{"title":"Ropivacaine and dexamethasone: Better to separate than mixing together.","authors":"Chitta Ranjan Mohanty, Amiya Kumar Barik, Rakesh Vadakkethil Radhakrishnan, Divya Mocharla","doi":"10.4103/ija.ija_1269_24","DOIUrl":"10.4103/ija.ija_1269_24","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"733"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626124","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}
Ahmed S Badran, Karim S Shata, Ahmed Elgammal, Ahmed A Samir, Mostafa O Farag, Salma Allam, Ahmed Samy
{"title":"Comparison of phenylephrine, ephedrine, and norepinephrine for the prevention and treatment of spinal-induced hypotension in pre-eclamptic patients undergoing caesarean section: A systematic review and network meta-analysis.","authors":"Ahmed S Badran, Karim S Shata, Ahmed Elgammal, Ahmed A Samir, Mostafa O Farag, Salma Allam, Ahmed Samy","doi":"10.4103/ija.ija_62_25","DOIUrl":"10.4103/ija.ija_62_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Spinal-induced hypotension in parturients with pre-eclampsia (PE) can lead to adverse perinatal outcomes, making effective prophylaxis and treatment crucial. We aim to compare the prophylactic and therapeutic roles of phenylephrine, ephedrine, and norepinephrine (NE) in treating post-spinal hypotension in PE patients.</p><p><strong>Methods: </strong>We conducted a comprehensive search of various databases up to June 2024, focusing on randomised clinical trials (RCTs). Standardised mean differences (SMDs) were used for continuous outcomes, while odds ratios (ORs) were employed for binary outcomes. Analyses were performed using R with both fixed-effect and random-effects models.</p><p><strong>Results: </strong>Nine RCTs (804 patients) were included in the analysis. Therapeutic comparisons revealed no differences in mean arterial pressure between NE and ephedrine (SMD = 0.51, 95% CI: -0.49, 1.53) or phenylephrine and ephedrine (SMD = 0.90, 95% CI: -0.01, 1.82). Phenylephrine was associated with a significantly higher risk of bradycardia compared to ephedrine (OR = 14.34, 95% CI: 1.8, 113.64, <i>P</i> = 0.018), whereas NE showed an insignificant difference (OR = 2.54, 95% CI: 0.27, 23.94). NE significantly improved the umbilical artery pH compared to ephedrine (SMD = 0.32, 95% CI: 0.02, 0.62, <i>P</i> = 0.036). No significant differences were identified in nausea or vomiting. Prophylactic comparisons revealed no significant differences between phenylephrine and NE for hypotension (OR = 0.98, 95% CI: 0.22, 4.26). For bradycardia, no difference was observed between NE and ephedrine (OR = 0.08, 95% CI: 0.002, 3.33) or phenylephrine and ephedrine (OR = 0.19, 95% CI: 0.006, 74).</p><p><strong>Conclusions: </strong>Phenylephrine, ephedrine, and NE exhibit comparable haemodynamic effects and maternal side effects, although phenylephrine increases the risk of bradycardia. NE improves umbilical artery pH.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"526-539"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225375","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}
Laila Shalabi, Ahmed Ibrahim, Mohamed Adel Elsawy, Sofian Zreigh, Muhiddin Dervis, Mohamed N Elshabrawi, Sohaila Mourad, Mohamed A Arafa, Mohamed Abuelazm
{"title":"L-carnitine supplementation to prevent postoperative complications after cardiac surgery: A systematic review and meta-analysis of randomised clinical trials.","authors":"Laila Shalabi, Ahmed Ibrahim, Mohamed Adel Elsawy, Sofian Zreigh, Muhiddin Dervis, Mohamed N Elshabrawi, Sohaila Mourad, Mohamed A Arafa, Mohamed Abuelazm","doi":"10.4103/ija.ija_1325_24","DOIUrl":"10.4103/ija.ija_1325_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Cardiac surgeries often lead to postoperative complications, which affect recovery and increase morbidity and mortality. This systematic review aims to assess L-carnitine's effect on preventing postoperative complications across various cardiac surgeries, addressing gaps in current literature on its potential therapeutic benefits.</p><p><strong>Methods: </strong>We systematically searched Web of Science, Cochrane, Embase, PubMed, and Scopus databases until March 2025. Statistical analysis was performed using R version 4.3.2. Effect sizes were measured with relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, while heterogeneity was evaluated using the I² statistic.