Anesthesia, Essays and Researches最新文献

Background and objectives: The study sought to compare the postoperative analgesia after ultrasonography (USG)-guided bilateral transversus abdominis plane (TAP) block versus quadratus lumborum (QL) 1 block with lower concentration of bupivacaine in patients undergoing lower-segment cesarean section (LSCS).

Materials and methods: A randomized controlled trial was conducted at a tertiary hospital, Bengaluru, from 2019 to 2021. Fifty-six patients belonging to the American Society of Anesthesiologists physical status Class I and II aged 20-40 years posted for LSCS under subarachnoid block were divided into two groups. Patients in Group I were given bilateral TAP block and patients in Group II were given bilateral QL1 block under USG guidance at the end of surgery using 0.125% bupivacaine (20 ml) and 4 mg dexamethasone. Patients were monitored for postoperative pain with Numerical Pain Intensity Scale (NPIS) at 0, 1, 4, 8, 12, and 24 h. Rescue analgesic was given if NPIS score was 6 or more. Time to first dose of rescue analgesic was noted. NPIS scores and time to rescue analgesic were compared using independent t test. P < 5% was considered statistically significant.

Results: Average NPIS scores were less at 0, 1, and 4 h (<6) and higher at 8, 12, and 24 h in both the groups postoperatively. NPIS scores at 8 h were significantly higher in Group I compared to Group II (P = 0.02). Time to first dose of rescue analgesic was 7.32 h in Group I and 9.07 h in Group II (P < 0.001).

Conclusions: Postoperative analgesia was better with USG-guided QL1 block versus USG-guided TAP block with 0.125% bupivacaine and 4 mg dexamethasone in patients undergoing LSCS.

Context: Laparoscopic surgeries involve the creation of pneumoperitoneum, which produces significant hemodynamic changes. Alpha-2 adrenergic receptor agonists like clonidine are used as adjuvants during aesthesia for analgesic, sedative, sympatholytic and cardiovascular stabilizing effects.

Aims: This study aims to assess the efficacy of intravenous (i.v.) clonidine premedication in the prevention of adverse hemodynamic changes during intubation in a patient undergoing laparoscopic surgery in comparison with (normal saline) placebo.

Settings and design: Eighty patients undergoing elective laparoscopic surgery were randomly assigned into two groups to receive either clonidine 3 μg.kg^-1 diluted in normal saline or an equivalent quantity of normal saline administered intravenously 20 min before surgery.

Materials and methods: The primary outcome was to compare the efficacy of clonidine premedication in the prevention of adverse hemodynamic changes during intubation in patients undergoing laparoscopic surgery. Other outcome parameters observed were requirements of induction agents and intraoperative analgesia and postoperative adverse effects.

Statistical analysis used: Analysis of variance has been used to find the significance of study parameters between three or more groups of patients; Chi-square/Fisher exact test has been used to find the significance of study parameters on a categorical scale between two or more groups.

Results: Heart rate reduced significantly after 10 min 3 μg.kg^-1 clonidine administration and the decrease persisted throughout induction and intubation. The fluctuations of systolic, diastolic, and mean arterial pressures were high in the control group when compared with the clonidine group, throughout induction and intubation.

Conclusions: Premedication with i.v. clonidine is a relatively safe and effective method that provides stable hemodynamics and protection against stress responses induced during laryngoscopy and intubation in patients undergoing laparoscopic surgery.

Context: Sore throat is a common complaint to both laryngeal mask airway (LMA) insertion and endotracheal tube intubation. Its incidence in LMA has been found to vary between 5.8% and 34%. Administration of medicated lozenges in the preoperative period is also a route available for the prevention of postoperative sore throat (POST).

Aim: The aim of this double-blinded randomized controlled study was to evaluate the efficacy of turmeric-based lozenges given preoperatively in patients undergoing general anesthesia (GA) under LMA insertion for the prevention of POST.

Settings and design: This study was conducted at the Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Rama Nagar, Dehradun, over a period of 12 months.

Subjects and methods: Two hundred and fifty patients of the American Society of Anesthesiologists classes I and II posted for elective surgeries under GA with insertion of LMA were included in our study. Randomization was done by the sealed envelope technique. Turmeric extract with menthol and eucalyptus oil lozenges was given in Group A (n = 125), while plain turmeric extract with orange flavor lozenges was given in Group B (n = 125) 30 min preoperatively. The patients were assessed for POST in the recovery room post-LMA removal at 30 min, 6 h, 12 h, and 24 h.

Statistical analysis: The data were analyzed using Chi-square test, Fisher's exact test, and Student's t-test. P < 0.05 was considered statistically significant.

Results: The turmeric lozenges containing 6.4 mg eucalyptus oil and 6.3 mg menthol oil along with turmeric extract 100 mg significantly reduced the incidence of POST across all time intervals (P < 0.05) as compared to orange-flavored plain turmeric lozenges containing turmeric extract 100 mg.

Conclusions: POST was reduced with preoperatively administered eucalyptus oil and menthol oil containing turmeric lozenges.

