Indian Journal of Anaesthesia最新文献

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.

Background and aims: Effective airway assessment prevents intubation failure. Despite the limited sensitivity of standard tools, ultrasonography (USG) offers promise, especially in predicting difficult laryngoscopies. Our study aims to evaluate tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue measurements on airway USG to predict difficult laryngoscopy.

Methods: This prospective observational study enroled 120 patients posted for elective surgery under general anaesthesia, without anticipated difficult airways. The skin to hyoid bone distance (SHBD), skin to epiglottis distance (SED), skin to thyrohyoid membrane distance (STHMD), and TTOHR were measured on USG. Modified Cormack-Lehane (CL) grading at laryngoscopy was the primary outcome. Statistical analysis included ROC curve analysis, multivariable logistic regression, and evaluation of predictive models combining multiple USG parameters.

Results: The incidence of difficult laryngoscopy and intubation was 11.6% and 6.6%, respectively. The highest diagnostic performance was observed for SED, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI): 0.91, 0.98], a cut-off value of 1.87 cm, a sensitivity of 100%, a specificity of 89%, and a diagnostic accuracy of 90%. STHMD followed with an AUC of 0.94 (95% CI: 0.88, 0.99), a cut-off of 1.58 cm, a sensitivity of 90%, a specificity of 86%, and a diagnostic accuracy of 84%. TTOHR showed an AUC of 0.92 (95% CI: 0.78, 1.00), with a cut-off value of 0.80, a sensitivity of 92%, a specificity of 98%, and the highest diagnostic accuracy of 97% (95% CI: 0.96, 1.00). Various models, tested using three or four parameters, showed AUC values ranging from 0.96 to 0.97. A model containing TTOHR, SHBD, and STHMD was identified as a best-fit model for predicting difficult laryngoscopy.

Conclusion: SED, STHMD, and TTOHR individually showed substantial diagnostic accuracy, with AUCs ranging from 0.92 to 0.95. Analysis of models combining parameters outperformed individual measurements, with statistically significant contributions from TTOHR and SHBD.