Indian Journal of Anaesthesia最新文献

{"title":"Impact of preoperative hypercoagulability on myocardial injury in overweight and obese patients undergoing lower limb arthroplasty: An observational study.","authors":"Usha Gurunathan, Joel Hines, Bronwyn Pearse, Scott McKenzie, Karen Hay, Harshal Nandurkar, Victoria Eley","doi":"10.4103/ija.ija_911_23","DOIUrl":"10.4103/ija.ija_911_23","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"298-302"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109942","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":"Influence of surgical scrubs outside the operation theatre on post-operative infections - A systematic review.","authors":"Hamed H Mohammed Al-Aamri, Abhijit S Nair, Khalid M Al Sawafi, Issa Al Sharji, Ahmed Al Jabri","doi":"10.4103/ija.ija_949_23","DOIUrl":"10.4103/ija.ija_949_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Healthcare workers (HCWs), which include surgeons, anaesthesiologists, nurses, technicians, and other non-medical staff working in the operation theatre (OT), change to surgical scrubs for providing designated services. This study was intended to investigate the association of moving in and out of OT to other hospital areas without changing scrubs and its impact on bacterial infection.</p><p><strong>Methods: </strong>After PROSPERO registration, we performed a systematic review to compare the occurrence of surgical site infections (SSIs) with or without the movement of HCWs outside OT. We searched PubMed, Scopus, and Cochrane Library using relevant keywords. RoB-2 and ROBINS-E tools were used to assess the risk of bias in randomised controlled trials (RCTs) and observational studies, respectively.</p><p><strong>Results: </strong>We identified six articles that fulfilled the inclusion criteria: three RCTs and three observational studies. A risk of bias assessment revealed an overall low bias in the RCTs and an overall high bias in the observational studies. The analysis revealed a comparable incidence of bacterial infection in terms of colony-forming units when scrubs when HCWs moved in and out of OT with the same scrubs. A meta-analysis was not performed due to heterogeneity in participants and the OT set-up, as well as fewer studies and sample size.</p><p><strong>Conclusion: </strong>The evidence is insufficient to suggest that wearing scrubs outside the OT could increase the incidence of SSI in surgical patients or transmit the organisms to patients, causing infection. The present review neither supports nor is against wearing surgical scrubs outside OT premises.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"223-230"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109943","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":"Effectiveness of high flow nasal cannula (HFNC) versus bilevel positive airway pressure (BiPAP) in preventing tracheal reintubation in patients with high risk of extubation failure in intensive care unit - A randomised comparative trial.","authors":"Nisha Kumari, Bibha Kumari, Sanjeev Kumar, Nidhi Arun, Ritu Kumari","doi":"10.4103/ija.ija_620_23","DOIUrl":"10.4103/ija.ija_620_23","url":null,"abstract":"<p><strong>Background and aims: </strong>The incidence of tracheal extubation failure in high-risk patients is higher, and non-invasive ventilation is suggested to avoid tracheal reintubation. This study compares the effectiveness of bilevel positive airway pressure (BiPAP) and high flow nasal cannula (HFNC) to reduce the rate of reintubation in intensive care unit (ICU) patients with increased risk of extubation failure.</p><p><strong>Methods: </strong>This randomised comparative trial was conducted on 60 high-risk patients on mechanical ventilators admitted to the ICU, ready for weaning after a spontaneous breathing trial. They were randomised to Group H for HFNC and Group B for BiPAP therapy. Designated therapy was administered in these high-risk patients for up to 48 hours after tracheal extubation. Haemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), a saturation of peripheral oxygen (SpO₂), electrocardiogram (ECG)], arterial blood gas analysis (ABG) parameter [potential of hydrogen (pH), partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen/fraction of inspired oxygen (paO₂/FiO₂) ratio], the effectiveness of cough, comfort level was recorded and continuous monitoring for signs of respiratory distress and failure was done.</p><p><strong>Results: </strong>Most of the patients were obese and had more than two risk factors for extubation failure. Several patients in Group B have significantly higher successful extubation than in Group H (<i>P</i> = 0.044). Most of the reintubation took place within 24 hours. The HFNC therapy was more comfortable and acceptable to patients.</p><p><strong>Conclusion: </strong>BiPAP therapy was more efficient than HFNC in preventing tracheal reintubation among patients with a high risk of extubation failure.