Journal of Anaesthesiology, Clinical Pharmacology最新文献

{"title":"Etomidate is a potential medical option in the management of severe and refractory Cushing's syndrome.","authors":"Vaishakh Tharavath, Ghansham Biyani, Suresh Vaikkakara, Raza S Gouri, Sadik Mohammed, Rajasekhar Metta","doi":"10.4103/joacp.joacp_312_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_312_25","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"295-297"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838155","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":"Internal jugular vein collapsibility index versus common carotid artery peak systolic velocity variation for prediction of post-spinal hypotension: A prospective observational study.","authors":"Parth Arora, Suneet Kathuria, Richa Jain, Shikha Gupta, Sumeet Jain","doi":"10.4103/joacp.joacp_345_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_345_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Post-spinal anesthesia hypotension (PSAH) is associated with significant adverse outcomes, prompting extensive research into predictive markers. This study aimed to evaluate and compare the predictive value of the internal jugular vein collapsibility index (IJV-CI) and common carotid artery peak systolic velocity variation (CCA-PSV) in forecasting PSAH.</p><p><strong>Material and methods: </strong>A prospective observational study was conducted on 53 ASA I, II, and III adult patients undergoing elective surgery under spinal anesthesia (SAB). IJV-CI and CCA-PSV were examined using ultrasonography in all patients. SAB was administered using a standard protocol. PSAH was defined as a reduction of systolic blood pressure (SBP) ≥20%. Our primary objective was to evaluate the predictive value of IJV-CI and CCA-PSV for PSAH. The secondary objective was to compare their diagnostic efficacy.</p><p><strong>Results: </strong>PSAH was found in 39.6% (21 out of 53) patients. The area under the ROC curve for IJV-CI was 0.769 (95% CI: 0.903-0.636, <i>P</i> = 0.001). IJV-CI > 21.58% predicted PSAH with 71.43% sensitivity, 84.38% specificity, and 79.25% accuracy. The area under the ROC curve for CCA-PSV was 0.760 (95% CI: 0.888-0.631, <i>P</i> = 0.002). CCA-PSV >12.16% predicted PSAH with 85.71% sensitivity, 56.25% specificity, and 67.92% accuracy. With the maximum % fall in SBP, IJV-CI had a significantly low-positive correlation (<i>r</i> = 0.298, <i>P</i> = 0.030), and CCA-PSV had a significant moderate positive correlation (<i>r</i> = 0.483, <i>P</i> = 0.0002).</p><p><strong>Conclusions: </strong>Both IJV-CI and CCA-PSV are reliable predictors of PSAH. In terms of accuracy, IJV-CI is a better predictor of hypotension post-spinal anesthesia as compared to CCA-PSV.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"250-256"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838176","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":"Ultrasound guided Quadro-iliac plane block for pain management in paediatric patients undergoing unilateral orchidopexy.","authors":"Poonam Kumari, Amarjeet Kumar, Sovan K Subudhi, Kunal Singh, Chandni Sinha","doi":"10.4103/joacp.joacp_301_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_301_25","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"298-299"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838179","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 supraclavicular nerve and upper trunk of brachial plexus (SCUT) block versus clavipectoral fascia and supraclavicular nerve block (CPFS) in mid-shaft clavicle fracture surgery - A randomized clinical trial.","authors":"P Guru Sandya, Bhavna Sriramka","doi":"10.4103/joacp.joacp_465_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_465_25","url":null,"abstract":"<p><strong>Background and aims: </strong>SCUT blocks the supraclavicular nerve (SCN) and upper brachial plexus trunk, and the clavipectoral fascia block (CPF) blocks the fascia-clavicle nerves. This study compares the SCUT block to the CPFS (CPF block and SCN block), which provides site-specific regional anesthesia (RA) for mid-clavicular surgery.</p><p><strong>Material and methods: </strong>A prospective, randomized controlled trial with two parallel arms and 1:1 allocation is presented here. 18-60-year-old ASA class 1 or 2 adults scheduled for unilateral mid-shaft clavicular surgery were studied. Group A received SCUT block (4 mL of 2% lidocaine + adrenaline, 4 mL 0.5% bupivacaine, and 2 mL dexamethasone). Group B received CPFS (CPF block and SCN block) with 16 mL of 2% lidocaine + adrenaline, 16 mL of 0.5% bupivacaine, and 2 mL of dexamethasone. Outcomes included block success, partial block success, failure, analgesia duration, and shoulder abduction after block.