V. Sivapurapu, Pratheeba Natarajan, R. Bhat, R. Remadevi
Myasthenia gravis (MG) patients with coronavirus disease (COVID-19) pose a unique challenge for intensive care management. Higher risk of infection is observed in patients with MG due to the immunosuppressant medications they are prescribed. The underlying component of respiratory muscle weakness predisposes these patients to experience a more severe form of illness. In the case of diagnosis of COVID-19 in MG patients, judicious continuation of immunosuppressants, avoiding drugs that worsen MG along with the continuation of cholinesterase inhibitors is prudent. Early diagnosis in cases with high-index of suspicion, extra precautions, COVID-appropriate behavior, and early immunization is paramount for the health of MG patients during this pandemic.
{"title":"Myasthenia Gravis and COVID-19 – A Clinical Checkmate","authors":"V. Sivapurapu, Pratheeba Natarajan, R. Bhat, R. Remadevi","doi":"10.4103/aer.aer_129_21","DOIUrl":"https://doi.org/10.4103/aer.aer_129_21","url":null,"abstract":"Myasthenia gravis (MG) patients with coronavirus disease (COVID-19) pose a unique challenge for intensive care management. Higher risk of infection is observed in patients with MG due to the immunosuppressant medications they are prescribed. The underlying component of respiratory muscle weakness predisposes these patients to experience a more severe form of illness. In the case of diagnosis of COVID-19 in MG patients, judicious continuation of immunosuppressants, avoiding drugs that worsen MG along with the continuation of cholinesterase inhibitors is prudent. Early diagnosis in cases with high-index of suspicion, extra precautions, COVID-appropriate behavior, and early immunization is paramount for the health of MG patients during this pandemic.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"39 1","pages":"457 - 459"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89109672","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}
Andrew Louis, M. Tiwary, P. Sharma, Abhijit S. Nair
Introduction: Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block. Methods: After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA. Results: Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group. Conclusion: RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.
{"title":"Comparison of Postoperative Pulmonary Outcomes in Patients Undergoing Cesarean Section under General and Spinal Anesthesia: A Single-Center Audit","authors":"Andrew Louis, M. Tiwary, P. Sharma, Abhijit S. Nair","doi":"10.4103/aer.aer_6_22","DOIUrl":"https://doi.org/10.4103/aer.aer_6_22","url":null,"abstract":"Introduction: Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block. Methods: After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA. Results: Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group. Conclusion: RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"62 1","pages":"439 - 442"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86486482","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}
Maha Younis Youssef Abdallah, Y. Khafagy, Mohamed Younes Yousef Abdallah
Background: Dexmedetomidine is associated with good perioperative hemodynamics together with decreased opioid requirements. Furthermore, propofol has been used to achieve hypotensive anesthesia as a part of total intravenous anesthesia. Aims: This study was performed to compare dexmedetomidine and propofol on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumors. Patients and Methods: A total of 110 cases were included in this prospective randomized study. They were randomized into two equal groups; Group D commenced on Dexmedetomidine, and Group P, which received propofol. Comparing intraoperative hemodynamic parameters and the Boezaart Bleeding Scale was our primary outcome. The secondary outcomes included isoflurane and propranolol consumption, recovery, postoperative analgesic profile. Statistical Analysis: IBM's SPSS Statistics (Statistical Package for the Social Sciences) for Windows (version 25, 2017) was used for the statistical analysis of the collected data. Shapiro–Wilk test was used to check the normality of the data distribution. The quantitative variables were expressed as mean and standard deviation, whereas the categorical variables were expressed as frequency and percentage. Independent sample t and Mann − Whitney tests were used for the comparison of parametric and nonparametric continuous data, respectively. For pair-wise comparison of data (within-subjects), the follow-up values were compared to their corresponding basal value using the paired samples t-test or Wilcoxon matched-pairs signed-ranks test. Fisher exact and Chi-square tests were used for inter-group comparison of nominal data using the crosstabs function. Results: Age, gender, body mass index, and systemic comorbidities did not significantly differ between the two groups. Furthermore, heart rate and blood pressure were comparable at baseline, during operation, and after extubation. Boezaart score, blood loss, isoflurane, and propranolol consumption were also comparable between the two groups. Group D expressed significantly longer emergence and extubation times than Group P. Nevertheless, cases in the same group expressed lower Visual Analog Scale values and postoperative analgesic requirements. Conclusion: Although Dexmedetomidine and propofol are associated with comparable intraoperative hemodynamic changes, the former drug appears to be superior regarding pain control, postoperative analgesic requirement.
