Pub Date : 2024-05-08DOI: 10.4103/joacp.joacp_493_23
Shalendra Singh, Roj T. Ninan, G. Ambooken, Mayank Dhiman
The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like health-care access disparities, stigma, and discrimination. As they undergo routine surgeries or specific gender-affirming surgeries, anesthesia providers must be cognizant of anatomical, physiological, and psychosocial considerations that may impact the perioperative experience. Anesthesia for transgender individuals requires gender identity assessment, understanding of surgical needs, hormone therapy impact, preoperative assessments evaluating comorbidities, medication history, and psychosocial factors. Anesthesiologists should modify airway care and pain management techniques to accommodate patients’ preferences and gender-affirming surgical goals. They should also take into account any potential differences in the airways of transgender patients and optimize postoperative pain management in accordance with each patient’s particular surgical recovery. This article aims to focus on the perioperative care of transgender individuals, highlighting the distinct challenges encountered and potential solutions to address these unique issues.
{"title":"Challenges in provision of anesthesia to transgender patients in India: A scoping review","authors":"Shalendra Singh, Roj T. Ninan, G. Ambooken, Mayank Dhiman","doi":"10.4103/joacp.joacp_493_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_493_23","url":null,"abstract":"\u0000 The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like health-care access disparities, stigma, and discrimination. As they undergo routine surgeries or specific gender-affirming surgeries, anesthesia providers must be cognizant of anatomical, physiological, and psychosocial considerations that may impact the perioperative experience. Anesthesia for transgender individuals requires gender identity assessment, understanding of surgical needs, hormone therapy impact, preoperative assessments evaluating comorbidities, medication history, and psychosocial factors. Anesthesiologists should modify airway care and pain management techniques to accommodate patients’ preferences and gender-affirming surgical goals. They should also take into account any potential differences in the airways of transgender patients and optimize postoperative pain management in accordance with each patient’s particular surgical recovery. This article aims to focus on the perioperative care of transgender individuals, highlighting the distinct challenges encountered and potential solutions to address these unique issues.","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000062","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 : 2024-05-08DOI: 10.4103/joacp.joacp_417_23
S. S. Deshpande, Madhuri S. Kurdi, Amrita Baiju, A. S. Athira, Athira G. Sarasamma, Arunima K. Gangadharan
Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality. Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation. Hence, alternative premedicants such as L-theanine and GABA will have a widespread appeal and are safer. The primary objective was to study and compare the effects of L-theanine and GABA on preoperative anxiety, sedation, and cognition in patients posted for major elective surgeries. The secondary objective was to study adverse reactions. A total of 168 patients aged between 18 and 55 years, belonging to the American Society of Anesthesiologists physical status class I and II, and satisfying all inclusion criteria were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs. Alprazolam produced more sedation than GABA and L-theanine (P = 0.0001). Psychomotor and cognitive functions improved with L-theanine and GABA (P = 0.0001) and decreased with alprazolam (P = 0.0001). GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.
