Pub Date : 2024-07-19DOI: 10.4103/joacp.joacp_226_23
M. R. Elghamry, W. E. Messbah, M. A. Abduallah, S. Elrahwan
Pilonidal sinus surgery (PSS) can be done with local anaesthetic infiltration, spinal anaesthesia, or general anaesthesia (GA). Erector spinae plane block (ESPB) is used for peri-operative analgesia. Erector spinae muscles extend to the sacral region, so it can provide post-operative analgesia in PSS. We evaluate the post-operative analgesic efficacy of ultrasound-guided sacral ESPB, a novel technique, in patients undergoing PSS under GA. Seventy patients aged 20–60 years, ASA class I and II, and scheduled for PSS under GA were included. Patients were randomly assigned to group I (control group), who received GA only, and in group II (SESPB group), sacral ESPB was performed after induction of GA. The primary outcome was post-operative pain evaluated by visual analogue score (VAS) at arrival to the post-anaesthesia care unit (PACU), 1, 2, 4, 8, 12, and 24 hours post-operative. The secondary outcomes were time to first analgesic request post-operative, intra-operative fentanyl consumption, and complications. There were significantly higher VAS scores in group I compared to group II at arrival to PACU, 1, 2, 8, and 24 hours post-operative (P = 0.017, <0.001, <0.001, <0.001, and 0.031, respectively), and no considerable changes between groups at 4 and 12 hours (P = 0.664 and 0.923, respectively). A significant decrease in intra-operative fentanyl consumption with prolonged duration to time of first analgesic request post-operative in group II compared to group I was observed (P < 0.001). No reported complications were observed. Sacral ESPB could provide an effective post-operative analgesia for PSS with no reported complications.
蝶窦手术（PSS）可采用局部麻醉浸润、脊髓麻醉或全身麻醉（GA）。脊柱后凸肌平面阻滞（ESPB）用于围手术期镇痛。脊骨后伸肌延伸至骶骨区域，因此可为 PSS 患者提供术后镇痛。我们评估了超声引导下骶骨ESPB（一种新技术）对在GA下进行PSS手术的患者的术后镇痛效果。 我们纳入了 70 名年龄在 20-60 岁之间、ASA I 级和 II 级、计划在 GA 下进行 PSS 手术的患者。患者被随机分配到只接受 GA 的 I 组（对照组）和在诱导 GA 后进行骶骨 ESPB 的 II 组（SESPB 组）。主要结果是在到达麻醉后护理病房（PACU）时、术后1、2、4、8、12和24小时用视觉模拟评分（VAS）评估术后疼痛。次要结果是术后首次申请镇痛药的时间、术中芬太尼用量和并发症。 与第二组相比，第一组在到达 PACU、术后 1、2、8 和 24 小时时的 VAS 评分明显更高（P = 0.017、<0.001、<0.001、<0.001 和 0.031，分别为 0.017、<0.001、<0.001 和 0.031），而在 4 和 12 小时时，组间无明显变化（P = 0.664 和 0.923，分别为 0.664 和 0.923）。与第一组相比，随着术后首次申请镇痛药时间的延长，第二组的术中芬太尼用量明显减少（P < 0.001）。未观察到并发症。 骶管ESPB可为PSS提供有效的术后镇痛，且无并发症报道。
{"title":"Role of ultrasound-guided sacral erector spinae plane block for post-operative analgesia in pilonidal sinus surgery: A randomised trial","authors":"M. R. Elghamry, W. E. Messbah, M. A. Abduallah, S. Elrahwan","doi":"10.4103/joacp.joacp_226_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_226_23","url":null,"abstract":"\u0000 \u0000 \u0000 Pilonidal sinus surgery (PSS) can be done with local anaesthetic infiltration, spinal anaesthesia, or general anaesthesia (GA). Erector spinae plane block (ESPB) is used for peri-operative analgesia. Erector spinae muscles extend to the sacral region, so it can provide post-operative analgesia in PSS. We evaluate the post-operative analgesic efficacy of ultrasound-guided sacral ESPB, a novel technique, in patients undergoing PSS under GA.\u0000 \u0000 \u0000 \u0000 Seventy patients aged 20–60 years, ASA class I and II, and scheduled for PSS under GA were included. Patients were randomly assigned to group I (control group), who received GA only, and in group II (SESPB group), sacral ESPB was performed after induction of GA. The primary outcome was post-operative pain evaluated by visual analogue score (VAS) at arrival to the post-anaesthesia care unit (PACU), 1, 2, 4, 8, 12, and 24 hours post-operative. The secondary outcomes were time to first analgesic request post-operative, intra-operative fentanyl consumption, and complications.\u0000 \u0000 \u0000 \u0000 There were significantly higher VAS scores in group I compared to group II at arrival to PACU, 1, 2, 8, and 24 hours post-operative (P = 0.017, <0.001, <0.001, <0.001, and 0.031, respectively), and no considerable changes between groups at 4 and 12 hours (P = 0.664 and 0.923, respectively). A significant decrease in intra-operative fentanyl consumption with prolonged duration to time of first analgesic request post-operative in group II compared to group I was observed (P < 0.001). No reported complications were observed.\u0000 \u0000 \u0000 \u0000 Sacral ESPB could provide an effective post-operative analgesia for PSS with no reported complications.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"112 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822425","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}
