Indian Journal of Anaesthesia最新文献

{"title":"Comparison of the efficacy of Enhanced Recovery After Surgery (ERAS) protocol tailor-made for head and neck free flap oncosurgery with conventional perioperative care: A randomised clinical trial.","authors":"Shagun B Shah, Nikhil Bhasin, Ajay K Dewan, Rajiv Chawla, Rajan Arora, Charanjeet Kaur","doi":"10.4103/ija.ija_1324_24","DOIUrl":"10.4103/ija.ija_1324_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Technological advances, accumulated experience, and evidence have made free-flap reconstruction [using the anterolateral thigh flap (ALT) and free fibular flap (FF)] for head and neck oncosurgical defects a routine procedure. This study aimed to assess the impact on recovery after head and neck oncosurgery by preoperative optimisation, intraoperative stress minimisation, and postoperative protocolised normalisation.</p><p><strong>Methods: </strong>This randomised study included 60 adult patients undergoing head and neck oncosurgery with ALT/FF reconstruction, allocated to either the Enhanced Recovery After Surgery (ERAS) group (Group E) or the conventional care group (Group C). Our primary outcome measures were the length of hospital stay (LOS) and time to Return to Intended Oncologic Therapy (RIOT). Surgical intensive care unit (SICU) stay, serum lactate, creatinine, and opioid consumption comprised the secondary outcome measures. An independent sample <i>t</i>-test or Welch test was performed for continuous variables, and a Chi-square test was used for categorical variables.</p><p><strong>Results: </strong>Mean LOS and time to RIOT [9.97 (standard deviation (SD): 2.19) and 34.6 (SD: 9.22) days] were significantly shorter in Group E versus Group C (10.97 (SD: 1.45) and 43.8 (SD: 20.89) days) (mean difference (MD): 1, 95% confidence interval (CI): 0.04, 1.96, <i>P</i> = 0.042, and MD: 9.2, 95% CI: 0.77, 17.63, <i>P</i> = 0.033, respectively). Mean pre-incisional, post-resection, and postoperative lactate levels were significantly lower in Group E versus Group C (<i>P</i> < 0.0001). Serum creatinine levels on the morning of surgery were significantly lower in Group E (<i>P</i> = 0.0225).</p><p><strong>Conclusion: </strong>At least 90% compliance with the described 15-element ERAS protocol reduces LOS and time to RIOT in head-neck oncosurgery patients with free-flap reconstruction.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"824-831"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835000","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 comparison of different bispectral index sensor placements in a neurosurgical patient and their impact on density spectral array data.","authors":"Yu-Hsuan Liu, Tsai-Shan Wu, Yu-Chi Tu, Yin-Tzu Liu","doi":"10.4103/ija.ija_148_25","DOIUrl":"10.4103/ija.ija_148_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"843-845"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834997","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":"Lignocaine instilled through the suction channel of a subglottic suction drainage tracheal tube improves tube tolerance during extubation compared to intravenous lignocaine: A double-blinded randomised controlled trial.","authors":"R Sripriya, Jyotsna Namburu, Ghansham Biyani, Nageswara Rao Tangirala, Vaishakh Tharavath, Raza S Gouri","doi":"10.4103/ija.ija_175_25","DOIUrl":"10.4103/ija.ija_175_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Cough is frequently encountered during extubation. We propose a novel technique of utilising the suction port of a subglottic suction drainage endotracheal tube (SSD-ETT) to instil lignocaine around the cuff and improve tube tolerance during extubation. The primary objective was to assess the cough score during emergence. Secondary objectives included changes in haemodynamics and postoperative oropharyngeal morbidities.</p><p><strong>Methods: </strong>In total, 108 patients undergoing nasal surgery were tracheally intubated with the SSD-ETT and randomised to receive normal saline (NS) both intravenous and subglottic (Group C), subglottic NS and intravenous lignocaine (Group IVL), and subglottic lignocaine and intravenous NS (Group SGL) before reversal of residual neuromuscular blockade. The volume for subglottic administration was fixed at 3 mL of either 2% lignocaine or NS. The volume for intravenous administration was 1.5 mg/kg of 2% lignocaine or an equivalent volume of NS. Tube tolerance was graded using a 5-point qualitative cough score. Haemodynamics were recorded at baseline, post-intubation, and post-extubation. Postoperative oropharyngeal morbidities were also compared.