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Journal of Anaesthesiology, Clinical... 2024Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with...
BACKGROUND AND AIMS
Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief.
MATERIAL AND METHODS
In this prospective, randomized trial, 42 patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 s, and having a BMI <40 kgm received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (gp I) (n 21) or the RLB (gp II) (n 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome.
RESULTS
Postoperative cumulative VAS score at rest at 24 , represented as mean ± S.D (95% CI), in the TAP block group was 3.54 3.04 2.16-4.93) and in the RLB group was 6.09 4.83 3.89-8.29). value was 0.112 and VAS on movement was 7.95 3.41 6.39-9.50 [2.5-15.0]) in TAP block group, whereas value was 0.110 and VAS on movement was 10.83 5.51 8.32-13.34) in the RLB group.
CONCLUSION
Similar postoperative cumulative pain score on movement at 24 was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 postoperatively.
PubMed: 38919452
DOI: 10.4103/joacp.joacp_424_22 -
Journal of Anaesthesiology, Clinical... 2024Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial...
BACKGROUND AND AIMS
Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission.
MATERIAL AND METHODS
In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors.
RESULTS
Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum ( = 0.035, AOR = 1.130) and minimum systolic arterial pressures ( = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66).
CONCLUSION
Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.
PubMed: 38919448
DOI: 10.4103/joacp.joacp_323_22 -
Journal of Anaesthesiology, Clinical... 2024Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be... (Review)
Review
Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.
PubMed: 38919442
DOI: 10.4103/joacp.joacp_346_22 -
Journal of Anaesthesiology, Clinical... 2024Regional anaesthesia has gained popularity in managing post-operative pain in paediatric patients. Quadratus lumborum block (QLB) is recognised as one of the...
BACKGROUND AND AIMS
Regional anaesthesia has gained popularity in managing post-operative pain in paediatric patients. Quadratus lumborum block (QLB) is recognised as one of the peri-operative pain management techniques used during abdominal surgeries. However, no consensus about the best approach has been reached.
MATERIAL AND METHODS
Sixty paediatric patients with ages ranging from 1 to 6 as well as classification I and II of the American Society of Anesthesiologists, scheduled for laparoscopic inguinal hernia, were allocated to receive either a posterior approach (Group I) or an anterior approach (Group II) QLB. Twenty four-hour morphine consumption, the face, legs, activity, cry, and consolability (FLACC) score, duration of analgesia, performance time, and block-related complications were recorded.
RESULTS
Group II showed significantly lower morphine consumption as well as a longer duration of analgesia ( = 0.039*, 0.020*, respectively), with an equivalent period for block performance being reported in the two groups ( = 0.080). At 2, 4, 6, and 12 hours post-operatively, the FLACC scores were substantially diminished in Group II compared to Group I ( = 0.001*, 0.012*, 0.002*, 0.028*, respectively). However, at twenty-four hours, comparable pain scores were observed between both groups ( = 0.626). In addition, there were no block-related complications.
CONCLUSIONS
In paediatric patients scheduled for laparoscopic inguinal hernia repair, the ultra-sound-guided anterior approach of the QLB was associated with significantly reduced post-operative morphine consumption, a lower FLACC score, and a longer analgesia duration when compared to the posterior approach.
PubMed: 38919434
DOI: 10.4103/joacp.joacp_366_22 -
Journal of Anaesthesiology, Clinical... 2024Anesthesiology, as an occupation, has its own unique sets of challenges, problems, issues, and circumstances, all leading to "occupational stress," which by now should... (Review)
Review
Anesthesiology, as an occupation, has its own unique sets of challenges, problems, issues, and circumstances, all leading to "occupational stress," which by now should be unequivocally accepted as a well-established fact. It is futile to continue pursuing research questions like, if there "really" is stress existing among practicing anesthesiologists/trainees, by conducting questionnaire-based surveys and doing meta-analyses. A significantly high incidence of existence of occupational stress in anesthesiologists is an undisputable and practical reality, which, when longstanding, gets culminated into "burnout syndrome" with its disastrous outcomes. Rather than pursuing the often-trodden path of finding the incidence, sources, and other superficial issues, an in-depth study of available literary evidence in relation to burnout has been carried out. Objectifying it as a "syndrome," its etiopathogenesis, pathophysiology inclusive of the prevalent theories of its causality, typology, and progression into various stages of/continuum of the process as an evolving clinical entity have been described. The preventive measures and "coping strategies" have been discussed at length in the end. It is the fervent hope and the desire of the authors that this discourse will sensitize all anesthesiologists, especially the younger and upcoming future generation, and help them avoid becoming a prey to this dreadful entity!