Pub Date : 2024-07-19DOI: 10.4103/joacp.joacp_198_22
Sumitra G Bakshi, K. Arya, Badal Dhurwe
For the aggressive treatment of postoperative pain, nonpharmacological methods (NPMs) are gaining importance complementary to routine multimodal pain management. The primary aim of the study was to assess the incidence of use of NPMs in our hospital. Secondary objectives were to correlate the pain scores, patient satisfaction, and percentage of time the patient was in severe pain within 72 h postsurgery with the use of NPMs when in pain/not in pain. The effect of NPMs on the physical and emotional outcome of patients as per the American Pain Society Patient Outcome Questionnaire (APS-POQ) was also assessed. After obtaining approval from the institutional ethics committee (IEC), the trial was registered with the Clinical Trials Registry of India (CTRI). Informed consent was obtained from adult patients on the third postoperative day of elective surgeries. Their responses to the APS-POQ and to a few additional questions about their beliefs on the use of NPM were recorded. Only one-fourth of the total study population were using NPMs for pain management in the hospital. After propensity matching for surgery and postoperative analgesia, two groups were made: one using NPM for pain relief (n = 49) and the other not using NPM (n = 98). There was no significant difference among the satisfaction score (P = 0.31), least pain score (P = 0.68), and worst pain score (P = 0.43) within 72 h postoperatively in either of the groups. Emotional and physical outcomes as per the APS-POQ were similar in both the groups. NPMs are rarely practiced and used during postoperative pain in our hospital. No difference in pain scores, patient satisfaction, and emotional and physical outcomes of the APS-POQ was seen in the group that indulged in NPMs.
{"title":"Prevalence of use of nonpharmacological methods of pain relief among patients following onco surgeries – A prospective, observational cohort study from a single center","authors":"Sumitra G Bakshi, K. Arya, Badal Dhurwe","doi":"10.4103/joacp.joacp_198_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_198_22","url":null,"abstract":"\u0000 \u0000 \u0000 For the aggressive treatment of postoperative pain, nonpharmacological methods (NPMs) are gaining importance complementary to routine multimodal pain management. The primary aim of the study was to assess the incidence of use of NPMs in our hospital. Secondary objectives were to correlate the pain scores, patient satisfaction, and percentage of time the patient was in severe pain within 72 h postsurgery with the use of NPMs when in pain/not in pain. The effect of NPMs on the physical and emotional outcome of patients as per the American Pain Society Patient Outcome Questionnaire (APS-POQ) was also assessed.\u0000 \u0000 \u0000 \u0000 After obtaining approval from the institutional ethics committee (IEC), the trial was registered with the Clinical Trials Registry of India (CTRI). Informed consent was obtained from adult patients on the third postoperative day of elective surgeries. Their responses to the APS-POQ and to a few additional questions about their beliefs on the use of NPM were recorded.\u0000 \u0000 \u0000 \u0000 Only one-fourth of the total study population were using NPMs for pain management in the hospital. After propensity matching for surgery and postoperative analgesia, two groups were made: one using NPM for pain relief (n = 49) and the other not using NPM (n = 98). There was no significant difference among the satisfaction score (P = 0.31), least pain score (P = 0.68), and worst pain score (P = 0.43) within 72 h postoperatively in either of the groups. Emotional and physical outcomes as per the APS-POQ were similar in both the groups.\u0000 \u0000 \u0000 \u0000 NPMs are rarely practiced and used during postoperative pain in our hospital. No difference in pain scores, patient satisfaction, and emotional and physical outcomes of the APS-POQ was seen in the group that indulged in NPMs.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822503","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}
Pub Date : 2024-07-19DOI: 10.4103/joacp.joacp_245_23
