95% CI) were -303.87 (-912.56, 304.82) and -14.79 (-49.05, 19.46), respectively]. The perioperative GDFT did not influence the neurological outcome. The postoperative complications and hospital and ICU stay were significantly reduced in the GDFT group.
{"title":"Intraoperative goal-directed fluid therapy in adult patients undergoing craniotomies under general anaesthesia: A systematic review and meta-analysis with trial sequential analysis","authors":"K. Jangra, A. Gandhi, Nitasha Mishra, M. A. Shamim, B. Padhi","doi":"10.4103/ija.ija_240_24","DOIUrl":"https://doi.org/10.4103/ija.ija_240_24","url":null,"abstract":"\u0000 \u0000 Goal-directed fluid therapy (GDFT) has conflicting evidence regarding outcomes in neurosurgical patients. This meta-analysis aimed to compare the effect of GDFT and conventional fluid therapy on various perioperative outcomes in patients undergoing neurosurgical procedures.\u0000 \u0000 \u0000 \u0000 A comprehensive literature search was conducted using PubMed, EMBASE, Scopus, ProQuest, Web of Science, EBSCOhost, Cochrane and preprint servers. The search was conducted up until 16 October 2023, following PROSPERO registration. The search strategy included terms related to GDFT, neurosurgery and perioperative outcomes. Only randomised controlled trials involving adult humans and comparing GDFT with standard/liberal/traditional/restricted fluid therapy were included. The studies were evaluated for risk of bias (RoB), and pooled estimates of the outcomes were measured in terms of risk ratio (RR) and mean difference (MD).\u0000 \u0000 \u0000 \u0000 No statistically significant difference was observed in neurological outcomes between GDFT and conventional fluid therapy [RR with 95% confidence interval (CI) was 1.10 (0.69, 1.75), two studies, 90 patients, low certainty of evidence using GRADEpro]. GDFT reduced postoperative complications [RR = 0.67 (0.54, 0.82), six studies, 392 participants] and intensive care unit (ICU) and hospital stay [MD (95% CI) were -1.65 (-3.02, -0.28) and -0.94 (-1.47, -0.42), respectively] with high certainty of evidence. The pulmonary complications were significantly lower in the GDFT group [RR (95% CI) = 0.55 (0.38, 0.79), seven studies, 442 patients, high certainty of evidence]. Other outcomes, including total intraoperative fluids administered and blood loss, were comparable in GDFT and conventional therapy groups [MD (95% CI) were -303.87 (-912.56, 304.82) and -14.79 (-49.05, 19.46), respectively].\u0000 \u0000 \u0000 \u0000 The perioperative GDFT did not influence the neurological outcome. The postoperative complications and hospital and ICU stay were significantly reduced in the GDFT group.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141372553","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}
{"title":"Evolution of low-flow anaesthesia","authors":"P. Zilberman","doi":"10.4103/ija.ija_441_24","DOIUrl":"https://doi.org/10.4103/ija.ija_441_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141370908","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}
Dileep Singh Rana, Anisha Singh, A. C. Swami, Nikhil Kumar Atolia
{"title":"A novel mouth guard in endoscopy suite for limited oral access","authors":"Dileep Singh Rana, Anisha Singh, A. C. Swami, Nikhil Kumar Atolia","doi":"10.4103/ija.ija_9_24","DOIUrl":"https://doi.org/10.4103/ija.ija_9_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141374088","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}
The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety. This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications. Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered. Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.