Background: Knee arthroscopic surgery is a commonly performed procedure for diagnosing and treating knee joint problems. This procedure can be achieved under various types of anesthesia, general; or by applying regional anesthesia or even local. Epidural anesthesia and peripheral nerve blockage have been utilized in short procedures and provided a shorter length of hospital stay than general anesthesia in many former articles; however, spinal anesthesia including bupivacaine infusion has also offered a shorter length of hospital stay compared to general anesthesia. While the literature has not compared optimal techniques for these valid options.

Aims: This review was conducted to challenge the hypothesis: What would be of choice for local anesthesia agents (either epidural or spinal anesthesia) that would be comparable to short-acting general anesthesia agents in terms of patient satisfaction and discharge times?!

Setting and design: The review was conducted as a prospective, randomized study. Patients were randomized using a sealed envelope method to be selected to one anesthesia technique (general, epidural, or spinal anesthesia).

Materials and methods: During the period between January 2019 and December 2020, 198 patients underwent unilateral knee joint arthroscopy. Seventy-seven patients refused anesthesia randomization and opted for one option directly. One hundred and twenty-one patients were qualified for the final recruitment stage of this analysis to contribute to the anesthesia randomization and they were assigned into three groups.

Results: Demographical analysis showed no significant differences between cohorts. No major surgical or anesthetic adverse effects were reported. Anesthesia reported satisfactory for incision among three groups. For regional anesthesia cohorts, sphincteric control (voiding) considered a mandatory parameter for discharge, was shorter in the epidural group compared to the spinal anesthesia cohort (154 ± 28 vs. 189 ± 47 min, P < 0.0013). Time to discharge for the three cohorts was also significantly shorter for general anesthesia and epidural cohorts as compared to spinal cohort (general, 106 ± 29 min; epidural, 90 ± 18 min; spinal, 151 ± 48 min, P < 0.003). A total of 114 patients stated that they would select the same anesthetic method over again.

Conclusion: This review revealed that regional epidural anesthesia using 2-chloroprocaine and general anesthesia using short-acting agents were similarly successful in terms of perioperative conditions and duration of hospital stay in our center. Whereas spinal anesthesia using 10 mg of bupivacaine combined with fentanyl in the same setting lacked behind in terms of extended discharge time and showed a higher prevalence of adverse effects.

Background: Clonidine as an adjuvant to local anesthetic for regional anesthesia in upper limb surgeries has been extensively studied in adults, but there is a paucity of data regarding the dose of clonidine which is effective and safe as an adjuvant in children.

Aims: To find the dose of clonidine that prolongs the duration of analgesia without prolonging the side effects.

Settings and design: Prospective, randomized, double-blind study.

Materials and methods: After taking informed consent from the parents/guardian, 42 children aged 3-12 years who were scheduled to undergo unilateral upper limb surgeries below the elbow were randomized into two groups of 21 each. Group A was given 0.5 μg.kg^-1 of clonidine in addition to 0.5 mL.kg^-1 of 0.25% bupivacaine and Group B received 1 μg.kg^-1 of clonidine added to the same volume and concentration of local anesthetic for supraclavicular brachial plexus block under general anesthesia using ultrasound guidance. The drug administration and the recording of the observations were done by an investigator blinded to the dose of clonidine.

Statistical analysis used: Statistical testing was conducted with the Statistical Package for the Social Sciences system version SPSS 17.0.

Results: The demographic parameters and baseline hemodynamic parameters were similar in the two groups. The block failed in one child in Group A. One patient in Group A required tramadol postoperatively while none of the patients in Group B required tramadol. The mean duration of analgesia (11.35 ± 1.54 h vs. 9.94 ± 1.04 h, P < 0.001) and the duration of motor block (8.86 ± 1.0 h vs. 7.77 ± 0.55 h, P < 0.001) were significantly higher in group B. Sedation scores were higher in the recovery room in Group B. Deep sedation, bradycardia, and respiratory depression were not observed in any of the cases.

Conclusions: Clonidine 1 μg.kg^-1 when added as an adjuvant to bupivacaine for pediatric supraclavicular brachial plexus block prolongs the duration of analgesia and motor block as compared to the dose of 0.5 μg.kg^-1. However, this was at the cost of increased duration of motor block and sedation. Considering the clinical equivalence of the effect, a lower dose of clonidine would be preferable to avoid the undesirable effects.

Background: To observe the correlation of central venous oxygen saturation (ScvO₂), serum lactate, standard base excess (SBE), and anion gap (AG) in septic and septic shock patients resuscitated with early goal-directed therapy (EGDT).

Materials and methods: A review was made of 130 severe septic shock patients (15-65 years) according to the consensus conference criteria admitted in intensive care unit. Blood samples were obtained from arterial and central venous line for ScvO_2, serum lactate, SBE, and AG on admission and after achieving all aims of EGDT i.e.; mean arterial pressure >65 mmHg, central venous pressure = 8-12 mmHg, ScvO₂ >70%, and urine output >0.5 mL.kg^-1.h^-1, and on 12 and 24 h. The statistical analysis was done using SPSS for windows version 16 software. For comparison, Pearson test was used. A P < 0.05 was considered as statistically significant.

