Journal of Anaesthesiology, Clinical Pharmacology最新文献

{"title":"Dexmedetomidine vs. midazolam-ketamine for sedation during awake fiberoptic nasal intubation in patients with difficult airway - A randomized, double-blinded, comparative trial.","authors":"R Sivakumar, Rashmi Ramachandran, Anjan Trikha, Shailendra Kumar, Bijaya Laxmi, Vimi Rewari","doi":"10.4103/joacp.joacp_247_24","DOIUrl":"10.4103/joacp.joacp_247_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Both dexmedetomidine and midazolam-ketamine are known for their minimal respiratory depressant effects. While many studies have documented the use of dexmedetomidine in providing conscious sedation during awake fiberoptic-guided nasal intubation (AFNI), the use of midazolam-ketamine combination for this procedure has not been reported. The aim of this study was to compare the efficacy of dexmedetomidine with midazolam-ketamine combination for AFNI in patients with difficult airways undergoing oromaxillofacial surgery.</p><p><strong>Material and methods: </strong>This study involved 60 patients undergoing oromaxillofacial surgery. They were randomized to receive either dexmedetomidine (1 μg/kg) (group D) or a combination of midazolam (0.02 mg/kg) and ketamine (0.5 mg/kg) (group MK) for sedation during awake fiberoptic nasotracheal intubation. Both groups received topical local anesthesia during the procedure using the spray-as-you-go technique. The primary outcome measured was cough score during intubation. Secondary outcomes included overall intubation, post-intubation, and sedation scores. Incidences of side effects such as hypoxemia and bradycardia were also measured.</p><p><strong>Results: </strong>The cough score (group D: 1.33 ± 0.61, group MK: 1.3 ± 0.53; <i>P</i> = 0.822), overall intubation score, and post-intubation score were comparable between the two groups. Patients receiving dexmedetomidine were significantly more sedated than patients receiving midazolam-ketamine. Patients receiving dexmedetomidine had significantly lower heart rates and blood pressure than patients receiving midazolam-ketamine. Four patients in group D had hypoxemia, while no patient in group MK developed hypoxemia.</p><p><strong>Conclusions: </strong>Both dexmedetomidine and midazolam-ketamine combinations were equally effective for sedation during AFNI in patients with difficult airways scheduled for orofacial maxillary surgery. Patients receiving dexmedetomidine were more sedated, but the incidence of side effects was similar in both groups.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"496-502"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600524","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":"Mind the gap: Unusual cause of intraoperative metabolic acidosis.","authors":"Surentharraj Elangobaalan, Kirthiha Govindaraj, Anusha Cherian, Manasa Rengarajan","doi":"10.4103/joacp.joacp_347_24","DOIUrl":"10.4103/joacp.joacp_347_24","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"560"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600535","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":"Supraglottic airway devices in neuroanesthesia practice: A narrative review.","authors":"Balaji Vaithialingam, Varadarajan Bhadrinarayan, Satish Rudrappa","doi":"10.4103/joacp.joacp_317_24","DOIUrl":"10.4103/joacp.joacp_317_24","url":null,"abstract":"<p><p>Supraglottic airway devices (SADs) have a great application as an alternative to tracheal intubation, prompting a paradigm shift in routine anesthetic practice. However, its usage in neuroanesthesia is limited and debatable, considering the clinical challenges and complexity of neurosurgical procedures. Even though literature evidence exits regarding successful airway management with SADs in neurosurgery, there is no clear-cut evidence or consensus among anesthesiologists. Articles were searched in PubMed and Google Scholar by using the keywords \"Supraglottic airway\" AND \"Laryngeal Mask\" OR \"LMA\" AND \"Craniotomy\" over the past 30 years. In addition, a manual search was performed (with additional keywords \"neurosurgery,\" spine surgery,\" \"I-gel,\" \"ILMA,\" \"awake craniotomy,\" \"radiology,\" \"electroconvulsive therapy,\" and \"magnetic resonance imaging\") to retrieve additional articles. The primary goal of this narrative review is to determine the applicability of SADs in various neurosurgical settings. According to the review, SADs play an important role as a rescue device during intraoperative emergencies such as accidental tracheal extubation (supine, lateral, and prone positions with head fixed on cranial pins), sudden airway loss due to seizure during awake craniotomy, postoperative airway loss following trans-nasal pituitary surgeries, and macroglossia. SADs can be used successfully for short-duration minimally invasive elective procedures such as cranioplasty, burr hole evacuation of subdural collection, battery implantation for deep brain stimulation, vario-guided biopsies, and minimally invasive spine surgeries. Furthermore, SADs serve a significant function in blunting extubation responses, thereby preventing cerebral edema and tumor bed hemorrhage. Only a few studies have supported the use of SADs in long-duration major intracranial tumour surgeries, making its use controversial in major surgeries where intracranial pressure control is the key. The SADs also have clinical utility in various non-operating room neuroanesthesia procedures.