Indian Journal of Anaesthesia最新文献

{"title":"My ISA -Vision and mission.","authors":"J Balavenkatasubramanian","doi":"10.4103/ija.ija_1353_24","DOIUrl":"https://doi.org/10.4103/ija.ija_1353_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566959","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":"Systematic review meta-analysis protocol preparation and registration - A narrative review.","authors":"Indubala Maurya, Rakesh Garg","doi":"10.4103/ija.ija_1165_24","DOIUrl":"10.4103/ija.ija_1165_24","url":null,"abstract":"<p><p>Systematic reviews and meta-analyses (SRMAs) help in decision making, especially on conflicting publication findings and quality. SRMA identifies the source of heterogeneity, reduces subjectivity and identifies and fills gaps in existing knowledge. However, conducting an SRMA requires a well-written protocol, which acts as a clear roadmap for the researcher and defines objectives, methods and expected outcomes. Predefined research questions and methods minimise bias, thus increasing the reliability of the results. The protocol ensures that the study team stays consistent in data collection, synthesis and interpretation. The SRMA protocol includes rationale, hypothesis, aims and methodology. A detailed protocol improves the overall quality of the research. All SRMA protocols must be registered and made available publicly. Protocol registration ensures transparency in the research process, which avoids the wastage of resources and prevents duplication. A well-planned protocol facilitates faster peer review and enhances the chances for publication. This narrative review primarily focuses on SRMA protocol preparation and its registration.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"132-137"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566974","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":"Impact of Enhanced recovery after surgery (ERAS) protocols in idiopathic scoliosis of children: A systematic review with meta-analysis and trial sequential analysis.","authors":"Soumya Sarkar, Bharat Yalla, Bhavuk Garg, Puneet Khanna","doi":"10.4103/ija.ija_953_24","DOIUrl":"10.4103/ija.ija_953_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Enhanced recovery after surgery (ERAS) protocols are widely adopted in various surgeries to improve outcomes and reduce length of stay (LOS). However, their cost-effectiveness in spine surgery for children is unclear.</p><p><strong>Methods: </strong>Studies comparing ERAS with conventional pathways for spinal surgery in children with idiopathic scoliosis were included after scrutiny of electronic databases (PubMed, Medline, and Embase), Google Scholar, preprint, and clinical trial databases after the protocol was enroled in PROSPERO (ID: CRD42023418323).</p><p><strong>Results: </strong>Twenty-five studies, including 15,399 patients, were included. Patients in the ERAS group had a significant reduction in LOS by -1.68 days [95% confidence interval (CI): -1.88, -1.47; I² = 96%), per-patient hospital cost by 3765.27 USD, as per 2023 valuation (95% CI: -5257.43, -2273.12, I² = 99.96%), risk of complications (log-odds ratio: -0.85; 95% CI: -1.45, -0.27; I² =50.4%), blood loss by 159.38 mL (95% CI: 121.8, 197.79, I² = 95.02%), compared to the traditional protocol group. On multivariable meta-regression analyses, the LOS was not impacted by age (<i>P</i> = 0.382), duration of surgery (<i>P</i> = 0.289), preoperative Cobb's angle (<i>P</i> = 0.405), and intraoperative blood loss (<i>P</i> = 0.525). The required information size estimated for a power of 95% based on the 30% reduction in the LOS, 50% relative risk reduction for complications, reduction of per patient hospital cost of USD 3500 as per 2023 valuation, and reduction of mean intraoperative blood loss of 100 mL were 8599, 904, 499, and 499 respectively, was achieved.</p><p><strong>Conclusion: </strong>ERAS protocols in children's scoliosis surgeries significantly reduce treatment costs through decreased hospital stays, fewer complications, and less intraoperative blood loss.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"23-37"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566954","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":"Message from the Immediate Past-President.","authors":"Jigeeshu V Divatia","doi":"10.4103/ija.ija_10_25","DOIUrl":"https://doi.org/10.4103/ija.ija_10_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"3-5"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566957","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":"Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA).","authors":"Lan Ma, Na Zhou, Kaiming Yuan, Zihao Xue, Kai Lv, Jingying Huang","doi":"10.4103/ija.ija_881_24","DOIUrl":"10.4103/ija.ija_881_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requires further validation. This meta-analysis evaluates the effectiveness of this method and uses trial sequential analysis (TSA) to assess evidence reliability and identify the need for further research.