Results: There were a positive correlation between ScvO₂ and SBE, a negative correlation between ScvO₂ and AG, a negative correlation between ScvO₂ and lactate, a negative correlation between SBE and AG, a negative correlation between AG and lactate, and a negative correlation between SBE and lactate. The ScvO₂ was initially low but was in an improving trend after a resuscitative period, SBE was initially low and correction of SBE was linear. AG was high in the beginning and goes on decreasing after resuscitation. Lactate level was also high initially and in decreasing trend after a resuscitative period.

Conclusions: ScvO₂ and SBE are correlated and can be used as a surrogate marker. ScvO₂ and AG are related but not absolutely codependent. ScvO₂ and lactate are correlated but they are not absolutely codependent. SBE and AG are correlated and can be used as a surrogate marker. AG and lactate are not related to each other. Hence, AG cannot be considered as a surrogate for lactate testing. SBE and lactate are related and can be used as a surrogate marker.

Coarctation of the aorta (CoA) is a congenital heart disease found in a newborn with an incidence of 6%. It presents a significant clinical challenge in neonates posted for major surgeries like tracheoesophageal fistula (TEF) repair. We report the case of anesthetic management of a 2-day-old infant with CoA and duct-dependent circulation posted for TEF repair. We describe how physiology affects its perioperative management and the role of maintaining balance in peripheral vascular resistance and systemic vascular resistance to maintain ductal flow.

Background: Multiple methods have been proposed to prevent the incidence of hypotension in women undergoing cesarean section under spinal anesthesia. This study was conducted to compare the efficacy of phenylephrine (50 μg.min^-1) versus ondansetron (8 mg) in the prevention of such complications.

Patients and methods: We included a total of 184 full-term pregnant women who were randomly divided into two groups: Group P included 92 cases who were commenced on phenylephrine infusion (50 μg.min^-1 given after puncture) and Group O included the other 92 cases who were administered ondansetron (8 mg given 5 min before puncture).

Results: Demographic data were not significantly different between the two groups. Maternal hypotension was significantly more encountered in the ondansetron group (51.6% vs. 22%) and ephedrine was used more significantly in that group (19.8% vs. 8.8%). In addition, nausea and skin flushing were more commonly encountered in the same group. The incidence of vomiting and patient discomfort was not significantly different between the two study groups.

Conclusion: Phenylephrine is markedly superior to ondansetron in the prevention of maternal hypotension and vasopressor need during cesarean section under spinal anesthesia.

Background and aims: Postoperative pain after laparoscopic cholecystectomy is very common complication hindering the early return of routine activity. Since agonist opioids are not easily available, the most common drug used for intraoperative analgesia is intravenous butorphanol in our institute. The purpose of our study is to compare the analgesic effect of intraperitoneal butorphanol and nalbuphine as additives with ropivacaine in laparoscopic cholecystectomy for postoperative pain.

Setting and design: Randomized, double-blind prospective study undertaken after approval from the Institutional Ethics Committee.

Materials and methods: In this study, 90 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: group A received intraperitoneal ropivacaine 0.2% of 20 mL with butorphanol 2 mg; Group B received intraperitoneal ropivacaine 0.2% 20 mL with nalbuphine 10 mg; and Group C received intraperitoneal ropivacaine 0.2% 20 mL with 0.9% normal saline. The primary outcome was to compare the analgesic efficacy of butorphanol with nalbuphine and the duration of postoperative pain relief. The secondary outcomes included the comparison of hemodynamic parameters, frequency of rescue analgesia, and complications among the three groups.

Statistical analysis: The data analysis was carried out with ANOVA and Chi-square test using the SPSS software version 26.0.

Results: The mean of the Numeric Rating Scale pain score was insignificant in Group A versus B at all-time intervals indicating similar efficacy of butorphanol and nalbuphine in terms of pain relief postoperatively. However, the time to first rescue analgesia was significantly higher in Group A (5.70 ± 3.57 h), followed by Group B (3.95 ± 2.06 h) and Group C (2.50 ± 1.24 h).

Conclusion: Butorphanol is better analgesic than nalbuphine as postoperative pain-free period was relatively more with lesser complications.

Liver resection is a major abdominal surgical procedure with its associated complications. A multidisciplinary team approach with appropriate preoperative planning is of utmost importance. The four cases managed successfully under general anaesthesia in a tertiary government hospital put forth a protocol based management for better outcome. The case series help to find out the perioperative anaesthetic challenges in management of liver resection. A 27-years old female and 40-years old male patients were admitted to a tertiary government hospital with diagnosis of hepatocellular malignancy and a 56-years old male and 52-years old female patients with gall bladder malignancy with liver metastases were admitted in the hospital for definitive cure. All patients were posted for tumour resection under general anaesthesia. This case series highlights the optimum preoperative preparation, optimization and discussion of perioperative concerns and anaesthesia management and importance of total intravenous anaesthesia. Role of protocol-based anaesthetic management and knowledge about surgical techniques for minimization of blood loss may decrease morbidity and mortality in liver resection surgery.