{"title":"Comparison of the effects of two amino acids, Gamma-aminobutyric acid (GABA) and L-theanine, on sedation, anxiety, and cognition in preoperative surgical patients – A randomized controlled study","authors":"S. S. Deshpande, Madhuri S. Kurdi, Amrita Baiju, A. S. Athira, Athira G. Sarasamma, Arunima K. Gangadharan","doi":"10.4103/joacp.joacp_417_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_417_23","url":null,"abstract":"\u0000 \u0000 \u0000 Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality. Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation. Hence, alternative premedicants such as L-theanine and GABA will have a widespread appeal and are safer. The primary objective was to study and compare the effects of L-theanine and GABA on preoperative anxiety, sedation, and cognition in patients posted for major elective surgeries. The secondary objective was to study adverse reactions.\u0000 \u0000 \u0000 \u0000 A total of 168 patients aged between 18 and 55 years, belonging to the American Society of Anesthesiologists physical status class I and II, and satisfying all inclusion criteria were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs.\u0000 \u0000 \u0000 \u0000 Alprazolam produced more sedation than GABA and L-theanine (P = 0.0001). Psychomotor and cognitive functions improved with L-theanine and GABA (P = 0.0001) and decreased with alprazolam (P = 0.0001).\u0000 \u0000 \u0000 \u0000 GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999219","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 : 2024-05-08DOI: 10.4103/joacp.joacp_322_23
Sabari K. Kumar, Satyajeet Misra, B. Behera, Neha Singh, D. Muduly, Anand Srinivasan
No studies have compared the effects of ketamine and dexmedetomidine on bowel recovery. We evaluated the effects of intraoperative low-dose ketamine or dexmedetomidine infusion on postoperative bowel recovery in patients undergoing gastrointestinal (GI) malignancy surgeries. This placebo-controlled, randomized study was carried out in 84 American Society of Anesthesiologists II patients, aged 18–70 years, of either gender, undergoing elective open GI malignancy surgeries. Patients received intraoperative infusion of ketamine @ 0.1 mg kg-1 h-1 (KET), dexmedetomidine @ 0.25 μg kg-1 h-1 (DEX), or normal saline (placebo). Primary outcome was the time to first flatus and/or stool. Secondary outcomes included time to extubation, total analgesic requirement, postoperative pain scores, time to feeds, duration of intensive care unit (ICU) and hospital stay, and the incidence of adverse events. Continuous data were analyzed by the one-way analysis of variance (ANOVA) or the Kruskal–Wallis test. Categorical data were analyzed by the Chi-square test or the Fisher’s exact test. Median time to passage of flatus and/or stool was 3 [interquartile range (IQR) 2–3] days in the KET group, 2 [IQR 2–3] days in the DEX group, and 2 [IQR 2–3] days in the placebo group (P = 0.53 for placebo vs. KET, 0.81 for placebo vs. DEX, and 0.99 for KET vs. DEX). Pain scores and analgesic consumption were significantly less in the intervention groups versus placebo (P < 0.001). No difference was seen in other secondary outcomes. Low-dose ketamine or dexmedetomidine did not result in early bowel recovery despite lower pain scores and opioid consumption in patients undergoing open GI malignancy surgeries. Key Message: What is known: Ketamine and dexmedetomidine may promote bowel recovery by improving analgesia and decreasing opioid usage.Main findings: This randomized controlled trial found no evidence of earlier bowel recovery with ketamine or dexmedetomidine versus placebo despite lower pain scores and analgesic consumption in the ketamine and dexmedetomidine groups.
目前还没有研究比较氯胺酮和右美托咪定对肠道恢复的影响。我们评估了术中输注低剂量氯胺酮或右美托咪定对胃肠道恶性肿瘤手术患者术后肠道恢复的影响。 这项安慰剂对照随机研究在 84 名美国麻醉医师协会 II 级患者中进行，患者年龄在 18-70 岁之间，性别不限，均接受择期开放式消化道恶性肿瘤手术。患者术中输注氯胺酮（0.1 毫克/公斤-1 小时-1）、右美托咪定（0.25 微克/公斤-1 小时-1）或生理盐水（安慰剂）。主要结果是首次胀气和/或排便的时间。次要结果包括拔管时间、总镇痛剂需求量、术后疼痛评分、进食时间、重症监护室（ICU）和住院时间以及不良事件发生率。连续数据采用单因素方差分析（ANOVA）或Kruskal-Wallis检验进行分析。分类数据采用卡方检验（Chi-square test）或费雪精确检验（Fisher's exact test）进行分析。 KET 组排出胀气和/或粪便的中位时间为 3 [四分位距 (IQR) 2-3] 天，DEX 组为 2 [IQR 2-3] 天，安慰剂组为 2 [IQR 2-3] 天（安慰剂 vs. KET 的 P = 0.53，安慰剂 vs. DEX 的 P = 0.81，KET vs. DEX 的 P = 0.99）。与安慰剂组相比，干预组的疼痛评分和镇痛剂用量明显减少（P < 0.001）。其他次要结果无差异。 尽管开放性消化道恶性肿瘤手术患者的疼痛评分和阿片类药物用量较低，但低剂量氯胺酮或右美托咪定并不能使患者尽早恢复肠道功能。 关键信息： 已知信息：氯胺酮和右美托咪定可通过改善镇痛和减少阿片类药物用量促进肠道恢复：这项随机对照试验发现，尽管氯胺酮组和右美托咪定组的疼痛评分和镇痛剂用量较低，但没有证据表明氯胺酮或右美托咪定与安慰剂相比能加快肠道恢复。