</p><p><strong>Results: </strong>Thirteen randomised controlled trials(RCTs) with 786 patients were included. L-carnitine significantly increased the cardiac index (CI) (MD: 0.14; 95% CI: 0.07, 0.20; <i>P</i> < 0.01) and left ventricular stroke work index (LVSWI) (MD: 0.42; 95% CI: 0.06, 0.78; <i>P</i> = 0.02). In addition, L-carnitine significantly improved the left ventricular ejection fraction (LVEF) (MD: 7.88; 95% CI: 6.67, 9.09; <i>P</i> < 0.01), with a significant reduction in postoperative atrial fibrillation (POAF) (RR: 0.53; 95% CI: 0.30, 0.95; <i>P</i> = 0.03). In contrast, there was no significant reduction in in-hospital mortality (RR: 0.51; 95% CI: 0.10, 2.63; <i>P</i> = 1.00) and stroke incidence (RR: 0.85; 95% CI: 0.12, 5.76; <i>P</i> = 0.82).</p><p><strong>Conclusion: </strong>Preoperative administration of L-carnitine demonstrates meaningful short-term benefits in enhancing CI, LVSWI, and LVEF while reducing the incidence of POAF following cardiac surgery. These findings suggest a potential role for L-carnitine supplementation in optimising perioperative cardiac care, enhancing recovery, and reducing complications following cardiac surgery. However, the existing studies are limited in scope, making it challenging to draw robust conclusions.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"547-560"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225381","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":"Modified costoclavicular block: A redemption shaped by fate, not choice!","authors":"Tuhin Mistry, Siddartha Patta, Kartik Sonawane","doi":"10.4103/ija.ija_158_25","DOIUrl":"10.4103/ija.ija_158_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"629-632"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225382","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}
Sayaka Hirai, Mitsuru Ida, Nobuhiro Tanaka, Kanta Hattori, Masahiko Kawaguchi
{"title":"Recording rates of high-frequency variability index monitoring and use of vasoactive medications in daily clinical practice: A prospective observational study.","authors":"Sayaka Hirai, Mitsuru Ida, Nobuhiro Tanaka, Kanta Hattori, Masahiko Kawaguchi","doi":"10.4103/ija.ija_185_25","DOIUrl":"10.4103/ija.ija_185_25","url":null,"abstract":"<p><strong>Background and aims: </strong>To assess data recording rates of the high-frequency variability index (HFVI), which becomes less reliable with vasoactive medication use, and examine the use of vasoactive medications in daily clinical practice. The hypothesis is that when an HFVI sensor is applied and anaesthesia management is left to the discretion of the anaesthesiologist in charge, HFVI interpretation would be limited.</p><p><strong>Methods: </strong>Patients aged ≥65 years who underwent elective major abdominal surgery for malignant disease under general anaesthesia in those scheduled for surgery for >2 h were eligible. The anaesthesiologists managed patients with HFVI sensors attached at their discretion, without any limitations on vasoactive medication use. The primary outcome was the HFVI data-recording rate. Secondary outcomes were intraoperative bolus and continuous use of vasoactive medications (ephedrine, phenylephrine, atropine, and noradrenaline). The percentage of administration time was calculated by dividing the total administration time by the surgery time.</p><p><strong>Results: </strong>Of 249 eligible patients, HFVI sensors were successfully attached with a mean data recording rate of 73.1% (95% confidence interval: 70.5%, 5.7%). Two hundred and ten patients received at least one administration of vasoactive medications during the assessment period, and ephedrine was dominant. Sixty-one patients received continuous administration of phenylephrine and noradrenaline, and the ratios of continuous administration time to the total surgical time were 77.8% and 84.9%, respectively.</p><p><strong>Conclusion: </strong>The data recording rate of HFVI in routine clinical practice was approximately 70%, and many patients were given vasoactive medications; thus, caution must be taken when interpreting HFVI in routine clinical practice.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"615-620"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225384","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 prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring.","authors":"Ying-Tzu Chen, Yueh-Ting Lai, Hou-Chuan Lai, Ann-Shung Lieu, Meei-Shyuan Lee, Zhi-Fu Wu","doi":"10.4103/ija.ija_911_24","DOIUrl":"10.4103/ija.ija_911_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Inadequate antinociception during skull pin fixation can destabilise haemodynamics in patients undergoing intracranial surgery. However, the concentration of remifentanil required to achieve sufficient antinociception and maintain stable haemodynamics under surgical pleth index (SPI) monitoring remains unestablished. We aimed to determine the 95% effective concentration (EC95) of remifentanil for skull pin fixation using haemodynamic and SPI monitoring.