Pub Date : 2024-06-01Epub Date: 2024-05-08DOI: 10.4103/ija.ija_1159_23
Bhavna Sriramka, Sasmita Panigrahy, Mathan Kumar Ramasubbu, Suvendu N Mishra
Background and aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT.
Methods: This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test.
Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05).
Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.
背景和目的：电休克疗法（ECT）是对精神病患者的一种有效干预措施。琥珀胆碱被认为是电休克疗法中肌肉松弛的首选药物。琥珀胆碱的显著不良反应包括筋束收缩和肌痛。右美托咪定是一种高选择性α-2肾上腺素能激动剂。本研究旨在确定小剂量右美托咪定对减轻接受电痉挛治疗的患者由琥珀胆碱引起的肌痛的疗效：这项随机对照试验以100名年龄在18-65岁之间的ECT患者为对象，将其随机分配到两组，分配比例为1:1。D组静脉注射右美托咪定 0.25 µg/kg，C组静脉注射生理盐水（0.9%）。手术 60 分钟后测量患者自我报告的肌痛评分。静脉注射琥珀酰胆碱后，患者会出现抽搐。心率（HR）和平均血压（MBP）分别在基线、输液后（5 分钟）和 ECT 后（0、2.5、5、10、15、30 分钟）进行测量。连续数据采用学生 t 检验进行两组比较，采用混合模型方差分析进行组间比较，并对不同时间点进行分析。分类数据采用卡方/费舍尔精确检验进行分析：结果：两组在人口统计学方面没有差异。D 组的肌痛和筋膜炎少于 C 组（P < 0.001）。MBP和心率变化相当（P > 0.05）：结论：小剂量右美托咪定（0.25 µg/kg）可有效减轻接受电休克治疗的患者因琥珀胆碱引起的肌痛和筋束收缩。
{"title":"Dexmedetomidine for reducing succinylcholine-induced myalgia in patients undergoing electroconvulsive therapy: A randomised controlled trial.","authors":"Bhavna Sriramka, Sasmita Panigrahy, Mathan Kumar Ramasubbu, Suvendu N Mishra","doi":"10.4103/ija.ija_1159_23","DOIUrl":"10.4103/ija.ija_1159_23","url":null,"abstract":"<p><strong>Background and aim: </strong>Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT.</p><p><strong>Methods: </strong>This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's <i>t</i>-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test.</p><p><strong>Results: </strong>There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (<i>P</i> < 0.001). MBP and HR changes were comparable (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11186527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naveen Vivek Sakkanan, Srinivasan Swaminathan, P. Bidkar, B. Vairappan, A. Sathiaprabhu, Ankita Dey
The choice of intravenous fluids is important in patients with traumatic brain injury (TBI), where large volumes may be required for resuscitation. Our study aimed to compare 0.9% normal saline (NS) with balanced crystalloid (Plasmalyte) in TBI patients in terms of metabolic and coagulation profile, brain relaxation score (BRS) and renal functions using serum urea, creatinine and urinary tissue inhibitor of metalloproteinases-2* insulin-like growth factor binding protein-7, [TIMP-2]*[IGFBP7], value to assess the risk of acute kidney injury. This randomised controlled trial on 90 TBI patients undergoing emergency craniotomy and subdural haematoma evacuation was conducted in a tertiary care institute. The patients were randomised to receive either NS (Group NS) or Plasmalyte (Group P) as the intraoperative maintenance fluid. The primary outcome measures included the potential of hydrogen (pH), base excess (BE) and chloride values from an arterial blood gas. The secondary outcomes were the coagulation profile, BRS and urinary [TIMP-2]*[IGFBP7]. The two groups’ metabolic profile differences were analysed using two-way repeated analysis of variance. BRS was analysed using the Mann–Whitney U test. A P value < 0.05 was considered to be statistically significant. The pH and chloride values were significantly higher, and the BE values were significantly lower in Group P compared to Group NS (P < 0.001). Brain relaxation and coagulation profiles were comparable between the two groups. Serum creatinine (P = 0.002) and urinary [TIMP-2]*[IGFBP7] (P = 0.042) were significantly higher in the NS group. Plasmalyte maintains a more favourable metabolic profile than NS in TBI patients without affecting brain relaxation adversely.