{"title":"The effect of intraoperative low-dose ketamine versus dexmedetomidine infusion on postoperative bowel recovery in patients undergoing gastrointestinal malignancy surgeries: Placebo-controlled, randomized trial","authors":"Sabari K. Kumar, Satyajeet Misra, B. Behera, Neha Singh, D. Muduly, Anand Srinivasan","doi":"10.4103/joacp.joacp_322_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_322_23","url":null,"abstract":"\u0000 \u0000 \u0000 No studies have compared the effects of ketamine and dexmedetomidine on bowel recovery. We evaluated the effects of intraoperative low-dose ketamine or dexmedetomidine infusion on postoperative bowel recovery in patients undergoing gastrointestinal (GI) malignancy surgeries.\u0000 \u0000 \u0000 \u0000 This placebo-controlled, randomized study was carried out in 84 American Society of Anesthesiologists II patients, aged 18–70 years, of either gender, undergoing elective open GI malignancy surgeries. Patients received intraoperative infusion of ketamine @ 0.1 mg kg-1 h-1 (KET), dexmedetomidine @ 0.25 μg kg-1 h-1 (DEX), or normal saline (placebo). Primary outcome was the time to first flatus and/or stool. Secondary outcomes included time to extubation, total analgesic requirement, postoperative pain scores, time to feeds, duration of intensive care unit (ICU) and hospital stay, and the incidence of adverse events. Continuous data were analyzed by the one-way analysis of variance (ANOVA) or the Kruskal–Wallis test. Categorical data were analyzed by the Chi-square test or the Fisher’s exact test.\u0000 \u0000 \u0000 \u0000 Median time to passage of flatus and/or stool was 3 [interquartile range (IQR) 2–3] days in the KET group, 2 [IQR 2–3] days in the DEX group, and 2 [IQR 2–3] days in the placebo group (P = 0.53 for placebo vs. KET, 0.81 for placebo vs. DEX, and 0.99 for KET vs. DEX). Pain scores and analgesic consumption were significantly less in the intervention groups versus placebo (P < 0.001). No difference was seen in other secondary outcomes.\u0000 \u0000 \u0000 \u0000 Low-dose ketamine or dexmedetomidine did not result in early bowel recovery despite lower pain scores and opioid consumption in patients undergoing open GI malignancy surgeries.\u0000 \u0000 Key Message:\u0000 \u0000 What is known: Ketamine and dexmedetomidine may promote bowel recovery by improving analgesia and decreasing opioid usage.Main findings: This randomized controlled trial found no evidence of earlier bowel recovery with ketamine or dexmedetomidine versus placebo despite lower pain scores and analgesic consumption in the ketamine and dexmedetomidine groups.\u0000 \u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140998331","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 : 2024-05-08DOI: 10.4103/joacp.joacp_339_23
M. Lestari, Djayanti Sari, Susilo Chandra, Purwoko Purwoko, I. Isngadi, Tungki Pratama Umar
Enhanced recovery after cesarean (ERAC) is an interdisciplinary approach to improve patient outcomes following cesarean section. ERAC’s execution must be constantly evaluated. Thus, we aimed to analyze parameters associated with ERAC adoption for clinical care in this expanded systematic review. A systematic literature search using Epistemonikos, Google Scholar, PubMed, and Scopus was done until February 2023. The appropriate observational and experimental research comparing the effects of ERAC protocols with conventional care on postoperative adverse events, operation-related characteristics, time to first (oral intake, mobilization, bowel movement, and urinary catheter removal), and opioid use. Meta-analyses were conducted using the RevMan 5.4.1. and Comprehensive Meta-Analysis version 3.3 software. In total, 23 studies were included in this systematic review. ERAC implementation was found to be associated with improvement in terms of shorter postoperative hospital stays and faster time to first liquid intake, first solid diet, urinary catheter removal, and mobilization. Furthermore, the rate of opioid-free treatment, total in-hospital morphine milligram equivalent (MME), daily in-hospital MME, and total prescribed opioid pills at discharge (all parameters, P < 0.01) were significantly better in the ERAC group than in the conventional care group. However, no significant difference was observed regarding postoperative adverse events, blood loss, operation duration, and total prescribed MME at discharge parameters between the two observed groups. ERAC implementation is associated with better healthcare delivery, as determined by shorter time to first, lower opioid consumption, and shorter postoperative length of stay compared with conventional care. However, it is not associated with a lower dosage of opioid prescription at discharge. Key Message: ERAC has demonstrated immense advantages and appears to be the future of cesarean delivery methods worldwide. However, based on our analysis, it is not associated with a lower dosage of opioid prescription at discharge.