</p><p><strong>Methods: </strong>Nineteen patients undergoing intracranial surgery were enroled. Anaesthesia was administered via target-controlled infusion (TCI) of remifentanil and propofol and monitored using the SPI and bispectral index (BIS). Skull pin fixation was conducted at varying remifentanil effect-site concentrations, determined using Dixon's up-and-down method with a 0.5-ng/mL step size while maintaining a BIS of 40-60. Severe pain was defined as SPI >80, haemodynamic change >20% from baseline, heart rate (HR) >100 bpm, or blood pressure >180/100 mmHg and classified as a failure. Success was defined as SPI ≤80 and haemodynamic stability (haemodynamic changes < 20% from baseline, HR ≤100 bpm, and arterial blood pressure ≤180/100 mmHg occurring simultaneously). Statistical tests were conducted using SPSS Statistics (Version 27.0; IBM, Armonk, NY) for Windows.</p><p><strong>Results: </strong>Probit analysis of seven pairs of failure-success outcomes revealed that the EC95 of remifentanil for skull pin fixation, providing adequate antinociception and haemodynamic stability, was 4.23 ng/mL.</p><p><strong>Conclusion: </strong>Skull pin fixation can be performed in 95% of patients without triggering noxious stimulation-induced cardiovascular responses by setting remifentanil to 4.23 ng/mL, utilising remifentanil/propofol TCI with SPI and BIS monitoring.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"594-599"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225360","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 inhalational agents in breast cancer surgery on tumour metastasis: Systematic review and meta-analysis.","authors":"Satheesh Gunashekar, Alisha Chachra, Soumya Subhra Datta, Ajit Kumar, Arun Jagath, Dhatri Jonna","doi":"10.4103/ija.ija_876_24","DOIUrl":"10.4103/ija.ija_876_24","url":null,"abstract":"<p><strong>Background and aims: </strong>The primary treatment for breast cancer involves surgically removing the affected breast. Different types of anaesthesia used during surgery may have an impact on cancer recurrence. This meta-analysis was conducted to assess the current level of evidence for the impact of the type of anaesthesia for breast cancer surgery on cancer recurrence.</p><p><strong>Methods: </strong>Following PROSPERO registration, a comprehensive database search was conducted across PubMed, Cochrane, Embase, Scopus, and Google Scholar, encompassing all available data up to December 2024. Randomised controlled trials (RCTs) and retrospective studies assessing the effect of inhalational anaesthetic agents on cancer recurrence after breast cancer surgeries were included. The Cochrane Collaboration's risk of bias and the Newcastle-Ottawa scale were used for risk of bias assessment in RCTs and retrospective studies, respectively. We inverted the hazard ratio (HR) to (1/HR) for studies that reported inhalational as the control group.</p><p><strong>Results: </strong>Eight studies were included: four RCTs and four retrospective cohort studies. No association between the anaesthetic agent used and the recurrence of breast cancer was seen in RCTs (risk ratio (RR) =1.07, 95% confidence interval (CI): 0.89, 1.29). Included retrospective cohort studies showed RR = 1.46 (95% CI: 1.32, 1.62), showing an association of recurrence with inhalational agents compared to total intravenous anaesthesia-based or regional anaesthesia with significant bias.</p><p><strong>Conclusion: </strong>The retrospective studies suggest a possible association between inhalational anaesthesia and breast cancer recurrence. However, these findings should be interpreted with caution due to the inherent limitations of retrospective studies, including a higher risk of bias and variability in control group definitions. This contradicts findings from prospective RCTs. Further research is needed to understand the mechanisms behind this association and to weigh the pros and cons of different anaesthesia techniques.