Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: The incidence of postoperative cough in patients undergoing endoscopic laryngeal surgery is 86%. This study aims to evaluate the efficacy of ultrasound-guided bilateral internal laryngeal nerve block as an adjunct to general anesthesia in reducing the incidence and severity of postoperative cough, sore throat, and hoarseness of voice, as well as managing the perioperative hemodynamic changes in endoscopic microlaryngeal laser surgery (MLS).

Material and methods: Forty patients aged 18-65 years scheduled to undergo endoscopic MLS under general anesthesia were recruited into the study. Patients were randomized into two groups of 20 patients in each group. Patients in group I received ultrasound-guided internal laryngeal nerve block bilaterally with 2.5 ml of 2% lignocaine on either side along with general anesthesia, whereas those in group II received only general anesthesia.

Results: At the time of emergence, only 35% of patients in group I had mild cough; however, in Group II, 60% patients had mild cough, 25% had moderate cough, and 5% had severe cough. The differences between the two groups were statistically significant (P < 0.05). We observed no significant differences in the incidence and severity of sore throat, hoarseness of voice at 1 week, perioperative hemodynamic parameters, and oxygen desaturation between the two groups (P > 0.05).

Conclusions: Bilateral internal laryngeal nerve block as an adjunct to general anesthesia significantly reduces the incidence and severity of cough at the time of emergence from anesthesia in MLS. However, no significant reduction in the incidence and severity of sore throat was detected.

Background and aims: Incidence and severity of postoperative sore throat (POST) is expected to be higher after lumbar spinal surgery performed under general anesthesia in the prone position. This study aims to compare the efficacy and safety of preoperative gargles with aspirin and magnesium sulphate for prevention of POST after lumbar laminectomy.

Material and methods: This prospective, randomized, double-blinded study was conducted on 60 adult American Society of Anesthesiologists grade I-III patients posted for lumbar laminectomy under general anesthesia. Patients, allocated into two groups of 30 patients each, received a solution of either aspirin 325 mg (Group A) or magnesium sulphate 1 g (Group B) dissolved in 20 ml of 5% dextrose to gargle for 30 s, 15 min before induction of anesthesia. Postoperatively, incidence, severity grade, and numeric rating scale (NRS) of POST were assessed at 1, 2, 4, 12, and 24 h. Incidence and severity of postoperative cough were assessed at 0, 1, 2, 4, 12, and 24 h.

Results: Incidence and severity grade of POST were significantly lower in Group B as compared to Group A at 1 h (P = 0.01, 0.002), while these were similar at 2, 4, 12, and 24 h postoperatively. NRS for POST was significantly lower at 1, 2, and 4 h in Group B (P = 0.002, 0.035, 0.024), whereas it was comparable at 12 and 24 h. No significant difference was observed in incidence and severity of postoperative cough.

Conclusion: Magnesium sulphate gargles are more effective than aspirin in preventing POST in the early hours of the postoperative period.

Background and aims: Early extubation is recommended for enhancing recovery in cardiac surgical patients, but premature extubation must be avoided. The diaphragm excursion-time index (DETI) is a novel, recently described index that can predict successful extubation. Its role in early extubation of cardiac patients has not been studied yet. This study was aimed at studying the role of DETI in the early extubation of cardiac surgical patients.

Material and methods: This prospective observational study was conducted at a tertiary care hospital. Bilateral DETI (primary outcome variable), diaphragm excursion (DE), inspiratory time (Ti), and diaphragm thickness fraction (DTF) of 150 adult cardiac surgical patients were assessed at the train-of-four ratio 0.95 and end of spontaneous breathing trial (SBT). Patients were classified as successful early extubation if extubated within 6 h. The secondary outcome variables were DE, DTF, and Ti. Receiver operator characteristic (ROC) was used to determine the predictive value of these variables.

Results: Early extubation was successful in 96 patients. DETI, DE, and DTF predicted successful early extubation. DETI≥1.31 cm-s of the right diaphragm at SBT predicted successful early extubation with a sensitivity of 0.890 and specificity of 0.779, with an area under ROC curve 0.858. For the left side, DETI≥1.65 cm-s at SBT had a sensitivity, specificity, and area under ROC curve of 0.902, 0.726, and 0.875 respectively. DETI, DE, and DTF were higher in patients early extubation.

Conclusion: For cardiac surgical patients, DETI has high sensitivity and specificity for successful early extubation.

Background and aims: Second-generation supraglottic airway devices (SAD), such as i-gel and Ambu AuraGain, offer higher sealing pressures and facilitate intubation. Although literature exists on their ventilatory characteristics, limited data are available on their performance as intubation conduits in the adult Indian population. The purpose of this study was to shed light on the clinical performance and intubation characteristics of both devices.

Material and methods: In this prospective, open-label study, 96 ASA I and II patients aged 18-60 years undergoing elective surgeries were equally randomized into Group A (Ambu AuraGain) and Group I (i-gel). All SADs were inserted under general anaesthesia using standard techniques. Outcomes included the Brimacombe score (primary), first-attempt success rate of SAD insertion, oropharyngeal leak pressure (OLP), ease of gastric tube insertion, success rate of intubation through SAD, intubation time, size of the endotracheal tube used, ease of intubation, and adverse events.