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"246-253"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109885","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 Acute Physiology and Chronic Health Evaluation (APACHE) II and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) scoring system in predicting postoperative mortality in patients undergoing emergency laparotomy: A retrospective study.","authors":"Pallavi Doda, Sukhyanti Kerai, Kanika Chauhan, Vineet Manchanda, Kirti N Saxena, Anurag Mishra","doi":"10.4103/ija.ija_888_23","DOIUrl":"10.4103/ija.ija_888_23","url":null,"abstract":"<p><strong>Background and aims: </strong>There is paucity of studies on preoperative risk assessment tools in patients undergoing emergency surgery. The present study evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and American Society of Anesthesiologists (ASA) physical status (PS) classification system in patients undergoing emergency exploratory laparotomy.</p><p><strong>Methods: </strong>This retrospective study included 60 adult patients who underwent emergency exploratory laparotomy for perforation peritonitis. The clinical details, ASA PS classification, laboratory investigations and postoperative course of patients were retrieved from their medical records. Based on these details, APACHE II and ACS-NSQIP were calculated for the patients. The study's primary outcome was the accuracy of the preoperative APACHE II, ACS-NSQIP risk calculator and ASA PS class in predicting the postoperative 30-day mortality of patients.</p><p><strong>Results: </strong>The area under the curve (AUC) of APACHE II, ACS-NSQIP score, and ASA PS classification for mortality 30 days after surgery was 0.737, 0.694 and 0.601, respectively. The <i>P</i> value for the Hosmer-Lemeshow (H-L) test of scoring systems was 0.05, 0.25 and 0.05, respectively. AUC for postoperative complications was 0.799 for APACHE II, 0.683 for ACS-NSQIP and 0.601 for ASA PS classification. H-L test of these scoring systems for complications after surgery revealed <i>P</i> values of 0.62, 0.36 and 0.53, respectively.</p><p><strong>Conclusion: </strong>Compared to the ACS-NSQIP and ASA PS classification system, the APACHE II score has a better discriminative ability for postoperative complications and mortality in adult patients undergoing emergency exploratory laparotomy.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"231-237"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109879","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 nasal and face mask ventilation in anaesthetised obese adults: A randomised controlled study.","authors":"Gyan Singh, Neeru Luthra, Richa Jain, Anju Grewal, Shubham Garg, Livleen Deep Mann","doi":"10.4103/ija.ija_404_23","DOIUrl":"10.4103/ija.ija_404_23","url":null,"abstract":"<p><strong>Background and aims: </strong>The use of a face mask while inducing general anaesthesia (GA) in obese patients is often ineffective in providing adequate ventilation. Although nasal mask ventilation has demonstrated effectiveness for continuous positive airway pressure (CPAP) in obese patients with obstructive sleep apnoea (OSA), it has not yet been applied to the induction of anaesthesia. This study evaluated the efficacy of nasal mask ventilation against standard face mask ventilation in anaesthetised obese patients with body mass index (BMI)>25 kg/m².</p><p><strong>Methods: </strong>Ninety adult patients with BMI >25 kg/m² were randomly assigned to receive either facemask (Group FM) or nasal-mask (Group NM) ventilation during induction of GA. Expired tidal volume (Vt_E), air leak, peak inspiratory pressure (PIP), plateau pressure (P_PLAT), oxygen saturation (SpO₂), and end-tidal carbon dioxide (EtCO₂) were recorded for10 breaths, and their mean was analysed.</p><p><strong>Results: </strong>The mean (standard deviation) Vt_E measured was not significantly higher in Group NM [455.98 (55.64) versus 436.90 (49.50) mL, <i>P</i> = 0.08, degree of freedom (df):88, mean difference (95% confidence interval [CI]) -19.08 (-41.14, 2.98) mL]. Mean air-leak [16.44 (22.16) versus 31.63 (21.56) mL, <i>P</i> = 0.001, df: 88, mean difference 95%CI: 15.19 (6.03,24.35)], mean PIP [14.79 (1.39) versus 19.94 (3.05) cmH₂O, <i>P</i> = 0.001, df: 88, mean difference, 95%CI: 5.15 (4.16, 6.14)], and mean P_PLAT [12.04 (1.21) versus 16.66 (2.56) cmH₂O, <i>P</i> = 0.001, df: 88, mean difference 95% CI: 4.62 (3.78, 5.45)] were significantly lower in Group NM. EtCO_2, SpO₂, and haemodynamic measurements were similar between the two groups.</p><p><strong>Conclusion: </strong>Nasal mask ventilation is an effective ventilation method and can be used as an alternative to face mask ventilation in anaesthetised obese adults with BMI>25 kg/m².</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"267-272"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109881","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 the effects of dexmedetomidine and nitroglycerin on cerebral oxygen saturation using near-infrared spectroscopy in patients undergoing controlled hypotensive anaesthesia: A randomised controlled non-inferiority trial.","authors":"J Koteswara Rao, Swati Chhabra, Sadik Mohammed, Pradeep K Bhatia, Shilpa Goyal, Rakesh Kumar","doi":"10.4103/ija.ija_712_23","DOIUrl":"10.4103/ija.ija_712_23","url":null,"abstract":"<p><strong>Background and aims: </strong>There is limited literature wherein the hypotensive drugs have been compared to know the cerebral effects by monitoring regional cerebral oxygen saturation (rScO₂). This study aimed to compare the effects of dexmedetomidine and nitroglycerin on rScO₂ during controlled hypotensive anaesthesia using near-infrared spectroscopy (NIRS). The primary objective was to evaluate the non-inferiority of dexmedetomidine versus nitroglycerin in the occurrence of cerebral desaturation events (CDEs) during hypotensive anaesthesia.