Anesthesia, Essays and Researches最新文献

Background: Cancer patients accept surgeries as part of their treatment. They may not be aware of the possibility of surgical pain persisting long after the surgery. Understanding chronic postsurgical pain is essential for effective pain management.

Aims: We aimed to assess the prevalence of chronic postsurgical pain in cancer patients and the associated symptom burden.

Settings and design: This study was carried out at a tertiary cancer center. It was a cross-sectional study.

Materials and methods: Participants who underwent surgeries were asked to provide feedback on the MD Anderson Symptom Inventory at 3 months.

Statistical analysis used: Descriptive statistics were used. Statistical tests included Kruskal-Wallis test, Chi-square test, Fisher's exact test, and Spearman's correlation. Logistic regression was used to assess the influence of variables on the presence or absence of chronic postsurgical pain.

Results: Nine hundred and eighteen participants completed the study. Ninety-two percent (n = 840) were asymptomatic. Eight percent (n = 78) had postsurgical pain. Chronic postsurgical pain was influenced by the type of surgery (P = 0.01), specifically orthopedic and thoracic surgeries. Patients who receive epidurals are three times less likely to continue to have pain at 3 months.

Conclusions: The prevalence of chronic postsurgical pain at 3 months in this study is lower than the rates in the literature. It is still associated with symptom burden that interferes with daily life. The risk of developing chronic postsurgical pain increases with thoracic and orthopedic surgeries. The risk may be lowered with epidural analgesia.

Introduction: Induction of general anesthesia is often associated with hypotension and is a common scenario faced by anesthesiologists. Intraoperative hypotension can have detrimental effects and cause various adverse effects leading to an extended hospital stay. Patients' preinduction volume status can have an effect on postinduction blood pressure. Ultrasonography is a useful tool for measuring intravascular volume status. We studied the ability of ultrasonographic measurement of subclavian vein (SCV) and inferior vena cava (IVC) diameter, collapsibility index (CI) to predict hypotension after induction of general anesthesia.

Materials and methods: We included 120 patients in our study. SCV measurements during spontaneous and deep inspiration and IVC measurements were taken before induction and postinduction blood pressure was monitored. Patients with mean arterial blood pressure <60 mmHg or with a 30% decrease from baseline were considered to be having hypotension.

Results: The CI of IVC with a cutoff 37% showed sensitivity of 94% and specificity of 84% which was statistically significant. The CI of 36% of SCV during deep breathing was found to have high sensitivity and specificity of 90% and 87%.

Conclusion: Our study in spontaneously breathing preoperative patients shows that SCV CI in deep breathing and IVC CI is very sensitive and reliable in predicting postinduction hypotension. Bedside ultrasound measurements can be easily done to obtain valuable information to recognize patients who could be at risk from postinduction hypotension.

Context: Smartphone use has revolutionized life in all spheres, including the medical field. Smartphones provide immense opportunities but may also lead to negative consequences due to the element of distraction. In the medical profession and more so among anesthesiologists, multitasking has become very common, but the presence of mind is equally important. This study attempts to analyze the smartphone practices and trends among anesthesiologists during work hours in our country.

Aims: The study aimed to identify recent trends and practices of smartphone use among anesthesiologists during working hours and its distribution as per designation and institutions. It also intends to determine the purposes of smartphones and their impact on patient care.

Settings and design: Online survey consisting of open-ended multiple-choice questions was conducted and circulated as Google Forms via E-mail and WhatsApp.

Subjects and methods: This survey was conducted to compare the respondents' views as per designation and workplace distribution. In addition, participants were asked about the current practices in smartphone use at their workplace, purposes of use, time spent on smartphones, and any negative medical consequences faced due to the same.

Statistical analysis used: One-way ANOVA test was used to compare the means between the groups. Chi-square test/Fisher's exact test was used to compare the proportions.

