Indian Journal of Anaesthesia最新文献

Peripheral nerve blocks (PNBs) in coagulopathic patients are typically avoided due to the risks of bleeding and potential nerve compression. This case series explores the use of perineural fresh frozen plasma (FFP) to enhance local haemostasis in such settings. Five patients with an international normalised ratio of > 1.8, requiring urgent surgery, received PNBs with perineural FFP after haematology consultation. Seven ultrasound-guided blocks were performed, with FFP injected perineurally and along the needle tract, followed by systemic FFP 20 minutes later. All procedures were completed under PNB without conversion or need for additional analgesia. One patient developed a localised haematoma post-supraclavicular block, resolving after perineural FFP. No neurological deficits, major bleeding, or infections were observed. These preliminary results suggest that perineural FFP may reduce bleeding complications in high-risk patients, though further research is needed. Until validated, its use should remain investigational and be undertaken with multidisciplinary oversight and strict adherence to aseptic technique and ultrasound guidance.

Background and aims: This study aimed to systematically evaluate the effectiveness and safety of dural puncture epidural (DPE) and combined spinal epidural (CSE) for labour analgesia in parturients.

Methods: Searches were performed in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and CBM Database up to June 2025 to identify randomised controlled trials (RCTs) investigating the application of DPE and CSE techniques for labour analgesia in parturients. Data from eligible studies were pooled to calculate the combined standardised mean difference (SMD) or risk ratio (RR).

Results: Eleven studies with 1461 parturients were included. DPE had higher visual analogue scale (VAS) pain scores at 10 min [SMD: 0.60; 95% confidence interval (CI): 0.24, 0.95; P = 0.001; I ² = 76%] compared to CSE but fewer parturients requiring physician top-up boluses (RR = 0.64; 95% CI: 0.46, 0.88; P = 0.006; I ² = 11%). It also showed significantly lower incidences of abnormal foetal heart rate patterns (RR = 0.27; 95% CI: 0.16, 0.44; P < 0.001; I ² = 0%), pruritus (RR = 0.27; 95% CI: 0.14, 0.53; P < 0.001; I ² = 54%), and maternal hypotension (RR = 0.36; 95% CI: 0.15, 0.89; P = 0.030; I ² = 74%). No significant intergroup differences were found in first-stage labour duration, neonatal Apgar scores, or adverse reactions. The trial sequential analysis suggested the need for further data.

Conclusion: Compared with CSE, although DPE has a slower onset of analgesia, it may provide more reliable analgesic effects and result in lower incidence rates of adverse reactions in both parturients and foetuses. Substantial heterogeneity in some outcomes, driven by clinical heterogeneity including dose variations and limited studies, warrants cautious interpretation.

Background and aims: Monitoring oxygen saturation (SpO₂) during general anaesthesia using pulse oximetry is mandatory, though it may not always reflect the actual oxygenation status. Arterial blood gas (ABG) analysis remains the gold standard for measuring the partial pressure of oxygen (PaO₂), but it is invasive and limited by complications. This study aims to validate five existing equations for predicting PaO₂ from SpO₂ and, if applicable, to derive and validate a new equation in adult patients undergoing surgeries under general anaesthesia.

Methods: A prospective cohort study was conducted on adult patients undergoing general anaesthesia and requiring ABG measurements at several time points intraoperatively. Using SPSS software, a Bland-Altman analysis was performed to assess the agreement between derived and measured PaO2 values using five existing equations. Regression analysis was then performed to develop a new equation for predicting PaO₂, which was validated in a second cohort.

Results: During the initial phase, 150 ABG samples were collected from 83 patients. Bland-Altman analysis revealed weak agreements with all existing equations. A new logarithmic equation, El-Khatib's equation (PaO₂ = 10^-25.6 × SpO₂ ^13.9), was derived. The validation phase involved 150 ABG samples from 65 patients, demonstrating strong agreement with El-Khatib's equation (systematic bias of 13 mmHg, limits of agreement: -189 to 214 mmHg).

