Journal of Anaesthesiology, Clinical Pharmacology最新文献

{"title":"Comparison of intravenous with perineural dexamethasone for ultrasound-guided erector spinae plane block in patients undergoing modified radical mastectomy-A randomized control trial.","authors":"Gokila Devrajan, Priyanka H Chhabra, Sushil Guria, Kapil Gupta","doi":"10.4103/joacp.joacp_134_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_134_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0.5% ropivacaine for erector spinae plane block (ESPB) in patients undergoing modified radical mastectomy (MRM).</p><p><strong>Material and methods: </strong>This prospective, double-blind, randomized study was conducted on 60 American Society of Anesthesiologists (ASA) physical status I/II adult females undergoing MRM under general anesthesia. Patients were divided into three groups: ropivacaine perineural dexamethasone (RPD), ropivacaine IV dexamethasone (RID), and ropivacaine normal saline (RNS). Time to rescue analgesia and morphine consumption over various time points (4, 8, 12, 24, and 48 h) were recorded postoperatively. Pain was assessed using the numeric rating scale (NRS).</p><p><strong>Results: </strong>The median time to first rescue analgesia was significantly higher in the RPD group (n = 20) 720 min [interquartile range (IQR: 465-1440), 95% confidence interval (CI): 638.78-1564.21)] in comparison to the RID group (n = 20) 435 min (IQR: 405-480, 95% CI: 284.8-811.1) and control (RNS) group (n = 20) 360 min (IQR: 240-415, 95% CI: 297.6-376.36) (<i>P</i> = 0.01). The median total morphine consumption in 24 h was least in the RPD group 2.0 mg (IQR: 1.0-3.0, 95% CI: 2-3) compared to the the RID 6.0 mg (IQR: 3.2-6.0, 95% CI: 6-8) and RNS groups 7.5 mg (IQR: 6.0-9.5, 95% CI: 6-8) (<i>P</i> = 0.01). The NRS scores both at rest and at physical activity were also lowest in the RPD group compared to other groups at various time points (4, 8,12, 24, and 48 h).</p><p><strong>Conclusions: </strong>Perineural dexamethasone added as an adjuvant to 0.5% ropivacaine to ESPB prolongs the duration of analgesia, reduces morphine consumption, and reduces NRS scores at rest and physical activity as compared to IV dexamethasone in patients undergoing MRM.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"357-362"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968309","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":"Postoperative analgesic effect of adding neostigmine to levobupivacaine in ultrasound-guided spermatic cord block for testicular sperm extraction surgery.","authors":"Amr Samir Wahdan, Ahmed Abdelhady Moussa, Mohamed Abdel Fattah Farag, Hasan Abdullah Alayyaf, Mennatallah Magdi Mohamed","doi":"10.4103/joacp.joacp_14_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_14_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Providing postoperative pain management in patients who underwent scrotal surgeries is achieved using several methods, one of which is the ultrasound-guided spermatic cord block (US-SCB). To enhance anesthesia quality and extend analgesia postoperatively, several agents have been added in conjunction with local agents. This study targeted assessing the results of combining neostigmine with levobupivacaine in US-SCB for providing perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery.</p><p><strong>Material and methods: </strong>This double-blind, randomized controlled study was performed for 112 subjects undergoing TESE operation using general anesthesia. They were randomly and equally divided into two groups. All participants received bilateral US-SCB after induction of general anesthesia by 19 mL of levobupivacaine 0.5% combined with 1 mL of neostigmine 500 μg in (group N) or 1 mL of normal saline in (group C). The first analgesic dose request time and the amount of analgesic consumed in the first 24 h were the main points of comparison in both groups.</p><p><strong>Results: </strong>The mean postoperative analgesia duration was noticeably increased in the N group compared to the C group, with a value of 480 ± 41.34 min versus 404 ± 34.14 min, independently (<i>P</i> < 0.001). Moreover, the total amount of postoperative analgesic consumption was remarkably decreased in group N when compared to group C without statistically remarkable divergence concerning complications between both groups.</p><p><strong>Conclusion: </strong>Adding neostigmine to a local anesthetic solution in US-SCB proved to detain the first analgesic request postoperatively with reduced perioperative analgesia consumption, without significant side effects.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"333-339"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002011","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 two different doses of nebulized intraperitoneal dexamethasone on postoperative pain in laparoscopic surgeries.","authors":"Neha Shrivastava, Rashmi Taneja, Mamta Kumari, Rajesh Sood, Niharika Grover","doi":"10.4103/joacp.joacp_232_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_232_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Postoperative pain is a major cause of discomfort after laparoscopic surgeries and thus necessitates prevention and treatment. This study aims to evaluate and compare two different doses of intraperitoneally nebulized (aerosol size: 0.4-4.5 micrometers) dexamethasone for the prevention of postoperative pain.