</p><p><strong>Results: </strong>A total of 30 patients per group were studied. In the SCUT group, block onset time was 5 (2) min, with a 93% success rate, a procedure time of 12 (5) min, and an analgesia duration of 15 (1.75) hours. In comparison, CPFS block onset time was 6 (2) min, success rate was 80%, procedure time was 12 (3) min, and analgesia duration was 6 (2) hours. Shoulder abduction was absent in the SCUT group but present in the CPFS group in all blocked patients.</p><p><strong>Conclusion: </strong>The SCUT and CPFS blocks are effective and site-specific for mid-shaft fracture clavicle surgery. However, the duration of analgesia is longer with the SCUT block requiring a lower drug volume. The CPFS block allows better shoulder movement. Both blocks have similar success rates, onset times, and procedure times.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"268-273"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838236","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":"Unexpected one-lung ventilation in the prone position: EZ-blocker to the rescue.","authors":"Sireesha Chilakapati, Priyanka Sethi, Malar Vizhi, Pradeep K Bhatia","doi":"10.4103/joacp.joacp_460_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_460_25","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"303-304"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838237","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 gastric insufflation between LMA Protector and i-gel using ultrasound in adult patients - A randomized controlled trial.","authors":"Mamta Bhardwaj, Deepika Kumari, Jatin Lal, Dhiren Bhardwaj, Kiranpreet Kaur, Avinash Punia, Suresh K Singhal","doi":"10.4103/joacp.joacp_396_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_396_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Second-generation supraglottic airway devices (SADs) have the risk of gastric insufflation and aspiration with positive pressure ventilation. Gastric ultrasound is an emerging point-of-care tool used to assess gastric volume and evaluate perioperative aspiration risk. Hence, we planned this study to compare gastric insufflation using ultrasound between the LMA Protector and i-gel. The primary outcome was to compare the antral cross-sectional area (CSA) between the two SADs. Secondary outcomes included comparison of oropharyngeal leak pressure, peak airway pressure, and postoperative complications.</p><p><strong>Material and methods: </strong>After institutional ethics committee approval and trial registration, 92 patients aged 18-60 years with American Society of Anesthesiologists physical status I/II/III were recruited. Patients were randomly allocated to groups I (i-gel) and <i>P</i> (LMA Protector). Antral CSA and gastric volume were evaluated before induction, after facemask ventilation (FMV), and before removal of SAD. Categorical variables were analyzed using Chi-square or Fisher's exact test. Quantitative variables (CSA, gastric volume) were analyzed using independent samples <i>t</i>-test.</p><p><strong>Results: </strong>The mean antral CSA (cm²) and hence gastric volume increased significantly from before induction (2.56; 2.17) to after FMV (2.82; 2.57) and at the end of surgery (3.45; 3.19) in both groups I and P, respectively. However, the difference in CSA and gastric volume between the two groups at any time point was not statistically significant, indicating a comparable increase with both devices (<i>P</i> = 0.147; 0.356; 322). Oropharyngeal leak pressure (cm H₂O) was significantly higher in group P (32.43) than in I (35.98) (<i>P</i> = 0.008). Peak airway pressure and postoperative complications were similar between the groups.</p><p><strong>Conclusion: </strong>Both LMA Protector and i-gel functioned comparably in terms of gastric insufflation.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"263-267"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838243","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":"Methylene blue: An adjunct therapy in shock patients in resource-poor settings.","authors":"Amit Srivastava, Afzal Azim","doi":"10.4103/joacp.joacp_292_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_292_25","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"291-292"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838167","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":"Double relief: A systematic review and meta-analysis of intravenous ketamine and morphine combination for acute trauma analgesia.","authors":"Clara Alverina, Muhammad F Kamaruddin, Herdiani S Putri","doi":"10.4103/joacp.joacp_480_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_480_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute trauma pain often remains inadequately treated despite opioid therapy. Low-dose ketamine has emerged as a promising adjunct analgesic that may enhance morphine effectiveness while reducing opioid requirements. This systematic review assessed the efficacy and safety of morphine combined with low-dose ketamine versus morphine alone for acute trauma analgesia.