Sindwani G, Desai S, Dhingra U
… +3 more, Bharadwaj A, Pamecha V, Arora MK
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542208
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BACKGROUND AND AIMS: Intrathecal morphine (ITM) has been widely used to provide effective postoperative analgesia. This study aims to compare the efficacy and safety of three different doses of ITM - 200, 300, and 400 μg...BACKGROUND AND AIMS: Intrathecal morphine (ITM) has been widely used to provide effective postoperative analgesia. This study aims to compare the efficacy and safety of three different doses of ITM - 200, 300, and 400 μg - in patients undergoing open donor hepatectomy. MATERIAL AND METHODS: A total of 90 patients were randomized into three groups (30 patients each) receiving either 200 μg (Group A), 300 μg (Group B), or 400 μg (Group C) of ITM, along with 5 mg of 0.5% bupivacaine. Postoperative pain was managed using intravenous patient-controlled analgesia with fentanyl. Total fentanyl consumption, visual analog scale (VAS) scores, Ramsay Sedation Scale score, and incidence of side effects were recorded for 72 h postoperatively. Data was analyzed using the Student's -test, Mann-Whitney test, and Fisher's exact test. A value < 0.05 was considered significant. RESULTS: Cumulative postoperative fentanyl consumption at 24 h was similar across all three groups: Group A (100 [50-200] μg), Group B (100 [50-225] μg), and Group C (100 [50-231] μg) ( = 0.92). VAS scores at rest and during movement were comparable among the groups at all time points. Group C exhibited a higher incidence of side effects when compared to groups B and A, respectively (35 vs. 13 vs. 5, < 0.001). CONCLUSIONS: A dose of 200 μg of ITM provides effective postoperative pain control in patients undergoing open live donor hepatectomy and results in fewer opioid-related side effects, compared to 300 and 400 μg doses.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542207
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BACKGROUND AND AIMS: Ultrasound-guided adductor canal block (ACB) has been increasingly used for postoperative analgesia in total knee replacement (TKR) surgery patients. We hypothesized that the addition of ketamine to...BACKGROUND AND AIMS: Ultrasound-guided adductor canal block (ACB) has been increasingly used for postoperative analgesia in total knee replacement (TKR) surgery patients. We hypothesized that the addition of ketamine to levobupivacaine in ultrasonograsonography (USG)-guided ACB would result in prolonged and better postoperative analgesia in patients undergoing TKR. MATERIAL AND METHODS: This randomized prospective study was conducted on 90 patients undergoing unilateral TKR. In Group LK (n = 45), levobupivacaine 0.25% plus ketamine 1 mg/kg (total volume 20 ml) was given, and in Group L (n = 45), 20 ml of 0.25% levobupivacaine was given. The primary objective was to compare the pain-free interval, i.e. the time until the first dose of rescue analgesia, between Group LK and Group L. The secondary objectives were to assess the amount of rescue analgesic, pain scores, and complications. RESULTS: We observed that the time to the first dose of rescue analgesia in Group LK (9.33 h ± 2.17) was significantly longer than in Group L. (5.02 h ± 1.63) ( value = 0.001; Cohen's d = 2.243). The total dose of rescue analgesic was significantly lower in Group LK (188.89 mg ± 48.72) compared to Group L (271.11 mg ± 50.55) ( value = 0.001). Patients in Group L had significantly higher numerical rating scale compared to Group LK at rest at 4, 6, and 12 h and on movement at 2, 4, 6, and 12 h postoperatively. CONCLUSIONS: The addition of ketamine to levobupivacaine in ACB resulted in prolongation of the pain-free interval, decreased requirement for rescue analgesia, and better pain control during rest and movement.
Bansal T, Bhagat S, Kumar R
… +4 more, Jain M, Singh AK, Lal J, Singhal S
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542205
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BACKGROUND AND AIMS: There are two anatomical pathways in the nasal cavity through which the endotracheal tube may pass during nasotracheal intubation: the lower pathway and upper pathway. The upper pathway lies above th...BACKGROUND AND AIMS: There are two anatomical pathways in the nasal cavity through which the endotracheal tube may pass during nasotracheal intubation: the lower pathway and upper pathway. The upper pathway lies above the inferior turbinate, just below the middle turbinate. The lower pathway lies along the floor of the nose, underneath the inferior turbinate. The lower pathway is considered a safer route due to the lesser risk of epistaxis, as it is located away from the middle turbinate. However, we cannot select the lower pathway exclusively, as there are no clear indicators to differentiate between the upper and lower pathways blindly. The direction of the bevel of the tube may guide the pathway taken by the tracheal tube during nasotracheal intubation. MATERIAL AND METHODS: Sixty patients, aged 18 to 60 years, with American Society of Anaesthesiologist (ASA) physical status I or II, scheduled for elective surgery under general anesthesia requiring nasotracheal intubation, were included in this study. In Group I (n = 30), the tracheal tube was inserted with the bevel in a lateral direction (conventional group), and in Group II (n = 30), the tracheal tube was inserted with the bevel in a cephalad direction (interventional group). The primary objective was to determine the path followed by the tracheal tube through the nasal cavity during nasotracheal intubation. RESULTS: In Group I, the tracheal tube passed through the lower pathway in 15 patients (50%) and through the upper pathway in 15 patients (50%). In Group II, the tracheal tube passed through the lower pathway in 24 patients (80%) and through the upper pathway in 6 patients (20%) ( value 0.01). CONCLUSION: The results of the present study reveal that the cephalad bevel of the reinforced tracheal tube significantly favors the lower pathway compared to the lateral bevel during nasotracheal intubation.