{"title":"Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial","authors":"Naveen Vivek Sakkanan, Srinivasan Swaminathan, P. Bidkar, B. Vairappan, A. Sathiaprabhu, Ankita Dey","doi":"10.4103/ija.ija_1160_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1160_23","url":null,"abstract":"\u0000 \u0000 The choice of intravenous fluids is important in patients with traumatic brain injury (TBI), where large volumes may be required for resuscitation. Our study aimed to compare 0.9% normal saline (NS) with balanced crystalloid (Plasmalyte) in TBI patients in terms of metabolic and coagulation profile, brain relaxation score (BRS) and renal functions using serum urea, creatinine and urinary tissue inhibitor of metalloproteinases-2* insulin-like growth factor binding protein-7, [TIMP-2]*[IGFBP7], value to assess the risk of acute kidney injury.\u0000 \u0000 \u0000 \u0000 This randomised controlled trial on 90 TBI patients undergoing emergency craniotomy and subdural haematoma evacuation was conducted in a tertiary care institute. The patients were randomised to receive either NS (Group NS) or Plasmalyte (Group P) as the intraoperative maintenance fluid. The primary outcome measures included the potential of hydrogen (pH), base excess (BE) and chloride values from an arterial blood gas. The secondary outcomes were the coagulation profile, BRS and urinary [TIMP-2]*[IGFBP7]. The two groups’ metabolic profile differences were analysed using two-way repeated analysis of variance. BRS was analysed using the Mann–Whitney U test. A P value < 0.05 was considered to be statistically significant.\u0000 \u0000 \u0000 \u0000 The pH and chloride values were significantly higher, and the BE values were significantly lower in Group P compared to Group NS (P < 0.001). Brain relaxation and coagulation profiles were comparable between the two groups. Serum creatinine (P = 0.002) and urinary [TIMP-2]*[IGFBP7] (P = 0.042) were significantly higher in the NS group.\u0000 \u0000 \u0000 \u0000 Plasmalyte maintains a more favourable metabolic profile than NS in TBI patients without affecting brain relaxation adversely.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001525","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":"Anaesthesia for a patient of Hajdu Cheney syndrome scheduled for scoliosis surgery-A case study","authors":"Apoorv Chaturvedi, Rajeshwari Subramaniam, Ravindra Pandey, Sreyashi Naskar","doi":"10.4103/ija.ija_5_24","DOIUrl":"https://doi.org/10.4103/ija.ija_5_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998603","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}
Swapnil Y. Parab, S.C. Majety, Priya Ranganathan, S. Jiwnani, CS Pramesh, M. Shetmahajan
Acute kidney injury (AKI) is a significant postoperative complication. Multiple perioperative factors are implicated in the causation of AKI in the postoperative period in patients with oesophageal cancer. The study aimed to find out the incidence, causes and effects of AKI following oesophagectomy surgery. A prospective observational study was conducted in consecutive adult patients undergoing elective oesophagectomy at a tertiary cancer care hospital. Patients with preoperative chronic renal insufficiency (serum creatinine >1.5 mg/dl), AKI in the past and a history of renal replacement therapy were excluded. Serum creatinine values were measured on postoperative days 1, 3, 5, the day of discharge or day 15 and on the day of first follow-up or day 28, following oesophagectomy surgery. The incidence of AKI was measured using the ‘Kidney Disease Improving Global Outcome’ (KDIGO) criteria. The incidence of AKI was 14.7% [95% confidence interval (CI) 9.9%, 20.7%] (i.e., 27/183) in patients who underwent elective oesophagectomy. AKI was associated with prolonged hospital stay [median- 13 days (interquartile range {IQR} 11–21.5) versus 9 days (IQR 8–12), P < 0.001] and increased in-hospital mortality (14.8% versus 1.3%, P 0.004, odds ratio = 13.2, 95% CI 2.3, 77.3). After multivariate analysis, age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI. The incidence of AKI was 14.7% after elective oesophagectomy. AKI was associated with prolonged hospital stay and in-hospital mortality. Higher age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI.
