{"title":"Intraperitoneal fire during abdominal surgeries: ‘Fire in the belly’ not always a good thing!","authors":"Malini Joshi, S. Bhosale, A. Kulkarni, S. Patkar","doi":"10.4103/ija.ija_775_23","DOIUrl":"https://doi.org/10.4103/ija.ija_775_23","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709796","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}
Elayavel Ravichandran, N. Goel, Babita Ghai, Vikas Saini, Sushmita Kaushik
Sevoflurane, a preferred anaesthetic for children, exhibits a dose-dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end-tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction. Two paediatric groups (1–12 months and 12–36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as ‘no movement’, and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient’s responses. The study included 75 children. The effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1–12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12–36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1–12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12–36 months group. In paediatric patients, a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in 1–12 months age group compared to 0.5% required in 12–36 months age group, achieving success in 50% of the study population.
{"title":"Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study","authors":"Elayavel Ravichandran, N. Goel, Babita Ghai, Vikas Saini, Sushmita Kaushik","doi":"10.4103/ija.ija_1058_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1058_23","url":null,"abstract":"\u0000 \u0000 Sevoflurane, a preferred anaesthetic for children, exhibits a dose-dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end-tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction.\u0000 \u0000 \u0000 \u0000 Two paediatric groups (1–12 months and 12–36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as ‘no movement’, and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient’s responses.\u0000 \u0000 \u0000 \u0000 The study included 75 children. The effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1–12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12–36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1–12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12–36 months group.\u0000 \u0000 \u0000 \u0000 In paediatric patients, a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in 1–12 months age group compared to 0.5% required in 12–36 months age group, achieving success in 50% of the study population.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709782","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}
José Miguel Esparza Miñana, G. Mazzinari, José Emilio Llopis-Calatayud, Germán Cerdá-Olmedo
Painful shoulder is one of the most frequent consultation causes. Multiple treatments have been described to relieve pain, restore range of motion and improve functionality. This randomised clinical trial was conducted in 60 patients. The treatment group received combined pulsed radiofrequency (PRF) on suprascapular nerve (SN) and axillary-circumflex nerve (ACN). The control group received PRF on SN only. The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS). The secondary outcomes were the Shoulder Pain and Disability Index (SPADI), the Constant–Murley range of motion scale and Disability of the Arm, Shoulder and Hand (DASH) scale. The patients were monitored at the baseline visit and at 1, 3, 6 and 9 months. A mixed ordinal regression model was estimated to evaluate the association between the study group and pain measured with NRS. A global decrease in pain at the end of the study was noted. The global baseline NRS was 8.4, and the global final NRS at 9 months of follow-up was 6.2. Combined PRF on SN and ACN was not associated with lower NRS pain scores compared to single SN PRF [odds ratio (OR) =1.04, 95% confidence interval (CI) 0.91–1.20, P = 0.507]. Secondary outcomes showed no significant differences: SPADI (OR = 1.04, 95% CI 0.92–1.18), Constant–Murley (OR = 1.01, 95% CI 0.90–1.14), DASH (OR = 1.04, 95% CI 0.92–1.17). Combined PRF applied to SN and ACN was not superior to PRF applied to SN alone.