</p><p><strong>Material and methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, comprehensive searches were conducted across six databases (2006-2024) for studies comparing morphine-ketamine combination versus morphine monotherapy in acute trauma patients. Six eligible randomized controlled trials (RCTs) (<i>n</i> = 708) were included. Meta-analysis was performed using RevMan 5.4 software with random-effects modeling.</p><p><strong>Results: </strong>Six RCTs involving 708 patients from emergency departments and prehospital settings were analyzed. Morphine-ketamine combination demonstrated superior analgesic efficacy with significantly lower final pain scores (mean difference (MD): -0.26; 95% confidence interval (CI): -0.40 to -0.12; <i>P</i> = 0.0003). Subgroup analysis by ketamine dose indicated the most pronounced and statistically significant pain reduction at 0.3 mg/kg (MD: -0.30; 95% CI: -0.48 to -0.12; <i>P</i> = 0.001), while lower doses showed similar trends. Significant pain reduction occurred at 30 min after sensitivity analysis (MD: -0.64, <i>P</i> < 0.00001) and sustained through 60 min (MD: -0.32, <i>P</i> < 0.0001). The combination reduced total morphine consumption by 2.93 mg (<i>P</i> = 0.07). Overall, adverse events increased (odds ratio: 2.37, <i>P</i> = 0.05), but specific events-nausea, vomiting, and hallucinations-showed no significant differences between groups. No serious adverse events occurred.</p><p><strong>Conclusion: </strong>Low-dose ketamine as a morphine adjunct improves acute trauma pain control, shows a trend toward reduced opioid requirements, and maintains an acceptable safety profile, supporting its clinical implementation in emergency settings.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"175-186"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838181","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":"Pseudo-myocardial infarction in a case of traumatic diaphragmatic hernia.","authors":"Yaal Elango, Priya Rudingwa, Deepika Nachimuthu Valarmathi","doi":"10.4103/joacp.joacp_285_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_285_25","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"294-295"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838188","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":"Analgesic efficacy of ultrasound-guided pudendal nerve block versus caudal block for penile surgeries in children.","authors":"Vatsala Bagri, Akilandeswari Manickam, Aruna Parameswari, Venkatesh Kumar, Babu S Ramesh","doi":"10.4103/joacp.joacp_339_25","DOIUrl":"https://doi.org/10.4103/joacp.joacp_339_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Pain management strategies in pediatric penile surgery are an essential component of anesthetic care that directly influences maternal-child comfort in the postoperative period. While caudal analgesia remains the standard technique, ultrasound-guided regional techniques, particularly the pudendal nerve block, have emerged as viable alternatives. This study explores the analgesic efficacy of ultrasound-guided pudendal block versus caudal blockade using clonidine as an adjuvant in children undergoing penile surgeries.</p><p><strong>Material and methods: </strong>This prospective, randomized, comparative study included 60 children aged 6 months to 6 years scheduled for penile surgery. Children were randomly assigned to either Group A (Caudal Block) or Group B (Ultrasound-Guided Pudendal Nerve Block) and received 0.2% ropivacaine with clonidine (1 mcg kg^-1) as an adjuvant. A blinded observer assessed the FLACC scale, the number of rescue analgesia doses within 24 hours, and the duration of analgesia. The primary outcome was the difference in rescue analgesia requirements.</p><p><strong>Results: </strong>There was no significant difference in rescue analgesia requirements between the groups (P 0.92). Eleven patients (36.7%) in both the groups did not require any rescue analgesia within 24 hours postextubation. The median time to first rescue analgesia was 11.5 hours (6-24) in Group A and 12.3 hours (6.5-24) in Group B (P- 0.72). The FLACC scores were comparable between groups.</p><p><strong>Conclusions: </strong>The pudendal nerve block provides analgesia comparable to caudal block in terms of rescue analgesia requirements and duration of analgesia when clonidine is added with local anesthetics.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"42 2","pages":"257-262"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838215","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}