背景:右美托咪定与良好的围手术期血流动力学以及减少阿片类药物需求相关。此外，异丙酚已被用于实现低血压麻醉，作为全静脉麻醉的一部分。目的:本研究比较右美托咪定和异丙酚在经蝶窦垂体肿瘤切除术中降压麻醉的充分性。患者和方法:这项前瞻性随机研究共纳入110例患者。他们被随机分为两组;D组开始使用右美托咪定，P组开始使用异丙酚。比较术中血流动力学参数和Boezaart出血量表是我们的主要结果。次要结局包括异氟醚和心得安的消耗、恢复、术后镇痛情况。统计分析:使用IBM的SPSS Statistics (Statistical Package for the Social Sciences) for Windows (version 25, 2017)对收集的数据进行统计分析。采用Shapiro-Wilk检验检验数据分布的正态性。定量变量用均值和标准差表示，分类变量用频率和百分比表示。分别使用独立样本t检验和Mann - Whitney检验对参数和非参数连续数据进行比较。对于数据的成对比较(受试者内)，使用配对样本t检验或Wilcoxon配对对带符号秩检验将随访值与其相应的基础值进行比较。使用交叉表函数对标称数据进行组间比较，采用Fisher精确检验和卡方检验。结果:两组患者的年龄、性别、体重指数和全身合并症无显著差异。此外，心率和血压在基线、手术中和拔管后比较。Boezaart评分、出血量、异氟醚和心得安用量在两组之间也具有可比性。D组患者的急诊和拔管时间明显高于p组。然而，同一组患者的视觉模拟评分值和术后镇痛需求均较低。结论:尽管右美托咪定和异丙酚在术中血流动力学变化方面具有可比性，但前者在疼痛控制和术后镇痛需求方面似乎更胜一筹。
{"title":"Efficacy of Dexmedetomidine versus Propofol in Patients Undergoing Endoscopic Transnasal Transsphenoidal Pituitary Tumor Resection","authors":"Maha Younis Youssef Abdallah, Y. Khafagy, Mohamed Younes Yousef Abdallah","doi":"10.4103/aer.aer_154_21","DOIUrl":"https://doi.org/10.4103/aer.aer_154_21","url":null,"abstract":"Background: Dexmedetomidine is associated with good perioperative hemodynamics together with decreased opioid requirements. Furthermore, propofol has been used to achieve hypotensive anesthesia as a part of total intravenous anesthesia. Aims: This study was performed to compare dexmedetomidine and propofol on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumors. Patients and Methods: A total of 110 cases were included in this prospective randomized study. They were randomized into two equal groups; Group D commenced on Dexmedetomidine, and Group P, which received propofol. Comparing intraoperative hemodynamic parameters and the Boezaart Bleeding Scale was our primary outcome. The secondary outcomes included isoflurane and propranolol consumption, recovery, postoperative analgesic profile. Statistical Analysis: IBM's SPSS Statistics (Statistical Package for the Social Sciences) for Windows (version 25, 2017) was used for the statistical analysis of the collected data. Shapiro–Wilk test was used to check the normality of the data distribution. The quantitative variables were expressed as mean and standard deviation, whereas the categorical variables were expressed as frequency and percentage. Independent sample t and Mann − Whitney tests were used for the comparison of parametric and nonparametric continuous data, respectively. For pair-wise comparison of data (within-subjects), the follow-up values were compared to their corresponding basal value using the paired samples t-test or Wilcoxon matched-pairs signed-ranks test. Fisher exact and Chi-square tests were used for inter-group comparison of nominal data using the crosstabs function. Results: Age, gender, body mass index, and systemic comorbidities did not significantly differ between the two groups. Furthermore, heart rate and blood pressure were comparable at baseline, during operation, and after extubation. Boezaart score, blood loss, isoflurane, and propranolol consumption were also comparable between the two groups. Group D expressed significantly longer emergence and extubation times than Group P. Nevertheless, cases in the same group expressed lower Visual Analog Scale values and postoperative analgesic requirements. Conclusion: Although Dexmedetomidine and propofol are associated with comparable intraoperative hemodynamic changes, the former drug appears to be superior regarding pain control, postoperative analgesic requirement.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"49 1","pages":"368 - 374"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89259193","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}
K. Sravani, S. Nikhar, N. Padhy, P. Durga, G. Ramachandran
Background: Diabetic patients usually experience neuropathic pain and have a decreased response to opioids. Fractures are acute conditions and as such, they are very painful. No data is available related to fracture and postoperative pain in diabetics. Aim: This study was conducted to evaluate postoperative pain and analgesics requirement among diabetic and nondiabetic patients undergoing lower limb fracture surgery and the effect of glycosylated hemoglobin (HbA1c) on the postoperative pain. Setting and Design: This was a prospective observational study, conducted on 80 patients comprising of nondiabetic and diabetic, scheduled for elective lower limb fracture surgery under spinal anesthesia. Materials and Methods: HbA1c was done in all the patients who were included in the study. Postoperative Visual Analog Scale (VAS) and analgesic consumption were assessed by an anesthesiologist blinded to the diabetic or nondiabetic status of the patients. VAS was assessed every 2nd hourly, for 24 h and rescue analgesia was given if the VAS was ≥4 and record was maintained. Sedation scores and adverse effects were also recorded postoperatively. Statistical Analysis: The Chi-square test was used for the analysis of categorical variables and Student's t-test was used for continuous variables. Results: Diabetic group of patients had a significantly high VAS score with P ≤ 0.05. Rescue analgesics requirement was significantly different in two groups with diabetic patients requiring more supplementation of analgesia with a P = 0.025. The overall patient satisfaction was lesser in diabetic group (P = 0.004). There was statistically significant correlation between glycosylated hemoglobin and VAS at 2nd, 16th, 18th, 20th, 22nd, and 24th h. Conclusion: Postoperative pain and analgesic requirement was significantly higher in diabetic patients with lower limb fracture. Glycosylated hemoglobin had good correlation with higher VAS.