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, Medline, Embase, Cochrane CENTRAL, Ovid, ISI Web of Science, and the Wanfang Database from 2014 to 2023. The included studies assessed diaphragmatic ultrasonography for predicting extubation success. Successful extubation is defined as maintaining spontaneous breathing for at least 48 hours post-extubation. Data extraction and quality assessment were performed using a random-effects model. Quality was assessed via the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated through funnel plots and Egger's test. Cumulative meta-analysis, sub-group analyses, and TSA were used to explore heterogeneity and assess evidence reliability.</p><p><strong>Results: </strong>Fourteen studies were included, demonstrating high quality. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were significant predictors of extubation success. The diagnostic odds ratio (DOR) was 4.80 [95% confidence interval (CI): 3.86, 5.97)], with a sensitivity of 81.48% and a specificity of 86.86%. Significant heterogeneity was observed (<i>I</i> ² =85%, χ² =87.19, <i>P</i> < 0.00001). TSA indicated that the cumulative evidence was insufficient.</p><p><strong>Conclusions: </strong>Diaphragmatic ultrasound, particularly DE and DTF, is useful for predicting extubation success, but current evidence is inconclusive. Further research is required to confirm these findings.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"38-53"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566960","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 efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials.","authors":"Babu Lal, Ragavi Alagarsamy, Jitendra Kumar, Anshul J Rai, Vineeta Yadav, Rajnish Joshi, Md Yunus","doi":"10.4103/ija.ija_1017_24","DOIUrl":"10.4103/ija.ija_1017_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in preventing PONV in patients undergoing non-laparoscopic surgeries.</p><p><strong>Methods: </strong>A PRISMA-guided systematic review and meta-analysis was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at postoperative time points, namely T1 (0-2 hours), T2 (0-6 hours), T3 (12-24 hours), T4 (24-48 hours), and T5 (24-72 hours), as well as safety (number of incidence of adverse effects). A meta-analysis of the efficacy and safety groups was performed using a random-effects model.</p><p><strong>Results: </strong>Nineteen randomised controlled trials were included. Pooled risk ratio (RR) revealed that patients receiving palonosetron were significantly less likely to develop nausea [0-2 h, RR = 0.82 (95% confidence interval (CI): 0.50, 1.34), <i>P</i> = 0.317, I² = 15.3%], [0-6 h, RR = 0.76 (95% CI: 0.44, 1.29), <i>P</i> = 0.137, I² = 45.7%], [12-24 h, RR = 0.39 (95%CI: 0.16, 0.96), <i>P</i> = 0.088, I² = 54.2%], [24-48 h, RR = 0.44 (95% CI: 0.20, 0.96), <i>P</i> = 0.598, I² = 0%], [24-72 h, RR 0.22 (95% CI: 0.08, 0.57), <i>P</i> = 0.119, I² = 53.0%] and vomiting [0-2 h, RR = 0.59 (95% CI: 0.29, 1.23), <i>P</i> = 0.868, I² = 0%], [0-6 h, RR = 1.42 (95% CI: 0.74, 2.72), <i>P</i> = 0.790, I² = 0%], [12-24 h, RR = 0.14 (95% CI: 0.04, 0.51), <i>P</i> = 0.749, I² = 0.0%], [24-48 h, RR = 0.24 (95%CI: 0.09, 0.62), <i>P</i> = 0.561, I² = 0%], [24-72 h, RR = 0.11 (95% CI: 0.02, 0.58), <i>P</i> = 0.859, I² = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), <i>P</i> = 0.940, I² = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), <i>P</i> = 0.870, I² = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), <i>P</i> = 0.650, I² = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), <i>P</i> = 0.644, I² = 0%].</p><p><strong>Conclusion: </strong>Palonosetron and ondansetron exhibited comparable efficacy in the early hours (0-6 h). Palonosetron showed superior efficacy beyond 6 hours, providing sustained PONV prophylaxis in patients undergoing various surgeries, excluding laparoscopic procedures.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"108-122"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566948","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":"Meta-analysis - interpretation of forest plots: A wood for the trees.","authors":"Soumya Sarkar, Dalim Kumar Baidya","doi":"10.4103/ija.ija_1155_24","DOIUrl":"10.4103/ija.ija_1155_24","url":null,"abstract":"<p><p>A forest plot is a graphical tool to visualise and interpret the summary of estimated results in a meta-analysis. However, it is limited by its inability to control for random error, publication bias, heterogeneity, and confounding factors. Therefore, the interpretation can be misleading, resulting in flawed conclusions. A careful interpretation and other complementing techniques are necessary to comprehensively summarise evidence in meta-analyses, reducing the risk of erroneous conclusions. The present review explores the components of forest plots, how to interpret them correctly, fundamental limitations, and techniques to mitigate them, along with examples to provide practical insights to ensure more accurate and reliable meta-analytic results.