Abhijit Nair, Ujjwalraj I Dudhedia, Prasad Vilas Bodas, Manmohan Rangaiah, Nitinkumar Borkar
Sublingual (SL) buprenorphine has been used as a modality of managing acute postoperative pain in many studies. This systematic review aimed to investigate the safety and efficacy of SL buprenorphine as an analgesic for various surgeries. After registering the protocol with PROSPERO, we searched PubMed, Cochrane Library, and Ovid databases with relevant keywords. The primary outcomes were 24-hour pain scores, and the secondary outcomes were postoperative nausea and vomiting, sedation scores, pruritus, rescue analgesia, and urinary retention. The risk of bias scale was used to identify the quality of evidence. From the 103 articles identified, four randomized-controlled trials fulfilled the inclusion criteria for qualitative analysis. The overall risk of bias was low. Most of the studies showed that the use of SL buprenorphine led to either better or comparable pain scores when compared to a control group with lesser or tolerable adverse events. There was a lot of heterogeneity across the studies in this systematic review in terms of the type of surgery performed, the comparison groups, doses of buprenorphine, and the outcomes that were assessed. Therefore, a quantitative meta-analysis was not performed. The results of this systematic review should be interpreted with caution due to heterogeneity in the methodology. Adequately powered studies with robust methodology should investigate the safety and efficacy of SL buprenorphine when used for postoperative analgesia.
{"title":"Efficacy and safety of sublingual buprenorphine in managing acute postoperative pain – A systematic review","authors":"Abhijit Nair, Ujjwalraj I Dudhedia, Prasad Vilas Bodas, Manmohan Rangaiah, Nitinkumar Borkar","doi":"10.4103/joacp.joacp_245_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_245_23","url":null,"abstract":"\u0000 Sublingual (SL) buprenorphine has been used as a modality of managing acute postoperative pain in many studies. This systematic review aimed to investigate the safety and efficacy of SL buprenorphine as an analgesic for various surgeries. After registering the protocol with PROSPERO, we searched PubMed, Cochrane Library, and Ovid databases with relevant keywords. The primary outcomes were 24-hour pain scores, and the secondary outcomes were postoperative nausea and vomiting, sedation scores, pruritus, rescue analgesia, and urinary retention. The risk of bias scale was used to identify the quality of evidence. From the 103 articles identified, four randomized-controlled trials fulfilled the inclusion criteria for qualitative analysis. The overall risk of bias was low. Most of the studies showed that the use of SL buprenorphine led to either better or comparable pain scores when compared to a control group with lesser or tolerable adverse events. There was a lot of heterogeneity across the studies in this systematic review in terms of the type of surgery performed, the comparison groups, doses of buprenorphine, and the outcomes that were assessed. Therefore, a quantitative meta-analysis was not performed. The results of this systematic review should be interpreted with caution due to heterogeneity in the methodology. Adequately powered studies with robust methodology should investigate the safety and efficacy of SL buprenorphine when used for postoperative analgesia.","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 1094","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141823336","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}
Pub Date : 2024-07-19DOI: 10.4103/joacp.joacp_22_24
Neeraj Kumar, R. Shreehari, C. Jha
{"title":"Anesthetic challenges in using posterior retroperitoneoscopic approach for phaeochromocytoma in pregnancy","authors":"Neeraj Kumar, R. Shreehari, C. Jha","doi":"10.4103/joacp.joacp_22_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_22_24","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"102 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141820850","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}
