Indian Journal of Anaesthesia最新文献

{"title":"Adductor canal block (ACB) plus infiltration of the posterior capsule of the knee (iPACK) block versus 4-in-1 block in an arthroscopic anterior cruciate ligament (ACL) repair: A randomised study.","authors":"Ritesh Roy, Gaurav Agarwal, Priyanka Ahuja, Ankita Mohta","doi":"10.4103/ija.ija_671_24","DOIUrl":"10.4103/ija.ija_671_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Anterior cruciate ligament (ACL) repair is a common sports-related surgery requiring early rehabilitation. Injection between the popliteal artery and the capsule of the knee (iPACK) provides analgesia to the posterior knee and, when combined with adductor canal block (ACB), can provide complete analgesia for knee surgery. A 4-in-1 block, a single injection, has been studied for analgesia in TKR but not ACL repair. This study was done with the objective of comparing the postoperative analgesia of iPACK + ACB versus 4-in-1 block in ACL repair.</p><p><strong>Methods: </strong>The study was conducted on 184 participants undergoing ACL repair in the age group of 18-70 years. Patients were randomly allocated to iPACK +ACB or 4-in-1 block. After the preoperative and intraoperative protocol, a guided nerve block was performed. The duration of motor blockade of spinal anaesthesia and pain scores were monitored using the visual analogue scale (VAS), and the time for first rescue analgesia was noted at 3, 6, 12, 24, and 36 hours. An independent sample <i>t</i>-test was used to find the association of all quantitative variables, and a Chi-square test was used to find the association of categorical variables with both groups of patients (<i>P</i> < 0.05).</p><p><strong>Results: </strong>VAS scores were statistically similar between the two groups at 3, 6, 12, and 24 hours but were significantly less at 36 hours in group B (<i>P</i> < 0.001). The time to perform the regional block was lower in group B, a single injection technique (<i>P</i> < 0.001). None of the patients showed muscle weakness in the postoperative period and could cooperate reasonably with physiotherapy.</p><p><strong>Conclusion: </strong>The 4-in-1 block provides non-inferior analgesia compared to the established iPACK plus ACB for arthroscopic ACL surgery.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 11","pages":"959-964"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806914","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 target concentration of propofol during three phases of live donor liver transplant surgery using a target-controlled infusion of propofol total intravenous anaesthesia - A prospective, observational pilot study.","authors":"Neha Garg, Yatin Kalra, Shivali Panwar, Mahesh K Arora, Udit Dhingra","doi":"10.4103/ija.ija_535_24","DOIUrl":"10.4103/ija.ija_535_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Three phases (dissection, anhepatic, and neohepatic) exist for propofol pharmacokinetics during liver transplantation (LT), resulting in varying cardiac output, volume of distribution, and drug metabolism. The primary objective was to compare the mean target concentration of propofol required to maintain the bispectral index (BIS) between 40 and 60 during three phases of LT by using a target-controlled infusion of total intravenous anaesthesia (TCI-TIVA).</p><p><strong>Methods: </strong>In this prospective, observational study, 20 adult patients diagnosed with chronic liver disease scheduled for live-donor LT were included. After anaesthesia induction and tracheal intubation, BIS-guided propofol infusion was started using TCI-TIVA with target plasma concentration (TPC) set initially at 2.5 μg/mL in all patients using the Marsh model. The TPC was decreased or increased by 0.2 μg/mL whenever the BIS values were persistently below 40 or above 60 for 15 minutes. Data were analysed using ANOVA and repeated measure ANOVA, followed by a post-hoc test.</p><p><strong>Results: </strong>The mean TPC was significantly higher during dissection [2.12 (Standard deviation (SD): 0.63 μg/mL)] as compared to anhepatic and neohepatic phases [1.29 (SD: 0.65) μg/mL and 1.35 (SD: 0.54) μg/mL], respectively (<i>P</i> < 0.001). A significant difference was observed between dissection and anhepatic (mean difference: -0.87 (95% confidence interval (CI): -0.98, -0.75) or dissection and neohepatic phase (mean difference: -0.77 (95% CI: -1.02, -0.53). The propofol dose was significantly higher in dissection compared to the anhepatic and neohepatic phases (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The propofol's mean TPC when using TCI-TIVA decreased in the anhepatic and neohepatic phases to 61% and 63.7% of the dissection phase, respectively.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 11","pages":"971-977"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806896","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":"Hypotension prediction index for minimising intraoperative hypotension: A systematic review and meta-analysis of randomised controlled trials.","authors":"Kamath Sriganesh, Thomas Francis, Rajeeb Kumar Mishra, Nisarga N Prasad, Dhritiman Chakrabarti","doi":"10.4103/ija.ija_677_24","DOIUrl":"10.4103/ija.ija_677_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Reports on the utility of the hypotension prediction index (HPI) in reducing the occurrence of intraoperative hypotension are conflicting. Therefore, the aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the overall effect of using HPI on intraoperative hypotension outcomes of time-weighted average (TWA), area under the hypotension threshold (AUHT), incidence and duration of hypotension.