Anesthesia, Essays and Researches最新文献

Background: Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery.

Aims: This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management.

Design: Prospective, randomized case-controlled trial study.

Setting: Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain.

Materials and methods: A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction.

Statistical analysis: Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared.

Results: Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P = 0.039). Pain intensity scores were less in patients with CEB than those without (P < 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P = 0.012).

Conclusions: Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.

Background: Limited studies are available for assessing the optimal pillow height for sniffing position to obtain the best glottic view during laryngoscopy and intubation in the Indian population.

Aims: This study was designed to evaluate laryngoscopic view and intubation conditions in sniffing position using three different pillow heights (without a pillow, 4 cm, and 7 cm) during direct laryngoscopy.

Settings and design: This prospective analytical study was done in a tertiary care teaching institute.

Materials and methods: In 60 patients, direct laryngoscopy was performed in the sniffing position first without a pillow (0 cm), followed by a 4-cm pillow, and then a 7-cm pillow to assess the glottic view after administration of anesthesia. The laryngoscopic views were graded using the percentage of glottic opening (POGO) score and Cormack and Lehane (CL) grade. The pillow with the best laryngoscopic view was subsequently used to intubate the patient. Intubation difficulty was assessed by the Intubation Difficulty Score (IDS). The patient was followed up for 24 h postoperatively to evaluate postoperative complications due to intubation.

Statistical analysis: The categorical data were expressed in frequency and percentages and analyzed using the Chi-square test.

Results: With a 4-cm pillow, there are a lower CL grade and a higher POGO score compared to views without a pillow and a 7-cm pillow which was statistically significant. There is a significantly lesser IDS score with a 4-cm pillow.

Conclusions: The sniffing position with a 4-cm pillow provides a better laryngoscopic view and improved intubation condition than without a pillow and a 7-cm pillow in the study population.

Background: In long bone surgeries, the severity of pain is more, demanding good intraoperative anesthesia, and prolonged postoperative analgesia. This is achieved in spinal anesthesia with adjuvants to local anesthetics, which act synergistically.

Aims: The aim of this study was to compare the efficacy of nalbuphine and dexmedetomidine as adjuvants to bupivacaine versus bupivacaine alone in lower limb orthopedic surgeries under the subarachnoid block (SAB).

Settings and design: This is a prospective, randomized, double-blind control study conducted on 60 patients belonging to the American Society of Anesthesiologists physical status Classes I and II, undergoing lower limb orthopedic surgeries under SAB.

Materials and methods: Sixty patients were divided into three groups by computer-generated randomization. Group A received 2.7 mL of 0.5% hyperbaric bupivacaine with 1.5 mg nalbuphine, Group B received 2.7 mL of 0.5% hyperbaric bupivacaine with 10 μg dexmedetomidine, and Group C received 2.7 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of normal saline (total volume made to 3.2 mL in all groups with normal saline). Time of onset of block, duration of sensory, and motor blocks were noted. Changes in hemodynamic parameters, postoperative first rescue analgesia requirement, and side effects were recorded.

Statistical analysis used: Data were analyzed using SPSS 22 version software. P < 0.05 was considered statistically significant.

Results: There was no significant difference in the onset of sensory or motor blocks in the three groups. However, the time taken for regression of sensory block was longer in Group B that was statistically significant.

Conclusion: Intrathecal dexmedetomidine acts as a better adjuvant with bupivacaine in providing quality anesthesia, prolonged sensory and motor block, and good postoperative analgesia with less incidence of adverse effects compared to nalbuphine and bupivacaine alone.

Background: As the waves of coronavirus disease 2019 (COVID-19) pandemic continues, the current treatment modalities emphasize the use of antiviral agents to save the human lives. Even though remdesivir is one of the current recommended modalities, data on the efficacy of remdesivir in reducing the rate of 28-day mortality are still not concurrent in all the reports.

Aim: The present study aimed to determine the effectiveness of remdesivir in reducing the rate of mortality in a tertiary care hospital as retrospective comparative analysis.

Setting and design: The present study is a retrospective, comparative analysis of accurate and well-documented case files.

Methods: Data (n = 262) of COVID-19-infected patients admitted and treated with remdesivir (Gp R; n = 160) and without remdesivir (Gp NR: n = 102) between June 1, 2021, and November 30, 2021, were collected and analyzed to obtain the results.