{"title":"Enhanced recovery after cesarean (ERAC) versus conventional care: An expanded systematic review and meta-analysis of 18,368 subjects","authors":"M. Lestari, Djayanti Sari, Susilo Chandra, Purwoko Purwoko, I. Isngadi, Tungki Pratama Umar","doi":"10.4103/joacp.joacp_339_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_339_23","url":null,"abstract":"\u0000 \u0000 \u0000 Enhanced recovery after cesarean (ERAC) is an interdisciplinary approach to improve patient outcomes following cesarean section. ERAC’s execution must be constantly evaluated. Thus, we aimed to analyze parameters associated with ERAC adoption for clinical care in this expanded systematic review.\u0000 \u0000 \u0000 \u0000 A systematic literature search using Epistemonikos, Google Scholar, PubMed, and Scopus was done until February 2023. The appropriate observational and experimental research comparing the effects of ERAC protocols with conventional care on postoperative adverse events, operation-related characteristics, time to first (oral intake, mobilization, bowel movement, and urinary catheter removal), and opioid use. Meta-analyses were conducted using the RevMan 5.4.1. and Comprehensive Meta-Analysis version 3.3 software.\u0000 \u0000 \u0000 \u0000 In total, 23 studies were included in this systematic review. ERAC implementation was found to be associated with improvement in terms of shorter postoperative hospital stays and faster time to first liquid intake, first solid diet, urinary catheter removal, and mobilization. Furthermore, the rate of opioid-free treatment, total in-hospital morphine milligram equivalent (MME), daily in-hospital MME, and total prescribed opioid pills at discharge (all parameters, P < 0.01) were significantly better in the ERAC group than in the conventional care group. However, no significant difference was observed regarding postoperative adverse events, blood loss, operation duration, and total prescribed MME at discharge parameters between the two observed groups.\u0000 \u0000 \u0000 \u0000 ERAC implementation is associated with better healthcare delivery, as determined by shorter time to first, lower opioid consumption, and shorter postoperative length of stay compared with conventional care. However, it is not associated with a lower dosage of opioid prescription at discharge.\u0000 \u0000 Key Message:\u0000 ERAC has demonstrated immense advantages and appears to be the future of cesarean delivery methods worldwide. However, based on our analysis, it is not associated with a lower dosage of opioid prescription at discharge.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001199","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 : 2024-05-08DOI: 10.4103/joacp.joacp_315_23
Kunal K Sharma, Rohini M. Surve, K. M. Reddy, Rita Christopher, D. Chakrabarti, Sundaravadivel Pandarisamy, Shruti V. Palakuzhiyil, S. Kamath
Anesthetic induction plays a pivotal role in determining the operative course and the outcome in patients with acute traumatic brain injury (TBI). The present study compared the effect of anesthetic induction with etomidate, thiopentone, and propofol primarily on systemic hemodynamics and regional cerebral oxygenation (rScO2) and secondarily on the serum cortisol levels in TBI patients. In this prospective observational study, eligible patients were recruited and divided into three groups as per the induction agent received. Data collected were hemodynamic parameters and rScO2 levels at baseline, following 3 min of preoxygenation, and over 10 min of induction. Serum cortisol levels were measured before and after 24 h of induction. The statistical analysis was done using R software. A total of 115 patients were included: 32, 33, and 50 in thiopentone, propofol, and etomidate groups, respectively. A significant increase (P < 0.001) in bilateral rScO2 was noted in all three groups following anesthetic induction. Intergroup comparison of the propofol and the etomidate groups revealed significantly lesser increase in contralateral rScO2 (P = 0.019) and a greater fall in mean arterial pressure (P = 0.003) on using propofol as an induction agent. Trend changes in bilateral rScO2 and hemodynamic parameters were comparable between thiopentone and etomidate groups. An insignificant fall in serum cortisol was observed in etomidate (P = 0.332) and thiopentone (P = 0.364) groups, but a significant increase was observed in the propofol group (P = 0.004). The Glasgow coma scale (GCS) score at discharge improved significantly in all the groups (P < 0.001). In TBI patients, anesthetic induction with etomidate resulted in least hemodynamic changes compared to induction with thiopentone and propofol. The rScO2 increased in all three groups after induction, with the maximal increase observed with etomidate compared to propofol and thiopentone. Insignificant fall in serum cortisol was observed with etomidate and thiopentone, but not with propofol. Outcome at discharge, assessed with GCS, was comparable in all the groups. Key Messages: Anesthetic induction with etomidate produced least hemodynamic changes compared to induction with thiopentone and propofol in patients with traumatic brain injury. Consequently, maximal increase in cerebral oxygen saturation occurred with etomidate among the three induction agents. An insignificant decrease in serum cortisol was observed with etomidate and thiopentone, but not with propofol. Neurological outcome at discharge was similar with all drugs.