{"title":"Comparison of the classical approach and costoclavicular approach of ultrasound-guided infraclavicular block: A systematic review and meta-analysis","authors":"Heena Garg, Purva Makhija, Dhruv Jain, Shailendra Kumar, Lokesh Kashyap","doi":"10.4103/ija.ija_1124_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1124_23","url":null,"abstract":"\u0000 \u0000 The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety.\u0000 \u0000 \u0000 \u0000 This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications.\u0000 \u0000 \u0000 \u0000 Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered.\u0000 \u0000 \u0000 \u0000 Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141374132","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}
Artificial intelligence (AI) chatbots like Conversational Generative Pre-trained Transformer (ChatGPT) have recently created much buzz, especially regarding patient education. Such informed patients understand and adhere to the management and get involved in shared decision making. The accuracy and understandability of the generated educational material are prime concerns. Thus, we compared ChatGPT with traditional patient information leaflets (PILs) about chronic pain medications. Patients' frequently asked questions were generated from PILs available on the official websites of the British Pain Society (BPS) and the Faculty of Pain Medicine. Eight blinded annexures were prepared for evaluation, consisting of traditional PILs from the BPS and AI-generated patient information materials structured similar to PILs by ChatGPT. The authors performed a comparative analysis to assess materials’ readability, emotional tone, accuracy, actionability, and understandability. Readability was measured using Flesch Reading Ease (FRE), Gunning Fog Index (GFI), and Flesch-Kincaid Grade Level (FKGL). Sentiment analysis determined emotional tone. An expert panel evaluated accuracy and completeness. Actionability and understandability were assessed with the Patient Education Materials Assessment Tool. Traditional PILs generally exhibited higher readability (P values < 0.05), with [mean (standard deviation)] FRE [62.25 (1.6) versus 48 (3.7)], GFI [11.85 (0.9) versus 13.65 (0.7)], and FKGL [8.33 (0.5) versus 10.23 (0.5)] but varied emotional tones, often negative, compared to more positive sentiments in ChatGPT-generated texts. Accuracy and completeness did not significantly differ between the two. Actionability and understandability scores were comparable. While AI chatbots offer efficient information delivery, ensuring accuracy and readability, patient-centeredness remains crucial. It is imperative to balance innovation with evidence-based practice.
{"title":"Comparing patient education tools for chronic pain medications: Artificial intelligence chatbot versus traditional patient information leaflets","authors":"P. Gondode, Sakshi Duggal, Neha Garg, Surrender Sethupathy, Omshubham Asai, Pooja Lohakare","doi":"10.4103/ija.ija_204_24","DOIUrl":"https://doi.org/10.4103/ija.ija_204_24","url":null,"abstract":"\u0000 \u0000 Artificial intelligence (AI) chatbots like Conversational Generative Pre-trained Transformer (ChatGPT) have recently created much buzz, especially regarding patient education. Such informed patients understand and adhere to the management and get involved in shared decision making. The accuracy and understandability of the generated educational material are prime concerns. Thus, we compared ChatGPT with traditional patient information leaflets (PILs) about chronic pain medications.\u0000 \u0000 \u0000 \u0000 Patients' frequently asked questions were generated from PILs available on the official websites of the British Pain Society (BPS) and the Faculty of Pain Medicine. Eight blinded annexures were prepared for evaluation, consisting of traditional PILs from the BPS and AI-generated patient information materials structured similar to PILs by ChatGPT. The authors performed a comparative analysis to assess materials’ readability, emotional tone, accuracy, actionability, and understandability. Readability was measured using Flesch Reading Ease (FRE), Gunning Fog Index (GFI), and Flesch-Kincaid Grade Level (FKGL). Sentiment analysis determined emotional tone. An expert panel evaluated accuracy and completeness. Actionability and understandability were assessed with the Patient Education Materials Assessment Tool.\u0000 \u0000 \u0000 \u0000 Traditional PILs generally exhibited higher readability (P values < 0.05), with [mean (standard deviation)] FRE [62.25 (1.6) versus 48 (3.7)], GFI [11.85 (0.9) versus 13.65 (0.7)], and FKGL [8.33 (0.5) versus 10.23 (0.5)] but varied emotional tones, often negative, compared to more positive sentiments in ChatGPT-generated texts. Accuracy and completeness did not significantly differ between the two. Actionability and understandability scores were comparable.\u0000 \u0000 \u0000 \u0000 While AI chatbots offer efficient information delivery, ensuring accuracy and readability, patient-centeredness remains crucial. It is imperative to balance innovation with evidence-based practice.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141370849","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}
Postoperative pain after hip surgeries in children could be classified as severe, requiring combined intra- and postoperative opioid analgesia with regional blocks. This study was carried out to investigate ultrasound-guided pericapsular nerve group (PENG) block versus ultrasound-guided erector spinae plane (ESP) block for pain management after paediatric hip surgery. The primary objective was to assess the time of the first request for morphine rescue analgesia. In this randomised study, 56 children scheduled for elective unilateral hip surgery were distributed randomly to ESP and PENG groups. Intraoperative haemodynamics, fentanyl consumption, postoperative pain measurement, morphine consumption, time of first rescue analgesia, adverse effects and parents’ satisfaction score were studied. The primary outcome was the time of the first request for morphine rescue analgesia. The Chi-square test, Student’s t-test and the Mann–Whitney U test were used, where applicable, to compare the groups. The time to first rescue analgesia was significantly longer in Group ESP than in Group PENG (P < 0.001), with significantly higher postoperative morphine consumption in Group PENG than in Group ESP (P = 0.04). The pain scores of Group ESP were lower than those of Group PENG at 2 and 4 h postoperatively (P = 0.006 and P < 0.001, respectively). At 8 h postoperatively, the score was significantly higher in Group ESP than in Group PENG (P = 0.005). Other outcomes were comparable between both groups (P > 0.05). ESP and PENG could be both effective for intraoperative and postoperative analgesia in paediatric hip surgeries, but the ESP block prolonged the time of first rescue analgesia more than the PENG block.
