Indian Anaesthetists Forum最新文献

{"title":"Efficacy of dexmedetomidine as an adjuvant with ropivacaine in USG guided erector spinae plane block for modified radical mastectomy surgery- prospective randomized double blind controlled study","authors":"Krishna Boliwal, I. Kumari, Sandeep Savitaprakash Sharma, S. Ola, S. Choudhary, Vidhu Yadav","doi":"10.4103/theiaforum.theiaforum_2_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_2_23","url":null,"abstract":"Background and Aims: Modified radical mastectomy (MRM) is associated with considerable acute postoperative pain and even chronic persistent pain. Erector spinae plane block (ESPB) is interfascial block for thoracic analgesia. This study was planned to evaluate efficacy of dexmedetomidine as adjuvant with ropivacaine in ESPB for postoperative analgesia in MRM surgery. Materials and Methods: In this prospective randomized double-blind controlled study, 60 American Society of Anesthesiologists Grade I and II female patients, aged 18–60 years scheduled for MRM surgery under general anesthesia were randomly allocated into Group R and RD to receive ultrasound (USG)-guided ESPB with 20 ml 0.375% ropivacaine and 1 μg/kg dexmedetomidine added to 20 ml 0.375% ropivacaine, respectively. Visual Analog Score (VAS) was recorded at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperatively. Duration of analgesia together with total number and amount of analgesic drug required was recorded in first 24 h postoperatively. Patient's satisfaction score was recorded on 10-point scale. Chi-square test, t-test, and Wilcoxon signed-rank test were applied where deemed appropriate. P <0.05 was considered statistically significant. Results: VAS score was less in Group RD at all measured time points postoperatively. Duration of analgesia was prolonged in Group RD (683.00 ± 83.99 min vs. 620.63 ± 70.42 min). Total number and amount of intravenous diclofenac (rescue analgesic) was lower in Group RD (1.13 ± 0.57 vs. 1.46 ± 0.57, 85.00 ± 42.85 vs. 110.00 ± 42.85). Patients in group RD were better satisfied with their anesthesia experience (8 [8–9] vs. 8 [7–8], P = 0.00194). Group RD demonstrated a lower heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure intraoperatively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in USG-guided ESPB for MRM surgery leads to lower postoperative pain scores, prolongs postoperative analgesia, reduces postoperative rescue analgesics requirements, and provides better hemodynamic stability and good patient satisfaction.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46827000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of effect of dexamethasone and bicarbonate as adjuvants to intracuff lignocaine on endotracheal tube tolerance during emergence and incidence of postoperative cough and sore throat","authors":"M. Hasan, A. Javed, K. Das, A. Bindra","doi":"10.4103/theiaforum.theiaforum_8_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_8_23","url":null,"abstract":"Background: Smooth uneventful extubation and prevention of postoperative complications such as cough and sore throat adds to the quality of perioperative care and patient outcome. This study was designed to compare tube tolerance and hemodynamics during extubation, as well as the incidence of postoperative cough and sore throat, in patients operated under general anesthesia of more than 2-h duration. Materials and Methods: This prospective double-blinded, randomized controlled study included 100 patients posted for elective surgical procedures with expected duration of more than 2 h, under general anesthesia. Patients were divided randomly into two equal groups, namely Group A and Group B. In Group A, endotracheal tube (ETT) cuff was filled with lignocaine with sodium bicarbonate as an adjuvant, while in Group B, dexamethasone was added as an adjuvant to intracuff lignocaine. ETT tolerance at the time of extubation was recorded and compared. Other parameters such as rate pressure product, volume of drug diffused through cuff, and incidence of postoperative cough and sore throat were also compared. Data analysis was done using unpaired t-test and Chi-square test as appropriate, where P < 0.05 was considered statistically significant. Results: Eighty-two percent of patients in Group A while 78% of patients in Group B were categorized as tube tolerant during extubation (P = 0.62). The incidence of postextubation sore throat at 1 h was 30% versus 16% (P = 0.09) while at 24 h was 20% versus 6% (P = 0.03) in Group A and Group B, respectively. The incidence of cough postextubation at 1 h was 6% versus 0 (P = 0.07) while at 24 h was 18% versus 4% (P = 0.02) in Group A and Group B, respectively. The volume of intracuff drug diffused during anesthesia was 0.71 ± 0.27 (mean ± standard deviation [SD]) ml in Group A and 0.5 ± 0.23 (mean ± SD) ml in Group B (P = 0.02). Majority of patients (>85%) in both the groups remained hemodynamic stable during emergence with no statistical difference between the groups. Conclusion: Both bicarbonate and dexamethasone as an adjuvant to 2% intracuff lignocaine offer smooth emergence in terms of tube tolerance and hemodynamic stability during extubation. However, dexamethasone when used as an adjuvant has a better effect on prevention of development of postoperative cough and sore throat.