Enhanced recovery after surgery (ERAS) has been applied in various laparoscopic procedures. Intravenous lidocaine (IVL) infusion is used for laparoscopic procedures as a part of ERAS protocols. The study aimed to evaluate the role of IVL infusion in enhanced bowel recovery after laparoscopic renal surgeries. A randomized, double-blind, placebo-control trial was conducted on 80 patients (with American Society of Anesthesiologists physical status I–II) who presented for laparoscopic renal surgeries under general anesthesia. The study period was from Oct 2018 to Sept 2019. By computer-generated codes, patients were randomly divided into two groups: L (lidocaine) and C (control). Group L received an intravenous (IV) bolus (1.5 mg/kg) of 2% lidocaine over 2 min, followed by an IV lidocaine infusion at the rate of 1.5 mg/kg/h until skin closure. Group C received the same volume of bolus followed by normal saline infusion. Patients were monitored for bowel functions, total hospital stay, and total analgesic consumption. Student’s t-test and Chi-square test were used for quantitative data and occurrence of events, respectively. P <0.05 was considered to be statistically significant. First bowel sound, flatus, and defecation occurred in 16.4 ± 2.50, 26.7 ± 9.02, and 39.1 ± 6.31 h, respectively, in group L and 18.2 ± 2.90, 32.3 ± 3.11, and 43.3 ± 4.22 h, respectively, in group C (P = 0.006, 0.001, and 0.01, respectively). Total hospital stay was 4.0 ± 0.74 and 5.3±0.0.91 days in groups L and C, respectively (P < 0.001). The present study concluded that IVL could enhance the bowel recovery and reduce total hospital stay after laparoscopic renal surgeries.
{"title":"The role of intravenous lidocaine infusion in enhanced recovery after laparoscopic renal surgeries: A randomized control trial","authors":"Dinesh J. Prajapati, Manoj Patel, Pankaj Patel, Arvind Ganpule, Deepak Mistry","doi":"10.4103/joacp.joacp_98_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_98_23","url":null,"abstract":"\u0000 \u0000 \u0000 Enhanced recovery after surgery (ERAS) has been applied in various laparoscopic procedures. Intravenous lidocaine (IVL) infusion is used for laparoscopic procedures as a part of ERAS protocols. The study aimed to evaluate the role of IVL infusion in enhanced bowel recovery after laparoscopic renal surgeries.\u0000 \u0000 \u0000 \u0000 A randomized, double-blind, placebo-control trial was conducted on 80 patients (with American Society of Anesthesiologists physical status I–II) who presented for laparoscopic renal surgeries under general anesthesia. The study period was from Oct 2018 to Sept 2019. By computer-generated codes, patients were randomly divided into two groups: L (lidocaine) and C (control). Group L received an intravenous (IV) bolus (1.5 mg/kg) of 2% lidocaine over 2 min, followed by an IV lidocaine infusion at the rate of 1.5 mg/kg/h until skin closure. Group C received the same volume of bolus followed by normal saline infusion. Patients were monitored for bowel functions, total hospital stay, and total analgesic consumption. Student’s t-test and Chi-square test were used for quantitative data and occurrence of events, respectively. P <0.05 was considered to be statistically significant.\u0000 \u0000 \u0000 \u0000 First bowel sound, flatus, and defecation occurred in 16.4 ± 2.50, 26.7 ± 9.02, and 39.1 ± 6.31 h, respectively, in group L and 18.2 ± 2.90, 32.3 ± 3.11, and 43.3 ± 4.22 h, respectively, in group C (P = 0.006, 0.001, and 0.01, respectively). Total hospital stay was 4.0 ± 0.74 and 5.3±0.0.91 days in groups L and C, respectively (P < 0.001).\u0000 \u0000 \u0000 \u0000 The present study concluded that IVL could enhance the bowel recovery and reduce total hospital stay after laparoscopic renal surgeries.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"111 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822658","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}
Pub Date : 2024-07-19DOI: 10.4103/joacp.joacp_227_23
G. Sindwani
{"title":"From heel protection to heel burns: Thermal injuries caused by heated silicone gel pads in surgery","authors":"G. Sindwani","doi":"10.4103/joacp.joacp_227_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_227_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" March","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141824059","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}
Pub Date : 2024-05-23DOI: 10.4103/joacp.joacp_153_23
Nishant Kumar, Gunjan Bansal, Aruna Jain
Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC. This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded. BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent >5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor. Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.