</p><p><strong>Methods: </strong>We searched the electronic databases of PubMed, ProQuest and Scopus from inception till 30 October 2023. The search strategy was refined for each database. No time or language restrictions were applied. Only RCTs were included. The systematic review protocol is registered with PROSPERO (ID: CRD42023478150). Statistical analysis was performed using Review Manager Software.</p><p><strong>Results: </strong>Of 281 records, eight eligible RCTs (613 patients) were included. Significant differences were found between HPI and no HPI groups for the TWA of hypotension during surgery [mean difference (MD) = -0.19 mmHg, 95% confidence interval (95% CI): -0.31, -0.08, <i>P</i> = 0.001], AUHT [MD = -65.03 (mmHg × min), 95% CI: -105.47, -24.59, <i>P</i> = 0.002], incidence of hypotension (risk ratio = 0.83, 95% CI: 0.7, 0.99, <i>P</i> = 0.04), total hypotension duration (MD = -12.07 min, 95% CI: -17.49, -6.66, <i>P</i> < 0.001) and hypotension duration as a percentage of surgery time (MD = -6.30%, 95% CI: -10.23, -2.38, <i>P</i> = 0.002).</p><p><strong>Conclusions: </strong>Available evidence supports the role of HPI in minimising hypotension outcomes during surgery. The certainty of evidence is low to moderate for studied outcomes.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 11","pages":"942-950"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806942","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":"Left ventricular dysfunction following intravenous dexmedetomidine.","authors":"Vijay Shankar, Meera Kharbhanda, Vikram Mahajan, Chitra Chatterji","doi":"10.4103/ija.ija_555_24","DOIUrl":"10.4103/ija.ija_555_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 11","pages":"1027-1028"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806945","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 Adequacy of Anaesthesia (AoA) monitors with CONOX^® monitor regarding sevoflurane consumption during routine general anaesthesia: A randomised clinical trial.","authors":"Rajendran Arulkumaran, Anusha Cherian, Aswini Kuberan, Prasanna Udupi Bidkar","doi":"10.4103/ija.ija_174_24","DOIUrl":"10.4103/ija.ija_174_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Adequacy of Anaesthesia (AoA) and CONOX^® are combined monitors that assess levels of anaesthesia and analgesia and give a comprehensive score. No studies have measured and compared the total consumption of inhaled anaesthetic agents while using these monitors. We designed a study to compare AoA and CONOX in terms of sevoflurane usage, fentanyl usage and recovery from the effects of anaesthesia.</p><p><strong>Methods: </strong>A randomised trial was conducted in 58 patients. Group A (<i>n</i> = 31) patients were monitored with AoA, and Group C (<i>n</i> = 27) patients were monitored with CONOX. Sevoflurane was titrated to maintain a state entropy value of 40-60 in AoA and a Quantium consciousness index (qCON) value of 40-60 in CONOX. Similarly, fentanyl was titrated with bolus doses of 0.5 μg/kg to maintain a surgical pleth index value of 40-60 in AoA and Quantium noxious index (qNOX) value of 40-60 in CONOX. Intraoperative awareness was assessed postoperatively using a modified Brice questionnaire. The <i>t</i>-test or Chi-square test was used to compare the parameters between the groups.</p><p><strong>Results: </strong>Mean sevoflurane consumption was similar between AoA and CONOX groups [13.2 (standard deviation {SD}: 3.9) (95% confidence interval {CI}:11.8, 14.5) versus 14.4 (SD: 3.7) (95% CI: 13.0, 15.7) ml/h] (<i>P</i> = 0.236). Fentanyl usage was higher in the AoA group compared to the CONOX group [146.2 (SD: 34.28) (95% CI: 134.13, 158.26) versus 128.2 (SD: 26.7) (95% CI: 118.12, 138.27) μg] (<i>P</i> = 0.031). The emergence time and haemodynamic instability events were similar between AoA and CONOX.</p><p><strong>Conclusion: </strong>Both AoA and CONOX measure anaesthetic depth similarly. However, interpreting qNOX values requires caution, as the patient's consciousness status influences them.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 11","pages":"996-1002"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806873","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":"Enhanced recovery after anaesthesia (ERAA) protocols must be followed in all surgeries.","authors":"Mukul C Kapoor","doi":"10.4103/ija.ija_724_24","DOIUrl":"https://doi.org/10.4103/ija.ija_724_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 10","pages":"859-860"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516413","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":"Comparing the effects of three local anaesthetic agents on cardiac conduction system - A randomised study.","authors":"Vaishali Agarwal, Pravin K Das, Soumya S Nath, Manoj Tripathi, Bhuwan Tiwari","doi":"10.4103/ija.ija_1185_23","DOIUrl":"https://doi.org/10.4103/ija.ija_1185_23","url":null,"abstract":"<p><strong>Background and aims: </strong>This study aimed to compare the effects of three local anaesthetic (LA) agents, namely bupivacaine, levobupivacaine, and ropivacaine, on the cardiac conduction system as assessed by corrected QT (QTc) and P wave dispersion (PWD) intervals in lower limb orthopaedic surgeries and to find the most suitable LA agent that can be used for a long duration.