Indian Journal of Anaesthesia最新文献

{"title":"Anatomical level-dependent variation in ultrasonographic skin-to-epiglottis depth and its diagnostic performance for difficult laryngoscopy: A prospective observational study.","authors":"Çağdaş Savran, Özge Köner, Sibel Temür, Hatice Türe","doi":"10.4103/ija.ija_406_26","DOIUrl":"10.4103/ija.ija_406_26","url":null,"abstract":"<p><strong>Background and aims: </strong>Ultrasonographic skin-to-epiglottis depth (SED) has been proposed as a predictor of difficult laryngoscopy (DL). Most studies have evaluated transverse measurements at a single anatomical level, and the influence of parasagittal imaging and measurement level on diagnostic performance remains unclear. This study aimed to assess anatomical level-dependent variation in parasagittal SED and to compare its diagnostic accuracy for predicting DL.</p><p><strong>Methods: </strong>In this prospective observational study, 150 adult patients undergoing elective surgery under general anaesthesia were evaluated preoperatively. Parasagittal SED was measured at three anatomical landmarks: the upper hyoid border (HUB), lower hyoid border (HLB), and thyrohyoid membrane (THM). Difficult laryngoscopy was defined as Cormack-Lehane grade III-IV. Diagnostic performance was analysed using receiver operating characteristic analysis.</p><p><strong>Results: </strong>DL occurred in 32 patients (21.3%). Parasagittal SED differed significantly across anatomical levels. HUB measurements demonstrated superior predictive performance [area under the curve (AUC) 0.86; 95% confidence interval 0.79-0.92] compared with HLB (AUC 0.75) and THM (AUC 0.65). The HUB/THM ratio showed similarly high discrimination (AUC 0.86). Conventional airway tests showed modest predictive values (AUC 0.62-0.72). Multivariable analysis identified HUB SED >24 mm, inter-incisor distance ≤4 cm, and upper lip bite test class II-III as independent predictors of DL.</p><p><strong>Conclusion: </strong>Parasagittal SED demonstrates anatomical level-dependent variability that affects diagnostic performance. Assessment at the upper hyoid border provides the highest discrimination and may improve ultrasound-based airway risk stratification.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"935-942"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919652","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":"Response to comments on \"Cricoid versus paratracheal pressure as airway protective manoeuvres for oesophageal occlusion: A prospective randomised crossover study\".","authors":"B Shashi Kanth, A Chaitanya Pratyusha, Dilip Kumar Kulkarni, Ch Rama Krishna Prasad, R Gopinath, V Dinesh","doi":"10.4103/ija.ija_1079_26","DOIUrl":"10.4103/ija.ija_1079_26","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"979-980"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919660","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":"Reassessing the accuracy of SpO₂-based PaO₂ estimation in anaesthetised adults.","authors":"Jay Prakash, Shio Priye","doi":"10.4103/ija.ija_1442_25","DOIUrl":"10.4103/ija.ija_1442_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"971-972"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919663","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":"Beyond the numbers: Contextualising the carbon footprint of Desflurane versus Sevoflurane in India.","authors":"Abhijit Kumar, S Sanjay Prabhu","doi":"10.4103/ija.ija_1162_26","DOIUrl":"10.4103/ija.ija_1162_26","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"951-953"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919595","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":"Quantifying carbon dioxide emissions in paediatric anaesthesia practice: The impact of volatile anaesthetic choice: A prospective, randomised, single-blinded comparative study.","authors":"Saumya Pant, Parul Jindal, Amit K Chauhan","doi":"10.4103/ija.ija_1690_25","DOIUrl":"10.4103/ija.ija_1690_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Carbon foot printing provides a metric for the environmental burden-energy, waste, and potent greenhouse emissions-inherent in our daily clinical practice. This study quantifies and compares the carbon dioxide (CO₂)-equivalent emissions of sevoflurane versus desflurane in paediatric patients using the validated Dr. Tom Pierce anaesthetic gas calculator.</p><p><strong>Methods: </strong>Fifty American Society of Anesthesiologists physical status I-II children aged between 3 and 12 years of either gender with no congenital anomalies undergoing elective surgery with second-generation supraglottic airways were prospectively evaluated. Patients were randomised into Group S (Sevoflurane, <i>n</i> = 25) or Group D (Desflurane, <i>n</i> = 25). Environmental impact was calculated based on real-time consumption data using Dr Tom Pierce's anaesthetic gases calculator application.</p><p><strong>Results: </strong>While haemodynamic stability and bispectal index-monitored depth remained consistent across both cohorts, the ecological divergence was profound. The mean agent consumption was significantly lower in the S group (28.39 ± 15.88) as compared to the D group (49.30 ± 0.29). Most strikingly, the mean CO₂ emission for sevoflurane (3.68 ± 2.02) was a mere fraction of the impact seen with desflurane (100.55 ± 74.68), representing a massive reduction in the global warming potential per case.</p><p><strong>Conclusion: </strong>Sevoflurane demonstrated a significantly lower carbon footprint than desflurane. Given that clinical outcomes and haemodynamic stability remained consistent across cohorts, the transition to sevoflurane-based maintenance represents a high-impact, actionable intervention for sustainable paediatric practice. These findings advocate the preferential use of sevoflurane as the primary volatile agent in \"green anaesthesia\" protocols, though further multicentre validation is required to solidify these environmental benchmarks.