{"title":"Impact of anesthetic induction with etomidate, thiopentone, and propofol on regional cerebral oxygenation: An observational study in patients with traumatic brain injury","authors":"Kunal K Sharma, Rohini M. Surve, K. M. Reddy, Rita Christopher, D. Chakrabarti, Sundaravadivel Pandarisamy, Shruti V. Palakuzhiyil, S. Kamath","doi":"10.4103/joacp.joacp_315_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_315_23","url":null,"abstract":"\u0000 \u0000 \u0000 Anesthetic induction plays a pivotal role in determining the operative course and the outcome in patients with acute traumatic brain injury (TBI). The present study compared the effect of anesthetic induction with etomidate, thiopentone, and propofol primarily on systemic hemodynamics and regional cerebral oxygenation (rScO2) and secondarily on the serum cortisol levels in TBI patients.\u0000 \u0000 \u0000 \u0000 In this prospective observational study, eligible patients were recruited and divided into three groups as per the induction agent received. Data collected were hemodynamic parameters and rScO2 levels at baseline, following 3 min of preoxygenation, and over 10 min of induction. Serum cortisol levels were measured before and after 24 h of induction. The statistical analysis was done using R software.\u0000 \u0000 \u0000 \u0000 A total of 115 patients were included: 32, 33, and 50 in thiopentone, propofol, and etomidate groups, respectively. A significant increase (P < 0.001) in bilateral rScO2 was noted in all three groups following anesthetic induction. Intergroup comparison of the propofol and the etomidate groups revealed significantly lesser increase in contralateral rScO2 (P = 0.019) and a greater fall in mean arterial pressure (P = 0.003) on using propofol as an induction agent. Trend changes in bilateral rScO2 and hemodynamic parameters were comparable between thiopentone and etomidate groups. An insignificant fall in serum cortisol was observed in etomidate (P = 0.332) and thiopentone (P = 0.364) groups, but a significant increase was observed in the propofol group (P = 0.004). The Glasgow coma scale (GCS) score at discharge improved significantly in all the groups (P < 0.001).\u0000 \u0000 \u0000 \u0000 In TBI patients, anesthetic induction with etomidate resulted in least hemodynamic changes compared to induction with thiopentone and propofol. The rScO2 increased in all three groups after induction, with the maximal increase observed with etomidate compared to propofol and thiopentone. Insignificant fall in serum cortisol was observed with etomidate and thiopentone, but not with propofol. Outcome at discharge, assessed with GCS, was comparable in all the groups.\u0000 \u0000 Key Messages: Anesthetic induction with etomidate produced least hemodynamic changes compared to induction with thiopentone and propofol in patients with traumatic brain injury. Consequently, maximal increase in cerebral oxygen saturation occurred with etomidate among the three induction agents. An insignificant decrease in serum cortisol was observed with etomidate and thiopentone, but not with propofol. Neurological outcome at discharge was similar with all drugs.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999918","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 : 2024-05-08DOI: 10.4103/joacp.joacp_204_22
Jyotsna Agarwal, Joy Babuwe-Ngobi, Kumar G. Belani, Naveen Malhotra
Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required. Key Messages: Peripheral nerve blocks form an effective component of multi-model analgesic regimens for pain control following cesarean section. Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine is the most effective strategy. In the absence of intrathecal morphine, lateral transversus abdominis plane block or local anesthetic wound infiltration should be administered.