Statistical analysis: The data from individual case files were transferred to excel files (Microsoft office, Redmond, WA, USA) and then analyzed using Statistical Package for the Social Studies (SPSS, IBM, Armonk, NY, USA). The descriptive statistical values were expressed as mean ± standard deviation and number, frequencies/percentages. Student's t-test, Chi-square test, and ANOVA were employed for comparative statistics. P < 0.05 was considered statistically significant.

Results: On analysis of the extracted data, the age, Acute Physiology and Chronic Health Evaluation-IV score, and predicted mortality rate between two groups have not shown significant difference (P > 0.05, ANOVA) and were comparable (P > 0.05, ANOVA). Furthermore, the 28-day mortality rate was significantly reduced (P < 0/001) in the Gp R where the rate of mortality was found to be 6.87%, whereas in Gp NR, it was 29.41%.

Conclusion: Treatment with remdesivir was able to significantly increase the rate of survival of the patients and reduction in day-28 mortality when compared with the patients who had undergone treatment without remdesivir. Therefore, the results of the current retrospective, observational analysis from a tertiary care hospital could also be a piece of remarkable information to a significant number of existing data globally.

Background: Hydrocortisone showed an important role in reversal of shock when added to standard therapy in managing septic shock. Hyperglycemia is one of the most common side effects associated with corticosteroid treatment.

Aims: This study aimed to evaluate the risk of hyperglycemia of intermittent hydrocortisone boluses versus continuous infusion in septic shock patients.

Settings and design: This was a prospective randomized controlled study conducted in a tertiary care teaching hospital.

Materials and methods: One hundred and forty patients with septic shock and who received noradrenaline were enrolled in this randomized study. Group 1 was intermittent bolus hydrocortisone group (n = 70) and Group 2 was continuous infusion group (n = 70). All patients who were admitted with septic shock and who received noradrenaline and hydrocortisone were included in the study. Those patients who had exceeded 200 mg per day of hydrocortisone were excluded from the study. The primary outcome of the study was mean blood glucose.

Statistical analysis used: Qualitative variables were compared between the two groups with the Chi-square of the Fisher's exact test and continuous variables were compared using the Student's t-test or the Wilcoxon rank-sum test.

Results: Out of 112 patients, 54 patients received hydrocortisone as intermittent boluses (48.2%), and 58 patients (51.8%) received continuous infusion. For the primary outcome, no statistically or clinically significant difference was found in the blood glucose estimated marginal mean: 154.44 mg.dL^-1 (95% confidence interval [CI]: 144.18-166.88) in the bolus group and 160.2 mg.dL^-1 (95% CI: 143.82-176.76) in the infusion group with a mean difference of 05.76 mg.dL^-1 (95% CI: -13.86-25.38). For the secondary outcomes of the study, no difference was found between the two groups in hyperglycemic or hypoglycemic events, mortality, length of stay in intensive care unit, and reversal of shock.

Conclusions: The risk of hyperglycemia is almost equal in both intermittent and continuous infusions of hydrocortisone in septic shock patients.

Background: Recently, opoids are linked with cancer recurrence. Duloxetine hydrochloride (DH), an anxiolytic may reduce total opoid requirement after cancer surgery.

Aims: We assessed the efficacy of a single dose of DH in reducing the total morphine requirement after open radical cholecystectomy. We also calculated the Visual Analog Scale (VAS) score, patient satisfaction score (PSS), and time taken to the use of the first rescue analgesic.

Setting and designes: This is a prospective, randomized, double blind, controlled study conducted in the patients aged 20-70 years (American Society of Anaesthesiologists classes I-III) undergoing open radical cholecystectomy under general anesthesia for carcinoma gall bladder.

Materials and methods: The patients were divided into two groups of 32 patients each by computer-generated randomization. Group A received oral DH (60 mg); Group B received identical placebo capsules 2 h before surgery with a sip of water. Postoperatively, intravenous morphine was given using a patient-controlled analgesia pump. After 24 h, total morphine consumption, the VAS score, time to the first rescue analgesia, and PSS were recorded.

Statistical analysis: Statistical Package for the Social Sciences software (SPSS version 22.0, IBM Corp., Chicago, IL, USA 2013). P value < 0.05 or 0.001 was considered statistically significant.

Results: The total morphine consumption and VAS score were significantly lower in Group A. No significant effects was observed on PSS.

Conclusion: A single 60 mg dose of DH administered 2 h before open radical cholecystectomy reduced total morphine consumption and improved VAS score postoperatively with no effect on PSS.