{"title":"Comparison of Postoperative Pain and Analgesia Requirement among Diabetic and Nondiabetic Patients undergoing Lower Limb Fracture Surgery – A Prospective Observational Study","authors":"K. Sravani, S. Nikhar, N. Padhy, P. Durga, G. Ramachandran","doi":"10.4103/aer.aer_157_21","DOIUrl":"https://doi.org/10.4103/aer.aer_157_21","url":null,"abstract":"Background: Diabetic patients usually experience neuropathic pain and have a decreased response to opioids. Fractures are acute conditions and as such, they are very painful. No data is available related to fracture and postoperative pain in diabetics. Aim: This study was conducted to evaluate postoperative pain and analgesics requirement among diabetic and nondiabetic patients undergoing lower limb fracture surgery and the effect of glycosylated hemoglobin (HbA1c) on the postoperative pain. Setting and Design: This was a prospective observational study, conducted on 80 patients comprising of nondiabetic and diabetic, scheduled for elective lower limb fracture surgery under spinal anesthesia. Materials and Methods: HbA1c was done in all the patients who were included in the study. Postoperative Visual Analog Scale (VAS) and analgesic consumption were assessed by an anesthesiologist blinded to the diabetic or nondiabetic status of the patients. VAS was assessed every 2nd hourly, for 24 h and rescue analgesia was given if the VAS was ≥4 and record was maintained. Sedation scores and adverse effects were also recorded postoperatively. Statistical Analysis: The Chi-square test was used for the analysis of categorical variables and Student's t-test was used for continuous variables. Results: Diabetic group of patients had a significantly high VAS score with P ≤ 0.05. Rescue analgesics requirement was significantly different in two groups with diabetic patients requiring more supplementation of analgesia with a P = 0.025. The overall patient satisfaction was lesser in diabetic group (P = 0.004). There was statistically significant correlation between glycosylated hemoglobin and VAS at 2nd, 16th, 18th, 20th, 22nd, and 24th h. Conclusion: Postoperative pain and analgesic requirement was significantly higher in diabetic patients with lower limb fracture. Glycosylated hemoglobin had good correlation with higher VAS.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"34 1","pages":"448 - 453"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80856048","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}
Background: Prolonged working hours in operation theater may impair cognitive and psychomotor function. Aims: This study was done to evaluate the changes in cognitive and psychomotor changes in the anesthesia residents after 6 and 12 h of continuous work in operation theater. Settings and Design: Sixty anesthesia residents whose working hours were expected to be longer than 12 h were recruited for this prospective, observational study. Methods: The study consisted of a set of five tests used for assessing the cognitive and psychomotor functions. The tests were conducted for the participants at 0, 6, and 12 h of work and the total scores at the respective time period were noted. The tests were manual dexterity test using purdue peg board, finger tapping test, visual spatial capacity memory test, digit symbol substitution test (DSST), and frontal assessment battery. Statistical Analysis: The observations of the purdue peg board test, finger tapping test, and digit symbol substitution test at 0, 6, and 12 h were tested using the repeated measures analysis of variance and paired t-test. The observations of visual spatial capacity memory test and frontal assessment battery were tested using the Chi-square test. Results: In the purdue peg board test, there was significant reduction in the mean number of pins assembled by the participants over 12 h of work. There was a significant difference in the number of finger taps by the dominant hand between 0 and 12 h and also between 6 and 12 h. In the visual spatial memory test, there was no significant difference in the performance of the participants with incorrect response at 0 and 12 h of duration. There was a significant decrease in the number of correct response among the participants in the digit symbol substitution test at 0 and 12 h of work. There was no significant difference in the scores obtained in frontal assessment battery test which was used to assess the cognitive function. Conclusion: There was a significant reduction in the psychomotor functions of the anesthesiology residents after 12 continuous hours of work in the operation theater and there was no significant reduction in cognitive function observed during that period.