儿童髋关节手术后的疼痛可被归类为严重疼痛，需要术中和术后联合使用阿片类镇痛药和区域阻滞。本研究旨在探讨超声引导下囊周神经群（PENG）阻滞与超声引导下竖脊面（ESP）阻滞在儿童髋关节手术后疼痛治疗中的应用。主要目的是评估首次请求吗啡镇痛的时间。 在这项随机研究中，56名计划接受择期单侧髋关节手术的儿童被随机分配到ESP组和PENG组。研究了术中血流动力学、芬太尼消耗量、术后疼痛测量、吗啡消耗量、首次镇痛抢救时间、不良反应和家长满意度评分。主要结果是首次请求吗啡镇痛的时间。在适当的情况下，采用卡方检验、学生 t 检验和曼-惠特尼 U 检验对各组进行比较。 ESP组首次抢救性镇痛时间明显长于PENG组（P < 0.001），PENG组术后吗啡消耗量明显高于ESP组（P = 0.04）。术后 2 小时和 4 小时，ESP 组的疼痛评分低于 PENG 组（分别为 P = 0.006 和 P <0.001）。术后 8 小时，ESP 组的疼痛评分明显高于 PENG 组（P = 0.005）。两组的其他结果相当（P > 0.05）。 ESP和PENG对小儿髋关节手术的术中和术后镇痛均有效，但ESP阻滞比PENG阻滞更能延长首次抢救性镇痛的时间。
{"title":"Comparison of ultrasound-guided erector spinae plane block with ultrasound-guided pericapsular nerve group block for paediatric hip surgery: A randomised, double-blinded study","authors":"T. Mostafa, A. Omara, N. Khalil","doi":"10.4103/ija.ija_867_23","DOIUrl":"https://doi.org/10.4103/ija.ija_867_23","url":null,"abstract":"\u0000 \u0000 Postoperative pain after hip surgeries in children could be classified as severe, requiring combined intra- and postoperative opioid analgesia with regional blocks. This study was carried out to investigate ultrasound-guided pericapsular nerve group (PENG) block versus ultrasound-guided erector spinae plane (ESP) block for pain management after paediatric hip surgery. The primary objective was to assess the time of the first request for morphine rescue analgesia.\u0000 \u0000 \u0000 \u0000 In this randomised study, 56 children scheduled for elective unilateral hip surgery were distributed randomly to ESP and PENG groups. Intraoperative haemodynamics, fentanyl consumption, postoperative pain measurement, morphine consumption, time of first rescue analgesia, adverse effects and parents’ satisfaction score were studied. The primary outcome was the time of the first request for morphine rescue analgesia. The Chi-square test, Student’s t-test and the Mann–Whitney U test were used, where applicable, to compare the groups.\u0000 \u0000 \u0000 \u0000 The time to first rescue analgesia was significantly longer in Group ESP than in Group PENG (P < 0.001), with significantly higher postoperative morphine consumption in Group PENG than in Group ESP (P = 0.04). The pain scores of Group ESP were lower than those of Group PENG at 2 and 4 h postoperatively (P = 0.006 and P < 0.001, respectively). At 8 h postoperatively, the score was significantly higher in Group ESP than in Group PENG (P = 0.005). Other outcomes were comparable between both groups (P > 0.05).\u0000 \u0000 \u0000 \u0000 ESP and PENG could be both effective for intraoperative and postoperative analgesia in paediatric hip surgeries, but the ESP block prolonged the time of first rescue analgesia more than the PENG block.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141373287","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}
Vidya Mohan, P. Rudingwa, S. Panneerselvam, A. Kuberan, G. Srinivasan, Santhosh Arulprakasam
Postoperative sore throat (POST) can be as high as 42% in supraglottic devices. LMA® Protector™ is a novel second-generation laryngeal mask airway (LMA) with Cuff Pilot™ technology that allows continuous cuff pressure monitoring. Elevated cuff pressure is a risk factor for POST in supraglottic devices, so we conducted this study to determine whether continuous cuff pressure monitoring can alleviate POST. This randomised double-blinded clinical trial compared the incidence of sore throat between LMA® Protector™ and LMA® ProSeal™ and was conducted in 118 patients scheduled for elective short surgical procedures. They were randomised to either LMA® Protector™ (Group PT) or LMA® ProSeal™ (Group P). The airway was secured with either of the two devices. The primary outcome was the incidence of sore throat at 1, 6, and 24 hours postoperatively and compared using the Chi-square test along with other parameters like first attempt success rate and blood staining of the device. The time taken for insertion and oropharyngeal seal pressure were compared using an independent t-test. The incidence of POST was low with Group PT (12%) compared to Group P (28.8%) (P = 0.005). The mean oropharyngeal seal pressure was significantly higher in Group PT than in Group P [33.72 (3.07) versus 27.72 (3.88) cm of H2O], P < 0.005. The first attempt success rate was 81.2% and 100% in LMA® Protector™ versus LMA® ProSeal™. LMA® Protector™ had a reduced incidence of POST compared to LMA ProSeal. However, a longer insertion time and difficult placement may be a concern.
