Journal of Anaesthesiology, Clinical Pharmacology最新文献

{"title":"Post-operative vomiting after pediatric strabismus surgery: A comparison of propofol versus sevoflurane anaesthesia.","authors":"Shalini Subramanian, Deepa Shetty, Poornima Shivanna, Priyanka Das, Medha Phadke","doi":"10.4103/joacp.joacp_363_22","DOIUrl":"10.4103/joacp.joacp_363_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Squint surgery is a risk factor for postoperative vomiting (POV) in children. This study was designed to compare the incidence of POV in children undergoing strabismus surgery under balanced anesthesia with sevoflurane versus intravenous anesthesia with propofol.</p><p><strong>Material and methods: </strong>In this prospective randomized controlled study conducted in a tertiary care ophthalmology hospital, 70 ASA I-II children aged 1-12 years undergoing strabismus surgery were randomized to two groups -Group S (sevoflurane-based anesthesia) and Group P (propofol-based anesthesia) for maintenance. The surgical details, intraoperative hemodynamic parameters, recovery characteristics, and emergence delirium were recorded. Any episode of postoperative vomiting in the 0-2 hours, 2-6 hours, and 6-24 hours period was noted. Rescue antiemetic was administered if there was more than one episode of vomiting.</p><p><strong>Results: </strong>Both the groups were similar with respect to demographic and surgical details. The average duration of surgery was 118.2 ± 41.88 min in group S and 137.32 ± 39.09 min in group P (<i>P</i> = .05). Four children in group S (11.4%) and one child in group P (2.9%) had POV in the first 24 hours but this was not statistically significant (<i>P</i> = .36). The median time to discharge from post anesthesia care unit was significantly less (<i>P</i> = .02) in the P group (50 min) than in the S group (60 min).</p><p><strong>Conclusion: </strong>Propofol-based anesthesia does not offer advantage over sevoflurane, in reducing POV after squint surgery, when dual prophylaxis with dexamethasone and ondansetron is administered. It, however, reduces the duration of stay in the post anesthesia care unit.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450551","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 midpoint transverse process to pleura (MTP) block and erector spinae plane block (ESP) for postoperative analgesia in modified radical mastectomy patients: A double-blinded, randomized control trial.","authors":"Priyanka Sethi, Manbir Kaur, Pradeep K Bhatia, Shilpa Goyal, Ankur Sharma, Shipra Roy, Narender Kaloria","doi":"10.4103/joacp.joacp_429_22","DOIUrl":"10.4103/joacp.joacp_429_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Modified radical mastectomy (MRM) is associated with moderate severity of postoperative pain. Besides intravenous (IV) analgesics, various nerve blocks are being described for pain relief of MRM patients. We compared erector spinae plane (ESP) block with midpoint transverse process to pleura (MTP) block in these patients for postoperative analgesia.</p><p><strong>Material and methods: </strong>After receiving ethical committee approval from the institutional ethics committee (AIIMS, Jodhpur) and written informed consent from study participants, 66 patients who were assigned American Society of Anesthesiologists (ASA) physical status I and II, aged 18-75 years, and were scheduled to undergo MRM were enrolled and randomly allocated into two groups. Unilateral block was given before surgery at T3 or T4 level and with 15 ml of 0.5% ropivacaine in both the groups. Infusion of 0.5% ropivacaine (Neon laboratories limited, Mumbai, India) and 0.2% ropivacaine at a rate of 5 ml/h was maintained intraoperatively and postoperatively, respectively. Pain was assessed using the Visual Analogue Scale (VAS) for the next 24 hours. The total number of patients needing rescue analgesia, the total amount of rescue analgesics consumed in the next 24 hours, and patient satisfaction score were also compared between groups.</p><p><strong>Results: </strong>Demographics and baseline vitals were comparable in the groups. On comparing VAS scores in both the groups during rest and movement at different time intervals, there was no difference in pain scores during the initial two hours. From the third hour, there was a statistically significant difference (<i>P</i> < 0.001) in pain VAS scores in both groups. The ESP group had lower VAS scores compared to the MTP group when followed for the next 24 hours. There was a statistically significant difference in patient satisfaction.</p><p><strong>Conclusion: </strong>ESP block is more efficacious when compared to MTP block for postoperative analgesia in MRM patients.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450545","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 neuraxial acoustic target window of the spine among rider sitting, cross leg, hamstring stretch, and classical sitting position: An observational study.","authors":"Govind Singh, Priyanka Sethi, Manbir Kaur, Pradeep Bhatia, Pawan K Garg, Kamlesh Kumari, Pawan K Dixit","doi":"10.4103/joacp.joacp_450_22","DOIUrl":"10.4103/joacp.joacp_450_22","url":null,"abstract":"<p><strong>Background and aims: </strong>To compare ultra-sonographic dimensions of acoustic target window of the spine in the participants at four different sitting positions namely cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP) and riders sitting position (RSP). The primary objective of this study was to measure the neuraxial acoustic target window (defined as interlaminar distance between L3-L4 lamina). The secondary objective was to compare ultra-sonographic measurements of the depth of ligamentum flavum from the skin, and to compare the diameter of intrathecal space and comfort score in the four different sitting positions.