Results: Two hundred and sixteen (54%) were resident doctors, whereas 184 (46%) were consultants. Most of the respondents were young, with a mean age around 36 years. 31.5% of the residents used smartphones very often during anesthetized patient care compared to 10.3% of the consultants. Purposes of using smartphones were multiple, with phone calls (100%) being the most common followed by WhatsApp messaging (79.2%). 86.1% of the residents, as compared to 61% of the consultants, had anesthesia/intensive care unit-related apps on their smartphones. There was almost an equivocal response to how the smartphone has impacted patient care. 50.9% of the residents and 43% of the consultants felt improved patient care, whereas 38% of the residents and 43.5% of the consultants believed it had worsened.

Conclusion: There was no clear-cut consensus whether smartphone use improved or worsened patient care. On the one hand, there can be distractions leading to adverse medical consequences, while on the other hand, the use of medical apps has been made possible because of the handy and easily accessible smartphones. Thus, the use of smartphones may be carried out with a sense of responsibility by the anesthesiologists during work hours.

Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents to provide prolonged analgesia in peripheral nerve blocks. This study aimed at determining the optimal dose of dexmedetomidine, which when combined with ropivacaine will produce a superior quality block in terms of extended pain-free period and reduced perioperative analgesic/opioid use, which in turn improves patient satisfaction.

Objective: The objective of the study is to assess the duration of analgesia with two different doses (25 μg and 50 μg) of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block.

Subjects and methods: This prospective randomized controlled study included 50 patients undergoing upper limb surgeries under supraclavicular brachial plexus block randomly divided into two groups. Group D25 received 29 mL of 0.5% ropivacaine +25 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL); Group D50 received 29 mL of 0.5% ropivacaine +50 μg dexmedetomidine diluted in 1 mL of normal saline (total 30 mL). Onset and duration of sensorimotor block, duration of analgesia, and time interval for the rescue analgesia and hemodynamic stability were observed.

Results: The mean onset of motor and sensory block was significantly higher in the D25 group (P = 0.001). The Visual Analog Scale pain scores and rescue analgesia consumption were significantly lower in the D50 group (P = 0.013, 0.001). The duration of analgesia was significantly higher in the D50 group (P = 0.001).

Conclusion: Dexmedetomidine 50 μg is an effective adjuvant dose to ropivacaine with insignificant hemodynamic changes with better duration of analgesia and lesser pain scores.

Background: Certain anthropometric measurements that are practically obtainable explain the variability in the spread of spinal anesthesia. These are useful for quick assessment of the spread of spinal anesthesia to avoid the risk of high block and also the inadequate level of block.

Aims: The study aims to evaluate the effect of hip/shoulder-width ratio (HSR) on the sensory level of spinal anesthesia.

Settings and design: This prospective observational study was undertaken at a tertiary care hospital.

Statistical analysis: Pearson's correlation and multiple linear regression analyses were used to analyze the relationship between study variables with the level of sensory block.

Materials and methods: One hundred patients undergoing various surgical procedures were enrolled for the study. With a patient in a sitting position, hip-width was measured between the two iliac crests, shoulder-width was measured between two acromion processes, and vertebral column length was noted by measuring the distance from C₇ vertebra to sacral hiatus. 3 mL of 0.5% hyperbaric bupivacaine was administered intrathecally at L₃-L₄ with 25G Quincke's needle in the lateral position. Assessment of block level was done by loss of cold sensation and loss of pinprick sensation every 5 min till 30 min. The numbers of segments blocked were noted from the S₅ segment. The relationship between various factors with the level of sensory block was analyzed by the Pearson's correlation coefficient.

Results: HSR and body mass index (BMI) have a significant correlation with the sensory level of spinal anaesthesia, HSR (r = 0.297, P < 0.05) and BMI (r =0.385, P < 0.05).

Conclusion: HSR can help predict the cephalad spread of spinal anesthesia. We can expect a higher level of sensory blockade of spinal anesthesia in females who generally have an HSR more than one.