</p><p><strong>Methods: </strong>Adult patients scheduled to undergo head and neck surgery under general anaesthesia randomised to receive either dexmedetomidine or nitroglycerin infusion for controlled hypotensive anaesthesia. Cerebral oximetry was monitored with NIRS, and data regarding CDEs, bilateral rScO₂, and peri-operative haemodynamics were collected. Continuous data were analysed using unpaired Student's <i>t</i>-tests except for intra-group analyses, which were analysed using paired t-tests. Categorical data were analysed using the Chi-square test. For comparison of time to CDEs, Kaplan-Meier survival analysis with log-rank test was performed.</p><p><strong>Results: </strong>Of the 82 patients in both groups, CDEs were observed in 15 patients each. A decrease from baseline by 20% was observed in three patients: one in Group N and two in Group D. Statistically, there was an equal risk of getting CDEs in the groups. The time to CDE was comparable (<i>P</i> > 0.05). The difference in heart rate was statistically significant (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Dexmedetomidine is non-inferior to nitroglycerin in terms of the occurrence of cerebral desaturation events when used for controlled hypotensive anaesthesia in head and neck surgeries.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"254-260"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109882","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":"Spontaneous subdural haemorrhage in an <i>in vitro</i> fertilisation conceived triplet pregnancy - A case study.","authors":"Shivam Shekhar, Sakshi Kadian, Yashwant Singh Payal, Priyanka Gupta","doi":"10.4103/ija.ija_838_23","DOIUrl":"10.4103/ija.ija_838_23","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"303-304"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109946","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 bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial.","authors":"Xiaoqian Yang, Hui Yang, Mengci Li, Kairun Zhu, Lulu Shen, Chenglan Xie","doi":"10.4103/ija.ija_852_23","DOIUrl":"10.4103/ija.ija_852_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy.</p><p><strong>Methods: </strong>A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test.</p><p><strong>Results: </strong>Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (<i>P</i> < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (<i>P</i> < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (<i>P</i> < 0.05). The results of other parameters were lower in groups N and L than in Group C (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"238-245"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109884","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":"Assessing postoperative analgesic efficacy of a new regional block for video-assisted thoracoscopic surgery.","authors":"Xin-Yue Li, Wen-He Yang, Fu-Shan Xue","doi":"10.4103/ija.ija_26_24","DOIUrl":"10.4103/ija.ija_26_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"313-314"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109876","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":"Comparative evaluation of continuous infusion versus programmed intermittent bolus techniques in erector spinae plane block in modified radical mastectomy - A preliminary randomised controlled trial.","authors":"Thamizharasan Datchinamourthy, Debesh Bhoi, Anjolie Chhabra, Virender K Mohan, Kanil R Kumar, Poornima Ranganathan","doi":"10.4103/ija.ija_922_23","DOIUrl":"10.4103/ija.ija_922_23","url":null,"abstract":"<p><strong>Background and aims: </strong>Single-shot erector spinae plane block (ESPB) provides excellent analgesia in mastectomy in the immediate post-operative period but is not sufficient to maintain for prolonged duration. This study compares the efficacy of programmed intermittent bolus (PIB) versus continuous infusion (CI) techniques after ESPB by placing a catheter for mastectomy.</p><p><strong>Methods: </strong>After ethical approval and patient consent, ESPB was performed at the T4 level in 50 patients with an initial bolus of 20 mL 0.375% ropivacaine and a catheter placed 30 min before surgery. In the postoperative period, they were randomised to Group I - intermittent bolus of 20 mL 0.2% ropivacaine every 4 h for 24 h and Group C - continuous infusion of 0.2% ropivacaine at 5 mL/h for 24 h. The primary outcome was the 24-h fentanyl consumption by patient-controlled analgesia device. Data was analysed using Stata 14.0.</p><p><strong>Results: </strong>Group I patients had reduced post-operative fentanyl consumption {mean [standard deviation (SD)]: 166 (139.17) µg vs 332 (247.96) µg, <i>P</i> = 0.002} and lower median NRS scores (1 h: 3 vs 5), (2 h: 3 vs 5), (4 h: 3 vs 5), (6 h: 4 vs 5) with a higher mean (SD) Quality of Recovery-15 score {134.4 (8.53) vs 127 (12.89), <i>P</i> = 0.020} compared to Group C, respectively. The 24-h dermatomal sensory coverage was more comprehensive in Group I compared to Group C.</p><p><strong>Conclusion: </strong>The PIB technique after ESPB provides decreased postoperative opioid consumption, better post-operative analgesia and quality of recovery compared to the CI technique in patients undergoing mastectomy.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"68 3","pages":"273-279"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109878","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}