</p><p><strong>Results: </strong>Seventy-five percent of patients in Group SGL had no cough, compared to 27.8% in Group IVL and 30% in Group C (<i>P</i> < 0.001). The heart rate immediately following extubation was significantly lower (<i>P</i> = 0.006) in Group SGL: 96 [standard deviation (SD): 19)] [95% confidence interval (CI): 90, 103] beats/min when compared with Group C: 107 (SD: 15) (95% CI: 102, 112) and Group IVL: 108 (SD: 18) (95% CI: 102, 114). The mean arterial pressure and oropharyngeal morbiditiy were comparable (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Subglottic instillation of lignocaine significantly improves tube tolerance during extubation and has favourable effects on heart rate compared to intravenous administration.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"794-800"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834919","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":"Modulating AMPA receptor-dependent synaptic plasticity: Mechanistic interventions against remifentanil-induced hyperalgesia in reoperative rats - A randomised controlled trial.","authors":"Suqian Guo, Qi Zhao, Linlin Zhang, Chengcheng Song, Guolin Wang","doi":"10.4103/ija.ija_1351_24","DOIUrl":"10.4103/ija.ija_1351_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Intraoperative remifentanil can induce postoperative hyperalgesia. In clinical practice, either unplanned or planned second operations may occur within a short period. However, the impact of remifentanil during this process remains unclear. This study aimed to investigate the pain threshold following two incisional operations under remifentanil analgesia and to examine the contribution of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR).</p><p><strong>Methods: </strong>Experimental rats received remifentanil infusion combined with plantar incision. This dual intervention was repeated twice, separated by a 7-day interval. After completing both treatment cycles, mechanical paw withdrawal thresholds (PWTs) and thermal withdrawal latencies (PWLs) were assessed. Simultaneously, C-fibre evoked field potentials were recorded in parallel with dendritic spine morphology analysis. Additionally, the intrathecal administration of 1-naphthylacetyl spermine trihydrochloride (NASPM) was used to investigate the role of the AMPAR.</p><p><strong>Results: </strong>In rats with two incisions and remifentanil infusions, the second treatment led to lower minimum PWT and PWL values than the first. Compared to controls, these rats exhibited a significantly greater increase in the C-fibre-evoked field potential, as well as in the number of primary branches and spines of spinal dorsal horn neurons. The AMPAR inhibitor NASPM attenuated remifentanil-induced exacerbation of reoperative hyperalgesia, reversed remifentanil-enhanced spinal long-term potentiation, and mitigated the associated morphological changes.</p><p><strong>Conclusion: </strong>Repetitive remifentanil administration during consecutive operations within a short temporal window significantly potentiated opioid-induced hyperalgesia in a rat reoperation model. This hyperalgesic priming was mechanistically associated with upregulated trafficking of spinal AMPARs.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"816-823"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834920","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":"New interfascial plane block for spine surgery: Serratus posterior superior intercostal plane block.","authors":"Tamara B Topgül, Okkes Basak, Bahadir Ciftci","doi":"10.4103/ija.ija_318_25","DOIUrl":"10.4103/ija.ija_318_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"845-846"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834921","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 intravenous lignocaine on haemodynamic responses to laryngoscopy and tracheal intubation in adults under general anaesthesia: A systematic review and meta-analysis.","authors":"Junjun Qin, Changlin He, Zhengwei Chen, Sijun Yan, Jiasen Ma","doi":"10.4103/ija.ija_201_25","DOIUrl":"10.4103/ija.ija_201_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Haemodynamic fluctuations during laryngoscopy and tracheal intubation remain a key concern in anaesthetic practice, with cardiovascular stress responses posing risks of serious complications. This meta-analysis aims to assess the benefits and risks of pre-intubation intravenous (IV) lignocaine, focusing on enhancing haemodynamic stability and developing evidence-based dosing guidelines.</p><p><strong>Methods: </strong>Searches were performed in PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, and key references up to 16 February 2025 to identify randomised controlled trials (RCTs) comparing adult patients who received or did not receive IV lignocaine prior to tracheal intubation. Data from eligible studies were pooled to calculate the combined risk ratio (RR) or mean difference (MD).