Background: Postoperative nausea and vomiting (PONV) are one of the common distressing conditions after anesthesia. The PONV are related to several potential risk factors are patient related, anesthesia related, and surgery related. In surgery-related risk, middle ear surgery is associated with a high incidence of PONV.

Aims: This study aimed to compare the efficiency of palonosetron versus palonosetron with dexamethasone in the prevention of PONV in middle ear surgeries.

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

Statistical analysis: The data were presented as descriptive statistics for continuous variables and percentages for categorical variables and were subjected to Z-test/Chi-square test/Fisher's exact test. The value of P < 0.05 was considered statistically significant.

Results: Demographic parts in comparison to age, duration of surgery, and duration of anesthesia were similar in both the groups. Our study showed that the incidence of PONV during 0-6 h was 38% (n = 19) in Group A and 12% (n = 6) in Group B and the incidence during 6-12 h postoperatively was 14% (n = 7) in Group A and 8% (n = 4) in Group B. During 12-24 h, the incidence was 8% (n = 4) and 6% (n = 3) in Group A and B, respectively. Hence, the difference of total early PONV in Group A was 60% (n = 30) and in Group B, it was 26% (n = 13) which was statistically significant (P < 0.03).

Conclusions: The above result proves that palonosetron and dexamethasone group is superior in the prevention of PONV in middle ear surgery.

Background: Femur fracture causes excruciating pain and surgical repair is recommended. To obtain satisfactory patient co-operation in the perioperative period, various analgesics have been used. Femoral nerve block (FNB) provides an excellent alternative for analgesia in the perioperative period. Dexmedetomidine of up to 2 μg.kg^-1 has been used in FNB as adjuvants in lower limb surgeries.

Aims: The aim was to study the effect of addition of Dexmedetomidine to Bupivacaine in FNB on the comfort of positioning for subarachnoid block (SAB) and postoperative analgesia.

Materials and methods: Prospective, randomized, double-blind design was followed. Seventy American Society of Anesthesiologist I and II patients aged 18-70 years of either gender were randomly allocated into Group B (20 mL 0.25% Bupivacaine + 2 mL Normal Saline) and Group BD (received 20 mL 0.25% Bupivacaine + Dexmedetomidine 2 μg.kg^-1 diluted to 2 mL) for FNB. Numerical rating scale (NRS) was recorded before and after FNB and comfort of positioning graded. After 10 min, subarachnoid block (SAB) was administered. NRS was recorded postoperatively until 24 h.

Results: The comfort of positioning improved in both the groups after FNB but was statistically not significant when compared among the groups (P = 0.7). Duration of postoperative analgesia was significantly higher in the Group BD (741 min ± 97 min) compared to the Group B (440 min ± 45 min) (P = 0.001) and was statistically significant.

Conclusion: FNB improved the comfort of positioning for SAB, but the addition of Dexmedetomidine did not have any added advantages with respect to comfort of positioning. However, the addition of Dexmedetomidine significantly increased the duration of postoperative analgesia with minimal hemodynamic changes.

Background: Numerous unfavorable complications may occur with strabismus surgery as emergency agitation (EA), oculocardiac reflex (OCR), postoperative pain, and postoperative nausea and vomiting (PONV).

Aims: This study was designed to evaluate the dexmedetomidine effect in sub-Tenon's block on EA in strabismus surgery in the pediatric population under sevoflurane anesthesia.

Design: This was a prospective randomized double-blind clinical trial.

Patients and methods: Eighty American Society of Anesthesiologists (ASA) Physical Status Class I and II pediatric patients, in an age group ranging from 2 to 8 years of either sex, had strabismus surgery under sevoflurane anesthesia using laryngeal mask airway. Patients were divided randomly into two groups (each = 40). Sub-Tenon's block is performed in the operated eye with 0.5% bupivacaine (0.08 mL.kg^-1) alone in Group B (bupivacaine group), and with 0.5% bupivacaine (0.08 mL.kg^-1) and dexmedetomidine (0.5 μg.kg^-1) in Group D (dexmedetomidine group). Hemodynamics were monitored, and OCR was recorded. Furthermore, postoperative EA (Pediatric Anesthesia Emergence Delirium and Cravero Scales), pain (Face, Legs, Activity, Cry, and Consolability), and incidence of PONV were recorded as well.

Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 26).

Results: The dexmedetomidine group exhibited a lower EA incidence, pain, and PONV as compared to the bupivacaine group. No statistically significant differences regarding hemodynamics, OCR, or emergence time were found between both the groups.

Conclusion: The addition of dexmedetomidine to bupivacaine in sub-Tenon's block can alleviate postoperative EA and nausea and vomiting with better pain management and hemodynamic stability in pediatric strabismus surgery under sevoflurane anesthesia.

Background: Choosing the correct Endotracheal tube (ETT) size is important in paediatric patients because an inappropriately large and small sized tube has its own disadvantages and chances of re-intubation with different size tube is high. The currently available modalities do not reflect the actual tracheal diameter for selection of endotracheal tube. Ultrasonography (USG) guided evaluation of transverse diameter at subglottic region may be helpful to estimate the proper size of ETT. We tested the hypothesis that Ultrasound guided subglottic diameter better predicts optimal ETT size than existing methods.

Aims: To predict the appropriate size of ETT in pediatric patients to avoid multiple attempts of intubation and airway edema using simple noninvasive USG-guided methods.

Settings and design: Design: Prospective study.

Settings: Tertiary care hospital.

Materials and methods: Institutional ethical committee clearance no. BMCRI/PS/138/2020-21 was taken. Laryngoscopy and endotracheal intubation were done in 27 pediatric patients of age 2-15 years using a predetermined-sized ETT, estimated by ultrasonography. ETT size was considered optimal when the cuff leak test was negative. If there was resistance to ETT passage into the trachea, the tube was exchanged with one that was 0.5 mm smaller. If the cuff leak test was positive, then the ETT was exchanged for one with the 0.5-mm larger tube. The comparison was done between the size of ETT calculated by USG-guided subglottic diameter, age, height-related formulas, and clinical methods to look for accuracy of prediction for proper ETT size after cuff leak test.

Statistical analysis: The data collected were entered into Microsoft Excel and analyzed using SPSS version 22. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Appropriate parametric and nonparametric tests were applied wherever necessary.

Categorical data: Represented in the form of frequencies and proportions. Continuous data: Represented as mean and standard deviation. Paired sample test: Test to identify the mean difference between two quantitative variables. Kappa statistics: To measure the level of agreement.

Results: A total of 27 children of age between 2 and 15 years were selected, out of which 15 were male and 12 were female. The accuracy of predicting appropriate ETT size is greater in ultrasound-guided subglottic diameter when compared to conventional clinical assessment and age- and height-related formula and almost the same accuracy as the clinical method.

Conclusion: Ultrasound-guided subglottic diameter is an easy, effective, and noninvasive way of predicting accurate ETT size in the pediatric population.

Background: Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects.

Aims: We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1-16 years) at T_8-9, T_9-10, and L_1-2 interspaces to identify the safe space for epidural insertion in Asian children.

Settings and design: It was a retrospective study including 141 children aged 1-16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications.

Materials and methods: Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T_8-9, T_9-10, and L_1-2 interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body.

Statistical analysis used: Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages.

Results: The mean DTC distance at T_8-9, T_9-10, and L_1-2 interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35-3.67), 2.73 ± 0.94 mm (95% CI: 2.57-2.89), and 2.83 ± 1.08 mm (95% CI: 2.66-3.02), respectively. A significant difference was found between the genders at T_9-10 (P = 0.02) and L_1-2 levels (P = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T_8-9 showed a significant correlation with age (R ² = 0.0479; P = 0.04), weight (R ² = 0.038; P = 0.02), and height (R ² = 0.037; P = 0.03).

Conclusion: Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T_8-9 level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.