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"561-569"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225376","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 intravenous lignocaine infusion on propofol requirement using a closed-loop anaesthesia delivery system: A randomised controlled study.","authors":"Jijo Francis, Goverdhan D Puri, Tanvir Samra, Vighnesh Ashok, Rajarajan Ganesan","doi":"10.4103/ija.ija_830_24","DOIUrl":"10.4103/ija.ija_830_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Closed-loop anaesthesia delivery systems (CLADS) have made total intravenous anaesthesia easier, safer and more precise. lignocaine is a local anaesthetic with analgesic properties. This study aimed to compare the consumption of propofol and fentanyl delivered using CLADS in patients administered intraoperative lignocaine infusion.</p><p><strong>Methods: </strong>In this randomised trial, 70 females (18-60 years) undergoing elective breast surgery between March 2021 and December 2022 were randomised into two groups: a group administered lignocaine (1.5 mg/kg bolus followed by infusion of 2 mg/kg/h) and a placebo group. In both groups, propofol was administered using CLADS with a target bispectral index (BIS) set at 50 and an initial set fentanyl concentration of 2 ng/ml. The data were analysed using measures of central tendency and dispersion.</p><p><strong>Results: </strong>The mean total consumption of propofol (mg/kg/h) was 6.0 [standard deviation (SD): 1.4] [95% confidence interval (CI): 5.54, 6.46] in the lignocaine group and 6.2 (SD: 1.7) (95% CI: 5.64, 6.76) in the placebo group (<i>P</i> = 0.719). The mean dose of propofol (mg/kg) to achieve target BIS of 50 at induction was 2.00 (SD: 0.39) (95% CI: 1.87, 2.13) in the lignocaine group and 1.95 (SD: 0.38) (95% CI: 1.82, 2.08) in the placebo group (<i>P</i> = 0.515). The total dose of intraoperative fentanyl, as well as the performance parameters of CLADS (Median Performance Error, Median Absolute Performance Error and Wobble), time to extubation, time to rescue analgesia and duration of post-anaesthesia care unit stay were similar in both groups.</p><p><strong>Conclusion: </strong>There were no significant additive anaesthetic or analgesic effects of intraoperative lignocaine given during breast surgery, where anaesthesia was maintained with propofol, fentanyl and nitrous oxide.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"587-593"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225377","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}
Puneet Gupta, Hong-Jui Shen, Kunj Patel, Rui Guo, Eric R Heinz, Rameshbabu Manyam
{"title":"Artificial intelligence for predicting 30-day mortality after surgery for femoral shaft fractures: A retrospective study.","authors":"Puneet Gupta, Hong-Jui Shen, Kunj Patel, Rui Guo, Eric R Heinz, Rameshbabu Manyam","doi":"10.4103/ija.ija_1060_24","DOIUrl":"10.4103/ija.ija_1060_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Surgical repair of femoral shaft fractures continues to have notable perioperative morbidity and mortality. The purpose of this study is to assess whether artificial intelligence (AI)-driven models can be utilised to predict 30-day mortality after surgery for femoral shaft fractures and to identify patient risk factors for mortality using AI.</p><p><strong>Methods: </strong>This retrospective study utilised data from the National Surgical Quality Improvement Program between 2015 and 2020. Five AI-driven models were developed and tested using patient clinical information to predict mortality within 30 days of surgery. Additionally, the most important variables for the best-performing model were identified.</p><p><strong>Results: </strong>A total of 1720 patients were identified, and the 30-day mortality rate after femoral shaft fracture surgery was 3.4% (n = 58). XGBoost demonstrated the best predictive performance, with an area under the curve (AUC) of 0.83, a calibration intercept of -0.03, a calibration slope of 1.17, and a Brier score of 0.02. The most important variables for prediction were age, preoperative white blood cell count, creatinine, haematocrit, platelets, blood urea nitrogen, and body mass index.</p><p><strong>Conclusion: </strong>This study is the first to internally validate an AI-driven model for predicting mortality within 30 days of surgery in an isolated population of femoral shaft fracture patients, demonstrating good performance. Further research is needed to develop an excellent-performing, AI-driven model that is externally validated prior to clinical translation to support anaesthesiologists and orthopaedic surgeons in perioperative risk stratification and patient education.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 6","pages":"606-614"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225361","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}