{"title":"Evaluation of Cognitive and Psychomotor Functional Changes in Anesthesiology Residents after 12 hours of Continuous Work in Operation Theater: An Observational Study","authors":"R. V. Prasad, S. Gupta, Srinivasan Swaminathan","doi":"10.4103/aer.aer_153_21","DOIUrl":"https://doi.org/10.4103/aer.aer_153_21","url":null,"abstract":"Background: Prolonged working hours in operation theater may impair cognitive and psychomotor function. Aims: This study was done to evaluate the changes in cognitive and psychomotor changes in the anesthesia residents after 6 and 12 h of continuous work in operation theater. Settings and Design: Sixty anesthesia residents whose working hours were expected to be longer than 12 h were recruited for this prospective, observational study. Methods: The study consisted of a set of five tests used for assessing the cognitive and psychomotor functions. The tests were conducted for the participants at 0, 6, and 12 h of work and the total scores at the respective time period were noted. The tests were manual dexterity test using purdue peg board, finger tapping test, visual spatial capacity memory test, digit symbol substitution test (DSST), and frontal assessment battery. Statistical Analysis: The observations of the purdue peg board test, finger tapping test, and digit symbol substitution test at 0, 6, and 12 h were tested using the repeated measures analysis of variance and paired t-test. The observations of visual spatial capacity memory test and frontal assessment battery were tested using the Chi-square test. Results: In the purdue peg board test, there was significant reduction in the mean number of pins assembled by the participants over 12 h of work. There was a significant difference in the number of finger taps by the dominant hand between 0 and 12 h and also between 6 and 12 h. In the visual spatial memory test, there was no significant difference in the performance of the participants with incorrect response at 0 and 12 h of duration. There was a significant decrease in the number of correct response among the participants in the digit symbol substitution test at 0 and 12 h of work. There was no significant difference in the scores obtained in frontal assessment battery test which was used to assess the cognitive function. Conclusion: There was a significant reduction in the psychomotor functions of the anesthesiology residents after 12 continuous hours of work in the operation theater and there was no significant reduction in cognitive function observed during that period.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"12 1","pages":"362 - 367"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73886262","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}
A. Jacob, J. Paul, S. Rajan, G. Ravindran, L. Kumar
Background and Aims: Spinal anesthesia is a technique widely used for gynecological, lower abdominal, pelvic and lower limb procedures. Even though it causes a profound nerve block, it is associated with profound hypotension. Aims of the Study: To assess the effect of the speed of injection of heavy bupivacaine on quality of block and hemodynamic changes in patients undergoing gynecological surgeries under spinal anesthesia. Methods: This was a prospective randomized study conducted on 40 patients. Group F patients were given 3.2 mL of 0.5% heavy bupivacaine intrathecally in 15 s and Group S patients were given the same drug over 60 s. The time to achieve T10 dermatomal block, maximum block height, block height at 5 min were recorded. Heart rate (HR), systolic, diastolic blood pressures, and mean arterial pressures (MAP) were also recorded at different time points. Results: HR, systolic BP, diastolic BP, and MAPs and mean block height at 5 min were comparable between the two groups at all time points. The time to achieve T10 dermatome block was significantly faster in Group F (1.85 ± 1.14 min) as compared to Group S (3.98 ± 1.58 min). Majority of patients in Group F (65%) had a maximum block up to T6 and those in Group S (45%) had a block upto T4. The usage of vasopressors was found to be significantly higher in Group F compared to Group S with P = 0.041. Conclusion: Using faster speed of injection of heavy bupivacaine during spinal anesthesia can lead to faster achievement of blockade but with significantly higher usage of vasopressors.
{"title":"Effect of Injection Speed of Heavy Bupivacaine in Spinal Anesthesia on Quality of Block and Hemodynamic Changes","authors":"A. Jacob, J. Paul, S. Rajan, G. Ravindran, L. Kumar","doi":"10.4103/aer.aer_1_22","DOIUrl":"https://doi.org/10.4103/aer.aer_1_22","url":null,"abstract":"Background and Aims: Spinal anesthesia is a technique widely used for gynecological, lower abdominal, pelvic and lower limb procedures. Even though it causes a profound nerve block, it is associated with profound hypotension. Aims of the Study: To assess the effect of the speed of injection of heavy bupivacaine on quality of block and hemodynamic changes in patients undergoing gynecological surgeries under spinal anesthesia. Methods: This was a prospective randomized study conducted on 40 patients. Group F patients were given 3.2 mL of 0.5% heavy bupivacaine intrathecally in 15 s and Group S patients were given the same drug over 60 s. The time to achieve T10 dermatomal block, maximum block height, block height at 5 min were recorded. Heart rate (HR), systolic, diastolic blood pressures, and mean arterial pressures (MAP) were also recorded at different time points. Results: HR, systolic BP, diastolic BP, and MAPs and mean block height at 5 min were comparable between the two groups at all time points. The time to achieve T10 dermatome block was significantly faster in Group F (1.85 ± 1.14 min) as compared to Group S (3.98 ± 1.58 min). Majority of patients in Group F (65%) had a maximum block up to T6 and those in Group S (45%) had a block upto T4. The usage of vasopressors was found to be significantly higher in Group F compared to Group S with P = 0.041. Conclusion: Using faster speed of injection of heavy bupivacaine during spinal anesthesia can lead to faster achievement of blockade but with significantly higher usage of vasopressors.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"4 1","pages":"348 - 351"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89669261","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}