{"title":"Peripheral nerve blocks for analgesia following cesarean delivery A narrative review","authors":"Jyotsna Agarwal, Joy Babuwe-Ngobi, Kumar G. Belani, Naveen Malhotra","doi":"10.4103/joacp.joacp_204_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_204_22","url":null,"abstract":"\u0000 Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.\u0000 \u0000 Key Messages: Peripheral nerve blocks form an effective component of multi-model analgesic regimens for pain control following cesarean section. Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine is the most effective strategy. In the absence of intrathecal morphine, lateral transversus abdominis plane block or local anesthetic wound infiltration should be administered.","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":" 53","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000451","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}
{"title":"Anesthesia management of a patient with multiple facial hemangiomas: Sometimes less is more!","authors":"Navneh Samagh, Utkarsh, Vandana Sharma, Anju Grewal","doi":"10.4103/joacp.joacp_104_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_104_23","url":null,"abstract":"","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712753","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 : 2024-04-11DOI: 10.4103/joacp.joacp_280_23
J. Eiamcharoenwit, P. Akavipat
Control of the hemodynamic response during intubation is essential. To assess the effect of age on the median effective dose (ED50) and 95% effective dose (ED95) of fentanyl for blunting the hemodynamic response to intubation. Patients (n = 86) undergoing general anesthesia were randomly stratified according to age (groups 1–4); fentanyl was administered to each patient according to the Dixon and Massey method, starting at 2 μg/kg. The dose was increased or decreased by 0.5 μg/kg for the subsequent patient, depending on the failure or success of blunting of the hemodynamic response, respectively. Success was defined as a change in heart rate and blood pressure by <20% below the baseline at 1, 3, and 5 min after intubation. ED50 and ED95 were analyzed using R statistical software. ED50s of fentanyl in groups 1 (20–35 years), 2 (36–50 years), 3 (51–65 years), and 4 (66–80 years) were 2 μg/kg (90% confidence interval, 1.50–2.50), 2.25 μg/kg (2.00–2.50), 1.89 μg/kg (1.54–2.21), and 1.27 μg/kg (0.72–1.82), respectively. ED95s in groups 1, 2, 3, and 4 were 2.45 μg/kg (2.32–2.96), 2.79 μg/kg (2.58–4.38), 2.44 μg/kg (2.33–3.06), and 2.70 μg/kg (2.30–5.18), respectively. There was a statistically significant incidence of cough in group 2. Patients aged 65–80 years required the lowest ED50 of fentanyl dose, whereas patients aged 36–50 years required the highest ED50 and ED95 dose to blunt the hemodynamic response during intubation.
{"title":"Effect of age on the median effective dose and 95% effective dose of intravenous fentanyl for blunting the hemodynamic response to tracheal intubation: A double-blind, up-and-down sequential method trial","authors":"J. Eiamcharoenwit, P. Akavipat","doi":"10.4103/joacp.joacp_280_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_280_23","url":null,"abstract":"\u0000 \u0000 \u0000 Control of the hemodynamic response during intubation is essential. To assess the effect of age on the median effective dose (ED50) and 95% effective dose (ED95) of fentanyl for blunting the hemodynamic response to intubation.\u0000 \u0000 \u0000 \u0000 Patients (n = 86) undergoing general anesthesia were randomly stratified according to age (groups 1–4); fentanyl was administered to each patient according to the Dixon and Massey method, starting at 2 μg/kg. The dose was increased or decreased by 0.5 μg/kg for the subsequent patient, depending on the failure or success of blunting of the hemodynamic response, respectively. Success was defined as a change in heart rate and blood pressure by <20% below the baseline at 1, 3, and 5 min after intubation. ED50 and ED95 were analyzed using R statistical software.\u0000 \u0000 \u0000 \u0000 ED50s of fentanyl in groups 1 (20–35 years), 2 (36–50 years), 3 (51–65 years), and 4 (66–80 years) were 2 μg/kg (90% confidence interval, 1.50–2.50), 2.25 μg/kg (2.00–2.50), 1.89 μg/kg (1.54–2.21), and 1.27 μg/kg (0.72–1.82), respectively. ED95s in groups 1, 2, 3, and 4 were 2.45 μg/kg (2.32–2.96), 2.79 μg/kg (2.58–4.38), 2.44 μg/kg (2.33–3.06), and 2.70 μg/kg (2.30–5.18), respectively. There was a statistically significant incidence of cough in group 2.\u0000 \u0000 \u0000 \u0000 Patients aged 65–80 years required the lowest ED50 of fentanyl dose, whereas patients aged 36–50 years required the highest ED50 and ED95 dose to blunt the hemodynamic response during intubation.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715336","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}
Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient’s pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.