Gupta N, Bindra A, Verma A
… +2 more, Singh S, Dube SK
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542203
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BACKGROUND AND AIMS: Ventilating acute brain injury patients, with normal lung, using low tidal volume (LTV) ventilation may lead to improved outcomes. Nonetheless, investigations are ongoing to understand its impact on...BACKGROUND AND AIMS: Ventilating acute brain injury patients, with normal lung, using low tidal volume (LTV) ventilation may lead to improved outcomes. Nonetheless, investigations are ongoing to understand its impact on intracranial pressure and cerebral oxygenation. Our study aimed to see the effect of LTV on optic nerve sheath diameter (ONSD) and regional cerebral oxygen saturation (rScO) in patients with severe traumatic brain injury (sTBI). MATERIAL AND METHODS: This single-center, prospective, single-blinded, pre-post interventional study included 18 patients with sTBI who were mechanically ventilated with standard high tidal volume (HTV) ventilation (10 ml/kg). After recording outcome variables, ONSD and rScO with HTV, patients were ventilated with LTV (6 ml/kg) for 30 minutes and the outcome variables were recorded. RESULTS: LTV had no effect on right ONSD ( = 0.94), whereas left ONSD was 0.04 cm less with LTV, but the difference in spite of reaching statistical significance ( = 0.04) was not clinically significant. Mean end-tidal carbon dioxide (EtCO) with LTV was 2.5 mm Hg more as compared to HTV. Adjusting for the effect of EtCO, ONSD was comparable bilaterally with both tidal volumes (right ONSD; = 0.52 and left ONSD; = 0.45). Change in tidal volume had no effect on rScO. CONCLUSIONS: Our findings suggest that LTV does not affect ONSD and rScO in sTBI patients. However, ventilator parameters should be guided to control EtCO. Larger studies are required to look at the effect of site of injury as a factor affecting ONSD.
Rajan S, Selvaraj S, Roy RA
… +3 more, Sreekumar G, Arul L, Mathew J
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542202
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BACKGROUND AND AIMS: Awake fiberoptic intubation (AFOI) is the gold standard for predicted difficult airways. Optimal sedation is crucial for patient comfort and procedural success. Nebulized sedatives offer a noninvasiv...BACKGROUND AND AIMS: Awake fiberoptic intubation (AFOI) is the gold standard for predicted difficult airways. Optimal sedation is crucial for patient comfort and procedural success. Nebulized sedatives offer a noninvasive approach, allowing for titration and rapid cessation if needed. We aimed to compare patient comfort, as reflected by patient reactions during AFOI, following dexmedetomidine versus midazolam nebulization in patients with a predicted difficult airway. The ease of the intubation process and degree of the patient's alertness/sedation were also compared. MATERIAL AND METHODS: It was a prospective randomized, double-blinded study. Fifty patients with predicted difficult airways received either dexmedetomidine 1 μg/kg or midazolam 0.2 mg/kg nebulization. The airway was then topicalized with lignocaine spray, jelly, and a transtracheal block, and AFOI was performed. Following intubation, patients were induced intravenously. Patient comfort, ease of intubation, hemodynamic stability, and adverse events were assessed in both groups and compared. RESULTS: Midazolam nebulization resulted in significantly better patient comfort, as evidenced by lower patient reactions and higher comfort behavioral scores. Both drugs provided adequate sedation for AFOI. The ease of intubation was comparable between the two groups. No significant hemodynamic changes or adverse events were observed. CONCLUSIONS: Midazolam nebulization prior to AFOI in patients with a difficult airway provided significantly better patient comfort compared to dexmedetomidine nebulization. The ease of intubation was comparable following nebulization of both drugs.