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"147-152"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566958","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":"5-point airway (5-AIR) ultrasound protocol for confirmation of endotracheal intubation and position in paediatric patients undergoing surgery: A prospective observational study.","authors":"Adhiraj Baruah, Zainab Ahmad, Vaishali Waindeskar, Shikha Jain, Roshan Chanchlani, Pranita Mandal, Amit Agarwal, Shristi Agarwal","doi":"10.4103/ija.ija_682_24","DOIUrl":"10.4103/ija.ija_682_24","url":null,"abstract":"<p><strong>Background and aims: </strong>We devised and compared the accuracy and time required for a 5-point airway (5-AIR) ultrasound (USG) protocol for confirming endotracheal intubation (ETI) and endotracheal tube (ETT) positioning (ETP) with the current reference standard of quantitative waveform capnography (QWC) and auscultation.</p><p><strong>Methods: </strong>In this prospective observational study, 75 American Society of Anesthesiologists physical status I or II children between 2 and 12 years undergoing elective surgery were recruited. ETI and ETP were confirmed clinically and sonographically using the 5-AIR USG protocol, which involves real-time tracheal USG followed by bilateral pleural and diaphragmatic ultrasonography.</p><p><strong>Results: </strong>There was no oesophageal intubation in this study; hence, the accuracy of the USG protocol for ETI could not be determined. For ETP, 68 patients had correctly placed ETTs. The 5-AIR USG protocol identified 4 out of 7 endobronchial placements, resulting in a sensitivity of 100%, specificity of 57.14%, and an overall diagnostic accuracy of 96%. The mean time for confirmation of ETI by QWC (20.77 s (standard deviation (SD): 4.11 s; 95% confidence interval (CI): 19.84, 21.70) was longer than real-time tracheal USG (2.11 s (SD: 0.31 s; 95% CI: 2.04, 2.18) (<i>P</i> = 0.001). For ETP, the mean time for 5-point auscultation was 12.69 s (SD: 2.48 s; 95% CI: 12.19, 13.25) versus 6.39 s (SD: 0.54 s; 95% CI: 6.27, 6.51) for pleural USG (<i>P</i> = 0.001). Adding diaphragmatic scanning increased the mean time to 11.45 s (SD: 0.87 s; 95% CI: 11.25, 11.65) and 30.68 s (SD: 2.01 s; 95% CI: 30.22, 31.13) if a probe change was required (<i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>The 5-AIR USG protocol was useful, fast, and demonstrated high diagnostic accuracy to confirm endotracheal intubation and position in paediatric patients. This protocol may be incorporated along with clinical signs, auscultation, and QWC to confirm endotracheal intubation and position.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 12","pages":"1068-1074"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407360","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":"Data-based regression models for predicting remifentanil pharmacokinetics.","authors":"Prathvi Shenoy, Mahadev Rao, Shreesha Chokkadi, Sushma Bhatnagar, Naveen Salins","doi":"10.4103/ija.ija_549_24","DOIUrl":"10.4103/ija.ija_549_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Remifentanil is a powerful synthetic opioid drug with a short initiation and period of action, making it an ultra-short-acting opioid. It is delivered as an intravenous infusion during surgical procedures for pain management. However, deciding on a suitable dosage depends on various aspects specific to each individual.</p><p><strong>Methods: </strong>Conventional pharmacokinetic and pharmacodynamic (PK-PD) models mainly rely on manually choosing the parameters. Target-controlled drug delivery systems need precise predictions of the drug's analgesic effects. This work investigates various supervised machine learning (ML) methods to analyse the pharmacokinetic characteristics of remifentanil, imitating the measured data. From the Kaggle database, features such as age, gender, infusion rate, body surface area, and lean body mass are extracted to determine the drug concentration at a specific instant of time.</p><p><strong>Results: </strong>The characteristics show that the prediction algorithms perform better over traditional PK-PD models with greater accuracy and minimum mean squared error (MSE). By optimising the hyperparameters with Bayesian methods, the performance of these models is significantly improved, attaining the minimum MSE value.</p><p><strong>Conclusion: </strong>Applying ML algorithms in drug delivery can significantly reduce resource costs and the time and effort essential for laboratory experiments in the pharmaceutical industry.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 12","pages":"1081-1091"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407387","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":"Effects of intracuff and intravenous lignocaine on recovery from anaesthesia after thyroid surgery: IJA Infographics.","authors":"","doi":"10.4103/ija.ija_1241_24","DOIUrl":"https://doi.org/10.4103/ija.ija_1241_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 12","pages":"1034"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407391","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}