Anesthesia, Essays and Researches最新文献

Background and aims: Transversus abdominis plane (TAP) block has been used to provide analgesia in renal transplant surgery with varying results. This study was designed to assess if the addition of clonidine in TAP block would decrease 24-h postoperative morphine consumption in adult renal transplant recipients.

Materials and methods: Forty adult patients undergoing renal transplantation under general anesthesia in a tertiary care hospital were randomized into either group RC (TAP block with 20 mL of 0.5% ropivacaine plus 2 μg.kg^-1 clonidine) or group R (TAP block with 20 mL 0.5% ropivacaine) after induction of anesthesia. Postoperative analgesia was provided using patient-controlled morphine. The primary outcome was 24-h patient-controlled morphine consumption. The secondary outcomes were a) intraoperative hemodynamics, b) fentanyl and ephedrine requirement, c) postoperative pain using the Visual Analog Scale at 0, 2, 6, 12 and 24 hours, d) time to first postoperative analgesia, e) postoperative hemodynamics, and f) side effects.

Results: There was no significant difference in postoperative morphine consumption between the groups (25 mg in group RC vs. 28.5 mg in group R) (median interquartile range) (P = 0.439). Postoperative pain scores were comparable between the groups. Intraoperatively, fewer patients required rescue fentanyl in group RC (7 patients) as compared to group R (17 patients) (P = 0.003). Significantly more patients in group RC required ephedrine boluses as compared to group R (9 patients in group RC vs. 2 in group R, P = 0.014).

Conclusions: The addition of 2 μg.kg^-1 clonidine to ropivacaine in TAP block did not reduce 24-h postoperative morphine consumption after renal transplantation. It reduced the need for intraoperative analgesics but increased the need for intraoperative ephedrine administration.

Background: The occurrence of postoperative pulmonary complications (PPCs) and other sequelae of COVID-19 infections like thromboembolic events in patients coming for surgery following COVID-19 infection in the Indian population had not been adequately studied.

Aim of the study: We evaluated the incidence of PPCs, acute kidney injury, and thromboembolic complications such as pulmonary embolism, deep-vein thrombosis, myocardial infarction, stroke, and 30-day mortality rate in post-COVID-19 patients undergoing surgery compared to those without a history of COVID-19 infection.

Settings and design: It was a retrospective, observational, case-control study conducted in a tertiary care center.

Materials and methods: One hundred and sixty-six post-COVID-19 surgical patients were included. A matched control group (n = 166) was formed by choosing patients with no history of COVID-19 who underwent similar surgical procedures under a similar technique of anesthesia. Their medical records were analyzed for the development of postoperative pulmonary and nonpulmonary complications and 30-day mortality.

Statistical analysis used: Independent samples t-test and Chi-squared test were used for statistical analysis.

Results: The mean age of patients in the control group was significantly higher than those in the post-COVID-19 group. The number of patients who received two doses of vaccine was also significantly higher in the control group. Comparison of the distribution of preexisting medical conditions and postoperative complications, duration of hospital stay, and incidence of 30-day mortality did not show any significant difference in both groups.

Conclusion: Incidence of postoperative complications, length of hospital stay, and 30-day mortality in post-COVID-19 patients undergoing surgical procedures were comparable with patients with no history of COVID-19 infection.

Background: Children with cleft palate are usually operated on before 18 months of age. Cleft palate surgery demands stable hemodynamic parameters, a bloodless surgical field, and an awake and pain-free child after surgery.

Aims: We aimed to study the anesthesia technique using buprenorphine and propofol for cleft palate surgery.

Settings and design: The design involves prospective observational study. The study was conducted at a tertiary care hospital.

Materials and methods: After the Institutional Ethics Committee approval, 42 patients aged 6 months to 12 years undergoing cleft palate surgery were enrolled. Anesthesia induction commenced with sevoflurane or propofol 3 mg.kg^-1. After intubation, buprenorphine 3 μg.kg^-1 was given, and propofol infusion was started at 2-8 mg.kg^-1.h^-1. Hemodynamic parameters, awakening time, and surgeon's satisfaction score were noted. After extubation, pain score, emergence agitation (EA) score, sedation score, recovery score, and adverse events were noted.

Statistical analysis: All statistical analyses were performed using the 20.0 version of the Statistical Package for the Social Science (SPSS) software program. Continuous data were summarized as mean and standard deviation, and were analyzed using a two-sided Student's unpaired t-test. Categorical data were represented using frequencies and proportions.

Results: The single dose of buprenorphine with propofol infusion started immediately postintubation causes a significant decrease in heart rate after 1 h. This contributed to a favorable operative field, increasing the surgeon's satisfaction score. In the recovery room, patients were essentially pain-free till 2.5 h after surgery, with only one patient requiring rescue analgesia. Furthermore, 90% of patients showed a smooth and calm recovery with no EA. The Steward's recovery score remained high throughout without any complication.

Conclusions: In cleft palate surgeries, a single-dose buprenorphine 3 μg.kg^-1 and propofol maintenance infusion 2-8 mg.kg^-1.h^-1 were effective in maintaining hemodynamic parameters and a bloodless surgical field and managing postoperative pain with a good recovery profile.