Background: Apnoeic oxygenation is an established method of increasing safe apnoea times during intubation and this is of more importance in obese patients. The usefulness of buccal Ring, Adair and Elwyn (RAE) oxygenation has been established in previous studies, however a head-to-head comparison with nasal cannula (NC) is lacking. Aim: The aim of this study was to compare apnoea time with buccal RAE (BR) versus NC in obese patients. Setting and Design: This was a prospective, nonblinded randomized controlled trial conducted in a tertiary hospital where fifty American Society of Anaesthesiologists Physical Status Class I and II, obese patients with body mass index ≥30, posted for elective surgery were included. Materials and Methods: Following adequate preoxygenation and standard induction of anaesthesia, a prolonged simulated difficult laryngoscopy was performed during which oxygen was provided via either BR or NC. The primary outcome was time to desaturation to <95% or 10 min, which ever occurred first. Other outcomes recorded were lowest saturation, time to resaturation and highest end tidal carbon di oxide. Statistical Analysis: Mean with standard deviation (SD) or median with inter quartile range were used for continuous variables and absolute number with percentage were used for categorical variables. The primary outcome was analyzed using Kaplan-Meier survival curves, and log-rank tests were applied. Results: Patient characteristics were similar in both arms. The mean apnoea time in seconds (SD) in the BR group, 375.3 (116.6) was higher than the NC group 316.1 (94.1), P = 0.054. From the Kapan Meier curves the probability of desaturating to <95% was earlier in the NC group than the BR group (P = 0.092). The other outcomes were similar in both groups. Conclusion: This is the first study that demonstrates that oxygenation via a BR is better than NC in providing apnoeic oxygenation in obese patients and can safely be used when NC are contraindicated.
{"title":"Apnoeic Oxygenation during Simulated Difficult Intubation in Obese Patients: Comparison of Buccal Ring, Adair and Elwyn Tube Versus Nasal Cannula: A Prospective Randomized Controlled Trial","authors":"R. Mohanty, L. George, S. George, M. Babu","doi":"10.4103/aer.aer_114_21","DOIUrl":"https://doi.org/10.4103/aer.aer_114_21","url":null,"abstract":"Background: Apnoeic oxygenation is an established method of increasing safe apnoea times during intubation and this is of more importance in obese patients. The usefulness of buccal Ring, Adair and Elwyn (RAE) oxygenation has been established in previous studies, however a head-to-head comparison with nasal cannula (NC) is lacking. Aim: The aim of this study was to compare apnoea time with buccal RAE (BR) versus NC in obese patients. Setting and Design: This was a prospective, nonblinded randomized controlled trial conducted in a tertiary hospital where fifty American Society of Anaesthesiologists Physical Status Class I and II, obese patients with body mass index ≥30, posted for elective surgery were included. Materials and Methods: Following adequate preoxygenation and standard induction of anaesthesia, a prolonged simulated difficult laryngoscopy was performed during which oxygen was provided via either BR or NC. The primary outcome was time to desaturation to <95% or 10 min, which ever occurred first. Other outcomes recorded were lowest saturation, time to resaturation and highest end tidal carbon di oxide. Statistical Analysis: Mean with standard deviation (SD) or median with inter quartile range were used for continuous variables and absolute number with percentage were used for categorical variables. The primary outcome was analyzed using Kaplan-Meier survival curves, and log-rank tests were applied. Results: Patient characteristics were similar in both arms. The mean apnoea time in seconds (SD) in the BR group, 375.3 (116.6) was higher than the NC group 316.1 (94.1), P = 0.054. From the Kapan Meier curves the probability of desaturating to <95% was earlier in the NC group than the BR group (P = 0.092). The other outcomes were similar in both groups. Conclusion: This is the first study that demonstrates that oxygenation via a BR is better than NC in providing apnoeic oxygenation in obese patients and can safely be used when NC are contraindicated.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"15 1","pages":"408 - 412"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86933979","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}
Lakshmi Iyer, Shreyas Bhat, H. Nethra, H. Vijayakumar, K. Sudheesh, Ramachandriah
Context: Dexmedetomidine, an α2-agonist, has been studied widely as an adjuvant to local anesthetics in regional anesthesia techniques to enhance the quality and duration of analgesia (DOA). It was hypothesized that addition of dexmedetomidine 0.5 ug.kg‒1 to levobupivacaine would prolong the DOA. Aims: We aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor blockade, and duration of analgesia. Settings and Design: This was a prospective randomized double-blind study carried out at a tertiary hospital attached to medical college. Subjects and Methods: Sixty American Society of Anesthesiologists PS Class I and II patients aged between 18 and 60 years of either sex, undergoing elective upper-limb surgery lasting more than 30 min, were included in the study. They were randomly divided into two groups of thirty each to receive ultrasound-guided supraclavicular brachial plexus block. Group L was given nerve block with 20 mL of 0.25% levobupivacaine and 1 mL saline, and Group D received 20 mL of 0.25% levobupivacaine with 0.5 ug.kg‒1 of dexmedetomidine (diluted to volume of 1 mL). Onset time and duration of sensory and motor blockade, time to first rescue analgesia, and hemodynamic parameters were recorded. Statistical Analysis Used: Chi-square test for qualitative variables and Student's unpaired "t" test for continuous variables were used for statistical analysis. Results: The onset of sensory and motor blockade was 6.51 ± 0.77 min and 10.71 ± 0.34 min in Group D and 9.9 ± 0.45 and 15.93 ± 1.92 min in Group L, respectively (P < 0.005). DOA was 9.53 ± 0.29 h in Group D and 3.89 ± 0.30 h in Group L (P < 0.001). The duration of sensory and motor block was 9.14 ± 0.19 h and 8.55 ± 0.31 h in Group D and 6.15 ± 3.02 and 5.61 ± 2.98 h in Group L, respectively (P < 0.005). No adverse effects were observed in either of the groups. Conclusions: Addition of 0.5 ug.kg‒1 of dexmedetomidine to 20 mL 0.25% levobupivacaine in ultrasound guided (USG)-guided supraclavicular brachial plexus block shortens the onset time of sensory and motor blockade and prolongs duration of sensory and motor block and DOA.
