Pub Date : 2023-10-01Epub Date: 2022-12-23DOI: 10.4103/joacp.joacp_307_22
Vanita Ahuja, Lekshmi V Nair, Deepak Thapa, Sukanya Mitra, Sudesh K Arya
{"title":"Effect of infratrochlear nerve block on discharge readiness in patients undergoing strabismus surgery.","authors":"Vanita Ahuja, Lekshmi V Nair, Deepak Thapa, Sukanya Mitra, Sudesh K Arya","doi":"10.4103/joacp.joacp_307_22","DOIUrl":"10.4103/joacp.joacp_307_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"1 1","pages":"679-680"},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42853487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthetic management in a Tessier cleft child with CHARGE syndrome: A new association?","authors":"Anju Gupta, Pratibha Mudgal, Madhu Dayal, Nishkarsh Gupta","doi":"10.4103/joacp.joacp_28_22","DOIUrl":"10.4103/joacp.joacp_28_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"39 4","pages":"665-666"},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-12-20DOI: 10.4103/joacp.joacp_175_22
Himel Mondal, Shaikat Mondal, Rudrashish Haldar
{"title":"Criteria to be an author of a manuscript: Time to revisit the ICMJE criteria and CRediT.","authors":"Himel Mondal, Shaikat Mondal, Rudrashish Haldar","doi":"10.4103/joacp.joacp_175_22","DOIUrl":"10.4103/joacp.joacp_175_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"39 4","pages":"674-675"},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery.
Material and methods: In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite.
Results: There was a statistically significant decrease in both pain threshold (P < 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery (P = 0.048). The magnitude of change in pain scalars was greater in females (P < 0.001), those with a high anxiety score, and a history of severe painful experience in the past.
Conclusion: Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research.
{"title":"Effect of stress on contextual pain sensitivity in the preoperative period- A proof of concept study.","authors":"Shibani Padhy, Ruhi Fatima, Shubhranshu Jena, Akhya Kumar Kar, Padmaja Durga, Vishal Kumar Neeradi","doi":"10.4103/joacp.joacp_187_22","DOIUrl":"10.4103/joacp.joacp_187_22","url":null,"abstract":"<p><strong>Background and aims: </strong>The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery.</p><p><strong>Material and methods: </strong>In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite.</p><p><strong>Results: </strong>There was a statistically significant decrease in both pain threshold (<i>P</i> < 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery (<i>P</i> = 0.048). The magnitude of change in pain scalars was greater in females (<i>P</i> < 0.001), those with a high anxiety score, and a history of severe painful experience in the past.</p><p><strong>Conclusion: </strong>Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"39 4","pages":"603-608"},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-12-20DOI: 10.4103/joacp.joacp_515_23
Ghansham Biyani, Rajasekhar Metta
{"title":"Green anesthesia: How green is our practice?","authors":"Ghansham Biyani, Rajasekhar Metta","doi":"10.4103/joacp.joacp_515_23","DOIUrl":"10.4103/joacp.joacp_515_23","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"39 4","pages":"519-520"},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-18DOI: 10.4103/joacp.joacp_132_22
Sunil Rajan, Aishwarya P. Suresh, Madhumita Ramakrishnan, Jerry Paul
Dear Editor, Securing endotracheal tubes (ETT) during facial cosmetic surgeries can be challenging.