Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: Anesthetic agents like propofol and etomidate are known to affect intracellular calcium homeostasis during diastole. Hence, this study has been designed to study the effects of etomidate and propofol on left ventricular diastolic function in adults (>18 years) undergoing elective noncardiac surgery under general anaesthesia.

Material and methods: E-wave velocity, septal and lateral e' velocities, left atrial volume index (LAVI), and tricuspid regurgitation maximum jet velocity (TRVmax) were measured before and after induction of anesthesia (etomidate and propofol).

Results: A total of 187 patients were screened, and parameters from 157 patients were analyzed in this study. There was a statistically significant decrease in the mean E velocity, septal e', and lateral e' velocities with both propofol and etomidate. The difference-in-difference analysis revealed that etomidate caused a statistically significant reduction in E velocity (-11.59 ± 6.61 vs. -6.46 ± 9.84, P = 0.0002) compared with propofol.

Conclusions: This study found that anaesthesia induction with propofol and etomidate in adults resulted in a statistically significant decrease in E-wave, septal, and lateral e' velocities within the groups. The reduction in E-wave velocity caused by etomidate was more profound when compared with propofol. While both propofol and etomidate may mildly worsen certain parameters of diastolic function, this study did not demonstrate any worsening of diastolic parameters like LAVI, TRVmax, and E/e'.

Background and aims: Ventilating acute brain injury patients, with normal lung, using low tidal volume (LTV) ventilation may lead to improved outcomes. Nonetheless, investigations are ongoing to understand its impact on intracranial pressure and cerebral oxygenation. Our study aimed to see the effect of LTV on optic nerve sheath diameter (ONSD) and regional cerebral oxygen saturation (rScO₂) in patients with severe traumatic brain injury (sTBI).

Material and methods: This single-center, prospective, single-blinded, pre-post interventional study included 18 patients with sTBI who were mechanically ventilated with standard high tidal volume (HTV) ventilation (10 ml/kg). After recording outcome variables, ONSD and rScO₂ with HTV, patients were ventilated with LTV (6 ml/kg) for 30 minutes and the outcome variables were recorded.

Results: LTV had no effect on right ONSD (P = 0.94), whereas left ONSD was 0.04 cm less with LTV, but the difference in spite of reaching statistical significance (P = 0.04) was not clinically significant. Mean end-tidal carbon dioxide (EtCO₂) with LTV was 2.5 mm Hg more as compared to HTV. Adjusting for the effect of EtCO₂, ONSD was comparable bilaterally with both tidal volumes (right ONSD; P = 0.52 and left ONSD; P = 0.45). Change in tidal volume had no effect on rScO₂.

Conclusions: Our findings suggest that LTV does not affect ONSD and rScO₂ in sTBI patients. However, ventilator parameters should be guided to control EtCO₂. Larger studies are required to look at the effect of site of injury as a factor affecting ONSD.

Introduction: For oral care and prevention of ventilator- associated pneumonia (VAP) in patients admitted to intensive care units (ICU), chlorhexidine gluconate is the commonly used antiseptic solution. Recent studies, however, have shown uncertainty regarding its benefit, with some reporting increased mortality in patients.

Material and methods: This randomised controlled study was performed on 154 patients who were receiving invasive mechanical ventilation for more than 48 hours. The patients were randomised into two study groups; in Group I oral care was provided with chlorhexidine gluconate solution, and in Group II a comprehensive oral care protocol that omitted chlorhexidine was adopted. The primary outcome of the study was patient outcome at 14 days after enrolment and secondary outcomes included incidence of VAP and oral health assessment.

Results: We found that the oral hygiene in the study groups was comparable. The incidence of VAP was significantly higher in Group I as compared to Group II (40.2% vs 23.3%; P = 0.025). The mortality observed in Groups I and II at 14 days after study enrollment was 67.9% and 54.5% respectively (P = 0.002). In logistic regression analysis, the comorbidities, VAP and patients with underlying neurological conditions were found to be the independent factors affecting the mortality of patients.

Conclusion: A comprehensive oral care regime consisting of mechanical disruption of dental plaque, moisturization of lips and oral cavity compared to chlorhexidine -based oral care is found to be more effective in reducing VAP in mechanically ventilated patients admitted in a general ICU.

Background and aims: This prospective, randomized, double-blind controlled trial investigated whether adding perineural dexamethasone and dexmedetomidine to ropivacaine in adductor canal block (ACB) improves postoperative analgesia compared to using only perineural dexamethasone with ropivacaine in patients undergoing total knee arthroplasty (TKA).