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42713564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sugammadex: A disruptive innovation but will it stay?","authors":"Manila Singh, S. Chhabra","doi":"10.4103/theiaforum.theiaforum_60_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_60_23","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46665084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alleviating hemodynamic response to tracheal extubation: A comparative study between dexmedetomidine and lignocaine in surgical patients","authors":"Neha Gaidhankar, K. Mohan, R. Kumar, Amar Kumar","doi":"10.4103/theiaforum.theiaforum_74_22","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_74_22","url":null,"abstract":"Background: Tracheal extubation is a crucial step during general anesthesia involving the removal of artificial airway when the indication for its placement no longer exists. Airway and circulatory interferences could be due to diminished tolerance to the tracheal tube, catecholamine surge, surgical pain, and airway irritation on behalf of suctioning or change in posture of the tube. Complications are more common during extubation than that occurring during induction and intubation. Aim: The main aim of the study was to compare the effectiveness of a single dose of dexmedetomidine and lignocaine in alleviating hemodynamic and stress responses during extubation and recovery. Materials and Methodology: Sixty patients of the age group between 20 and 65 years belonging to ASA 1 and 2 undergoing elective surgical procedures with a minimum anticipated duration of 60 min requiring endotracheal intubation were included in the study. The patients were assigned randomly into two groups with 30 participants in each group and were called as Group D receiving dexmedetomidine 0.5 μg/kg and Group L receiving lignocaine 1.5 mg/kg. Observation and Results: Data were statistically analyzed with the SPSS version 20.0 software. Independent t-test analysis was used, and all the statistical test was examined with P ≤ 0.05 level of significance. Hemodynamic response was noted as more significant in Group D, whereas emergence and extubation time was noted sooner in Group L. Conclusion: We conclude that Dexmedetomidine 0.5 mcg/kg causes significant attenuation of hemodynamic stress response and deeper sedation when compared to lignocaine 1.5 mg/kg.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70846892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To study the effect of three different doses of dexmedetomidine as premedication on the incidence and severity of etomidate-induced myoclonus","authors":"Ketki Kaushal, A. Kumari, Pooja Abbi, Ruchi Gupta","doi":"10.4103/theiaforum.theiaforum_3_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_3_23","url":null,"abstract":"Background and Aims: Etomidate, a carboxylated imidazole is a rapid-acting nonbarbiturate, nonopioid hypnotic agent that has unique hemodynamic stability, favorable toxic profile, and rapid recovery after a single dose. Myoclonus may occur when etomidate is used for induction of general anesthesia. We tested the hypothesis that premedication with different doses of dexmedetomidine reduces the incidence and severity of myoclonus as well as the side effects induced by etomidate. Materials and Methods: This prospective, randomized, double-blinded study was done on ninety patients undergoing elective surgical procedures who were randomly allocated into three groups for intravenous administration of premedication of 0.3 μg/kg (Group DL), 0.5 μg/kg (Group DM), and 1.0 μg/kg (Group DH) dexmedetomidine in 100 mL normal saline 10 min before induction of general anesthesia with 0.3 mg/kg etomidate. The primary outcome was to evaluate the incidence of etomidate-induced myoclonus, while the severity of etomidate-induced myoclonus and the incidence of adverse effects were taken as secondary outcomes. Results: The incidence of etomidate-induced myoclonus was reduced by 13.3% in Group DL, 36.7% in Group DM, and 56.7% in Group DH. The severity of myoclonus was significantly reduced in Group DH as compared to Group DL and DM (P = 0.001). Side effects such as bradycardia, hypotension, and nausea and vomiting were comparable among the three groups. Conclusion: Premedication with dexmedetomidine 1 μg/kg before induction of general anesthesia not only resulted in a 56.7% reduction in the incidence of etomidate-induced myoclonus but also reduced the severity of myoclonus, without inducing any significant adverse effects, as compared to other two doses.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44562751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory hypokalemia in intensive care unit: Efforts in vain","authors":"S. Singh, Jayanth R Seshan, G. Singh","doi":"10.4103/theiaforum.theiaforum_5_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_5_23","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42271865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relevance of the wake-up test in scoliosis surgery: A narrative review","authors":"S. Nikhar, Abinash Patro, Raju Iyengar, R. Gopinath","doi":"10.4103/theiaforum.theiaforum_25_23","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_25_23","url":null,"abstract":"The corrective scoliosis surgery is associated with many complications; the neurologic complication is one of them. It is very important to assess spinal cord integrity intraoperatively to avoid postoperative damage and have a good outcome. Wake-up test was the standard of care in old generations but now with the availability of advanced neurophysiologic monitoring somatosensory and motor-evoked potentials; the relevance of wake-up test is questionable. This