急性肾损伤（AKI）是一种重要的术后并发症。食道癌患者术后急性肾损伤的发生与多种围手术期因素有关。该研究旨在了解食道癌切除术后 AKI 的发生率、原因和影响。 这项前瞻性观察研究针对在一家三级癌症治疗医院接受择期食道癌切除术的连续成年患者。排除了术前患有慢性肾功能不全（血清肌酐>1.5 mg/dl）、既往曾发生过 AKI 以及有肾脏替代治疗史的患者。术后第1、3、5天、出院当天或第15天、首次随访当天或第28天测量血清肌酐值。AKI的发生率是根据 "肾脏疾病改善总体预后"（KDIGO）标准来衡量的。 在接受择期食管切除术的患者中，AKI的发生率为14.7% [95%置信区间（CI）为9.9%, 20.7%]（即27/183）。AKI 与住院时间延长[中位数为 13 天（四分位数间距{IQR}11-21.5）对 9 天（四分位数间距 8-12），P < 0.001]和院内死亡率增加（14.8% 对 1.3%，P 0.004，几率比 = 13.2，95% CI 2.3，77.3）有关。经过多变量分析，年龄、吻合口漏和术后使用血管加压药是预测 AKI 的独立因素。 择期食管切除术后的 AKI 发生率为 14.7%。AKI 与住院时间延长和院内死亡率有关。年龄越大、吻合口漏和术后使用血管加压药是预测AKI的独立因素。
{"title":"Incidence of acute kidney injury and its associated risk factors in patients undergoing elective oesophagectomy surgeries at a tertiary care cancer institute – A pilot prospective observational study","authors":"Swapnil Y. Parab, S.C. Majety, Priya Ranganathan, S. Jiwnani, CS Pramesh, M. Shetmahajan","doi":"10.4103/ija.ija_98_24","DOIUrl":"https://doi.org/10.4103/ija.ija_98_24","url":null,"abstract":"\u0000 \u0000 Acute kidney injury (AKI) is a significant postoperative complication. Multiple perioperative factors are implicated in the causation of AKI in the postoperative period in patients with oesophageal cancer. The study aimed to find out the incidence, causes and effects of AKI following oesophagectomy surgery.\u0000 \u0000 \u0000 \u0000 A prospective observational study was conducted in consecutive adult patients undergoing elective oesophagectomy at a tertiary cancer care hospital. Patients with preoperative chronic renal insufficiency (serum creatinine >1.5 mg/dl), AKI in the past and a history of renal replacement therapy were excluded. Serum creatinine values were measured on postoperative days 1, 3, 5, the day of discharge or day 15 and on the day of first follow-up or day 28, following oesophagectomy surgery. The incidence of AKI was measured using the ‘Kidney Disease Improving Global Outcome’ (KDIGO) criteria.\u0000 \u0000 \u0000 \u0000 The incidence of AKI was 14.7% [95% confidence interval (CI) 9.9%, 20.7%] (i.e., 27/183) in patients who underwent elective oesophagectomy. AKI was associated with prolonged hospital stay [median- 13 days (interquartile range {IQR} 11–21.5) versus 9 days (IQR 8–12), P < 0.001] and increased in-hospital mortality (14.8% versus 1.3%, P 0.004, odds ratio = 13.2, 95% CI 2.3, 77.3). After multivariate analysis, age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI.\u0000 \u0000 \u0000 \u0000 The incidence of AKI was 14.7% after elective oesophagectomy. AKI was associated with prolonged hospital stay and in-hospital mortality. Higher age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000809","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}
Soumya Thakur, P. Tewari, Chetna Shamshery, Prabhakar Mishra
Correctly holding the endotracheal tube (ETT) is essential for successful tracheal intubation. The study’s primary objective was to compare the between-the-fingers grip with the conventional pen-holding grip regarding the number of attempts required for orotracheal intubation and usage of external aids. Three hundred patients undergoing elective surgeries under general anaesthesia were randomised according to the method to hold the ETT to Group C (conventional grip) and Group M (modified, between-the-fingers grip) during oro-tracheal intubation. A designated anaesthetist blinded to the groups performed laryngoscopy in all the patients, and difficult Cormack-Lehane grade 3b and 4 (n = 24) were excluded. Then, the group was revealed to the anaesthetist, and intubation was done accordingly; the number of attempts, use of backward upward rightward pressure (BURP), and time taken were noted. The sample size was estimated using the software G*Power version 3.1.9.2. Statistical Package for Social Sciences, version 23 (SPSS-23, IBM, Chicago, USA) was used for data analysis. Single-attempt intubation was comparable between the groups (99.3% versus 97.2%, P = 0.197). In contrast, the external assistance as BURP (0.75% versus 6.99%, P = 0.009) and the time taken for intubation (P = 0.008) were reduced in group M significantly. The between-the-fingers grip seems as effective as the standard grip to hold the ETT during intubation. However, it proved to be better as it can reduce the requirement for external assistance in BURP.