Conclusion: Five existing equations for predicting PaO₂ from SpO₂ revealed weak agreement in adult patients under general anaesthesia. El-Khatib's equation demonstrated strong potential for predicting PaO₂, providing a reliable non-invasive alternative for determining PaO₂ in clinical practice.

Background and aims: The optimal perioperative management of patients chronically using renin-angiotensin system inhibitors (RASIs) is still uncertain. This study aims to compare the outcomes of withholding versus continuing RASIs before surgery, focusing on efficacy and safety.

Methods: A systematic review and meta-analysis synthesising evidence from randomised controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until September 2024. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes by using the risk ratio (RR) with a 95% confidence interval (CI).

Results: Ten RCTs with 3,740 patients were included. There was no statistical difference between both groups regarding the incidence of major adverse cardiac events (MACE) [Risk ratio (RR): 0.99; 95% confidence interval (CI): 0.84, 1.16; P = 0.88], all-cause mortality (RR: 0.88; 95% CI: 0.44, 1.78; P = 0.72), myocardial infarction (MI) (RR: 1.67; 95% CI: 0.61, 4.58; P = 0.32), heart failure/acute pulmonary oedema (RR: 1.87; 95% CI: 0.51, 6.84; P = 0.34), stroke (RR: 1.22; 95% CI: 0.35, 4.24; P = 0.75), postoperative hypotension (RR: 0.85; 95% CI: 0.66, 1.10; P = 0.22), perioperative hypertension (RR: 1.21; 95% CI: 1.00, 1.46; P = 0.05), and acute kidney injury (AKI) (RR: 1.01; 95% CI: 0.80, 1.26; P = 0.97). However, withholding RASIs was significantly associated with a decreased incidence of intraoperative hypotension (RR: 0.82; 95% CI: 0.75, 0.89; P < 0.001).

Conclusion: Stopping RASIs in patients undergoing surgery was not associated with a higher risk of postoperative complications, such as MACE, all-cause mortality, myocardial infarction, heart failure/acute pulmonary oedema, stroke, or AKI. Conversely, discontinuing RASIs notably reduced the incidence of intraoperative hypotension.

Background and aims: The age-dependent decline in sevoflurane's minimum alveolar concentration is well established. However, the relationship between ageing and its hypnotic potency at the effect-site concentration (Ceff) remains unclear. This study aimed to evaluate the impact of ageing on sevoflurane's hypnotic potency and induction kinetics during the wash-in period.

Methods: This prospective observational study enroled 83 female patients stratified by age into four decades: 30-39, 40-49, 50-59, and 60-69 years. Anaesthesia was induced using 5% sevoflurane in a non-rebreathing manner. We continuously recorded bispectral index (BIS) values and end-tidal sevoflurane concentrations during the 4 min wash-in period, with Ceff values calculated through pharmacokinetic modelling. Subsequently, the end-tidal concentration was maintained at 1.5% for 20 min (10 min equilibration + 10 min stabilisation) at 2 L/min to achieve a cerebral steady-state, and the final stabilised BIS value was calculated. One-way ANOVA with Bonferroni post-hoc correction or Kruskal-Wallis test was used to compare continuous variables. Pearson's Chi-square test was used to compare categorical variables, with the significant difference set at P < 0.05.

Results: During the wash-in period, the 60-69-year group exhibited a prolonged time from awakening to BIS 50 compared to younger cohorts (P < 0.05 or < 0.01). Ceff values exhibited progressively delayed kinetics with increasing age, but Ceff values of sevoflurane at BIS 50 were not different across the four age groups (P > 0.05). At a steady state of 1.5% sevoflurane anaesthesia, the intergroup analysis revealed no significant variations in BIS values.

Conclusion: The hypnotic potency of sevoflurane is preserved among female patients aged 30-69 years despite delayed induction kinetics in older individuals.