Indian Journal of Anaesthesia最新文献

Background and aims: Ultrasonographic (USG) optic nerve sheath diameter (ONSD) provides a real-time, non-invasive method for assessing intracranial pressure. This study investigates perioperative ONSD variations and contributing factors in patients undergoing elective intracranial tumour resection.

Methods: A prospective observational study was conducted on 94 adults with intracranial tumours, excluding orbital lesions and sellar/suprasellar tumours. Preoperative symptoms, Glasgow coma scale scores, and radiological findings were noted. USG-ONSD was assessed in the transverse and sagittal plane on each eye, with an average of three readings at the following time-points: pre-induction, post-induction, post-extubation, and 24-hour post-tumour resection. The presence of ventriculo-peritoneal (VP) shunt, duration of surgery/anaesthesia, intraoperative position, use of osmotic agents, and complications during surgery were noted. The data were analysed using linear regression and general linear modelling in R software.

Results: ONSD increased significantly (P = 0.001) immediately after surgery and decreased 24 hours after surgery (P < 0.001) compared to preoperative values. Although the trend of ONSD changes was similar for both supratentorial and infratentorial tumours, supratentorial tumours consistently showed higher values (P = 0.549). Higher American Society of Anesthesiologists physical status, nausea/vomiting, visual field affection, midline shift, mass effect, and larger tumour size were associated with higher preoperative values. Similarly, large-size tumours (P < 0.001), shorter duration of symptoms (P = 0.001), and lateral intraoperative positioning (P = 0.028) showed significantly higher values and greater changes, whereas the presence of VP shunt, use of osmotherapy, and sitting position for surgery showed a lower trend of ONSD postoperatively.

Conclusion: USG-ONSD demonstrates dynamic changes in patients undergoing intracranial tumour resection. ONSD is affected by the size of the tumour, duration of symptoms, and intraoperative positioning, though the trend is homogenous among supratentorial and infratentorial tumours.

Background and aims: Traditional airway assessment methods likely miss findings, resulting in unanticipated difficult airways. Surgeons routinely do computed tomography (CT) scans of head and neck cancer patients to determine the extent and resectability of the disease. We used these images for 3-dimensional CT (3D CT) reconstruction to provide additional airway-related information to the anaesthesiologist and studied its impact on airway management.

Methods: We randomly allocated 60 patients into two groups to formulate the airway management plan: Group A (Conventional airway assessment) and Group B (Conventional airway assessment along with 3D CT findings). A CT reporting format was prepared based on a literature review after discussion with radiologists and airway experts. In the case of luminal obstruction, a virtual endoscopy video was also created. These findings were shown to the anaesthesiologist managing the airway, and any change in the primary plan was noted. The primary outcome was the total time required for successful airway management. Secondary outcomes included the number of attempts, number of alternative techniques, other manoeuvres required, incidence of failed intubation, and any complications. Data were analysed using the SPSS statistics software.

Results: The airway management time between both groups was comparable, with a median difference of 0 [95% confidence interval (CI): -14, 20; P = 0.752]. Among the manoeuvres used, optimal external laryngeal manipulation (OELM) was required more in Group A (P = 0.007). Both groups had no difference in the number of attempts (P > 0.99), number of alternative techniques (P = 0.052), and complications (P > 0.99). There was a significant change in the endotracheal tube size after CT findings were shown (P < 0.001). It aided in selecting the preferred side of the nostril for nasotracheal intubation (kappa = 0.545, showing moderate agreement between before and after CT groups). As per the feedback from anaesthesiologists who rated 3D CT on a Likert scale, it was considered beneficial for airway assessment.

Conclusion: 3D CT reconstruction and virtual endoscopy can be a valuable method of airway assessment.

Background and aims: Recovery after general anaesthesia (GA) may vary depending on personal factors and the type of anaesthetic agent used. The primary objective of this study was to compare the recovery profiles of cognitive functions following desflurane- and sevoflurane-based GA in terms of the time required for cognitive functions to return to their baseline values.

Methods: This randomised comparative trial was conducted in 60 patients aged 18-50 years, scheduled for laparoscopic cholecystectomy under GA. The total cognitive score (TCS) recorded before surgery was considered the baseline. Patients were randomly allocated into Group D (n = 30) and Group S (n = 30). Anaesthesia was maintained with a mixture of oxygen, air, and desflurane or sevoflurane in groups D and S, respectively, with a 1.1 minimum alveolar concentration, adjusted to sustain a bispectral index of 50-60. Postoperatively, all patients were transferred to the post-anaesthesia care unit (PACU), and cognitive function was reevaluated at 30, 90, and 150 minutes. The Wilcoxon-Mann-Whitney test, the Friedman test, and the generalised estimating equations method were used to compare TCS at each time-point between groups, TCS over time within each group, and the variation in TCS changes between the two groups over time, respectively.