双谱指数（BIS）和最小肺泡浓度（MAC）通常用于监测麻醉深度。目的是研究麻醉维持阶段 BIS 与年龄调整后的最小肺泡浓度 (aaMAC) 之间的相关性。研究了影响 BIS 和或 aaMAC 的变量的影响，以确定 BIS 和 aaMAC 之间的等式。 这项前瞻性观察研究是在机构伦理批准后进行的，研究对象为全身麻醉下接受择期手术的 18-60 岁成年患者，性别不限，ASA I 级和 II 级。在麻醉维持阶段，气道管理后 5 分钟记录 BIS 值和 aaMAC 当量。在麻醉剂浓度在前 5 分钟内保持不变直至麻醉剂关闭期间，每分钟记录 aaMAC 和相应的 BIS 值。此外，还记录了年龄、性别、ASA 状态、氧化亚氮使用情况、吸入剂、咪达唑仑剂量和阿片类药物使用情况。 BIS/aaMAC 呈反相关。年龄增加、ASA II 状态、吗啡当量大于 5 以及使用一氧化二氮、七氟烷或异氟醚与同等 aaMAC 时 BIS 值升高有关。利用可交换相关结构，得出了一个广义估计方程作为最佳预测因子。 影响 aaMAC 和 BIS 的因素会影响二者之间的关系，虽然二者之间的差异很大，但 BIS 和 aaMAC 可以等同，如果知道其中一个因素，就可以使用广义估计方程计算出二者的值。
{"title":"A study of the relationship between Bispectral index and age-adjusted minimum alveolar concentration during the maintenance phase of general anesthesia in elective surgery","authors":"Nishant Kumar, Gunjan Bansal, Aruna Jain","doi":"10.4103/joacp.joacp_153_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_153_23","url":null,"abstract":"\u0000 \u0000 \u0000 Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC.\u0000 \u0000 \u0000 \u0000 This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded.\u0000 \u0000 \u0000 \u0000 BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent >5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor.\u0000 \u0000 \u0000 \u0000 Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"23 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141107226","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}
Pub Date : 2024-05-23DOI: 10.4103/joacp.joacp_338_23
MV Eeshwar, Alankrita Chari, Yogesh K. Gaude, Abhishek Rao Kordcal
Post-spinal anaesthesia hypotension (PSAH) can occur in 25–75% of patients. The preload or volume status of a patient is an important contributor to PSAH, and coloading with fluids is advocated to prevent PSAH. Instead of blind volume loading, prediction of volume status using inferior vena cava (IVC) collapsibility index (IVCCI) and caval aorta index (IVC:Ao index) may be used to guide fluid administration. In our study, we used ultrasound in the immediate pre-operative period to calculate IVCCI and IVC:Ao index in patients scheduled for elective surgery in the supine position, under spinal anaesthesia. Spinal anaesthesia was given in the lateral position with 0.5% hyperbaric bupivacaine. Patients were placed supine thereafter, sensory blockade level was ascertained, and blood pressure (BP) was measured every 2 min for 30 min. Episodes of hypotension were treated with fluids or vasopressors as per the discretion of the treating anaesthesiologist. In the study, 73 patients were screened, out of which 69 were included. Totally, 23 participants out of 69 developed PSAH. The receiver operating characteristic (ROC) curve was made and the area under the curve analysis was done on our collected data. We found that IVC:Ao index has better sensitivity (0.696 for IVC:Ao index ≤0.810) and specificity (0.717 for IVC:Ao index ≤0.810) than IVCCI (sensitivity 0.522 and specificity 0.630 for IVCCI ≥33.32%) to predict PSAH. IVC:Ao index is a better predictor of PSAH than IVCCI. Thus, it may be used to predict volume status and guide in coloading with fluids during spinal anaesthesia.