{"title":"To compare the efficacy of the between-the-fingers grip with the conventional pen-holding grip to hold an endotracheal tube for orotracheal intubation: A randomised controlled trial","authors":"Soumya Thakur, P. Tewari, Chetna Shamshery, Prabhakar Mishra","doi":"10.4103/ija.ija_1079_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1079_23","url":null,"abstract":"\u0000 \u0000 Correctly holding the endotracheal tube (ETT) is essential for successful tracheal intubation. The study’s primary objective was to compare the between-the-fingers grip with the conventional pen-holding grip regarding the number of attempts required for orotracheal intubation and usage of external aids.\u0000 \u0000 \u0000 \u0000 Three hundred patients undergoing elective surgeries under general anaesthesia were randomised according to the method to hold the ETT to Group C (conventional grip) and Group M (modified, between-the-fingers grip) during oro-tracheal intubation. A designated anaesthetist blinded to the groups performed laryngoscopy in all the patients, and difficult Cormack-Lehane grade 3b and 4 (n = 24) were excluded. Then, the group was revealed to the anaesthetist, and intubation was done accordingly; the number of attempts, use of backward upward rightward pressure (BURP), and time taken were noted. The sample size was estimated using the software G*Power version 3.1.9.2. Statistical Package for Social Sciences, version 23 (SPSS-23, IBM, Chicago, USA) was used for data analysis.\u0000 \u0000 \u0000 \u0000 Single-attempt intubation was comparable between the groups (99.3% versus 97.2%, P = 0.197). In contrast, the external assistance as BURP (0.75% versus 6.99%, P = 0.009) and the time taken for intubation (P = 0.008) were reduced in group M significantly.\u0000 \u0000 \u0000 \u0000 The between-the-fingers grip seems as effective as the standard grip to hold the ETT during intubation. However, it proved to be better as it can reduce the requirement for external assistance in BURP.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998507","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}
N. P. Singh, J. Makkar, N. Goel, K. Karamchandani, Mandeep Singh, Preet M. Singh
Postoperative neurocognitive dysfunction (PNCD) commonly occurs after surgery and prolongs hospital stays. Both direct noxious stimuli to the central nervous system and systemic inflammation have been implicated. Due to their potent anti-inflammatory effects, corticosteroids have been utilised to attenuate the incidence and severity of PNCD. This systematic review and meta-analysis strived to evaluate the prophylactic role of perioperative corticosteroids for PNCD. A search was run in pre-defined databases for randomised controlled trials (RCTs) assessing the role of corticosteroids in preventing PNCD. The incidence of PNCD within 1 month was the primary outcome. Secondary outcomes included the use of antipsychotic medications for the treatment, postoperative infection, and hospital length of stay. The results are exhibited as odds ratio (OR) and the mean difference (MD) with 95% confidence interval (CI). Fifteen RCTs comprising 15,398 patients were included. The incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled OR of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). Trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD; however, the requisite information size is still inadequate. The sub-group analysis supported the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery. Our meta-analysis revealed statistically significant protective effects of corticosteroids on the incidence of PNCD. However, further studies are still needed to confirm the protective role of this commonly used and relatively safe strategy for preventing PNCD.