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"410-417"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600544","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":"Cangrelor to facilitate epidural catheter removal after urgent antithrombotic therapy.","authors":"Anju Kumari, Saloni Paranjape, Jasbir Khanuja, Umesh K Valecha","doi":"10.4103/joacp.joacp_250_24","DOIUrl":"10.4103/joacp.joacp_250_24","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"553-554"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600515","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 caudal bupivacaine and dexmedetomidine with caudal bupivacaine and intravenous dexmedetomidine for postoperative analgesia in children: A randomized controlled trial.","authors":"Kuldeep Singh, Jeetendra Bajaj, Sapna Bathla, Khushboo Mehta","doi":"10.4103/joacp.joacp_142_24","DOIUrl":"10.4103/joacp.joacp_142_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Caudal block is a part of multimodal analgesic regimen to alleviate pain in pediatric patients undergoing variety of surgeries. This study compares the effectiveness of caudal versus intravenous dexmedetomidine as an additive to caudal bupivacaine for prolonging analgesia in children posted for elective lower abdominal surgeries. The level of sedation and hemodynamic effects through both routes were also compared.</p><p><strong>Material and methods: </strong>Ninety-six children (aged 1-8 years) of either gender scheduled for elective lower abdominal and pelvic surgeries were prospectively enrolled and randomized into two groups of 48 each: Group A (caudal bupivacaine + caudal dexmedetomidine) and Group B (caudal bupivacaine + intravenous dexmedetomidine). The postoperative pain was monitored using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, and sedation was assessed using the Ramsay sedation scale (RSS).</p><p><strong>Results: </strong>The degree of analgesia was comparable in both groups in the initial hours after surgery. Significantly higher FLACC scores were seen in Group B at 8 h (<i>P</i>- 0.016), 12 h (<i>P</i> < 0.001), and 16 h (<i>P</i> < 0.001), with 89.58% patients needing two rescue analgesic doses. RSS was higher in Gr=oup A till 12 h postsurgery.</p><p><strong>Conclusion: </strong>Caudal dexmedetomidine with bupivacaine provides improved analgesia after 8 h of surgery in comparison to caudal bupivacaine with intravenous dexmedetomidine in children undergoing lower abdominal surgeries.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"455-463"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600518","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":"Correlation of end-tidal carbon dioxide with transthoracic echocardiography derived cardiac output for the assessment of fluid responsiveness: A prospective observational study.","authors":"S Keerthi Raj, Debendra K Tripathy, Praveen Talawar, Deepak Singla","doi":"10.4103/joacp.joacp_288_24","DOIUrl":"10.4103/joacp.joacp_288_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Judicious use of intravenous fluid therapy can be lifesaving in the intraoperative period. An assessment of fluid responsiveness is important for it. So, our study aimed to study the correlation between end-tidal carbon dioxide (EtCO₂) and transthoracic echocardiography-derived cardiac output for assessing fluid responsiveness in patients undergoing elective surgery under general anesthesia.</p><p><strong>Material and methods: </strong>Patients who underwent elective lower abdominal or lower limb surgeries in a supine position under general anesthesia with positive pressure ventilation were included in this study. Cardiac output was calculated using transthoracic echo, and by measuring the diameter of the left ventricular outflow tract (LVOT), velocity time integral of LVOT (LVOT-VTI), and heart rate. Cardiac output (CO), EtCO₂, and hemodynamic and ventilatory parameters were analyzed by the operator before and 1 min after the infusion of 250 mL of normal saline.</p><p><strong>Results: </strong>EtCO₂ variations showed a weak correlation with the changes in CO induced by a fluid challenge (Spearman's correlation <i>r =</i> 0.3, <i>P</i> = 0.005). When fluid responsiveness (FR) is defined as an increase in CO by > 15%, the AUROC of ∆ EtCO₂ was 0.638 (95% confidence interval [CI], 0.507-0.77). At a cut-off of ≥ 1 mmHg, it predicted FR status (responder vs. non-responder) with a sensitivity of 66% and a specificity of 64%. When percentage variation in EtCO₂ (percent ∆ EtCO₂) was considered, the AUROC was almost similar (0.618) (95% CI, 0.481-0.756), and it was not statistically significant (<i>P</i> = 0.093).</p><p><strong>Conclusions: </strong>Our study demonstrated a weak positive correlation between volume-induced changes in EtCO₂ and changes in CO in mechanically ventilated patients in the operating room. Variations in EtCO₂ can be used as an adjunct to guide hemodynamic optimization when no COcardiac output monitors are available.