Indian Journal of Anaesthesia最新文献

{"title":"Efficacy of endotracheal tube cuff lignocaine in the prevention of postextubation cough in children undergoing elective surgeries – A randomised controlled trial","authors":"M. B. Kavyashree, Pankaj Kundra, S. Vinayagam","doi":"10.4103/ija.ija_1013_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1013_23","url":null,"abstract":"\u0000 \u0000 Postextubation airway complications are more common in paediatric patients than in adults. Intravenous lignocaine effectively prevents extubation response; however, data on using intracuff lignocaine in microcuff endotracheal tubes is scarce. The primary aim of this study was to compare the incidence of postextubation cough between intracuff lignocaine and intracuff air in the paediatric population during tracheal extubation.\u0000 \u0000 \u0000 \u0000 This randomised controlled study was conducted in 120 paediatric patients aged 1 month to 12 years who were scheduled to undergo surgeries under general anaesthesia. They were randomised to Group C (intracuff air) and Group L (intracuff 2% lignocaine). After administering general anaesthesia, the airway was secured with an age-appropriate microcuff endotracheal tube. According to groups, the cuff was inflated with air or lignocaine to achieve a cuff pressure of 10 cm H2O. Incidences of cough, desaturation, laryngospasm, apnoea and haemodynamic changes were recorded after tracheal extubation. Categorical variables were compared using the Chi-square or Fisher’s exact test, and continuous variables were compared using the Student’s t-test or Mann–Whitney U test. Intergroup differences between the variables were analysed by a two-way repeated measure analysis of variance.\u0000 \u0000 \u0000 \u0000 The incidence of postextubation cough was significantly higher in Group C [17 (28.3%) (confidence interval {CI} = 17.4–41.4)] when compared to Group L [8 (13.3%) (CI = 5.9–24.6)], with P = 0.043. One patient in Group C had laryngospasm compared to none in Group L. In Group C, there was also a significant increase in heart rate at all time points (1–5 min after extubation) from the baseline, and this increase was also significantly higher when compared to Group L (P < 0.05).\u0000 \u0000 \u0000 \u0000 The incidence of postextubation cough was significantly lower with intracuff lignocaine compared to that with intracuff air in paediatric patients.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709848","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}

{"title":"Inadvertent administration of intravenous anaesthesia induction agents via the intracerebroventricular, neuraxial or peripheral nerve route – A narrative review","authors":"Santosh Patel","doi":"10.4103/ija.ija_1276_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1276_23","url":null,"abstract":"Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high-risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration.","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709841","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}

{"title":"Effect of ultrasound-guided quadratus lumborum block on neuroendocrine stress response and postoperative analgesia in paediatric patients undergoing elective open pyeloplasty – A randomised clinical trial","authors":"P. Rathod, D. Bhoi, Ajeet Kumar, Bikash Ranjan Ray, V. Mohan, L. Kashyap","doi":"10.4103/ija.ija_608_23","DOIUrl":"https://doi.org/10.4103/ija.ija_608_23","url":null,"abstract":"\u0000 \u0000 Quadratus lumborum block (QLB) is a compartmental block of the anterior abdominal wall. Surgical trauma produces neuroendocrine surgical stress responses, which are modified by anaesthetic blocks. The aim of this study was to evaluate the effect of ultrasound (US)-guided QLB on analgesia and surgical neuroendocrine stress response in paediatric patients undergoing pyeloplasty.\u0000 \u0000 \u0000 \u0000 A randomised trial was conducted in 60 children aged 1–7 years undergoing elective open pyeloplasty. Patients were randomised into Group QLB [US-guided QLB with 0.5 ml/kg of 0.25% ropivacaine after induction of general anaesthesia (GA)], and Group GA, which received only GA. Perioperative haemodynamic parameters, serum cortisol, blood glucose, analgesic consumption and postoperative FLACC scores were recorded. Unpaired t-test, Wilcoxon rank-sum test or Mann–Whitney U test was used to compare variables between the two groups. Two-way analysis of variance or the Friedmann test was used to compare quantitative variables at various points within a group.\u0000 \u0000 \u0000 \u0000 A decrease in serum cortisol and blood glucose values was observed in Group QLB at 30 min after surgical incision and 24 h after surgery compared to the preoperative value and compared to Group GA (P < 0.05). The quality of analgesia assessed by the FLACC scale was significantly better in group QLB. Dose of fentanyl consumption (µg/kg) was higher in Group GA compared to Group QLB in the intraoperative and postoperative period (P < 0.05).\u0000 \u0000 \u0000 \u0000 QLB is effective as part of multimodal analgesia and attenuates the neuroendocrine stress in paediatric patients undergoing open pyeloplasty.\u0000","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710057","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}

{"title":"External oblique intercostal plane block: Anatomical landmark-guided technique!","authors":"Tuhin Mistry, Santosh K. Sharma, Kartik B. Sonawane","doi":"10.4103/ija.ija_172_24","DOIUrl":"https://doi.org/10.4103/ija.ija_172_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711117","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}