声门上装置的术后咽喉痛 (POST) 发生率可高达 42%。LMA® Protector™ 是一种新型第二代喉罩通气道 (LMA)，采用 Cuff Pilot™ 技术，可对充气罩囊压力进行连续监测。充气罩囊压力升高是声门上装置发生 POST 的一个风险因素，因此我们进行了这项研究，以确定持续充气罩囊压力监测是否能减轻 POST。 这项随机双盲临床试验比较了 LMA® Protector™ 和 LMA® ProSeal™ 的咽喉痛发生率，并在 118 名计划接受择期短小手术的患者中进行。他们被随机分配到 LMA® Protector™（PT 组）或 LMA® ProSeal™（P 组）。使用这两种装置中的任何一种固定气道。主要结果是术后 1、6 和 24 小时的咽喉痛发生率，并使用卡方检验与首次尝试成功率和装置血迹等其他参数进行比较。插入时间和口咽密封压力采用独立的 t 检验进行比较。 与 P 组（28.8%）相比，PT 组（12%）的 POST 发生率较低（P = 0.005）。PT 组的平均口咽密封压力明显高于 P 组 [33.72 (3.07) 对 27.72 (3.88) cm H2O]，P < 0.005。LMA® Protector™ 与 LMA® ProSeal™ 的首次尝试成功率分别为 81.2% 和 100%。 与 LMA ProSeal™ 相比，LMA® Protector™ 的 POST 发生率更低。不过，插入时间较长和置放困难可能是一个问题。
{"title":"Comparison of incidence of sore throat with laryngeal mask airway Protector and laryngeal mask airway ProSeal: A randomised clinical trial","authors":"Vidya Mohan, P. Rudingwa, S. Panneerselvam, A. Kuberan, G. Srinivasan, Santhosh Arulprakasam","doi":"10.4103/ija.ija_1068_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1068_23","url":null,"abstract":"\u0000 \u0000 Postoperative sore throat (POST) can be as high as 42% in supraglottic devices. LMA® Protector™ is a novel second-generation laryngeal mask airway (LMA) with Cuff Pilot™ technology that allows continuous cuff pressure monitoring. Elevated cuff pressure is a risk factor for POST in supraglottic devices, so we conducted this study to determine whether continuous cuff pressure monitoring can alleviate POST.\u0000 \u0000 \u0000 \u0000 This randomised double-blinded clinical trial compared the incidence of sore throat between LMA® Protector™ and LMA® ProSeal™ and was conducted in 118 patients scheduled for elective short surgical procedures. They were randomised to either LMA® Protector™ (Group PT) or LMA® ProSeal™ (Group P). The airway was secured with either of the two devices. The primary outcome was the incidence of sore throat at 1, 6, and 24 hours postoperatively and compared using the Chi-square test along with other parameters like first attempt success rate and blood staining of the device. The time taken for insertion and oropharyngeal seal pressure were compared using an independent t-test.\u0000 \u0000 \u0000 \u0000 The incidence of POST was low with Group PT (12%) compared to Group P (28.8%) (P = 0.005). The mean oropharyngeal seal pressure was significantly higher in Group PT than in Group P [33.72 (3.07) versus 27.72 (3.88) cm of H2O], P < 0.005. The first attempt success rate was 81.2% and 100% in LMA® Protector™ versus LMA® ProSeal™.\u0000 \u0000 \u0000 \u0000 LMA® Protector™ had a reduced incidence of POST compared to LMA ProSeal. However, a longer insertion time and difficult placement may be a concern.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141372375","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：