[1] We are reporting how ETT was secured in two patients who underwent cosmetic facial surgeries which demanded bilateral cheeks, chin, and nose to be free. Flexometallic ETTs were used and were secured to incisors. In case 1, a 25-year-old female was posted for rhinoplasty, chin implant placement, and liposuction of the cheeks. After intubation, ETT was brought to the midline and a firm knot was made around ETT using size 1.0 silk (Centisilk, Centenial Surgical Suture Ltd, India) that was tied twice around ETT, and the knot was kept near the inner aspect of the upper incisors. Threads were then slipped down to gum through either side of one upper incisor, like performing dental flossing, and tied firmly on the buccal aspect of the incisor [Figure 1a].Figure 1: (a) ETT secured with thread to the upper incisor, (b) ETT secured with stainless steel wire to lower incisorsIn case 2, a 55-year-old female was posted for a chin implant, neck lift, lip lift, and liposuction of nasolabial folds. As incisors were closely placed, we failed to slip the thread between teeth down to the gum. Therefore, we decided to use a pre-stretched 26 G stainless steel wire (Ortho Max Mfg Co Pvt Ltd, India) which is commonly used by dental surgeons for arch bar fixation. The wire was wound twice around ETT and twisted repeatedly by holding both wires at a short distance from ETT using a needle holder. Once the wire was tightly wound around ETT, both the free ends of the wire were brought out to the buccal aspect through the lateral part of the first two lower incisors close to the gum. Both the ends were held together and twisted repeatedly till it was secured tightly around the incisors. The extra length of twisted wire was then cut short, the free end turned away from the lip, and covered with a piece of transparent incision drape to avoid lip trauma [Figure 1b]. Fixing ETT using adhesive tapes to cheeks or chin was not practical in both patients as surgeries involved the chin and both cheeks and frequent assessment of facial symmetry intraoperatively was required. Preformed tube (oral/nasal) was avoided as surgeries involved the nose, chin, and neck. The use of a flexometallic tube prevented kinking of ETT and gave surgeons freedom to move the proximal part of ETT with an attached breathing circuit (covered in sterile plastic sheet) away from the surgical field with no distortion of facial anatomy. These requirements could have been met with submental intubation as in panfacial trauma,[2-4] but not considered as our patients were undergoing cosmetic procedures. Though tying ETT with silk to incisors is totally atraumatic, dental wires may cause minimal gum injury. As tips of incisors are always broader than root, the chance of suture slipping out intraoperatively is rare, if the knot is tied firmly close to the root of incisors. ETT should not be tied to loose or partly br
亲爱的编辑，在面部整容手术中固定气管内管(ETT)是很有挑战性的。[1]我们报告了两名接受面部美容手术的患者是如何获得ETT的，该手术要求双侧脸颊，下巴和鼻子自由。使用柔性金属假体并将其固定在门牙上。在病例1中，一名25岁的女性接受了鼻整形、下巴植入和脸颊吸脂手术。插管后，将ETT带至中线，用1.0号丝(Centisilk, Centenial Surgical Suture Ltd, India)在ETT周围打结，在ETT周围打结两次，结保持在上门牙内侧附近。然后将牙线从一个上门牙的两侧滑落到牙龈上，就像使用牙线一样，并牢固地系在门牙的颊面上[图1a]。图1:(a)上门牙螺纹固定ETT， (b)下门牙不锈钢丝固定ETT。病例2，一名55岁女性，行下巴种植、颈部提升、唇部提升和鼻唇沟吸脂术。由于门牙的位置很近，我们没能把牙间的线滑到牙龈上。因此，我们决定使用预拉伸的26g不锈钢丝(Ortho Max Mfg Co Pvt Ltd, India)，这是牙科医生常用的弓杆固定。将金属丝绕ETT两圈，并用夹针器将两根金属丝握在离ETT近的地方反复扭转。一旦金属丝紧紧缠绕在ETT上，金属丝的自由两端通过靠近牙龈的前两个下门牙的外侧部分被带到颊面。两端被固定在一起，反复扭曲，直到它被牢牢地固定在门牙周围。将多余的绞丝剪短，游离端远离唇部，并覆盖一层透明切口悬垂，避免唇部外伤[图1b]。由于手术涉及到下巴和双颊，且术中需要频繁评估面部对称性，因此使用胶带将ETT固定在两名患者的脸颊或下巴上并不实际。由于手术涉及鼻子、下巴和颈部，因此避免使用预成形管(口/鼻)。柔性金属管的使用防止了ETT的扭结，并使外科医生可以自由地将ETT的近端部分与附加的呼吸回路(覆盖在无菌塑料片上)移离手术场，而不会扭曲面部解剖结构。这些要求可以在全面外伤中通过颏下插管来满足[2-4]，但由于我们的患者正在接受美容手术，因此不被考虑。虽然将ETT用丝系在门牙上是完全无伤大雅的，但牙丝可能会对牙龈造成最小的伤害。由于切牙的尖端总是比牙根宽，如果结系紧靠近切牙的根部，术中缝线滑落的机会很少。ETT不应绑在松动或部分断裂的门牙上。1.0码的丝绸很厚，不容易断裂。如果可能的话，可以使用双线。然而，在任何面部手术中意外拔管的罕见可能性应牢记在心。即使长时间使用，牙间导线也是一种安全的技术。[5]我们建议在面部整形手术中考虑这两种确保ETT的技术。患者同意声明作者证明他们已经获得了所有适当的患者同意表格。以患者同意在期刊上报道其图像和其他临床信息的形式。患者明白他们的姓名和首字母缩写不会被公布，我们会尽力隐藏他们的身份，但不能保证匿名。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Techniques of securing endotracheal tube during cosmetic facial surgeries involving nose, cheeks, and chin","authors":"Sunil Rajan, Aishwarya P. Suresh, Madhumita Ramakrishnan, Jerry Paul","doi":"10.4103/joacp.joacp_132_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_132_22","url":null,"abstract":"Dear Editor, Securing endotracheal tubes (ETT) during facial cosmetic surgeries can be challenging.