</p><p><strong>Material and methods: </strong>This study is a prospective observational study. Eighty participants were included and positioned in four different sitting positions to perform an ultra-sonographic scan and measure various parameters of the acoustic neuraxial window. The interlaminar distance, the distance of skin from the ligamentum flavum, and the diameter of the spinal canal or intrathecal space was measured in the L3-L4 intervertebral space in different positions.</p><p><strong>Results: </strong>The mean value of interlaminar distance among four sitting positions was ranging from 1.40 cm to 1.44 cm (<i>P</i> value 0.725.) The distance of ligamentum flavum from skin and diameter of intrathecal space was also comparable in all the groups. The comfort score in CSP was significantly better when compared to other groups with a median score of 4 (<i>P</i> value < 0.001).</p><p><strong>Conclusions: </strong>There is no statistically significant difference in interlaminar distance in various sitting positions. All four positions are equally effective and can be used as an alternative to spinal/epidural intervention, but the CSP came out to be the most comfortable and more emphasis should be given to the comfort as it increases the chance of success rate of the procedure.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450546","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":"Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study.","authors":"Konish Biswas, Sanjay Agrawal, Priyanka Gupta, Rajnish Arora","doi":"10.4103/joacp.joacp_323_22","DOIUrl":"10.4103/joacp.joacp_323_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission.</p><p><strong>Material and methods: </strong>In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors.</p><p><strong>Results: </strong>Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (<i>P</i> = 0.035, AOR = 1.130) and minimum systolic arterial pressures (<i>P</i> = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66).</p><p><strong>Conclusion: </strong>Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450550","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":"Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions.","authors":"Heena Singh, Manikandan Rajarathinam","doi":"10.4103/joacp.joacp_304_22","DOIUrl":"10.4103/joacp.joacp_304_22","url":null,"abstract":"<p><p>Cervical sympathetic or stellate ganglion blocks (SGBs) have been commonly used in the treatment of painful conditions like complex regional pain syndrome (CRPS). However, there is literature to suggest its utility in managing non-painful conditions as well. The focus of this literature review is to provide an overview of indications for SGB for painful and non-painful conditions. We identified published journal articles in the past 25 years from Embase and PubMed databases with the keywords \"cervical sympathetic block, stellate ganglion blocks, cervical sympathetic chain, and cervical sympathetic trunk\". A total of 1556 articles were obtained from a literature search among which 311 articles were reviewed. Among painful conditions, there is a lack of evidence in favor of or against the use of SGB for CRPS despite its common use. SGB can provide postoperative analgesia in selective surgeries and can be effective in temporary pain control of refractory angina and the acute phase of herpes zoster infection. Among non-painful conditions, SGB may have beneficial effects on the management of post-traumatic stress disorder (PTSD), refractory ventricular arrhythmias, hot flashes in postmenopausal women, and breast cancer-related lymphedema. Additionally, there have been various case reports illustrating the benefits of SGB in the management of cerebral vasospasm, upper limb erythromelalgia, thalamic and central post-stroke pain, palmar hyperhidrosis, orofacial pain, etc. In our review of literature, we found that SGB can be useful in the management of various non-painful conditions beyond the well-known treatment for CRPS, although further studies are required to prove its efficacy.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41769066","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":"Efficacy of lignocaine nebulization in patients with COVID-19 respiratory infection: An exploratory randomized double-blinded controlled trial.","authors":"Praveen Talawar, Debendra Kumar Tripathy, Ashutosh Kaushal, Mridul Dhar, Adabala Vijaybabu, Praik Tuppad, Sangadala Priyanka, Deepak Kumar, Ruhi Sharma, Sumedha Suresh Kumar","doi":"10.4103/joacp.joacp_205_22","DOIUrl":"10.4103/joacp.joacp_205_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Coronavirus disease (COVID-19)-related pneumonia is proposed to be an inflammatory process. The treatment currently includes supportive therapy and low-dose steroids. Anti-inflammatory drugs have been proposed to prevent cytokine storms and improve oxygenation in such cases. The study aimed to assess the efficacy of nebulized lignocaine in COVID-19 patients with pneumonia.</p><p><strong>Material and methods: </strong>This was an exploratory randomized double-blinded control trial conducted in COVID-19 patients with respiratory failure requiring oxygen therapy either by face mask or non-invasive mechanical ventilation. Patients included were of the age of more than 18 years of either gender. The patients were randomized to receive either lignocaine or distilled water nebulization. The outcomes assessed were PaO₂/FiO₂ ratio, hemodynamics, respiratory parameters, and sequential organ failure score (SOFA).