</p><p><strong>Methods: </strong>The study included 75 patients with American Society of Anesthesiologists physical status I and II of either gender in the age group of 18-65 years undergoing elective lower limb orthopaedic surgeries under epidural anaesthesia. These were allocated to groups B (bupivacaine), L (levobupivacaine), and R (ropivacaine). We observed blood pressure, heart rate, respiratory rate, PWD, and QTc intervals from baseline value through Holter monitoring, pain assessment by visual analogue scale, and demand and total volume of LA consumed by patient-controlled analgesia devices. The repeated measures of ANOVA were carried out to find the effect of time and time-to-group interaction among the groups across the periods.</p><p><strong>Results: </strong>On intergroup comparison of QTc and PWD, no significant difference among groups was observed, but on intragroup analysis, a statistically significant increase in QTc and PWD from baseline was observed for each of groups B, L, and R at all time intervals. However, the mean increase in QTc and PWD recorded for Group B was higher than in groups L and R.</p><p><strong>Conclusions: </strong>Bupivacaine has the maximal tendency to prolong QTc and PWD. All three agents showed comparable haemodynamic effects and time to onset of sensory and motor blockade.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 10","pages":"889-895"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499526","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":"Limitations of high-frequency variability index in pain monitoring during pheochromocytoma resection.","authors":"Jun Honda, Rieko Oishi, Keisuke Yoshida, Satoki Inoue","doi":"10.4103/ija.ija_350_24","DOIUrl":"https://doi.org/10.4103/ija.ija_350_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 10","pages":"930-932"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499529","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":"Sensitivity and subgroup analysis in a meta-analysis - What we should know?","authors":"Abhijit Sukumaran Nair, Nitinkumar Borkar","doi":"10.4103/ija.ija_623_24","DOIUrl":"https://doi.org/10.4103/ija.ija_623_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 10","pages":"922-924"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499533","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":"Does the resistive index of the radial artery change after arterial cannulation in patients undergoing abdominal surgery? A prospective observational study.","authors":"Lakshmi Kumar, Rajasri Subramaniam, P Anandajith Kartha, Dimple E Thomas, Sunil Patel, Niveditha Kartha","doi":"10.4103/ija.ija_628_24","DOIUrl":"https://doi.org/10.4103/ija.ija_628_24","url":null,"abstract":"<p><strong>Background and aims: </strong>To evaluate the flow at the cannulation site in the radial artery, the resistive indices (RIs) before cannula insertion and 6 h after decannulation were measured (primary outcome). The secondary outcomes were measurement of the artery size by anteroposterior (AP) diameter at the insertion site, RI and AP diameter at a point 4 cm proximal and in the ipsilateral ulnar artery before insertion and 6 h after cannula removal.</p><p><strong>Methods: </strong>In 96 patients requiring an arterial line during surgery, peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured to derive RI using a linear ultrasound transducer. The RI was measured at R1 (insertion point), R2, 4 cm proximal to R1, and U1 on the ipsilateral ulnar artery. The AP diameter of the arteries at baseline R1₀, R2₀ and U1₀ was measured and repeated 6 h after removal of the cannula, R1₆, R2₆ and U1₆.</p><p><strong>Results: </strong>RI or AP diameter in R1 or R2 did not differ pre- and post-cannulation. Mean R1₀ 1.143 [standard deviation (SD: 0.239)] versus R1₆ 1.181 (SD: 0.260) m/sec [mean difference (MD): -0.0372 (95% confidence interval (CI): -0.098, 0.023), <i>P</i> = 0.230]. Mean AP diameter at baseline versus 6 h decannulation 0.177 (SD: 0.042) versus 0.172 (SD: 0.045) cm [MD: 0.005 (95% CI: 0.003, 0.013), <i>P</i> = 0.222] was also similar. The mean PSV in U1₀ versus U1₆ was higher: 0.480 (SD: 0.178) versus 0.528 (SD: 0.316) m/sec [MD: 0.120 (95% CI: -0.185, -0.054), <i>P</i> = 0.002] and AP diameter was also higher than baseline (<i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>The flow in the radial artery did not change following cannulation. The PSV and AP diameter in the ulnar artery increased after decannulation, suggesting a compensatory increase in flow.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 10","pages":"909-914"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499527","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}