review aimed to assess the relevance of wake-up test in scoliosis surgery with availability of advanced technology. Comprehensive literature search was performed in PubMed, Google Search and Scopus, EndNote X6 version, and the keywords used for the search were scoliosis, neurophysiologic monitoring, and wake-up test. The different study results were interpreted to come to conclusion. This review gives us a detailed idea of the different tests available and pitfalls with each and finally what should be our stand. The review highlighted the good collaboration between surgeon, anesthesiologist, and neurologist to conclude the results of the tests of neurophysiologic monitoring. Intraoperative neurologic monitoring improves postoperative outcome. Wake-up test is only and strongly recommended, in case of unavailability of advanced monitoring, confusion on test results, and persistent signal reduction.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49495199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of safety and efficacy of dexmedetomidine, midazolam and propofol for elective fiberoptic bronchoscopy: A randomised prospective double blind study","authors":"P. Chouhan, Shrutikirti Gupta, A. Kohli, R. Kour","doi":"10.4103/theiaforum.theiaforum_59_22","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_59_22","url":null,"abstract":"Background: Sedatives are used to improve the efficacy of fiberoptic bronchoscopy. This study was conducted to evaluate and compare the safety and efficacy of dexmedetomidine, midazolam, and propofol for elective fiberoptic bronchoscopy. Materials and Methods: One hundred and twenty patients of either gender aged between 18 and 80 years, belonging to the American Society of Anesthesiologists Grade I–III and requiring fiberoptic bronchoscopy, were randomly assigned in three groups of 40 patients each. Patients in Group D received intravenous dexmedetomidine 1 μg/kg; in Group M, received IV midazolam 0.05 mg/kg; and in Group P, received IV propofol 1.5 mg/kg before the start of bronchoscopy. Parameters such as composite score, ease of bronchoscopy, and adverse effects during the procedure were assessed and analyzed statistically. Results: Patients receiving dexmedetomidine showed significantly better tolerance and cooperation with ideal mean composite score compared to those receiving propofol and midazolam (P < 0.001). Bronchoscopist scoring showed significantly better ease of bronchoscopy in patients receiving dexmedetomidine compared to other two groups (P < 0.001). Adverse effects during the procedure were least in dexmedetomidine group compared to other two groups. Conclusion: Dexmedetomidine (1 μg/kg) provided a better sedation and comfort, better bronchoscopist satisfaction, and least adverse effect during elective fiberoptic bronchoscopy compared to midazolam (0.05 mg/kg) and propofol (1.5 mg/kg).","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44015739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy: A prospective randomized, double-blind study","authors":"K. Sengupta, Jitendra Ladhania, Amitava Kundu, Titisa Mitra, Tuhin Mistry","doi":"10.4103/TheIAForum.TheIAForum_34_22","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_34_22","url":null,"abstract":"Background and Aims: The application of ultrasound (USG)-guided interfascial plane blocks in transplant anesthesia is expanding. This study evaluates and compares the postoperative analgesic efficacy of USG-guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in adult individuals undergoing laparoscopic living donor nephrectomy (LLDN). Materials and Methods: A hundred donors of either sex, aged 30–60 years, scheduled to undergo LLDN were randomly allocated into two groups. After completion of the LLDN, USG-guided unilateral TAPB and QLB were performed in lateral position in Groups A (n = 48) and B (n = 48), respectively. A volume of 20 ml of 0.375% ropivacaine was administered in both groups. Postextubation donors were shifted to the postanesthesia care unit (PACU). Heart rate, systolic blood pressure, diastolic blood pressure, and numeric rating scale (NRS) scores were recorded on arrival at PACU at the time of discharge from PACU. Subsequently, the donor was shifted to the intensive care unit, and the vitals and NRS scores (static and dynamic) were monitored postoperatively on the 2nd, 6th, 12th, 18th, and 24th h. Duration of analgesia and the number of donors who needed rescue analgesia were also noted. All the donors were observed for any side effects and complications. P <0.05 was considered statistically significant. Results: The NRS score was significantly lower in Group B (QLB) than in Group A (TAPB). Duration of analgesia was significantly prolonged in Group B (11.34 ± 1.53 h) compared to Group A (9.05 ± 1.58 min). (P < 0.001) Conclusion: The QLB effectively prolonged the duration of analgesia, lowers pain scores, and decreases the requirement of rescue analgesia compared to the TAPB. Hence, the donors remain comfortable in the postoperative period without any potential side effects.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46800618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management of a rare case of an adolescent with goldenhar syndrome","authors":"Shalendra Singh, Voddepalli Rajesh, Ankit Singh","doi":"10.4103/TheIAForum.TheIAForum_63_22","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_63_22","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41807318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}