Results: Following GA, the TCS reverted to its baseline value in both groups at 150 minutes (P = 0.056).

Conclusion: Both desflurane and sevoflurane are comparable for cognitive recovery and duration of the PACU stay following GA.

The erector spinae plane block (ESPB), first described in 2016, has gained immense popularity worldwide due to its simplicity and effectiveness in providing pain relief for various surgeries. This bibliometric analysis aims to assess the contribution of Indian authors to the body of literature on ESPB. We searched Scopus using the keywords 'erector spinae plane block' and 'India'. The retrieved data were analysed using VOSviewer software. The analysis was done for co-authorship, co-occurrence, citation, bibliographic coupling and co-citation. From the 485 hits obtained after the database search, we included 262 articles for bibliometric analysis using the VOSviewer software. Co-authorship networks were identified among the All India Institute of Medical Sciences (AIIMS) in Bhubaneswar, the Postgraduate Institute of Medical Education and Research in Chandigarh and Sree Balaji Medical College in Chennai. The majority of publications originated from AIIMS, New Delhi and Bhubaneshwar. The Indian Journal of Anaesthesia published the highest number of ESPB-related articles (50), which collectively received 527 citations. This bibliometric analysis provides comprehensive details of the journals, citations, authors and institutions that have published articles on ESPB, including those authored by researchers from India. The findings may guide future research planning and collaboration using ESPB as an intervention.

Background and aims: The impact of anaesthetic agents on brain relaxation during neurosurgical procedures remains debatable. This study aimed to compare propofol and volatile anaesthetics during maintenance anaesthesia in achieving optimal brain relaxation in adults undergoing intracranial surgery.

Methods: We searched PubMed, Embase, Cochrane, and EBSCO Open Dissertations databases from inception to February 2024. Randomised controlled trials (RCTs) comparing anaesthetic agents in patients over 18 years old undergoing neurosurgical procedures were included. The primary outcome was the proportion of subjects who achieved satisfactory brain relaxation, as indicated by a score of 1 on the 4-point Brain Relaxation Score (BRS). The revised Cochrane risk of bias tool was used to evaluate the quality of included studies. Risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effects model. The effects on brain relaxation were ranked using the surface under the cumulative ranking (SUCRA). We also evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) online platform.

Results: Out of 2,264 articles identified, 11 RCTs involving 1,367 participants were included. The chance of having satisfactory brain relaxation of the following anaesthetics appeared to be lower than propofol: sevoflurane (RR: 0.93; 95% CI: 0.79, 1.09), isoflurane (RR: 0.89; 95% CI: 0.60, 1.34), and desflurane (RR: 0.83; 95% CI: 0.65, 1.07), with moderate certainty of evidence. Propofol had the highest SUCRA ranking (81.4%).

Conclusion: Although all anaesthetic agents had similar effects, propofol showed a tendency towards better brain relaxation during neurosurgery. Further robust evidence is required to confirm the potential advantages of propofol.

Background and aims: Technological advances, accumulated experience, and evidence have made free-flap reconstruction [using the anterolateral thigh flap (ALT) and free fibular flap (FF)] for head and neck oncosurgical defects a routine procedure. This study aimed to assess the impact on recovery after head and neck oncosurgery by preoperative optimisation, intraoperative stress minimisation, and postoperative protocolised normalisation.

Methods: This randomised study included 60 adult patients undergoing head and neck oncosurgery with ALT/FF reconstruction, allocated to either the Enhanced Recovery After Surgery (ERAS) group (Group E) or the conventional care group (Group C). Our primary outcome measures were the length of hospital stay (LOS) and time to Return to Intended Oncologic Therapy (RIOT). Surgical intensive care unit (SICU) stay, serum lactate, creatinine, and opioid consumption comprised the secondary outcome measures. An independent sample t-test or Welch test was performed for continuous variables, and a Chi-square test was used for categorical variables.

Results: Mean LOS and time to RIOT [9.97 (standard deviation (SD): 2.19) and 34.6 (SD: 9.22) days] were significantly shorter in Group E versus Group C (10.97 (SD: 1.45) and 43.8 (SD: 20.89) days) (mean difference (MD): 1, 95% confidence interval (CI): 0.04, 1.96, P = 0.042, and MD: 9.2, 95% CI: 0.77, 17.63, P = 0.033, respectively). Mean pre-incisional, post-resection, and postoperative lactate levels were significantly lower in Group E versus Group C (P < 0.0001). Serum creatinine levels on the morning of surgery were significantly lower in Group E (P = 0.0225).

Conclusion: At least 90% compliance with the described 15-element ERAS protocol reduces LOS and time to RIOT in head-neck oncosurgery patients with free-flap reconstruction.