</p><p><strong>Material and methods: </strong>In this double-blind, randomized control study, 135 patients undergoing laparoscopic surgeries were randomly assigned to three groups after obtaining ethical committee clearance and CTRI registration. Intraperitoneal nebulization was performed using the Aeroneb device, with group A receiving 16 mg dexamethasone, group B receiving 8 mg dexamethasone, and group C receiving 0.9% normal saline. The primary outcome was assessed by measuring visceral, somatic, and referred pain using a visual analog scale (VAS) at 6 hours postoperatively. Secondary outcomes included VAS at 1 and 24 hours, the hemodynamic response to pneumo-peritoneum, 24-hour anti-emetics, and opioid consumption.</p><p><strong>Results: </strong>VAS score at 6 hours was 0.9 ± 1.06 in group A, 1.7 ± 1.45 in group B, and 2.3 ± 1.87 in group C for referred pain; the values were statistically significant (<i>P</i> = 0.01). VAS score was 0.7 ± 0.76 in group A, 1.7 ± 1.82 in group B, and 2.2 ± 2.06 in group C for dull aching pain; the results were statistically significant at 24 hours (<i>P</i> = 0.001). None of the values at any time point were statistically significant (<i>P</i> < 0.05) for incisional pain. The rise in heart rate after 5 minutes of pneumoperitoneum was the least in group A compared to group C (<i>P</i> = 0.01). Group C had the highest consumption of anti-emetics and rescue analgesics (<i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>Intraperitoneal dexamethasone nebulization of 16 mg and 8 mg both are equi-effective in decreasing the severity of pain after laparoscopic surgeries compared to normal saline nebulization (<i>P</i> = 0.001).</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"250-256"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016366","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":"Role of ultrasound-guided brachiocephalic venous cannulation for difficult venous cannulation in pediatric patients: A narrative review.","authors":"Poonam Kumari, Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Kunal Singh","doi":"10.4103/joacp.joacp_67_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_67_24","url":null,"abstract":"<p><p>Difficult venous access is characterized by non-visible and non-palpable veins; a highly experienced operator is required with the use of technological aids to insert a vascular device. Patients with difficult venous cannulation undergo multiple, painful attempts to gain peripheral venous access. Compared to adults, inserting a central venous cannulation (CVC) is thought to be a more difficult procedure in children, particularly in neonates and young infants. IJV catheterization is perceived as the gold-standard route for CVC but remains difficult for newborn, premature, and critically ill children. Therefore, in recent years, novel ultrasound-guided brachiocephalic venous (BCV) cannulation in neonates has gained popularity. The aim of this narrative review was to assess the success rate. The primary objective of this review was to determine the first-attempt success rate. The secondary objectives were the total number of attempts, cannulation time, overall success rate, and complications. All articles relevant to BCV cannulation were searched in six major databases (PubMed, Embase, Medline, Ovid, PMC, and Google Scholar). A total of 16 records were included in this narrative review. According to Breschan <i>et al.</i>, Merchaoui <i>et al.</i>, and Vafek <i>et al.</i>, the success rate of BCV cannulation in children was 89.1%, 98.4%, and 50%, respectively. Kumar <i>et al.</i>, Erroz <i>et al.</i>, and Breschan <i>et al</i>. found that the first-attempt success rate was higher in the in-plane left BCV (74%, 73% and 82.9% respectively). Falay <i>et al</i>. and Erroz <i>et al</i>. found a lower complication and infection with BCV cannulation. There is evidence that during CVC placement, US-guided BCV cannulation has a higher first-attempt success rate, requires less cannulation time, and has a lower complication rate in comparison to other approaches.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"213-218"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025453","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":"Impact of sevoflurane anesthesia on S-adenosylmethionine in neonates under general anesthesia.","authors":"Saraswathi Nagappa, Sandhya Kalappa, Raghavendra B Sridhara, Dayananda S Biligi, R Annapoorneshwari, Ramachandraiah","doi":"10.4103/joacp.joacp_26_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_26_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Preclinical studies in rodents and primates have shown that anesthesia was neurotoxic to the developing brain after exposure in the neonatal period. Sevoflurane a commonly used inhalational anesthetic, especially in pediatric surgery, might cause behavioral impairment in the developing brain. Although favored for its rapid onset and minimal airway disturbance, sevoflurane has been implicated in neurotoxic effects such as anesthesia-induced developmental neurotoxicity in rodents, through various mechanisms. One of the mechanisms was disturbances in methylation metabolism which can be easily treated if it is proved. This study aims to evaluate the levels of S-adenosylmethionine [SAM] following sevoflurane anesthesia in neonates and to correlate the duration of sevoflurane exposure and S-adenosylmethionine levels.</p><p><strong>Material and methods: </strong>Sixty neonates were included in the study under general anesthesia. Pre- and postsevoflurane exposure arterial blood samples were collected in ethylenediamine tetraacetic acid vacutainers. Each sample was centrifuged at 1000 rpm for 10 min. Plasma was separated and stored at -80°C, then subjected to S-adenosylmethionine enzyme-linked immunoassay test for preand postsevoflurane exposure levels of SAM.