Background: Neuraxial anesthesia in obstetrics began with the spinal block by Oskar Kreis in 1900. The technique of subarachnoid blockade has been refined since then and various drugs have been used to provide analgesia and anesthesia for infraumbilical surgeries.

Materials and methods: This study was conducted because of newer options available, such as an intrathecal drug with appropriate sensory and motor blockade and minimal haemodynamic changes that can be used in the lower segment cesarean section safely. Ninety patients were randomly divided into three groups including 30 patients in each group. Group B, Group L, and Group R, each receiving 2.2 mL of 0.5% hyperbaric bupivacaine, 0.5% isobaric levobupivacaine, and 0.5% isobaric ropivacaine, respectively. All groups were compared concerning sensory block, motor block, hemodynamic stability, and complications if any.

Results: The onset of sensory block at T₈, two-segment regression time from the highest block, time of regression to L₁, total duration of analgesia, onset and total duration of motor block were comparable between Group B and L (P > 0.05), but both these groups were statistically significant with Group R (P < 0.05). Hypotension was observed among all the groups; however, the incidence was minimum in Group R.

Conclusion: 12 mg of isobaric ropivacaine and 12 mg of isobaric levobupivacaine, compared to 12 mg hyperbaric bupivacaine (2.2 mL of 0.5% each), when administered intrathecally provides adequate anesthesia for cesarean section. The lesser duration of motor block in ropivacaine compared to the other two drugs could be beneficial for early ambulation, also the incidence of hypotension was lower in Group R.

Background and aim: The COVID pandemic necessitated the use of masks to reduce the propagation of coronavirus by airborne transmission. This research was conducted in healthy volunteers to assess the changes in noninvasive measurable physiological variables over 45 min at rest.

Methods: This was a prospective randomized controlled crossover trial. Twenty-one healthy volunteers were monitored for pulse rate (PR), peripheral oxygen saturation (SpO₂), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), inspired carbon dioxide and expired carbon dioxide (ECO₂), inspired (FiO₂) and expired oxygen (FeO₂), every 15 min for 45 minute (min) with N95 respirator, N95 respirator with surgical mask (SM), N95 with SM and visor (V), SM with N95, and N95 respirator with visor.

Results: Repeated measures analysis of variance (ANOVA) of PR, RR, SpO₂, SBP, and DBP over time within the group and intragroup was calculated and found statistically insignificant. P value for comparison of mean value within the group was calculated by paired t-test with Bonferroni correction. There was a significant rise in ECO₂ in the N95 group over time, and repeated measures ANOVA showed P = 0.04 at 30 min between the N95 + V group and the N95 + SM + V group. Inspired CO₂ was statistically significant over time in the N95 + SM + V with P = 0.02.

Conclusion: N95 alone or in combination with a SM and visor does not cause any clinically significant measurable physiological derangements. The inspired CO₂ may be implicated in the symptoms manifested by individuals.

Context: Music is ubiquitous and found in all cultures; it elicits both physiological and psychological responses in its listener. It has been proven that music reduces perception of pain and dosages of anesthetics and sedatives used during surgery.

Aims: To study the effect spiritual music on perioperative anxiety and hemodynamic parameters in elderly patients undergoing procedures under spinal anesthesia.

Settings and design: A prospective, randomized controlled study.

Subjects and methods: Eighty patients fulfilling inclusion criteria were enrolled and randomly divided in two equal groups. Patients were transferred to the operation theater with the spiritual music still being played in Group I, while no music was played in Group C. Under aseptic precautions, neuraxial blockade was performed at L3/L4 interspace. Music was played throughout the surgery in Group I. Intraoperative visual analog scale for anxiety (VASA) was recorded. At the end of the surgery, spiritual music was stopped. The study parameters were recorded.

Statistical analysis used: A significant difference in the proportions of male and female candidates between the two groups was calculated using Chi-squared test. Significant differences in the mean VASA scores and blood pressures (systolic blood pressure [SBP] and diastolic blood pressure [DBP]) between the two groups were calculated using Student's t-test.

Results: No significant difference was observed between preoperative VASA score (P = 0.29) of both the groups, whereas a significant difference was present in intraoperative (P < 0.01) and postoperative VASA score (P < 0.01) of both the groups. In Group I, requirement for sedative was significantly lower (P < 0.01). Heart rate in Group I was on lower side, suggesting decrease in anxiety. No significant difference was observed in SBP or DBP of the patients of both the groups.

Conclusions: Spiritual music can act as a noninvasive, simple, and inexpensive intervention for elderly patients to alleviate perioperative anxiety. It can also reduce the need for sedatives intraoperatively, thereby lowering the risk of side effects.

Low back pain generally involves lumbosacral radicular syndrome, nerve root pain, and nerve root entrapment/irritation. Management options for patients are variable and diverging. To the highlight the efficacy of combined early decompressive surgery plus intraoperative steroid injections in terms of postoperative back pain in patients managed by our combined team. A prospective study conducted by reviewing all consecutive patients managed, over a 1-year period (2018-2019). This study showed that adjunct use of intraoperative foraminal and epidural steroids injections to treat back pain in patients with degenerative spine disease could significantly improve the pain score which leads to significant decrease in working days off and the need for pain killer medications or even obviating the usage rate.