{"title":"Bispectral index-guided comparison of dexmedetomidine and fentanyl as an adjuvant with propofol to achieve an adequate depth for endotracheal intubation - A double-blind randomised controlled trial.","authors":"Annu Choudhary, Swati Singh, Swati Singh, Faseehullah Alam, Harsh Kumar","doi":"10.4103/ija.ija_884_23","DOIUrl":"https://doi.org/10.4103/ija.ija_884_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Laryngoscopy and tracheal intubation require an adequate depth of anaesthesia. The study's primary objective was to compare the time needed to achieve the bispectral index (BIS)-guided adequate depth of anaesthesia for endotracheal intubation using fentanyl and dexmedetomidine.</p><p><strong>Methods: </strong>After institutional ethics committee clearance and written informed consent, this randomised study was conducted on 140 patients of either gender between 18 and 60 years who were scheduled for elective surgeries under general anaesthesia. Patients were randomised to intravenous dexmedetomidine 1 μg/kg (Group D) or fentanyl 2 μg/kg (Group F). The drugs were given as an intravenous infusion over 10 min before induction of anaesthesia. The primary outcome was the time required to achieve BIS 50. Normally distributed variables were compared using Student's <i>t-</i>test, and non-normally distributed variables were compared using the Mann-Whitney U test. Qualitative data were analysed using Chi-square/Fisher's exact test. A <i>P</i> value <0.05 was considered significant.</p><p><strong>Results: </strong>The time to achieve BIS 50 was lesser in Group F, 1546 (27) as compared to Group D, 1558 (11) s [mean difference (95% confidence interval (CI) 12[5.11, 18.89]), <i>P</i> < 0.001]. Haemodynamic parameters were comparable at all time points between both the groups, except heart rate, which was significantly lower. Propofol consumption was significantly less in group D than in group F [125.9 (25.36) versus 157.3 (42.80) mg, respectively, mean difference (95% CI) 31.4 (-44.16 to -20.63) <i>P</i> < 0.001)].</p><p><strong>Conclusion: </strong>Dexmedetomidine achieves BIS 50 faster and has a propofol-sparing effect as compared to fentanyl.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10993930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858829","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}

{"title":"Re-evaluating the level of evidence in research: Incorporating trial sequential analysis and fragility index.","authors":"Nitinkumar B Borkar, Abhijit Nair, Shilpa Meshram, Tridip D Baruah","doi":"10.4103/ija.ija_35_24","DOIUrl":"https://doi.org/10.4103/ija.ija_35_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10993941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858314","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}

{"title":"Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial.","authors":"Priyanka Sangadala, Praveen Talawar, Debendra K Tripathy, Ashutosh Kaushal, Amit Gupta, Nirjhar Raj","doi":"10.4103/ija.ija_729_23","DOIUrl":"10.4103/ija.ija_729_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in 'opioid-free' and 'opioid-based' TCSA.</p><p><strong>Methods: </strong>After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into 'opioid-free' (bupivacaine alone) and 'opioid-based' (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02-0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2-0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student <i>t</i>-test, Mann-Whitney and Fisher's exact tests.</p><p><strong>Results: </strong>The 'opioid-based' group performed significantly better compared with the 'opioid-free' group concerning pain scores at rest at 0 h (<i>P</i> = 0.023), 18 h (<i>P</i> = 0.023) and 24 h (<i>P</i> = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (<i>P</i> = 0.012) and maintenance (<i>P</i> = 0.031)], postoperative rescue fentanyl requirement (<i>P</i> = 0.018) and patient satisfaction (<i>P</i> = 0.032) at the cost of increased postoperative nausea and vomiting (<i>P</i> = 0.049).</p><p><strong>Conclusion: </strong>The 'opioid-based' TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the 'opioid-free' group in patients undergoing major abdominal surgery.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109880","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}

{"title":"Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study.","authors":"Ahmad Samir Alabd, Moustafa Abdelaziz Moustafa, Aly Mahmoud Moustafa Ahmed","doi":"10.4103/ija.ija_936_23","DOIUrl":"10.4103/ija.ija_936_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Motor-sparing analgesia after total knee arthroplasty (TKA) is crucial. The primary endpoint was the postoperative visual analogue scale (VAS) score after triple injection peri-sartorius (TIPS) block after TKA. Secondary endpoints were postoperative morphine consumption, 24-h postoperative ambulation distances and the degrees of active knee extension.</p><p><strong>Methods: </strong>After general anaesthesia or spinal anaesthesia administration and before surgical incision, 80 patients undergoing TKA were randomised into group TIPS (received ultrasound-guided TIPS block where 40 ml 0.25% bupivacaine and 4 mg dexamethasone were injected: 10 ml at the distal femoral triangle, 10 ml above the sartorius and 20 ml at the distal adductor canal) and group FNB (femoral nerve block; received ultrasound-guided FNB with 20 ml 0.25% bupivacaine mixed with 4 mg dexamethasone). Postoperative pain score was noted and compared.</p><p><strong>Results: </strong>Dynamic VAS scores were lower in the TIPS group than in FNB, while the resting VAS scores were not significantly different. Mean (standard deviation [SD]) postoperative morphine consumption was 5.82 (2.47) mg in the TIPS group (95% confidence interval [CI] 5.03,6.61) versus 9.87 (2.99) mg in the FNB group (95% CI 8.91,10.83). Ambulation distances and active postoperative knee extension in the TIPS group showed greater significance than in the FNB group (TIPS: 18.0 [7.37] m, 95% CI 15.64,20.35] vs. FNB: 8.95 [5.93] m, 95% CI 7.05,10.84) and (TIPS: 52.12 [16.39], 95% CI 46.88,57.33 vs. FNB: 26.05 [11.10], 95% CI 22.501,29.59). Nausea was more evident in FNB patients.</p><p><strong>Conclusion: </strong>TIPS block provides superior analgesia than FNB with motor sparing of the quadriceps after TKA.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109947","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}

{"title":"A modified technique of subclavian vein catheterisation: Remembering Sedillot.","authors":"Meenakshi Kumar, Kanika Rustagi","doi":"10.4103/ija.ija_808_23","DOIUrl":"10.4103/ija.ija_808_23","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109874","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}

{"title":"Arena of scoring systems in research and clinical practice.","authors":"Rakesh Garg","doi":"10.4103/ija.ija_150_24","DOIUrl":"https://doi.org/10.4103/ija.ija_150_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109875","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}