PubMed: 38919431
DOI: 10.4103/joacp.joacp_322_22 -
Journal of Anaesthesiology, Clinical... 2024
PubMed: 38919427
DOI: 10.4103/joacp.joacp_293_22 -
Journal of Anaesthesiology, Clinical... 2024Modified radical mastectomy (MRM) is associated with moderate severity of postoperative pain. Besides intravenous (IV) analgesics, various nerve blocks are being...
Comparison of midpoint transverse process to pleura (MTP) block and erector spinae plane block (ESP) for postoperative analgesia in modified radical mastectomy patients: A double-blinded, randomized control trial.
BACKGROUND AND AIMS
Modified radical mastectomy (MRM) is associated with moderate severity of postoperative pain. Besides intravenous (IV) analgesics, various nerve blocks are being described for pain relief of MRM patients. We compared erector spinae plane (ESP) block with midpoint transverse process to pleura (MTP) block in these patients for postoperative analgesia.
MATERIAL AND METHODS
After receiving ethical committee approval from the institutional ethics committee (AIIMS, Jodhpur) and written informed consent from study participants, 66 patients who were assigned American Society of Anesthesiologists (ASA) physical status I and II, aged 18-75 years, and were scheduled to undergo MRM were enrolled and randomly allocated into two groups. Unilateral block was given before surgery at T3 or T4 level and with 15 ml of 0.5% ropivacaine in both the groups. Infusion of 0.5% ropivacaine (Neon laboratories limited, Mumbai, India) and 0.2% ropivacaine at a rate of 5 ml/h was maintained intraoperatively and postoperatively, respectively. Pain was assessed using the Visual Analogue Scale (VAS) for the next 24 hours. The total number of patients needing rescue analgesia, the total amount of rescue analgesics consumed in the next 24 hours, and patient satisfaction score were also compared between groups.
RESULTS
Demographics and baseline vitals were comparable in the groups. On comparing VAS scores in both the groups during rest and movement at different time intervals, there was no difference in pain scores during the initial two hours. From the third hour, there was a statistically significant difference ( < 0.001) in pain VAS scores in both groups. The ESP group had lower VAS scores compared to the MTP group when followed for the next 24 hours. There was a statistically significant difference in patient satisfaction.
CONCLUSION
ESP block is more efficacious when compared to MTP block for postoperative analgesia in MRM patients.
PubMed: 38919425
DOI: 10.4103/joacp.joacp_429_22 -
Journal of Anaesthesiology, Clinical... 2024Predicting difficult airway and preparedness for the same can help prevent catastrophic situations while handling the airway. With the increasing familiarity of...
BACKGROUND AND AIMS
Predicting difficult airway and preparedness for the same can help prevent catastrophic situations while handling the airway. With the increasing familiarity of anaesthesiologists to the use of ultrasound machine and its easy availability and non-invasiveness, we sought to study its utility in airway assessment, by measuring the thickness of tongue, to predict difficult laryngoscopy and intubation.
MATERIAL AND METHODS
A total of 85 patients undergoing elective surgeries under general anaesthesia with endotracheal intubation were examined preoperatively. Tongue thickness was measured using submental ultrasonography in the median sagittal plane along with other tests of airway assessment. Cormack Lehane grade on laryngoscopy and Intubation Difficulty Scale Score was recorded. The sensitivity, specificity, positive and negative predictive value, and accuracy was calculated for tongue thickness for predicting difficult intubation.
RESULTS
The tongue thickness in those with difficult intubation (4.83 ± 0.62) was significantly higher than those without difficult intubation (4.38 ± 0.65). The ratio of tongue thickness to thyromental distance was also significantly higher in difficult intubation group. The area under the receiver operating characteristic curve for predicting difficult laryngoscopy and intubation was higher for tongue thickness as compared to other clinical parameters. The sensitivity and specificity of tongue thickness to predict difficult laryngoscopy was 100% and 83%, respectively, and to predict difficult intubation was 72% and 59%, respectively, with an accuracy of 72%.