肩部疼痛是最常见的会诊原因之一。有多种治疗方法可以缓解疼痛、恢复活动范围并改善功能。 这项随机临床试验在 60 名患者中进行。治疗组在肩胛上神经（SN）和腋环神经（ACN）上接受联合脉冲射频（PRF）治疗。对照组仅在SN上接受脉冲射频治疗。主要结果是用数字评分量表（NRS）测量疼痛强度。次要结果是肩部疼痛和残疾指数（SPADI）、恒定-默里运动范围量表和手臂、肩部和手部残疾（DASH）量表。患者在基线访问、1、3、6 和 9 个月时接受监测。研究人员采用混合序数回归模型来评估研究组与用 NRS 测量的疼痛之间的关系。 在研究结束时，疼痛总体上有所减轻。总体基线 NRS 为 8.4，随访 9 个月时的总体最终 NRS 为 6.2。与单一 SN PRF 相比，SN 和 ACN 的联合 PRF 与较低的 NRS 疼痛评分无关[几率比 (OR) =1.04，95% 置信区间 (CI) 0.91-1.20，P = 0.507]。次要结果无明显差异：SPADI（OR = 1.04，95% CI 0.92-1.18）、Constant-Murley（OR = 1.01，95% CI 0.90-1.14）、DASH（OR = 1.04，95% CI 0.92-1.17）。 将 PRF 联合应用于 SN 和 ACN 不优于单独应用于 SN 的 PRF。
{"title":"Efficacy of pulsed radiofrequency on the suprascapular and axillary-circumflex nerve for shoulder pain: A randomised controlled trial","authors":"José Miguel Esparza Miñana, G. Mazzinari, José Emilio Llopis-Calatayud, Germán Cerdá-Olmedo","doi":"10.4103/ija.ija_1107_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1107_23","url":null,"abstract":"\u0000 \u0000 Painful shoulder is one of the most frequent consultation causes. Multiple treatments have been described to relieve pain, restore range of motion and improve functionality.\u0000 \u0000 \u0000 \u0000 This randomised clinical trial was conducted in 60 patients. The treatment group received combined pulsed radiofrequency (PRF) on suprascapular nerve (SN) and axillary-circumflex nerve (ACN). The control group received PRF on SN only. The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS). The secondary outcomes were the Shoulder Pain and Disability Index (SPADI), the Constant–Murley range of motion scale and Disability of the Arm, Shoulder and Hand (DASH) scale. The patients were monitored at the baseline visit and at 1, 3, 6 and 9 months. A mixed ordinal regression model was estimated to evaluate the association between the study group and pain measured with NRS.\u0000 \u0000 \u0000 \u0000 A global decrease in pain at the end of the study was noted. The global baseline NRS was 8.4, and the global final NRS at 9 months of follow-up was 6.2. Combined PRF on SN and ACN was not associated with lower NRS pain scores compared to single SN PRF [odds ratio (OR) =1.04, 95% confidence interval (CI) 0.91–1.20, P = 0.507]. Secondary outcomes showed no significant differences: SPADI (OR = 1.04, 95% CI 0.92–1.18), Constant–Murley (OR = 1.01, 95% CI 0.90–1.14), DASH (OR = 1.04, 95% CI 0.92–1.17).\u0000 \u0000 \u0000 \u0000 Combined PRF applied to SN and ACN was not superior to PRF applied to SN alone.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712257","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}
Srinivasan Parthasarathy, J. Johnson, Kaushic A. Theerth
{"title":"Sellick’s manoeuvre – An old song with new lyrics","authors":"Srinivasan Parthasarathy, J. Johnson, Kaushic A. Theerth","doi":"10.4103/ija.ija_334_24","DOIUrl":"https://doi.org/10.4103/ija.ija_334_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711849","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":"Reviewing research reporting in randomised controlled trials: Confidence and P-values","authors":"V. Ganesh, Neeru Sahni","doi":"10.4103/ija.ija_189_24","DOIUrl":"https://doi.org/10.4103/ija.ija_189_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710061","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":"Advancement of supraglottic jet oxygenation and ventilation technique","authors":"Hua-Fang Wei","doi":"10.4103/ija.ija_330_24","DOIUrl":"https://doi.org/10.4103/ija.ija_330_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710555","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}
Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets. At the end of the investigation, only the subcostal nerve (anterolateral) and the ilioinguinal nerves were found near the QLM in all specimens. The iliohypogastric nerve was found in only two specimens. No further neural targets were found in the fascial planes before and posterior to the QLM.