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"943-950"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919724","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":"Effect of ultrasound-guided superior laryngeal nerve block on intubation-induced haemodynamic changes in hypertensive patients: A randomised clinical trial.","authors":"Krishnendu Sen, Prerna Varma, Kiran Jangra, Anudeep Jafra, Divya Jain","doi":"10.4103/ija.ija_98_26","DOIUrl":"10.4103/ija.ija_98_26","url":null,"abstract":"<p><strong>Background and aims: </strong>Laryngoscopy and endotracheal intubation are associated with a sympathetic response which is detrimental in hypertensive patients. Blocking afferent laryngeal reflexes with the internal branch of the superior laryngeal nerve block (iSLNB) may attenuate this response. This study aimed to evaluate the effectiveness of ultrasound-guided bilateral iSLNB as an adjunct to general anaesthesia (GA) in blunting the haemodynamic response to intubation in patients with hypertension.</p><p><strong>Methods: </strong>This prospective, randomised, single-blind clinical trial enroled adult patients with hypertension undergoing elective non-airway surgery under GA with tracheal intubation. Participants were randomly allocated to two groups. The iSLNB group received ultrasound-guided bilateral iSLNB using lignocaine following intravenous induction, while the control group received standard intravenous induction. The primary outcome was change in mean blood pressure (∆MBP) from pre-intubation to one-minute post-intubation. Secondary outcomes included change in systolic and diastolic blood pressure, heart rate at predefined intervals, incidence and severity of postoperative sore throat, and procedure-related adverse events.</p><p><strong>Results: </strong>A total of 50 patients were analysed, 25 in each group. The change in post-intubation MBP at one minute was significantly lower in the iSLNB group compared to the control group (mean difference 6.2 mm Hg; 95% confidence interval 0.73-11.67; <i>P</i> = 0.03), while changes in heart rate were comparable during the study period. The postoperative sore throat was significantly lower in the iSLNB group (<i>P</i> = 0.01), and no block-related adverse events were observed.</p><p><strong>Conclusion: </strong>Ultrasound-guided iSLNB as an adjunct to GA effectively attenuates the haemodynamic response to endotracheal intubation.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"927-934"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919614","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":"Iatrogenic femoral needle fracture during arterial blood gas sampling and an unplanned operation - A perioperative patient safety report.","authors":"K Sathya Narayanan, Ilango Ganesan, Loganathan Sundaram, Mohana Priya","doi":"10.4103/ija.ija_706_26","DOIUrl":"10.4103/ija.ija_706_26","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"969-971"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919633","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 randomised trial comparing 80% and 100% inspired oxygen concentrations for time to adequate preoxygenation using end-tidal oxygen concentration targets.","authors":"G Venkata Poornima, A Chaitanya Pratyusha, Ch Rama Krishna Prasad, Ramachandran Gopinath, Rama Krishna Ravula, R Sharanya","doi":"10.4103/ija.ija_216_26","DOIUrl":"10.4103/ija.ija_216_26","url":null,"abstract":"<p><strong>Background and aims: </strong>Preoxygenation with 100% oxygen is associated with absorption atelectasis. This study compared 80% and 100% fractional inspired oxygen concentration (FiO₂) for the time to achieve adequate preoxygenation, defined by end-tidal oxygen (EtO₂). Secondary outcomes included the incidence of postoperative atelectasis, proportion of patients requiring more than 3 minutes for preoxygenation, haemodynamic changes, and desaturation.</p><p><strong>Methods: </strong>Two-hundred patients for general anaesthesia were randomly divided into either Group I or Group S, the intervention and the standard practice groups, and were preoxygenated with 80% and 100% FiO₂, respectively. The time taken to reach an EtO₂ of 10% below the administered FiO₂ was considered the time to adequate preoxygenation. A lung ultrasonography was performed at baseline and again immediately after extubation. Independent <i>t</i>-test or Mann-Whitney U test and the Chi-square test were used for continuous and nominal categorical data, respectively. Non-inferiority was concluded if the lower bound of the confidence interval remained above the predefined non-inferiority margin of -15 seconds.</p><p><strong>Results: </strong>The median preoxygenation time was comparable between groups: 95 s [interquartile range (IQR) 70-133] and 99.5 s (IQR 80.3-140) in Group I and S, respectively (<i>P</i> = 0.484; 95% confidence interval -21 to 11). Non-inferiority was not demonstrated. The effect size was small (r = -0.096), indicating minimal clinical difference. However, atelectasis was significantly higher in Group S (31.9%) compared to Group I (8.6%) (<i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>Non-inferiority of FiO₂ 80% with 100% could not be established within the prespecified margin, though the median time to achieve adequate preoxygenation was comparable.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"898-904"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919558","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":"Common errors in sample size calculation in clinical research: A focused critique.","authors":"Farzan Madadizadeh, Amirhossein Mahdavian, Golnaz Afzal","doi":"10.4103/ija.ija_1320_25","DOIUrl":"10.4103/ija.ija_1320_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"967-968"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919593","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 weight-adjusted dosing improve outcomes over fixed-volume bupivacaine in transversus thoracic muscle plane block for cardiac surgery? A prospective randomised controlled trial.","authors":"Avneet Singh, Dheeraj Kapoor, Sidharth Garg, Sudhansoo Khanna","doi":"10.4103/ija.ija_10_26","DOIUrl":"10.4103/ija.ija_10_26","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"70 8","pages":"954-957"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919650","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}