背景:右美托咪定是一种α2激动剂，在区域麻醉技术中作为局麻药的辅助剂，以提高镇痛质量和持续时间(DOA)，已被广泛研究。假设加入右美托咪定0.5 ug。kg-1左布比卡因会延长死亡时间。目的:我们旨在评估右美托咪定作为左旋布比卡因辅助治疗锁骨上臂丛阻滞的疗效，包括感觉和运动阻断的开始时间和持续时间，以及镇痛的持续时间。背景与设计:本研究是在某医学院附属三级医院进行的前瞻性随机双盲研究。对象和方法:60例年龄在18 ~ 60岁的美国麻醉师学会(American Society of Anesthesiologists) PS I类和II类患者，男女不限，择期上肢手术时间超过30分钟。他们被随机分为两组，每组30人接受超声引导的锁骨上臂丛阻滞。L组给予0.25%左布比卡因20 mL +生理盐水1 mL的神经阻滞，D组给予0.25%左布比卡因20 mL + 0.5 ug的神经阻滞。kg-1右美托咪定(稀释至1ml体积)。记录感觉和运动阻滞的发生时间、持续时间、首次抢救镇痛时间和血流动力学参数。采用统计学方法:定性变量采用卡方检验，连续变量采用Student’s unpaired“t”检验进行统计学分析。结果:D组感觉和运动阻断发作时间分别为6.51±0.77 min和10.71±0.34 min, L组为9.9±0.45 min和15.93±1.92 min (P < 0.005)。D组DOA为9.53±0.29 h, L组为3.89±0.30 h (P < 0.001)。感觉和运动阻滞持续时间D组分别为9.14±0.19 h和8.55±0.31 h, L组分别为6.15±3.02 h和5.61±2.98 h (P < 0.005)。两组均未观察到不良反应。结论:添加0.5 ug。右美托咪定kg-1加0.25%左布比卡因20 mL超声引导下锁骨上臂丛阻滞可缩短感觉和运动阻滞的起效时间，延长感觉和运动阻滞的持续时间和阻滞时间。
{"title":"A Comparative Study of Effect of 0.25% Levobupivacaine with Dexmedetomidine versus 0.25% Levobupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block","authors":"Lakshmi Iyer, Shreyas Bhat, H. Nethra, H. Vijayakumar, K. Sudheesh, Ramachandriah","doi":"10.4103/aer.aer_145_21","DOIUrl":"https://doi.org/10.4103/aer.aer_145_21","url":null,"abstract":"Context: Dexmedetomidine, an α2-agonist, has been studied widely as an adjuvant to local anesthetics in regional anesthesia techniques to enhance the quality and duration of analgesia (DOA). It was hypothesized that addition of dexmedetomidine 0.5 ug.kg‒1 to levobupivacaine would prolong the DOA. Aims: We aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor blockade, and duration of analgesia. Settings and Design: This was a prospective randomized double-blind study carried out at a tertiary hospital attached to medical college. Subjects and Methods: Sixty American Society of Anesthesiologists PS Class I and II patients aged between 18 and 60 years of either sex, undergoing elective upper-limb surgery lasting more than 30 min, were included in the study. They were randomly divided into two groups of thirty each to receive ultrasound-guided supraclavicular brachial plexus block. Group L was given nerve block with 20 mL of 0.25% levobupivacaine and 1 mL saline, and Group D received 20 mL of 0.25% levobupivacaine with 0.5 ug.kg‒1 of dexmedetomidine (diluted to volume of 1 mL). Onset time and duration of sensory and motor blockade, time to first rescue analgesia, and hemodynamic parameters were recorded. Statistical Analysis Used: Chi-square test for qualitative variables and Student's unpaired \"t\" test for continuous variables were used for statistical analysis. Results: The onset of sensory and motor blockade was 6.51 ± 0.77 min and 10.71 ± 0.34 min in Group D and 9.9 ± 0.45 and 15.93 ± 1.92 min in Group L, respectively (P < 0.005). DOA was 9.53 ± 0.29 h in Group D and 3.89 ± 0.30 h in Group L (P < 0.001). The duration of sensory and motor block was 9.14 ± 0.19 h and 8.55 ± 0.31 h in Group D and 6.15 ± 3.02 and 5.61 ± 2.98 h in Group L, respectively (P < 0.005). No adverse effects were observed in either of the groups. Conclusions: Addition of 0.5 ug.kg‒1 of dexmedetomidine to 20 mL 0.25% levobupivacaine in ultrasound guided (USG)-guided supraclavicular brachial plexus block shortens the onset time of sensory and motor blockade and prolongs duration of sensory and motor block and DOA.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"1 1","pages":"443 - 447"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79589627","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}
Background and Objectives: Postoperative pain management and early recovery play an important role in the functional outcome following hip surgeries. Recently, pericapsular nerve group (PENG) block has been used as a good alternative for postoperative pain management following hip fracture surgeries. We compared the efficacy of (PENG) block and fascia iliaca compartment block (FICB) as postoperative pain management in hip surgeries. Methods: Forty patients of the age group of 18 years and older of American Society of Anesthesiologists Physical Status Classes I and II scheduled for hip fracture were selected and the patients were randomly allocated into two groups. Group A comprised of 20 patients who received PENG block and Group B comprised of 