CONCLUSION
Ultrasound based assessment of tongue thickness can be a useful predictor of difficult airway along with clinical assessment of the airway.
PubMed: 38919424
DOI: 10.4103/joacp.joacp_395_22 -
Cureus May 2024Dr. Virginia Apgar was an American anesthesiologist and researcher who heavily influenced the development of neonatal resuscitation in the immediate postpartum period... (Review)
Review
Dr. Virginia Apgar was an American anesthesiologist and researcher who heavily influenced the development of neonatal resuscitation in the immediate postpartum period with her simple five-point scoring system. Today, the APGAR scoring system is used around the world in delivery rooms to guide clinicians in the evaluation of newborns and to distinguish which might need urgent resuscitation. With a simple scoring system, timer, and clipboard, Dr. Virginia Apgar shifted focus from the parturient to the neonate, improving infant mortality as a result.
PubMed: 38919209
DOI: 10.7759/cureus.61115 -
Drug Design, Development and Therapy 2024The novel short-acting benzodiazepine drug, remimazolam tosilate, has been employed for sedation during endoscopic procedures. The optimal loading dosage of remimazolam... (Randomized Controlled Trial)
Randomized Controlled Trial Clinical Trial
BACKGROUND
The novel short-acting benzodiazepine drug, remimazolam tosilate, has been employed for sedation during endoscopic procedures. The optimal loading dosage of remimazolam tosilate in gastroscopy for elderly patients when co-administered with fentanyl remains unclear. Therefore, the primary objective of our research was to ascertain the median effective dose (ED50) and the 95% effective dose (ED95) of remimazolam tosilate in combination with various fentanyl dosages for elderly patients undergoing painless gastroscopy.
METHODS
Seventy-five patients aged ≥65 years and American Society of Anesthesiologists (ASA) class I-III were recruited to undergo elective painless gastroscopy. All patients were randomized assigned to group F, group F, and group F, and were injected intravenously with different doses of fentanyl (0.5 ug/kg, 1 ug/kg, and 1.5 ug/kg) 3 minutes prior to the administration of remimazolam tosilate, respectively. The initial preset dose of remimazolam tosilate was 0.3 mg/kg in group F, 0.2 mg/kg in group F, 0.15 mg/kg in group F. The dose gradient was 0.02 mg/kg per group according to the up-and-down sequential method. Probibt regression model was employed to determine the ED50 and ED95 of remimazolam tosilate.
RESULTS
The ED50 of remimazolam tosilate in group F was lower than that in group F and F (0.095 [0.088-0.108] mg/kg vs 0.162 [0.153-0.171] mg/kg; 0.258 [0.249-0.266] mg/kg, < 0.05). The ED95 of remimazolam tosilate was 0.272 mg/kg (95% CI: 0.264-0.295 mg/kg) in group F, 0.175 mg/kg (95% CI: 0.167-0.200 mg/kg) in group F and 0.109 mg/kg (95% CI: 0.101-0.135 mg/kg) in group F. The total dosage of remimazolam tosilate decreased gradually with the increasing of fentanyl ( < 0.001). The frequency of injection pain was higher in group F compared to groups F and F ( < 0.05). The patients in group F had a lower incidence of hypotension than in groups F and F ( < 0.05). There was no respiratory depression, intraoperative consciousness, dizziness or delirium in the three groups.
CONCLUSION
The concurrent use of fentanyl reduces the dosage of remimazolam tosilate required for sedative gastroscopy in elderly patients in a dose-dependent manner. Moreover, 1.5 ug/kg fentanyl combined with remimazolam tosilate may reduce the incidence of hypotension and injection pain. These findings should be confirmed in a large-scale study.
Topics: Humans; Aged; Benzodiazepines; Male; Female; Fentanyl; Gastroscopy; Dose-Response Relationship, Drug; Aged, 80 and over
PubMed: 38915865
DOI: 10.2147/DDDT.S462607