{"title":"Effect of prophylactic corticosteroids on postoperative neurocognitive dysfunction in the adult population: An updated systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials","authors":"N. P. Singh, J. Makkar, N. Goel, K. Karamchandani, Mandeep Singh, Preet M. Singh","doi":"10.4103/ija.ija_149_24","DOIUrl":"https://doi.org/10.4103/ija.ija_149_24","url":null,"abstract":"\u0000 \u0000 Postoperative neurocognitive dysfunction (PNCD) commonly occurs after surgery and prolongs hospital stays. Both direct noxious stimuli to the central nervous system and systemic inflammation have been implicated. Due to their potent anti-inflammatory effects, corticosteroids have been utilised to attenuate the incidence and severity of PNCD. This systematic review and meta-analysis strived to evaluate the prophylactic role of perioperative corticosteroids for PNCD.\u0000 \u0000 \u0000 \u0000 A search was run in pre-defined databases for randomised controlled trials (RCTs) assessing the role of corticosteroids in preventing PNCD. The incidence of PNCD within 1 month was the primary outcome. Secondary outcomes included the use of antipsychotic medications for the treatment, postoperative infection, and hospital length of stay. The results are exhibited as odds ratio (OR) and the mean difference (MD) with 95% confidence interval (CI).\u0000 \u0000 \u0000 \u0000 Fifteen RCTs comprising 15,398 patients were included. The incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled OR of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). Trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD; however, the requisite information size is still inadequate. The sub-group analysis supported the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery.\u0000 \u0000 \u0000 \u0000 Our meta-analysis revealed statistically significant protective effects of corticosteroids on the incidence of PNCD. However, further studies are still needed to confirm the protective role of this commonly used and relatively safe strategy for preventing PNCD.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998057","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}
N. Govil, Rishika Rathore, Ajeet Tiwari, Pankaj K. Garg, K. Parag, Priyanka Mishra
The quality of recovery (QoR)-40 score has been used worldwide and validated in many surgical cohorts to assess global patient recovery. We aim to translate and culturally adapt the QoR-40 score into Hindi and test the validity and reliability of the translated version in patients undergoing cancer surgery. The translation of the QoR-40 questionnaire was based on the forward and backward translation methods. Patients filled out the translated version of the QoR-40 preoperatively, on the third postoperative day in the morning (POD3) and the evening. The reliability of the translated questionnaire was checked for internal consistency, test-retest reliability and split-half reliability. Construct validity was assessed with a correlation coefficient value between the total QoR-40 score, visual analogue scale (VAS) for pain and total length of hospital stay. Content validity was evaluated for feasibility and understanding. The questionnaire was completed by 350 patients. The correlation coefficient r for repeatability was 0.21, the split-half test was 0.92, and Cronbach’s alpha was 0.82. The correlation between QoR-40 on POD3 with VAS score and length of stay was -0.35 and -0.67, respectively. The average time to complete the questionnaire was 3.8 minutes; 90% of the respondents found the translated questionnaire easy to understand, and 92% of the patients related the questions to their recovery. The Hindi translation of the QoR-40 questionnaire is a valid and reliable version of the original questionnaire in English to assess the QoR in Hindi-speaking patients after cancer surgery.