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"478-485"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600523","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 \"LeHeR maneuver\"on glottic view as assessed with POGO score during video laryngoscopy.","authors":"Sunil Rajan, Jacob Mathew, Gayathri Sreekumar, Lokeshshiva Arul, Kajol N Amin, Jerry Paul","doi":"10.4103/joacp.joacp_263_24","DOIUrl":"10.4103/joacp.joacp_263_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Left head rotation maneuver improves the glottic view during direct laryngoscopy. We assessed whether rotating the head to the left side to 45° in supine position improves the glottic view as assessed with the percentage of glottic opening (POGO) score during video laryngoscopy compared to sniffing position. Ease of intubation, time to intubate, and hemodynamic changes were also assessed.</p><p><strong>Material and methods: </strong>This prospective, observational study was conducted in 41 patients with difficult airway requiring video laryngoscope-aided nasotracheal intubation. Following intravenous induction and neuromuscular blockade, indirect laryngoscopy was attempted with C-MAC videolaryngoscope with the patient's head in sniffing position. Best glottic view was graded as per the POGO scoring system. In patients having partial or no glottic view, patient's head was rotated to the left side to 45° and the best glottic view was obtained and scored. Intubation was attempted in this position, and ease of intubation was documented.</p><p><strong>Results: </strong>Majority of patients showed improvement of >25% POGO score following left head rotation compared to sniffing position (85.37% vs. 14.63%). Significantly higher number of patients in sniffing position had a POGO score of 0-25%, while it was >50-100% in left head rotation position. Median POGO score was significantly higher in left lateral position compared to sniffing position (75% vs. 25%). Intubation was easy in 69.29% of patients. There was no significant change in hemodynamic parameters during intubation.</p><p><strong>Conclusion: </strong>Rotating the head to the left side to 45° in supine position improved the glottic view during indirect laryngoscopy using C-MAC videolaryngoscope compared to sniffing position.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"486-490"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600526","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":"Green urine following a single induction dose of propofol.","authors":"Namburu Jyotsna, R Sripriya, Raza Shabuddin Gouri, Mukesh Tripathi","doi":"10.4103/joacp.joacp_17_24","DOIUrl":"10.4103/joacp.joacp_17_24","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"543-544"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600532","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":"Anesthesia management of patients with ichthyosis vulgaris.","authors":"Nivedita, Shyam Charan Meena, Narender Kaloria, Manjari Jha, Manish K C Gautam","doi":"10.4103/joacp.joacp_255_24","DOIUrl":"10.4103/joacp.joacp_255_24","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"550-551"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600512","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 continuous infraclavicular block on early functional rehabilitation following elbow fractures: A pilot study.","authors":"A S Arun Jagath, Nidhi Bhatia, Kajal Jain, Deepak Kumar, Sharad Prabhakar, Jeetinder K Makkar","doi":"10.4103/joacp.joacp_120_24","DOIUrl":"10.4103/joacp.joacp_120_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Ultrasound-guided continuous peripheral nerve block catheter placement greatly aids in providing a prolonged peripheral nerve block. We investigated the effect of patient-controlled continuous infraclavicular brachial plexus block analgesia on early functional rehabilitation following surgeries around the elbow performed under general anesthesia.</p><p><strong>Material and methods: </strong>In this prospective, trial patients were randomized to two groups of 15 patients each to receive either patient-controlled IV morphine, using patient-controlled bolus of 1 mg morphine intravenously with a lockout interval of 15 min (control group, Group I) or patient-controlled continuous infraclavicular block with 0.2% ropivacaine at a basal rate of 5 mL/h, with a patient-controlled bolus of 3 mL and a lockout interval of 30 min (study group, Group II). The block was administered before extubation. The primary objective was to assess the Mayo Elbow Performance Score (MEPS) at 3 weeks following discharge from the hospital. Our secondary objectives included MEPS at 3 months following discharge, numeric rating scale (NRS) score at 4 h for an initial 72 h postoperatively and at the time of physiotherapy, a total dosage of rescue analgesic consumed, and time to the first dose of rescue analgesia.</p><p><strong>Results: </strong>At 3 months following discharge from the hospital, the median MEPS was significantly higher in Group II as compared to that in Group I (85 [83.75-90] vs. 80 [80-82.5]; <i>P</i> = 0.03). A strong negative correlation (<i>P</i> < 0.05) was found between pain scores during physiotherapy on days 2, 3, and MEPS at 3 weeks in Group II. The median number of analgesic boluses was also significantly higher in Group I (7 [6-8.25] vs. 4 [4-5]; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Ultrasound-guided continuous infraclavicular block resulted in significantly higher MEPS. It also improved baseline analgesia in the postoperative period. This facilitated early functional correction of the elbow joint, thereby promoting better rehabilitation.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 3","pages":"448-454"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600529","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}