Results: Ambu AuraGain exhibited a superior Brimacombe score when assessed via fibreoptic bronchoscope (P = 0.001), despite necessitating more attempts to achieve successful ventilation. No significant disparities were detected regarding OLP or gastric tube insertion. When evaluating intubation characteristics, the time required for intubation was similar; however, the success rate of intubation and ease of intubation favoured the AuraGain. AuraGain accommodated larger endotracheal tubes with ease. Adverse events, including minor mucosal injuries, were comparable between the two devices.

Conclusions: I-gel and Ambu AuraGain demonstrated similar effectiveness in ventilation characteristics. However, Ambu AuraGain facilitated easier endotracheal intubation via SAD in anesthetized adults, owing to its ability to accommodate larger endotracheal tubes compared to i-gel.

Background and aims: Awake fiberoptic intubation (AFOI) is the gold standard for predicted difficult airways. Optimal sedation is crucial for patient comfort and procedural success. Nebulized sedatives offer a noninvasive approach, allowing for titration and rapid cessation if needed. We aimed to compare patient comfort, as reflected by patient reactions during AFOI, following dexmedetomidine versus midazolam nebulization in patients with a predicted difficult airway. The ease of the intubation process and degree of the patient's alertness/sedation were also compared.

Material and methods: It was a prospective randomized, double-blinded study. Fifty patients with predicted difficult airways received either dexmedetomidine 1 μg/kg or midazolam 0.2 mg/kg nebulization. The airway was then topicalized with lignocaine spray, jelly, and a transtracheal block, and AFOI was performed. Following intubation, patients were induced intravenously. Patient comfort, ease of intubation, hemodynamic stability, and adverse events were assessed in both groups and compared.

Results: Midazolam nebulization resulted in significantly better patient comfort, as evidenced by lower patient reactions and higher comfort behavioral scores. Both drugs provided adequate sedation for AFOI. The ease of intubation was comparable between the two groups. No significant hemodynamic changes or adverse events were observed.

Conclusions: Midazolam nebulization prior to AFOI in patients with a difficult airway provided significantly better patient comfort compared to dexmedetomidine nebulization. The ease of intubation was comparable following nebulization of both drugs.

Background and aims: Post-operative pain has always been neglected in children. It is only recently that the issue is being given the much-needed consideration. Even today, the literature is sparse for paediatric post-thoracotomy pain management modalities. In this era of ultrasound guided (USG) regional blocks, serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) seem to offer promising results. We aimed to compare the ESPB with SAPB in patients undergoing open thoracotomy.

Material and methods: Sixty paediatric patients of age 5-14 years, scheduled to undergo open thoracotomies, were divided into two groups: Group S (SAPB) and group E (ESPB). Each group received 0.5 ml/kg of 0.25% bupivacaine under USG blocks. The primary outcome of the study was to compare the postoperative pain scores using the Wong-Baker Faces scale. The secondary outcomes were to compare cumulative fentanyl consumption, time to initiation of chest physiotherapy, and duration of hospital stays.

Results: The Faces score was significantly lower in Group E compared to Group S at 8 h, 12 h, 16 h, 20 h, and 24 h (P < 0.05). The mean cumulative fentanyl requirement in Group S was higher than in Group E (P = 0.002). Time to initiate chest physiotherapy and duration of hospital stays were both significantly shorter in Group E (P < 0.05).

Conclusions: ESPB is superior to SAPB in terms of providing better pain control and reduced opioid requirements in children post-thoracotomy.

Background and aims: Ultrasound-guided adductor canal block (ACB) has been increasingly used for postoperative analgesia in total knee replacement (TKR) surgery patients. We hypothesized that the addition of ketamine to levobupivacaine in ultrasonograsonography (USG)-guided ACB would result in prolonged and better postoperative analgesia in patients undergoing TKR.

Material and methods: This randomized prospective study was conducted on 90 patients undergoing unilateral TKR. In Group LK (n = 45), levobupivacaine 0.25% plus ketamine 1 mg/kg (total volume 20 ml) was given, and in Group L (n = 45), 20 ml of 0.25% levobupivacaine was given. The primary objective was to compare the pain-free interval, i.e. the time until the first dose of rescue analgesia, between Group LK and Group L. The secondary objectives were to assess the amount of rescue analgesic, pain scores, and complications.

Results: We observed that the time to the first dose of rescue analgesia in Group LK (9.33 h ± 2.17) was significantly longer than in Group L. (5.02 h ± 1.63) (P value = 0.001; Cohen's d = 2.243). The total dose of rescue analgesic was significantly lower in Group LK (188.89 mg ± 48.72) compared to Group L (271.11 mg ± 50.55) (P value = 0.001). Patients in Group L had significantly higher numerical rating scale compared to Group LK at rest at 4, 6, and 12 h and on movement at 2, 4, 6, and 12 h postoperatively.

Conclusions: The addition of ketamine to levobupivacaine in ACB resulted in prolongation of the pain-free interval, decreased requirement for rescue analgesia, and better pain control during rest and movement.