{"title":"Estimating the usefulness of inferior vena cava collapsibility index and caval aorta index to predict hypotension after spinal anaesthesia in adult patients undergoing elective surgery in a tertiary care hospital","authors":"MV Eeshwar, Alankrita Chari, Yogesh K. Gaude, Abhishek Rao Kordcal","doi":"10.4103/joacp.joacp_338_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_338_23","url":null,"abstract":"\u0000 \u0000 \u0000 Post-spinal anaesthesia hypotension (PSAH) can occur in 25–75% of patients. The preload or volume status of a patient is an important contributor to PSAH, and coloading with fluids is advocated to prevent PSAH. Instead of blind volume loading, prediction of volume status using inferior vena cava (IVC) collapsibility index (IVCCI) and caval aorta index (IVC:Ao index) may be used to guide fluid administration.\u0000 \u0000 \u0000 \u0000 In our study, we used ultrasound in the immediate pre-operative period to calculate IVCCI and IVC:Ao index in patients scheduled for elective surgery in the supine position, under spinal anaesthesia. Spinal anaesthesia was given in the lateral position with 0.5% hyperbaric bupivacaine. Patients were placed supine thereafter, sensory blockade level was ascertained, and blood pressure (BP) was measured every 2 min for 30 min. Episodes of hypotension were treated with fluids or vasopressors as per the discretion of the treating anaesthesiologist. In the study, 73 patients were screened, out of which 69 were included.\u0000 \u0000 \u0000 \u0000 Totally, 23 participants out of 69 developed PSAH. The receiver operating characteristic (ROC) curve was made and the area under the curve analysis was done on our collected data. We found that IVC:Ao index has better sensitivity (0.696 for IVC:Ao index ≤0.810) and specificity (0.717 for IVC:Ao index ≤0.810) than IVCCI (sensitivity 0.522 and specificity 0.630 for IVCCI ≥33.32%) to predict PSAH.\u0000 \u0000 \u0000 \u0000 IVC:Ao index is a better predictor of PSAH than IVCCI. Thus, it may be used to predict volume status and guide in coloading with fluids during spinal anaesthesia.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"41 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141103446","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}
Pub Date : 2024-05-23DOI: 10.4103/joacp.joacp_5_24
Abiya Pradhan, A. Sarkar, Srimanta Haldar, Arunangshu Chakraborty, A. Pal
Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort study on Enhanced Recovery After Surgery (ERAS) in liver resection aimed at correlating compliance with ERAS elements to length of stay (LOS) and the incidence of complications in a tertiary-level cancer hospital in Eastern India. In total, 44 hepatectomy patients were assessed retrospectively from June 2022 to May 2023. Data were collected from electronic medical records and patient charts. The overall compliance was 77.7%. Individual component compliance varied. Lower compliance rates were seen with some aspects such as fasting and carbohydrate loading, minimally invasive surgical techniques used, and avoidance or early removal of the drain. The cohort was divided into two groups. Group 1 had compliance to ≥75% of 21 elements of ERAS, and group 2 had compliance to <75%. Statistical analysis showed higher ERAS compliance and reduced complications, although LOS differences were not statistically significant (group 1 and group 2 with an LOS difference of 1 day). Severe complications such as re-exploration and death were noted in the group of patients with compliance to less than 75% of the components. With increased ERAS compliance, the patients benefited clinically and financially.