</p><p><strong>Results: </strong>The two groups were comparable concerning demographic variables. The PaO₂/FiO₂ were significantly higher in the lignocaine group from day 2 onward. The SPO₂ was significantly higher on day 3 in the lignocaine group and thereafter there was no significant difference. Other hemodynamic, respiratory parameters, and SOFA scores showed no difference in both the groups.</p><p><strong>Conclusion: </strong>Lignocaine nebulization improved oxygenation in COVID-19 patients and can be used as adjunctive therapy along with other supportive medications.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450547","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":"'Ten'der points of perioperative analgesia research.","authors":"Varun Suresh, Rohan Magoon","doi":"10.4103/joacp.joacp_39_24","DOIUrl":"10.4103/joacp.joacp_39_24","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450553","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":"Ropivacaine pharmacokinetics in the arterial and venous pools after ultrasound-guided continuous thoracic paravertebral nerve block.","authors":"Paraskevi Matsota, Vangelis Karalis, Theodosios Saranteas, Fay Kiospe, Sophia Liberty Markantonis","doi":"10.4103/joacp.joacp_353_22","DOIUrl":"10.4103/joacp.joacp_353_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required and manifestations of local anesthetic systemic toxicity (LAST) may appear. Currently, there are limited data on the pharmacokinetics of ropivacaine after continuous TPVB. The aim of this prospective study was to investigate ropivacaine kinetics, in the arterial and venous pools, after continuous TPVB and assess the risk of LAST.</p><p><strong>Material and methods: </strong>Immediately after induction of general anesthesia, an ultrasound-guided continuous TPVB at T5 or T6 or T7 thoracic level was performed in 18 adult patients subjected to open thoracotomy. A 25-ml single bolus injection of ropivacaine 0.5% was administered through thoracic paravertebral catheter, followed by a 14 ml/h continuous infusion of ropivacaine 0.2% starting at the end of surgery. Quantification of total ropivacaine concentrations was performed using a validated high-performance liquid chromatography method. Population pharmacokinetic models were developed separately for arterial and venous ropivacaine data.</p><p><strong>Results: </strong>The best model was one-compartment disposition with an additional pre-absorption compartment corresponding to thoracic paravertebral space. Gender had a significant effect on clearance, with females displaying lower elimination than males. Some patients had ropivacaine concentrations above the toxic threshold, but none displayed evidence of LAST. Continuous thoracic paravertebral nerve blocks provided adequate postoperative analgesia.</p><p><strong>Conclusion: </strong>Ropivacaine doses at the upper end of clinical use (800 mg/d) did not inflict the manifestations of LAST and provided adequate postoperative pain control. Pharmacokinetic models were developed, and the effect of gender was identified.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42984332","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":"Can the preuse check of epidural set detect all manufacturing defects?","authors":"Raksha Vyas, Sadik Mohammed, Priyabrat Karan, Rakesh Kumar","doi":"10.4103/joacp.joacp_389_22","DOIUrl":"10.4103/joacp.joacp_389_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450543","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 human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: A randomized controlled trial.","authors":"Deepanshu Dang, Manoj Kamal, Mritunjay Kumar, Bharat Paliwal, Ashish Nayyar, Pradeep Bhatia, Geeta Singariya","doi":"10.4103/joacp.joacp_234_22","DOIUrl":"10.4103/joacp.joacp_234_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Simulation is increasingly used in medical teaching. Various studies have evaluated different simulation models for training of regional anesthesia (RA). We compared the use of human cadaver and blue phantom models for training of regional anesthesia to novice postgraduate students of anesthesiology.</p><p><strong>Material and methods: </strong>Fifty students were taught knobology of the ultrasonography (USG) machine. They were divided into two equal groups by computer-generated random number table, and the groups assigned were kept in sealed envelopes. In group BP, students were trained on a blue phantom model, and in group HC, students were trained on human cadaver. After training, a didactic video of sonoanatomy of the supraclavicular block was shown to all participants. The block performance was then judged on patients requiring supraclavicular block. The primary objective of the study was to compare the block performance time, and secondary objectives were the quality of image acquired, orientation of transducer to the target, identification of ultrasound artifacts, errors committed, complications, and success rate.</p><p><strong>Results: </strong>The mean block performance time was shorter in group HC compared to group BP (451.96 ± 50.25 and 526.48 ± 43.486 s, respectively; <i>P</i> < 0.001). The image quality score, transducer orientation to the target, and identification of USG artifacts were better in group HC compared to group BP, with lesser number of needle passes.</p><p><strong>Conclusion: </strong>Cadaver-based training produced better results compared to blue phantom simulator model for teaching of ultrasound-guided RA to novice postgraduate trainees of anesthesiology.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450544","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}