20 patients who received FICB. 30 mL 0.25% Levobupivacaine and 4 mg dexamethasone was given for both blocks. The following outcomes were measured: Total fentanyl consumption in 24 h, dynamic pain during 2, 6, 10, 14, 18, and 24 h, Visual Analog Pain score during 2, 6, 10, 14, 18, and 24 h, quadriceps femoris muscle strength. Results: Even though there was no significant difference in the duration of analgesia and dynamic pain grades between these blocks, there was notable difference in Visual Analog Pain score and the motor power of quadriceps femoris which indicates the potency of sensory blockade and decrease in motor sparing was significantly seen in PENG block than FICB. Conclusion: The findings of this study suggest that PENG block was more appropriate analgesic modality than FICB in patients undergoing hip surgeries as postoperative analgesic.
{"title":"Comparison of Pericapsular Nerve Group Block versus Fascia Iliaca Compartment Block as Postoperative Pain Management in Hip Fracture Surgeries","authors":"Premvrat Kumar, KS Senthil, Lakshmi Ramakrishnan","doi":"10.4103/aer.aer_119_21","DOIUrl":"https://doi.org/10.4103/aer.aer_119_21","url":null,"abstract":"Background and Objectives: Postoperative pain management and early recovery play an important role in the functional outcome following hip surgeries. Recently, pericapsular nerve group (PENG) block has been used as a good alternative for postoperative pain management following hip fracture surgeries. We compared the efficacy of (PENG) block and fascia iliaca compartment block (FICB) as postoperative pain management in hip surgeries. Methods: Forty patients of the age group of 18 years and older of American Society of Anesthesiologists Physical Status Classes I and II scheduled for hip fracture were selected and the patients were randomly allocated into two groups. Group A comprised of 20 patients who received PENG block and Group B comprised of 20 patients who received FICB. 30 mL 0.25% Levobupivacaine and 4 mg dexamethasone was given for both blocks. The following outcomes were measured: Total fentanyl consumption in 24 h, dynamic pain during 2, 6, 10, 14, 18, and 24 h, Visual Analog Pain score during 2, 6, 10, 14, 18, and 24 h, quadriceps femoris muscle strength. Results: Even though there was no significant difference in the duration of analgesia and dynamic pain grades between these blocks, there was notable difference in Visual Analog Pain score and the motor power of quadriceps femoris which indicates the potency of sensory blockade and decrease in motor sparing was significantly seen in PENG block than FICB. Conclusion: The findings of this study suggest that PENG block was more appropriate analgesic modality than FICB in patients undergoing hip surgeries as postoperative analgesic.","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"1 1","pages":"352 - 356"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88265394","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 : 2021-07-01Epub Date: 2022-02-07DOI: 10.4103/aer.aer_122_21
Pratheeba Natrajan, Ravindra Rahuveera Bhat, R Remadevi, Idhuyya Raajesh Joseph, S Vijayalakshmi, T Deepak Paulose
Background: Fractures in and around the hip are a major concern in young as well as the elderly. Ultrasound-guided (USG) peripheral nerve blocks help in early surgical fixation of these fractures by providing perioperative pain relief as well as early mobilization resulting in reduced morbidity and mortality.
Aims: This study aims to compare the efficacy of USG pericapsular nerve group (PENG) block versus fascia iliaca compartment (FIC) block.
Setting and design: Prospective, randomized, double-blind, controlled study.
Materials and methods: Twenty-four patients above 18 years of age with hip fracture belonging to the American Society of Anaesthesiologists physical status Classes I and II scheduled for hip surgery were randomly allocated into two groups. Group 1(PENG block) received USG-guided PENG block and Group 2 (FIC block) received USG guided FIC block for postoperative pain relief. Postoperative pain relief (at rest) was evaluated by Numeric Rating Scale score from 20th min and at regular interval for 24 h. The total analgesic consumption in the first 24 h was also noted.