</p><p><strong>Results: </strong>The difference between the pre- and post-SAM values is not statistically significant and also with increasing the duration of sevoflurane exposure there was no reduction in the SAM levels (<i>r</i> = 0.17), and the correlation was not significant (<i>P</i> = 0.18).</p><p><strong>Conclusion: </strong>Single exposure to sevoflurane does not impact SAM levels in neonates undergoing general anesthesia.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"323-332"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016329","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 ropivacaine alone versus dexmedetomidine or ketamine as an adjuvant for pectoral type II nerve blocks in patients undergoing mastectomy - A randomized controlled trial.","authors":"Dharani Lenin, Rajnish Kumar, Nishant Sahay, Abhyuday Kumar, Poonam Kumari, Prashant Kumar Singh","doi":"10.4103/joacp.joacp_497_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_497_23","url":null,"abstract":"<p><strong>Background and aims: </strong>This study evaluates the analgesic efficacy of ketamine and dexmedetomidine as an adjuvant with ropivacaine 0.2% in pectoral nerve type II block (PECS-II) in modified radical mastectomy. The primary outcome of the study was the time to first rescue analgesia postoperatively. The secondary outcomes were intraoperative and postoperative opioid consumption and postoperative pain on the numerical rating scale.</p><p><strong>Material and methods: </strong>Seventy-five adult female patients who underwent a modified radical mastectomy participated in this prospective, randomized, double-blinded clinical trial. The patients received 30 ml of 0.2% ropivacaine with or without adjuvants by the ultrasound-guided PECS-II block. Group R (<i>n</i> = 25) received ropivacaine 0.2% without adjuvants. Group RD (<i>n</i> = 25) and group RK (<i>n</i> = 25) received dexmedetomidine 1μg/kg and ketamine 1 mg/kg, respectively, along with ropivacaine 0.2%.</p><p><strong>Results: </strong>Duration of analgesia determined by time to first rescue analgesia was longer in group RD (18.42 ± 02.15 h) compared to group RK (15.91 ± 03.21 h) and group R (14.64 ± 02.85 h), which was statistically significant (<i>P</i> < 0.001). Fentanyl consumption in the first 48 h after surgery was significantly less in the dexmedetomidine group compared to other groups.</p><p><strong>Conclusion: </strong>We conclude that dexmedetomidine with 0.2% ropivacaine in the PECS-II block provides better postoperative analgesia and has less sedative effects than ketamine with 0.2% ropivacaine.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"243-249"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966712","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 abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study.","authors":"Priyanka Bansal, Bhawna Jakhar, Rajesh C Arya, Nidhi S S Sultania, Sudha Puhal, Kunal Bansal, Devyani Verma, Aditya Aggarwal, Suresh Singhal","doi":"10.4103/joacp.joacp_161_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_161_24","url":null,"abstract":"<p><strong>Introduction: </strong>Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning.</p><p><strong>Aim: </strong>We conducted a prospective observational study to look for diaphragm and abdominal muscle thickness, contraction, and lung ultrasound as indicator for weaning and extubation.</p><p><strong>Material and methods: </strong>Patients of either gender aged between 20-50 years, who were on invasive mechanical ventilation for more than 48 hrs. and put on spontaneous breathing trial. A bedside ultrasound examination was performed. Abdominal expiratory muscle thickness, diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and lung ultrasound score (LUS) were measured.</p><p><strong>Results: </strong>12 patients had simple weaning pattern whereas 5 patients had difficult weaning and 8 patients had prolonged weaning. The mean value of DE was 1.97 cm, DTF- 2.3 mm. The mean value of SOFA score is significant between simple, difficult, prolonged weaning (2.24, 4.56, 7.33 respectively). The DE, which is 2.52, 1.26, 1.81 in simple difficult and prolonged weaning respectively is highly significant. The mean value of LUS was 8.34 and is significant in all weaning patterns. The highest sensitivity is found for SOFA score (84.62) with AUC of 0.88.</p><p><strong>Conclusion: </strong>Evaluation of patient with diaphragm thickness fraction (mean DTF of 26%) and diaphragm excursion (2.52 cm) with mean LUS score of 4.67 opens a new dimension to predict weaning in critically ill patients who are put on spontaneous breathing trial. The sequence of thickness of abdominal expiratory muscles adds to accuracy in successful weaning. Larger muti-center trials are required to make these parameters as a standard practice for weaning patients in critical care setup.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"257-264"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985002","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":"Ultrasonographic measurement of optic nerve sheath diameter during laparoscopic surgeries in pediatric patients: An observational study.","authors":"Swarup Ray, Uditi Parmar, Raylene Dias, Vishal Saxen, Fatema Mujpurwala, K A Anu","doi":"10.4103/joacp.joacp_77_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_77_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Laparoscopic surgery involves creation of carbondioxide (CO₂) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO₂ (EtCO₂), intrabdominal pressure (IAP), and a change in patient position (P).