Material and methods: Fifty-eight patients undergoing TKA received ultrasound-guided ACB (30 mL of 0.5% ropivacaine). They were randomly assigned to receive either perineural dexamethasone (4 mg) or a combination of perineural dexamethasone (4 mg) and dexmedetomidine (50 mcg), with 29 participants in each group. A blinded observer assessed the primary outcome: morphine consumption in the first 24 postoperative hours. Secondary outcomes included total 48-hour morphine consumption, postoperative pain scores (NRS) at rest and during movement, quadriceps muscle strength, timed up and go (TUG) test time, Ramsay sedation score, and incidence of nausea, vomiting, hypotension, bradycardia, and desaturation.

Results: The dexamethasone-dexmedetomidine group showed significantly lower 24-hour (14.38 ± 5.68 mg vs. 8.55 ± 4.37 mg, P = 0.0001) and 48-hour (20.96 ± 7.09 mg vs. 12.06 ± 6.11 mg, P = 0.00001) morphine consumption compared to the dexamethasone-only group. Pain scores at rest and with movement were also lower in the combination group during the first 12 postoperative hours. No significant between-group differences were observed in other secondary outcome measures (quadriceps strength, TUG time, sedation score, and complication rates). No serious adverse events were reported in either group.

Conclusion: The study suggests that adding dexamethasone and dexmedetomidine to ropivacaine for ACB may significantly improve postoperative pain relief in TKA patients without causing harmful side effects.

Background and aims: There are two anatomical pathways in the nasal cavity through which the endotracheal tube may pass during nasotracheal intubation: the lower pathway and upper pathway. The upper pathway lies above the inferior turbinate, just below the middle turbinate. The lower pathway lies along the floor of the nose, underneath the inferior turbinate. The lower pathway is considered a safer route due to the lesser risk of epistaxis, as it is located away from the middle turbinate. However, we cannot select the lower pathway exclusively, as there are no clear indicators to differentiate between the upper and lower pathways blindly. The direction of the bevel of the tube may guide the pathway taken by the tracheal tube during nasotracheal intubation.

Material and methods: Sixty patients, aged 18 to 60 years, with American Society of Anaesthesiologist (ASA) physical status I or II, scheduled for elective surgery under general anesthesia requiring nasotracheal intubation, were included in this study. In Group I (n = 30), the tracheal tube was inserted with the bevel in a lateral direction (conventional group), and in Group II (n = 30), the tracheal tube was inserted with the bevel in a cephalad direction (interventional group). The primary objective was to determine the path followed by the tracheal tube through the nasal cavity during nasotracheal intubation.

Results: In Group I, the tracheal tube passed through the lower pathway in 15 patients (50%) and through the upper pathway in 15 patients (50%). In Group II, the tracheal tube passed through the lower pathway in 24 patients (80%) and through the upper pathway in 6 patients (20%) (P value 0.01).

Conclusion: The results of the present study reveal that the cephalad bevel of the reinforced tracheal tube significantly favors the lower pathway compared to the lateral bevel during nasotracheal intubation.

Background and aims: Intrathecal morphine (ITM) has been widely used to provide effective postoperative analgesia. This study aims to compare the efficacy and safety of three different doses of ITM - 200, 300, and 400 μg - in patients undergoing open donor hepatectomy.

Material and methods: A total of 90 patients were randomized into three groups (30 patients each) receiving either 200 μg (Group A), 300 μg (Group B), or 400 μg (Group C) of ITM, along with 5 mg of 0.5% bupivacaine. Postoperative pain was managed using intravenous patient-controlled analgesia with fentanyl. Total fentanyl consumption, visual analog scale (VAS) scores, Ramsay Sedation Scale score, and incidence of side effects were recorded for 72 h postoperatively. Data was analyzed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. A P value < 0.05 was considered significant.

Results: Cumulative postoperative fentanyl consumption at 24 h was similar across all three groups: Group A (100 [50-200] μg), Group B (100 [50-225] μg), and Group C (100 [50-231] μg) (P = 0.92). VAS scores at rest and during movement were comparable among the groups at all time points. Group C exhibited a higher incidence of side effects when compared to groups B and A, respectively (35 vs. 13 vs. 5, P < 0.001).

Conclusions: A dose of 200 μg of ITM provides effective postoperative pain control in patients undergoing open live donor hepatectomy and results in fewer opioid-related side effects, compared to 300 and 400 μg doses.