[1] We are reporting how ETT was secured in two patients who underwent cosmetic facial surgeries which demanded bilateral cheeks, chin, and nose to be free. Flexometallic ETTs were used and were secured to incisors. In case 1, a 25-year-old female was posted for rhinoplasty, chin implant placement, and liposuction of the cheeks. After intubation, ETT was brought to the midline and a firm knot was made around ETT using size 1.0 silk (Centisilk, Centenial Surgical Suture Ltd, India) that was tied twice around ETT, and the knot was kept near the inner aspect of the upper incisors. Threads were then slipped down to gum through either side of one upper incisor, like performing dental flossing, and tied firmly on the buccal aspect of the incisor [Figure 1a].Figure 1: (a) ETT secured with thread to the upper incisor, (b) ETT secured with stainless steel wire to lower incisorsIn case 2, a 55-year-old female was posted for a chin implant, neck lift, lip lift, and liposuction of nasolabial folds. As incisors were closely placed, we failed to slip the thread between teeth down to the gum. Therefore, we decided to use a pre-stretched 26 G stainless steel wire (Ortho Max Mfg Co Pvt Ltd, India) which is commonly used by dental surgeons for arch bar fixation. The wire was wound twice around ETT and twisted repeatedly by holding both wires at a short distance from ETT using a needle holder. Once the wire was tightly wound around ETT, both the free ends of the wire were brought out to the buccal aspect through the lateral part of the first two lower incisors close to the gum. Both the ends were held together and twisted repeatedly till it was secured tightly around the incisors. The extra length of twisted wire was then cut short, the free end turned away from the lip, and covered with a piece of transparent incision drape to avoid lip trauma [Figure 1b]. Fixing ETT using adhesive tapes to cheeks or chin was not practical in both patients as surgeries involved the chin and both cheeks and frequent assessment of facial symmetry intraoperatively was required. Preformed tube (oral/nasal) was avoided as surgeries involved the nose, chin, and neck. The use of a flexometallic tube prevented kinking of ETT and gave surgeons freedom to move the proximal part of ETT with an attached breathing circuit (covered in sterile plastic sheet) away from the surgical field with no distortion of facial anatomy. These requirements could have been met with submental intubation as in panfacial trauma,[2-4] but not considered as our patients were undergoing cosmetic procedures. Though tying ETT with silk to incisors is totally atraumatic, dental wires may cause minimal gum injury. As tips of incisors are always broader than root, the chance of suture slipping out intraoperatively is rare, if the knot is tied firmly close to the root of incisors. ETT should not be tied to loose or partly br","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207765","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}
Abstract Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction ( P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.
背景与目的:褪黑激素的镇静作用可能对全身麻醉(GA)有附加作用。我们比较了口服褪黑激素和安慰剂治疗前插管后的血流动力学反应。并比较了异丙酚、异氟醚和芬太尼的诱导剂量。材料和方法:本前瞻性双盲研究将50例患者随机分为两组。M组术前2小时口服褪黑素6毫克，P组术前2小时口服安慰剂。所有患者均静脉注射异丙酚1.5 ~ 2.5mg/kg诱导至对口头命令失去反应，维库溴铵给药3分钟后行喉镜检查并插管。分别记录用药前、诱导前、诱导后及插管后1、3、5、10分钟的心率(HR)和平均动脉压(MAP)。结果:在整个研究期间，两组的平均HR具有可比性。M组诱导前和诱导后即刻MAP显著降低(P <0.05)。在所有其他时间点，两组的MAP保持可比性。与P组相比，M组的平均异氟醚消耗量显著降低(14.8±4.2 mL vs 19.7±3.2 mL)。诱导丙泊酚需用量M组显著低于对照组(102.4±19.6 mg vs 122.4±26.3mg)。术中芬太尼用量具有可比性。结论:术前2小时口服褪黑素6mg可显著降低GA诱导前后的MAP，异丙酚需用量显著降低。滴定异丙酚诱导剂量，直到对口头命令失去反应，并不能有效地减弱口服褪黑素预用药后对喉镜检查和插管的反应。
{"title":"Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial","authors":"Sunil Rajan, Reema Abubaker, Revathy Ajayachandran Kala, Niranjan Kumar Sasikumar, Mani Vignesh Kannan, Lakshmi Kumar","doi":"10.4103/joacp.joacp_159_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_159_22","url":null,"abstract":"Abstract Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction ( P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"225 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207768","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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