Arunachalam S, Senthilnathan M, Parida S
… +3 more, Suganya S, Kumar MR, Mishra SK
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542198
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BACKGROUND AND AIMS: Anesthetic agents like propofol and etomidate are known to affect intracellular calcium homeostasis during diastole. Hence, this study has been designed to study the effects of etomidate and propofol...BACKGROUND AND AIMS: Anesthetic agents like propofol and etomidate are known to affect intracellular calcium homeostasis during diastole. Hence, this study has been designed to study the effects of etomidate and propofol on left ventricular diastolic function in adults (>18 years) undergoing elective noncardiac surgery under general anaesthesia. MATERIAL AND METHODS: E-wave velocity, septal and lateral e' velocities, left atrial volume index (LAVI), and tricuspid regurgitation maximum jet velocity (TRVmax) were measured before and after induction of anesthesia (etomidate and propofol). RESULTS: A total of 187 patients were screened, and parameters from 157 patients were analyzed in this study. There was a statistically significant decrease in the mean E velocity, septal e', and lateral e' velocities with both propofol and etomidate. The difference-in-difference analysis revealed that etomidate caused a statistically significant reduction in E velocity (-11.59 ± 6.61 vs. -6.46 ± 9.84, = 0.0002) compared with propofol. CONCLUSIONS: This study found that anaesthesia induction with propofol and etomidate in adults resulted in a statistically significant decrease in E-wave, septal, and lateral e' velocities within the groups. The reduction in E-wave velocity caused by etomidate was more profound when compared with propofol. While both propofol and etomidate may mildly worsen certain parameters of diastolic function, this study did not demonstrate any worsening of diastolic parameters like LAVI, TRVmax, and E/e'.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542197
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The purpose of this narrative review is to investigate the existing evidence supporting the use of the snorkel breathing technique in anesthesia practice. In addition, this review aims to identify certain patient scenari...The purpose of this narrative review is to investigate the existing evidence supporting the use of the snorkel breathing technique in anesthesia practice. In addition, this review aims to identify certain patient scenarios where the snorkel breathing approach can be appropriate. A total of nine articles relevant to anesthesia and airway management were retrieved using the search strategy. A review of the final papers found that the snorkel breathing technique offers a few advantages over using a regular face mask in the operating room. The snorkel or mouthpiece breathing approach can be as effective as the traditional face mask for successful preoxygenation, as defined by an end-tidal oxygen concentration greater than 0.9. The snorkel breathing approach can be a viable option in patient populations where face mask application is challenging. It also has greater acceptance than the face mask among patients and healthy volunteers. Another advantage of the snorkel breathing technique is that it can be utilized to provide apneic oxygenation during rapid sequence induction using short-acting neuromuscular blocking drugs, reducing the use of plastic (face mask). For older children and claustrophobic adults who are apprehensive about masks, snorkel gas induction can make anesthesia induction smoother and more pleasant. The snorkel breathing technique has potential application in certain anesthetic scenarios, and this narrative review also incorporates the author's clinical experience with it. To validate the effect of this novel technique (snorkel preoxygenation and snorkel gas induction) on patient-centered outcomes, more randomized controlled trials are required.
Sagdeo GD, Kumar A, Sinha C
… +2 more, Kumari P, Bhavana K
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542195
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BACKGROUND AND AIMS: The incidence of postoperative cough in patients undergoing endoscopic laryngeal surgery is 86%. This study aims to evaluate the efficacy of ultrasound-guided bilateral internal laryngeal nerve block...BACKGROUND AND AIMS: The incidence of postoperative cough in patients undergoing endoscopic laryngeal surgery is 86%. This study aims to evaluate the efficacy of ultrasound-guided bilateral internal laryngeal nerve block as an adjunct to general anesthesia in reducing the incidence and severity of postoperative cough, sore throat, and hoarseness of voice, as well as managing the perioperative hemodynamic changes in endoscopic microlaryngeal laser surgery (MLS). MATERIAL AND METHODS: Forty patients aged 18-65 years scheduled to undergo endoscopic MLS under general anesthesia were recruited into the study. Patients were randomized into two groups of 20 patients in each group. Patients in group I received ultrasound-guided internal laryngeal nerve block bilaterally with 2.5 ml of 2% lignocaine on either side along with general anesthesia, whereas those in group II received only general anesthesia. RESULTS: At the time of emergence, only 35% of patients in group I had mild cough; however, in Group II, 60% patients had mild cough, 25% had moderate cough, and 5% had severe cough. The differences between the two groups were statistically significant ( < 0.05). We observed no significant differences in the incidence and severity of sore throat, hoarseness of voice at 1 week, perioperative hemodynamic parameters, and oxygen desaturation between the two groups ( > 0.05). CONCLUSIONS: Bilateral internal laryngeal nerve block as an adjunct to general anesthesia significantly reduces the incidence and severity of cough at the time of emergence from anesthesia in MLS. However, no significant reduction in the incidence and severity of sore throat was detected.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542193
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BACKGROUND AND AIMS: Adductor muscle spasm occurs when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope. Ultrasound-guided ONB is regarded as the optimal technique and...BACKGROUND AND AIMS: Adductor muscle spasm occurs when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope. Ultrasound-guided ONB is regarded as the optimal technique and is classified as the proximal and distal approach based on the anatomical location of the obturator nerve. MATERIAL AND METHODS: This study included 90 adult patients of ASA grades I-III and aged more than 18 years undergoing transurethral resection of bladder tumors under spinal anesthesia. Patients were randomized into two groups: group P received ultrasound-guided obturator nerve block (ONB) by proximal approach, and group D received ultrasound-guided ONB by distal approach. Adductor muscle power after the block, block performance time, complications, and adductor jerks during surgery were compared. A value of < 0.05 was considered statistically significant. RESULTS: Adductor jerks during the surgery were absent in 85.7% of patients in group P and 78.0% of patients in group D. The mean block performance time in group P was 4.33 ± 0.38 minutes, and in group D was 4.00 ± 0.34 minutes. Vascular puncture during the block was observed in nine patients in group P and two patients in group D. CONCLUSION: The success rate in terms of the absence of adductor spasm during surgery was higher in proximal than in distal ultrasound-guided ONB. However, the proximal technique requires more time to perform the block than the distal technique, as it is technically challenging and carries a risk of vascular puncture.