</p><p><strong>Results: </strong>Eighteen studies (1056 participants) were included. A single IV injection of lignocaine at 40 mg fixed-dose and 0.5-2 mg/kg was studied for preventing haemodynamic fluctuations induced by laryngoscopy and tracheal intubation. Relative to non-lignocaine, IV lignocaine suppressed the increases in mean arterial pressure (MAP) [MD: -3.85; 95% confidence interval (CI): -6.61, -1.09; <i>P</i> = 0.006; <i>I</i> ² <i>=</i> 84%] and heart rate (HR) (MD: -4.72; 95% CI: -7.55, -1.90; <i>P</i> = 0.001; <i>I</i> ² <i>=</i> 86%) caused by laryngoscopy and tracheal intubation. The lignocaine group had fewer complications compared with the non-lignocaine group.</p><p><strong>Conclusions: </strong>IV lignocaine 1-2 mg/kg can effectively suppress the increase in MAP caused by laryngoscopy and tracheal intubation. However, the effectiveness of lignocaine regarding HR seems to require optimisation based on both dosage and ethnicity.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"748-758"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834914","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":"Investigating the association between intention for labour epidural analgesia (LEA), actual delivery with LEA and postnatal depression: A secondary analysis.","authors":"J C Y Chan, R Sultana, C W Tan, B L Sng","doi":"10.4103/ija.ija_294_25","DOIUrl":"10.4103/ija.ija_294_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"832-834"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834917","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":"Is the pericapsular nerve group (PENG) block truly superior to the suprainguinal fascia iliaca (SIFI) block in terms of functional outcome with better quadriceps strength and enhanced weight bearing in hip surgery patients?","authors":"Vinodha Devi Vijayakumar, Arimanickam Ganesamoorthi","doi":"10.4103/ija.ija_251_25","DOIUrl":"10.4103/ija.ija_251_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"839-840"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834918","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":"Reply to comments on \"Enhanced Recovery After Hip Surgery: A comparative study of Pericapsular Nerve Group (PENG) block versus Supra-Inguinal Fascia Iliaca (SIFI) block for Superior Functional Outcome\".","authors":"Tanusha Saini, Meenakshi Aggarwal, Udeyana Singh, Rupinder Singh","doi":"10.4103/ija.ija_526_25","DOIUrl":"10.4103/ija.ija_526_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"840-841"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834924","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 dexmedetomidine combined with magnesium sulphate on intracranial tension in patients with severe pre-eclampsia using ultrasonographic optic nerve sheath Diameter - A randomised clinical trial.","authors":"Enas W Mahdy, Taghreed E Sakr, Samar R Amin","doi":"10.4103/ija.ija_19_25","DOIUrl":"10.4103/ija.ija_19_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Prompt diagnosis and treatment of increased intracranial tension (ICT) critically impact outcomes in patients with severe pre-eclampsia. This study aimed to investigate the influence of dexmedetomidine (DEX) infusion on optic nerve sheath diameter (ONSD), utilised as a surrogate marker for ICT assessment, in pre-eclamptic patients presenting with severe features.</p><p><strong>Methods: </strong>Fifty parturients with a confirmed diagnosis of severe pre-eclampsia were included in the study cohort. Participants were randomly allocated to receive either a DEX infusion 0.2-0.7 μg/kg/h or a matching volume of 0.9% saline as a control, both regimens co-administered with standard magnesium sulphate therapy (4 g loading dose and 1 g/h maintenance). Infusions were continued until surgical completion. The primary outcome was ONSD measured at baseline and at 6, 12, 24, and 48 h post-infusion. Secondary outcomes included haemodynamic variables, sedation scores, neonatal APGAR scores, incidence of adverse events, and length of hospitalisation.</p><p><strong>Results: </strong>Both groups exhibited comparable demographic characteristics. ONSD showed significantly decreased values after DEX infusion compared to baseline (<i>P</i> < 0.05) at all time points. Additionally, haemodynamic variables were significantly reduced compared to baseline in both groups. However, no substantial variations were detected between the two groups. APGAR score, sedation score, length of hospitalisation, and side effects showed no remarkable events, with comparable values between the two groups.</p><p><strong>Conclusion: </strong>Dexmedetomidine infusion in combination with magnesium sulphate effectively mitigates the elevation of intracranial tension observed in pre-eclamptic patients with severe features without increasing maternal or neonatal adverse events.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"786-793"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835001","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}