{"title":"Nerves in quadratus lumborum planes: A cadaveric study","authors":"S. Diwan, X. S. Blanch, Abhijit S. Nair","doi":"10.4103/ija.ija_84_24","DOIUrl":"https://doi.org/10.4103/ija.ija_84_24","url":null,"abstract":"Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets. At the end of the investigation, only the subcostal nerve (anterolateral) and the ilioinguinal nerves were found near the QLM in all specimens. The iliohypogastric nerve was found in only two specimens. No further neural targets were found in the fascial planes before and posterior to the QLM.","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711605","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":"Comment: Awake clavipectoral fascial plane block for clavicle surgeries: A case series","authors":"Vishnampettai Vaidyanathan Subramanian","doi":"10.4103/ija.ija_7_24","DOIUrl":"https://doi.org/10.4103/ija.ija_7_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710279","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}
Maxillofacial surgeries, including procedures to the face, oral cavity, jaw, and head and neck, are common in adults. However, they impose a risk of adverse cardiac events (ACEs). While ACEs are well understood for other non-cardiac surgeries, there is a paucity of data about maxillofacial surgeries. This systematic review and meta-analysis report the incidence and presentation of perioperative ACEs during maxillofacial surgery. We included primary studies that reported on perioperative ACEs in adults. To standardise reporting, ACEs were categorised as 1. heart rate and rhythm disturbances, 2. blood pressure disturbances, 3. ischaemic heart disease and 4. heart failure and other complications. The primary outcome was ACE presentation and incidence during the perioperative period. Secondary outcomes included the surgical outcome according to the Clavien–Dindo classification and trigeminocardiac reflex involvement. STATA version 17.0 and MetaProp were used to delineate proportion as effect size with a 95% confidence interval (CI). Twelve studies (34,227 patients) were included. The incidence of perioperative ACEs was 2.58% (95% CI 1.70, 3.45, I 2 = 96.17%, P = 0.001). Heart rate and rhythm disturbances resulted in the greatest incidence at 3.84% among the four categories. Most commonly, these ACEs resulted in intensive care unit admission (i.e. Clavien–Dindo score of 4). Despite an incidence of 2.58%, ACEs can disproportionately impact surgical outcomes. Future research should include large-scale prospective studies that may provide a better understanding of the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery.
{"title":"Perioperative adverse cardiac events in maxillofacial surgery: A systematic review and meta-analysis","authors":"Mehak Chohan, Winnie Liu, Tumul Chowdhury","doi":"10.4103/ija.ija_1206_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1206_23","url":null,"abstract":"\u0000 \u0000 Maxillofacial surgeries, including procedures to the face, oral cavity, jaw, and head and neck, are common in adults. However, they impose a risk of adverse cardiac events (ACEs). While ACEs are well understood for other non-cardiac surgeries, there is a paucity of data about maxillofacial surgeries. This systematic review and meta-analysis report the incidence and presentation of perioperative ACEs during maxillofacial surgery.\u0000 \u0000 \u0000 \u0000 We included primary studies that reported on perioperative ACEs in adults. To standardise reporting, ACEs were categorised as 1. heart rate and rhythm disturbances, 2. blood pressure disturbances, 3. ischaemic heart disease and 4. heart failure and other complications. The primary outcome was ACE presentation and incidence during the perioperative period. Secondary outcomes included the surgical outcome according to the Clavien–Dindo classification and trigeminocardiac reflex involvement. STATA version 17.0 and MetaProp were used to delineate proportion as effect size with a 95% confidence interval (CI).\u0000 \u0000 \u0000 \u0000 Twelve studies (34,227 patients) were included. The incidence of perioperative ACEs was 2.58% (95% CI 1.70, 3.45, I\u0000 2 = 96.17%, P = 0.001). Heart rate and rhythm disturbances resulted in the greatest incidence at 3.84% among the four categories. Most commonly, these ACEs resulted in intensive care unit admission (i.e. Clavien–Dindo score of 4).\u0000 \u0000 \u0000 \u0000 Despite an incidence of 2.58%, ACEs can disproportionately impact surgical outcomes. Future research should include large-scale prospective studies that may provide a better understanding of the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711036","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}
P. Natrajan, B. Vaidiyanathan, S. Dhanger, I. Rajesh
{"title":"Response to the comments on our published article: Awake clavipectoral fascial plane block for clavicle surgeries: A case series","authors":"P. Natrajan, B. Vaidiyanathan, S. Dhanger, I. Rajesh","doi":"10.4103/ija.ija_190_24","DOIUrl":"https://doi.org/10.4103/ija.ija_190_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711599","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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