Statistical analysis used: Data were analyzed by using nonparametric test and Chi-square test. Hemodynamic variables and pain scores were analyzed using analysis of variance for two groups and independent t-test was used for comparison between two groups.
Results: Postoperative NRS score was higher in FIC block than PENG block which was statistically significant at 1 h (P = 0.035) and at 4 h (P = 0.001). The first requirement of analgesic was significantly late in PENG block group (8.17 ± 3.129) as compared to FIC block group (4.00 ± 1.477).
Conclusions: PENG block provides better postoperative analgesia, with reduced requirement of rescue analgesics in 24 h as compared to FIC block in patients undergoing surgeries for hip fracture under spinal anesthesia.
背景:髋部及其周围骨折是年轻人和老年人的主要关注点。超声引导(USG)周围神经阻滞有助于这些骨折的早期手术固定，提供围手术期疼痛缓解以及早期活动，从而降低发病率和死亡率。目的:本研究旨在比较USG包膜神经组(PENG)阻滞与髂筋膜间室(FIC)阻滞的疗效。环境与设计:前瞻性、随机、双盲、对照研究。材料与方法:选取24例年龄在18岁以上、属于美国麻醉医师学会物理状态I类和II类、拟行髋关节手术的髋部骨折患者，随机分为两组。组1(PENG block)采用USG引导下的PENG block，组2 (FIC block)采用USG引导下的FIC block来缓解术后疼痛。术后(静息时)疼痛缓解从20分钟开始以数值评定量表评分，并定期间隔24小时进行评估。同时记录前24小时的总镇痛消耗。采用统计分析:采用非参数检验和卡方检验对数据进行分析。两组血流动力学变量和疼痛评分采用方差分析，两组间比较采用独立t检验。结果:术后NRS评分在1 h (P = 0.035)和4 h (P = 0.001)时高于PENG组(P = 0.035)。与FIC阻断组(4.00±1.477)相比，PENG阻断组(8.17±3.129)镇痛药的首次需要量明显晚于FIC阻断组(4.00±1.477)。结论:脊柱麻醉下髋部骨折手术患者，与FIC阻滞相比，PENG阻滞提供了更好的术后镇痛效果，24 h内对抢救镇痛药物的需求减少。
{"title":"Comparative Study to Evaluate the Effect of Ultrasound-Guided Pericapsular Nerve Group Block Versus Fascia Iliaca Compartment Block on the Postoperative Analgesic Effect in Patients Undergoing Surgeries for Hip Fracture under Spinal Anesthesia.","authors":"Pratheeba Natrajan, Ravindra Rahuveera Bhat, R Remadevi, Idhuyya Raajesh Joseph, S Vijayalakshmi, T Deepak Paulose","doi":"10.4103/aer.aer_122_21","DOIUrl":"https://doi.org/10.4103/aer.aer_122_21","url":null,"abstract":"<p><strong>Background: </strong>Fractures in and around the hip are a major concern in young as well as the elderly. Ultrasound-guided (USG) peripheral nerve blocks help in early surgical fixation of these fractures by providing perioperative pain relief as well as early mobilization resulting in reduced morbidity and mortality.</p><p><strong>Aims: </strong>This study aims to compare the efficacy of USG pericapsular nerve group (PENG) block versus fascia iliaca compartment (FIC) block.</p><p><strong>Setting and design: </strong>Prospective, randomized, double-blind, controlled study.</p><p><strong>Materials and methods: </strong>Twenty-four patients above 18 years of age with hip fracture belonging to the American Society of Anaesthesiologists physical status Classes I and II scheduled for hip surgery were randomly allocated into two groups. Group 1(PENG block) received USG-guided PENG block and Group 2 (FIC block) received USG guided FIC block for postoperative pain relief. Postoperative pain relief (at rest) was evaluated by Numeric Rating Scale score from 20<sup>th</sup> min and at regular interval for 24 h. The total analgesic consumption in the first 24 h was also noted.</p><p><strong>Statistical analysis used: </strong>Data were analyzed by using nonparametric test and Chi-square test. Hemodynamic variables and pain scores were analyzed using analysis of variance for two groups and independent <i>t</i>-test was used for comparison between two groups.</p><p><strong>Results: </strong>Postoperative NRS score was higher in FIC block than PENG block which was statistically significant at 1 h (<i>P</i> = 0.035) and at 4 h (<i>P</i> = 0.001). The first requirement of analgesic was significantly late in PENG block group (8.17 ± 3.129) as compared to FIC block group (4.00 ± 1.477).</p><p><strong>Conclusions: </strong>PENG block provides better postoperative analgesia, with reduced requirement of rescue analgesics in 24 h as compared to FIC block in patients undergoing surgeries for hip fracture under spinal anesthesia.</p>","PeriodicalId":7798,"journal":{"name":"Anesthesia, Essays and Researches","volume":"15 3","pages":"285-289"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40316969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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