{"title":"Compliance to enhanced recovery program in liver resection surgery: A retrospective cohort study","authors":"Abiya Pradhan, A. Sarkar, Srimanta Haldar, Arunangshu Chakraborty, A. Pal","doi":"10.4103/joacp.joacp_5_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_5_24","url":null,"abstract":"\u0000 \u0000 \u0000 Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort study on Enhanced Recovery After Surgery (ERAS) in liver resection aimed at correlating compliance with ERAS elements to length of stay (LOS) and the incidence of complications in a tertiary-level cancer hospital in Eastern India.\u0000 \u0000 \u0000 \u0000 In total, 44 hepatectomy patients were assessed retrospectively from June 2022 to May 2023. Data were collected from electronic medical records and patient charts.\u0000 \u0000 \u0000 \u0000 The overall compliance was 77.7%. Individual component compliance varied. Lower compliance rates were seen with some aspects such as fasting and carbohydrate loading, minimally invasive surgical techniques used, and avoidance or early removal of the drain. The cohort was divided into two groups. Group 1 had compliance to ≥75% of 21 elements of ERAS, and group 2 had compliance to <75%. Statistical analysis showed higher ERAS compliance and reduced complications, although LOS differences were not statistically significant (group 1 and group 2 with an LOS difference of 1 day). Severe complications such as re-exploration and death were noted in the group of patients with compliance to less than 75% of the components.\u0000 \u0000 \u0000 \u0000 With increased ERAS compliance, the patients benefited clinically and financially.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"29 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104807","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}
Intravenous (IV) lignocaine is often used to prevent the airway response to extubation, especially in children to prevent respiratory adverse events. It is known to prolong the duration of action of neuromuscular blocking drugs, but data in children are limited. The primary objective of this study was to compare neuromuscular recovery time with IV lignocaine versus fentanyl, in pediatric patients undergoing elective surgery under general anesthesia (GA). Secondary objectives included the comparison of clinical parameters and respiratory complications. A randomized double-blind pilot study was conducted in 42 children aged 2–8 years undergoing GA with neuromuscular blockade, who received either 1.5 mg/kg of lignocaine or 0.5 mcg/kg of fentanyl IV, just prior to giving reversal at a train of four (TOF) count of 2–3. Time to achieve a TOF ratio of 0.9 and extubation and hemodynamic and respiratory parameters were noted. Incidences of coughing, bucking, laryngospasm, etc., were also noted. P value < 0.05 was considered significant. Demographic and operative data were similar. Time from reversal to TOF ratio of 0.9 was similar with both lignocaine (6.79 ± 3.03 mins) and fentanyl (6.79 ± 3.31 mins), P = 0.99. Time to extubation was also similar in both groups (8.14 ± 3.31 vs 9.19 ± 2.89 min), P = 0.28. Bucking incidence was higher with fentanyl (23.8%) vs lignocaine (9.5%), P = 0.41. Single-dose IV lignocaine administered before reversal did not prolong neuromuscular recovery time compared to fentanyl, with a similar (low) incidence of respiratory events in pediatric patients.
{"title":"Effect of single-dose intravenous lignocaine versus fentanyl on neuromuscular recovery time after general anesthesia in elective pediatric surgery: A randomized controlled pilot study","authors":"Mridul Dhar, Ruhi Sharma, Yashwant S. Payal, Vaishali Gupta, Jyoti Rawat, Sachin Sogal","doi":"10.4103/joacp.joacp_460_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_460_23","url":null,"abstract":"\u0000 \u0000 \u0000 Intravenous (IV) lignocaine is often used to prevent the airway response to extubation, especially in children to prevent respiratory adverse events. It is known to prolong the duration of action of neuromuscular blocking drugs, but data in children are limited. The primary objective of this study was to compare neuromuscular recovery time with IV lignocaine versus fentanyl, in pediatric patients undergoing elective surgery under general anesthesia (GA). Secondary objectives included the comparison of clinical parameters and respiratory complications.\u0000 \u0000 \u0000 \u0000 A randomized double-blind pilot study was conducted in 42 children aged 2–8 years undergoing GA with neuromuscular blockade, who received either 1.5 mg/kg of lignocaine or 0.5 mcg/kg of fentanyl IV, just prior to giving reversal at a train of four (TOF) count of 2–3. Time to achieve a TOF ratio of 0.9 and extubation and hemodynamic and respiratory parameters were noted. Incidences of coughing, bucking, laryngospasm, etc., were also noted. P value < 0.05 was considered significant.\u0000 \u0000 \u0000 \u0000 Demographic and operative data were similar. Time from reversal to TOF ratio of 0.9 was similar with both lignocaine (6.79 ± 3.03 mins) and fentanyl (6.79 ± 3.31 mins), P = 0.99. Time to extubation was also similar in both groups (8.14 ± 3.31 vs 9.19 ± 2.89 min), P = 0.28. Bucking incidence was higher with fentanyl (23.8%) vs lignocaine (9.5%), P = 0.41.\u0000 \u0000 \u0000 \u0000 Single-dose IV lignocaine administered before reversal did not prolong neuromuscular recovery time compared to fentanyl, with a similar (low) incidence of respiratory events in pediatric patients.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"15 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141106728","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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