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542191
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BACKGROUND AND AIMS: Second-generation supraglottic airway devices (SAD), such as i-gel and Ambu AuraGain, offer higher sealing pressures and facilitate intubation. Although literature exists on their ventilatory charact...BACKGROUND AND AIMS: Second-generation supraglottic airway devices (SAD), such as i-gel and Ambu AuraGain, offer higher sealing pressures and facilitate intubation. Although literature exists on their ventilatory characteristics, limited data are available on their performance as intubation conduits in the adult Indian population. The purpose of this study was to shed light on the clinical performance and intubation characteristics of both devices. MATERIAL AND METHODS: In this prospective, open-label study, 96 ASA I and II patients aged 18-60 years undergoing elective surgeries were equally randomized into Group A (Ambu AuraGain) and Group I (i-gel). All SADs were inserted under general anaesthesia using standard techniques. Outcomes included the Brimacombe score (primary), first-attempt success rate of SAD insertion, oropharyngeal leak pressure (OLP), ease of gastric tube insertion, success rate of intubation through SAD, intubation time, size of the endotracheal tube used, ease of intubation, and adverse events. RESULTS: Ambu AuraGain exhibited a superior Brimacombe score when assessed via fibreoptic bronchoscope ( = 0.001), despite necessitating more attempts to achieve successful ventilation. No significant disparities were detected regarding OLP or gastric tube insertion. When evaluating intubation characteristics, the time required for intubation was similar; however, the success rate of intubation and ease of intubation favoured the AuraGain. AuraGain accommodated larger endotracheal tubes with ease. Adverse events, including minor mucosal injuries, were comparable between the two devices. CONCLUSIONS: I-gel and Ambu AuraGain demonstrated similar effectiveness in ventilation characteristics. However, Ambu AuraGain facilitated easier endotracheal intubation via SAD in anesthetized adults, owing to its ability to accommodate larger endotracheal tubes compared to i-gel.
Arora K, Reena, Rath A
… +3 more, Pandey AR, Singh AP, Sharma K
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542189
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BACKGROUND AND AIMS: Post-operative pain has always been neglected in children. It is only recently that the issue is being given the much-needed consideration. Even today, the literature is sparse for paediatric post-th...BACKGROUND AND AIMS: Post-operative pain has always been neglected in children. It is only recently that the issue is being given the much-needed consideration. Even today, the literature is sparse for paediatric post-thoracotomy pain management modalities. In this era of ultrasound guided (USG) regional blocks, serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) seem to offer promising results. We aimed to compare the ESPB with SAPB in patients undergoing open thoracotomy. MATERIAL AND METHODS: Sixty paediatric patients of age 5-14 years, scheduled to undergo open thoracotomies, were divided into two groups: Group S (SAPB) and group E (ESPB). Each group received 0.5 ml/kg of 0.25% bupivacaine under USG blocks. The primary outcome of the study was to compare the postoperative pain scores using the Wong-Baker Faces scale. The secondary outcomes were to compare cumulative fentanyl consumption, time to initiation of chest physiotherapy, and duration of hospital stays. RESULTS: The Faces score was significantly lower in Group E compared to Group S at 8 h, 12 h, 16 h, 20 h, and 24 h ( < 0.05). The mean cumulative fentanyl requirement in Group S was higher than in Group E ( = 0.002). Time to initiate chest physiotherapy and duration of hospital stays were both significantly shorter in Group E ( < 0.05). CONCLUSIONS: ESPB is superior to SAPB in terms of providing better pain control and reduced opioid requirements in children post-thoracotomy.