{"title":"Hindi translation and cultural adaptation of the quality of recovery score-40 (QoR-40 score): A validation study","authors":"N. Govil, Rishika Rathore, Ajeet Tiwari, Pankaj K. Garg, K. Parag, Priyanka Mishra","doi":"10.4103/ija.ija_1100_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1100_23","url":null,"abstract":"\u0000 \u0000 The quality of recovery (QoR)-40 score has been used worldwide and validated in many surgical cohorts to assess global patient recovery. We aim to translate and culturally adapt the QoR-40 score into Hindi and test the validity and reliability of the translated version in patients undergoing cancer surgery.\u0000 \u0000 \u0000 \u0000 The translation of the QoR-40 questionnaire was based on the forward and backward translation methods. Patients filled out the translated version of the QoR-40 preoperatively, on the third postoperative day in the morning (POD3) and the evening. The reliability of the translated questionnaire was checked for internal consistency, test-retest reliability and split-half reliability. Construct validity was assessed with a correlation coefficient value between the total QoR-40 score, visual analogue scale (VAS) for pain and total length of hospital stay. Content validity was evaluated for feasibility and understanding.\u0000 \u0000 \u0000 \u0000 The questionnaire was completed by 350 patients. The correlation coefficient r for repeatability was 0.21, the split-half test was 0.92, and Cronbach’s alpha was 0.82. The correlation between QoR-40 on POD3 with VAS score and length of stay was -0.35 and -0.67, respectively. The average time to complete the questionnaire was 3.8 minutes; 90% of the respondents found the translated questionnaire easy to understand, and 92% of the patients related the questions to their recovery.\u0000 \u0000 \u0000 \u0000 The Hindi translation of the QoR-40 questionnaire is a valid and reliable version of the original questionnaire in English to assess the QoR in Hindi-speaking patients after cancer surgery.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998827","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}
R. Mookambika, RV Hemanth Kumar, A. Areti, V. Jaya
The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. The study included 48 patients aged 18–60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist’s posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student’s t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack–Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Anaesthesiologists’ posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.
有人提出了头部抬高喉镜检查体位（HELP）和25°后备体位来增强声门可视化，但人们对人体工程学不适的担忧阻碍了它们的广泛采用。本研究比较了麻醉医师在对患者进行喉镜检查和气管插管时所采用的舒适度和姿势，以及患者采用 HELP 仰卧位或 25°后备位时的舒适度和姿势。 研究包括 48 名年龄在 18-60 岁之间、气道正常的患者和 12 名经验丰富的麻醉师。采用包络阻断随机法将患者随机分为两组。麻醉师以仰卧 HELP 体位和 25° 后备 HELP 体位进行喉镜检查和插管。通过测量颈部、手腕、肘部、背部和膝关节的角度来确定麻醉师的姿势，并使用学生 t 检验进行比较，使用李克特量表评估主观舒适度，并使用卡方检验进行比较。正如麻醉师所提到的，Cormack- Lehane 分级也被记录下来，并通过卡方检验进行组间比较，以 P 值小于 0.05 为显著。 两种体位的麻醉师姿势（P = 0.919）和舒适度（P = 0.644）都相当。然而，25°后备 HELP 体位显著提高了 Cormack-Lehane 分级，68% 达到 1 级，而仰卧 HELP 组只有 31% 达到 1 级（P = 0.012）。血流动力学稳定性和气管插管时间在两组间无明显差异（P = 0.475 和 0.117），两组均未报告并发症。 对于呼吸道通畅的患者，麻醉医师在喉镜检查和气管插管时的姿势和舒适度与仰卧位和 25° 仰卧位相似。
{"title":"Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial","authors":"R. Mookambika, RV Hemanth Kumar, A. Areti, V. Jaya","doi":"10.4103/ija.ija_1130_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1130_23","url":null,"abstract":"\u0000 \u0000 The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup.\u0000 \u0000 \u0000 \u0000 The study included 48 patients aged 18–60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist’s posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student’s t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant.\u0000 \u0000 \u0000 \u0000 Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack–Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group.\u0000 \u0000 \u0000 \u0000 Anaesthesiologists’ posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999477","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}
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