</p><p><strong>Material and methods: </strong>Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO₂, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired <i>t</i>-test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>Mean ONSD showed a significant change (<i>P</i> < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO₂(correlation coefficient = 0.629, <i>P</i> = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19).</p><p><strong>Conclusions: </strong>Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO₂ are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO₂ may help mitigate changes in ICP in children undergoing laparoscopic surgery.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"298-303"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990777","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 preoperative oral carbohydrate loading versus oral rehydration solution on enhanced recovery after surgery in elective open gynecological surgeries: A prospective interventional study.","authors":"Saniya Jaiswal, Pooja Singh, Vaishali Waindeskar, Sunaina Tejpal Karna, K Pushpalatha, Pranita Mandal","doi":"10.4103/joacp.joacp_86_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_86_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Enhanced recovery after surgery recommends preoperative consumption of carbohydrate within 2 hours before elective surgery to reduce perioperative discomfort and improve patient outcome.</p><p><strong>Material and methods: </strong>This prospective interventional study included 105 adult patients, undergoing elective open gynecological surgery under neuraxial anesthesia. Groups I, II, and III were administered commercially available preoperative carbohydrate drink, oral rehydration solution (ORS), and mineral water, respectively, at night and 3 hours before surgery. The primary objective was to assess the difference in hunger, thirst, anxiety, nausea, and fatigue using visual analog scale, postoperative blood sugar levels, and quality of recovery (QoR) 40 questionnaire among groups.</p><p><strong>Results: </strong>Severe hunger (22.9%), thirst (31.4%), and anxiety (34.3%) were experienced more in group III, while in group I and II, no patient had severe discomfort. The mean blood sugar levels in group III (111.3 ± 12.3, 129.4 ± 7.3) were higher compared to group I and II at both 1 hour and 24 hours after initiation of anesthesia. The mean QoR score was the highest in group I compared to group II and group III (<i>P</i> < 0.001). The majority of the patients in group I (77.1%) had an early return of gastrointestinal function and a shorter length of hospital stay.</p><p><strong>Conclusions: </strong>The overall effectiveness of commercially available preoperative carbohydrate solution was more compared to ORS and mineral water. The consumption of ORS drink resulted in less thirst and satisfactory outcomes due to its higher electrolyte content, making it a suitable option for low resource setting.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"311-317"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015573","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":"Development and validation of a prognostic model for postoperative hypotension in patients receiving epidural analgesia.","authors":"Carlos E Guerra-Londono, Erika Taco Vasquez, Efrain Riveros, Ehsan Noori, David Greiver, Srikanth Pillai, Theodore Schiff, James Soetedjo, Maylyn Wu, Jaime Garzon Serrano","doi":"10.4103/joacp.joacp_88_24","DOIUrl":"https://doi.org/10.4103/joacp.joacp_88_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aimed to develop and validate a multivariable, prognostic model for postoperative hypotension in patients receiving epidural analgesia.</p><p><strong>Material and methods: </strong>We retrieved retrospective cohort data of adults undergoing abdominal or thoracic surgery at five hospitals between 2014 and 2023 who received epidural analgesia for at least 24 hours after surgery. A systematic literature search helped define <i>a priori</i> candidate exposures. The primary outcome was postoperative hypotension during the first 72 hours after surgery. Multiple logistic regression was performed to evaluate a multivariable model. Exposures identified as statistically significant were used for logistic regression, linear discriminant analysis, and decision-tree model of random forest. Classification error was used to compare models, and variable importance was used for random forest analysis.</p><p><strong>Results: </strong>In total, 829 participants were included. The incidence of postoperative hypotension was 38.8%. Multivariable analysis identified the following independent prognostic factors: male sex, white race, body mass index, intraoperative hypotension, use of arterial line, bupivacaine concentration of 0.125% (vs. lower concentrations), and anesthesia duration. The error misclassification rate was 67% for multiple logistic regression, 27% for linear discriminant analysis, and 33.4% for random forest model.</p><p><strong>Conclusion: </strong>Using retrospective cohort data, a prognostic model of hypotension produced the best performance results using linear discriminant analysis, with an error misclassification rate of 27%. Further studies are required to perform model optimization for future clinical use.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"286-291"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021060","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}