Background: In peripheral nerve blocks, magnesium sulfate is an excellent adjuvant to local anesthetics. The use of magnesium sulfate as an adjuvant in wound infiltration for postoperative analgesia needs to be investigated.

Aims: This study was conducted to evaluate the analgesic efficacy of magnesium sulfate as an adjuvant when added to bupivacaine in wound infiltration technique in perianal surgeries.

Settings and design: This was a prospective, randomized, double-blind study.

Materials and methods: Sixty patients undergoing perianal surgeries were randomly divided into two groups, Group M and Group C. Following perianal surgery, Group M patients received a local wound infiltration of injection magnesium sulfate 750 mg (1.5 mL of injection 50% magnesium sulfate) added to 0.5% bupivacaine 13.5 mL making a total volume of 15 mL, whereas Group C patients received a local wound infiltration of injection 0.5% bupivacaine 13.5 mL and 1.5 mL normal saline. Postoperative vitals and pain scores were assessed.

Statistical analysis used: Student's t-test for normally distributed continuous data, Mann-Whitney U-test for ordinal data, and Chi-square test or Fisher's exact test, whichever is appropriate for categorical data, were used.

Results: The magnesium sulfate group had a lower postoperative pain score, a longer duration of postoperative analgesia, and a lesser number of rescue analgesic doses in the first 24 h.

Conclusion: We conclude that magnesium sulfate is an effective adjuvant to bupivacaine for wound infiltration in terms of postoperative analgesia quality and duration following perianal surgeries.

Background: Fractures of the clavicle are usually operated under general anesthesia (GA) as they need dense anesthesia, and the airway is difficult to access intraoperatively. There is no established regional anesthesia (RA) technique for clavicular fractures, also as the innervation is contentious. Some studies have been done using RA techniques, but they are all small case numbers. RA is superior to GA in many ways, and we wished to avoid GA specifically during the COVID-19 pandemic.

Aims: This study aimed to use a peripheral nerve stimulator and a landmark-based technique to give interscalene block (ISB) and superficial cervical plexus block (SCPB) as a sole anesthetic for clavicular fracture surgeries during the COVID-19 pandemic.

Settings and design: This was a prospective observational study in a tertiary care teaching hospital in eastern India.

Materials and methods: After approval from our ethics committee and informed consent, thirty patients of American Society of Anesthesiologists Class I or II, aged 18-65 years, after exclusion criteria were selected who had to undergo clavicular surgery. Three 10-mL syringes were made, each with 5 mL of 0.75% ropivacaine, 2 mL of 2% lignocaine with 1:200,000 adrenaline, and 3 mL of saline. Using the HNS Stimuplex (B. Braun Melsungen AG, Melsungen, Germany) nerve stimulator, 20 mL was given for an ISB and 5 mL for the SCPB. RA was considered successful if there was no conversion to GA and surgery could be performed.

Results: With an onset time of 6.53 ± 2.17 min, good operating conditions were obtained in all our patients. Horner's syndrome was noted in two patients. Surgery was successfully carried out in all thirty patients under RA. Pain relief lasted postoperatively for 5 ± 0.92 h.

Conclusion: ISB combined with SCPB is safe and effective as a sole anesthetic for clavicular surgery. We successfully avoided the use of a general anesthetic in these patients during the COVID-19 pandemic and gave them a safe and effective alternative.

Background: The incidence of difficult tracheal intubation includes not only difficult and failed intubation but also difficult laryngoscopy (DL) and difficult mask ventilation.

Aim: The study was done to compare the sonographic assessment of tongue thickness (TT) and condylar mobility with traditional airway assessment scores for prediction of difficult intubation (DI).

Settings and design: This experimental, randomized prospective study was conducted in the Department of Anaesthesia, Himalayan Institute of Medical Sciences, Dehradun.

Materials and methods: After obtaining approval from the Institutional Ethical and Research Committee, this study was conducted in the Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun. After obtaining written and informed consent, 385 subjects of either sex between 18 and 60 years of age, undergoing various elective surgeries under general anesthesia with endotracheal intubation, were selected. The number of attempts at intubation, the need for alternative DI approaches, and invasive airway access or cancellation of the procedure due to inability to secure the airway were noted.

Statistical analysis used: Data analysis was done using SPSS 20.0. Categorical data were assessed by Chi-square test, while independent t-test/Mann-Whitney test was used to determine the association between continuous data.

Results: Age, inter-incisor distance (IID), body mass index (BMI), and Mallampati score were positively correlated with TT. BMI (kg.m^-2) >26.0, modified Mallampati scoring >2, IID ≤5 cm, TT >6 cm, and condylar mobility >10 mm were significantly more among subjects with DL and difficult tracheal intubation.

Conclusion: Ultrasonography can be used in elective settings to rule out any possibility of difficult airway and to prevent airway-related complications.