{"title":"Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial","authors":"Savita Rana, L. Anand, Manpreet Singh, Dheeraj Kapoor, Deepika Gupta, Harpreet Kaur","doi":"10.4103/joacp.joacp_248_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_248_22","url":null,"abstract":"\u0000 \u0000 \u0000 Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient’s pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery.\u0000 \u0000 \u0000 \u0000 The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated.\u0000 \u0000 \u0000 \u0000 All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar.\u0000 \u0000 \u0000 \u0000 Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"14 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140714524","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 : 2024-04-11DOI: 10.4103/joacp.joacp_67_23
Rana Ather, S. Nikhar, Akhay Kumar Kar, P. Durga, Pindi Laxmi Prasanna
Intravenous sedation during spinal anesthesia has the advantages of increased duration of spinal anesthesia and better postoperative pain control. The aim of this study was to compare the effect of intravenous bolus and infusion of dexmedetomidine versus ketamine given intraoperative on the postoperative analgesia in fracture femur patients operated under subarachnoid block. In this prospective randomized double-blind controlled study, 75 patients aged 18–65 years posted for elective surgery were selected and randomly divided into three groups to receive ketamine (group K), dexmedetomidine (group D), and saline (control group C). Postoperative pain was evaluated using the numerical rating scale (NRS). The duration of analgesia and the amount of analgesic consumption were also recorded. Student’s t-test and Chi-square test were used to compare the two groups, and one-way ANOVA with posthoc analysis was performed for comparison of the three groups. Patients in the ketamine group had better postoperative analgesia as assessed by decreased pain (on the NRS scale) and decreased need for postoperative rescue analgesics (P < 0.001). The duration of sensory block and motor block was prolonged in group K as compared to the other two groups (P < 0.001). Intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block.
{"title":"Comparison of the effect of intraoperative dexmedetomidine versus ketamine on postoperative analgesia in fracture femur patients operated under subarachnoid block – A prospective randomized double-blind controlled trial","authors":"Rana Ather, S. Nikhar, Akhay Kumar Kar, P. Durga, Pindi Laxmi Prasanna","doi":"10.4103/joacp.joacp_67_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_67_23","url":null,"abstract":"\u0000 \u0000 \u0000 Intravenous sedation during spinal anesthesia has the advantages of increased duration of spinal anesthesia and better postoperative pain control. The aim of this study was to compare the effect of intravenous bolus and infusion of dexmedetomidine versus ketamine given intraoperative on the postoperative analgesia in fracture femur patients operated under subarachnoid block.\u0000 \u0000 \u0000 \u0000 In this prospective randomized double-blind controlled study, 75 patients aged 18–65 years posted for elective surgery were selected and randomly divided into three groups to receive ketamine (group K), dexmedetomidine (group D), and saline (control group C). Postoperative pain was evaluated using the numerical rating scale (NRS). The duration of analgesia and the amount of analgesic consumption were also recorded. Student’s t-test and Chi-square test were used to compare the two groups, and one-way ANOVA with posthoc analysis was performed for comparison of the three groups.\u0000 \u0000 \u0000 \u0000 Patients in the ketamine group had better postoperative analgesia as assessed by decreased pain (on the NRS scale) and decreased need for postoperative rescue analgesics (P < 0.001). The duration of sensory block and motor block was prolonged in group K as compared to the other two groups (P < 0.001).\u0000 \u0000 \u0000 \u0000 Intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block.\u0000","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"6 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715924","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：