Prabha R, Rastogi S, Raman R
… +3 more, Kaushal D, Siddiqui SS, Singh V
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542185
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BACKGROUND AND AIMS: Early extubation is recommended for enhancing recovery in cardiac surgical patients, but premature extubation must be avoided. The diaphragm excursion-time index (DETI) is a novel, recently described...BACKGROUND AND AIMS: Early extubation is recommended for enhancing recovery in cardiac surgical patients, but premature extubation must be avoided. The diaphragm excursion-time index (DETI) is a novel, recently described index that can predict successful extubation. Its role in early extubation of cardiac patients has not been studied yet. This study was aimed at studying the role of DETI in the early extubation of cardiac surgical patients. MATERIAL AND METHODS: This prospective observational study was conducted at a tertiary care hospital. Bilateral DETI (primary outcome variable), diaphragm excursion (DE), inspiratory time (Ti), and diaphragm thickness fraction (DTF) of 150 adult cardiac surgical patients were assessed at the train-of-four ratio 0.95 and end of spontaneous breathing trial (SBT). Patients were classified as successful early extubation if extubated within 6 h. The secondary outcome variables were DE, DTF, and Ti. Receiver operator characteristic (ROC) was used to determine the predictive value of these variables. RESULTS: Early extubation was successful in 96 patients. DETI, DE, and DTF predicted successful early extubation. DETI≥1.31 cm-s of the right diaphragm at SBT predicted successful early extubation with a sensitivity of 0.890 and specificity of 0.779, with an area under ROC curve 0.858. For the left side, DETI≥1.65 cm-s at SBT had a sensitivity, specificity, and area under ROC curve of 0.902, 0.726, and 0.875 respectively. DETI, DE, and DTF were higher in patients early extubation. CONCLUSION: For cardiac surgical patients, DETI has high sensitivity and specificity for successful early extubation.
Afshan R, Kundra P, Vinayagam S
… +3 more, Subbaiah M, Kate V, Abdulbasith KM
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542184
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BACKGROUND AND AIMS: The incidence of postoperative nausea and vomiting (PONV) ranges between 30% and 80%, and face mask ventilation (FMV) prior to intubation may be a significant risk factor. The primary aim of this stu...BACKGROUND AND AIMS: The incidence of postoperative nausea and vomiting (PONV) ranges between 30% and 80%, and face mask ventilation (FMV) prior to intubation may be a significant risk factor. The primary aim of this study was to investigate the effect of rapid sequence induction (RSI) on the occurrence of PONV. MATERIAL AND METHODS: This randomized controlled study was conducted in 128 adult patients with a moderate to high risk of PONV (Apfel score ≥2), who were scheduled to undergo elective gynecologic laparoscopic surgeries under general anesthesia. Recruited patients were divided into two groups: Control group and RSI group. In the control group, anesthesia was induced by conventional induction with FMV, and in the RSI group, anesthesia was induced by a modified RSI technique avoiding FMV. The primary outcome was to compare the incidence of PONV. Secondary outcomes included comparing the severity of PONV (Bellville score), severity of nausea [visual analogue scale (VAS)], and requirement of antiemetics. RESULTS: The 24-h incidence of postoperative nausea, retching, and vomiting was significantly less in the RSI group when compared to the control group [78.1% versus 17.2% ( < 0.001), 35.9% versus 9.4% ( < 0.001), and 42.2% versus 7.8% ( < 0.001), respectively]. The severity of PONV was significantly less in the RSI group, as evidenced by a reduced Bellville score [(0 (0-3) versus 2 (1-3), < 0.001], reduced VAS score, and reduced number of episodes of retching and vomiting. CONCLUSION: In patients with moderate to high risk, the incidence and severity of PONV were significantly reduced by the modified RSI technique.
Saranteas T, Moschovaki N, Papadimos T
… +6 more, Spiliotaki E, Briassoulis P, Boviatsis V, Antonopoulos D, Poulogianopoulou E, Riga M
J Anaesthesiol Clin Pharmacol
· 2026 · PMID 41542183
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BACKGROUND AND AIMS: This prospective, observational study investigated the performance of internal jugular vein (IJV) point-of-care ultrasonography in the prediction of spinal anesthesia-induced hypotension in aged, deh...BACKGROUND AND AIMS: This prospective, observational study investigated the performance of internal jugular vein (IJV) point-of-care ultrasonography in the prediction of spinal anesthesia-induced hypotension in aged, dehydrated patients. MATERIAL AND METHODS: Fifty-five elderly, dehydrated patients (blood urea-to-creatinine ratio >20) with a hip fracture were recruited. The 2-dimensional ultrasound area of each IJV was evaluated to determine which vein produced the dominant outflow from the brain. The IJV with the greatest measured area was considered the dominant outflow vein. The following measurements of both veins were obtained: the maximum and minimum area (during spontaneous breathing), the IJV collapsibility index, and the internal jugular maximum area-to-collapsibility index ratio. Receiver operating curve characteristics and gray zone analysis of ultrasound indices were performed to evaluate their prognostic utility in identifying patients with post-spinal anesthesia hypotension. RESULTS: Thirty-four patients (61.8%) manifested a hypotension incident. The right and the left IJV provided dominant flow in 42 (76%) and 13 (24%) cases, respectively. A collapsibility index of > 0.35 and a maximum area-to-collapsibility index ratio of <2.73 of the non-dominant vein demonstrated moderate diagnostic performance (area under the curve: 0.71 and 0.72, respectively) and were the most predictive indices of post-spinal anesthesia hypotension. However, these two indices were associated with a high number of inconclusive cases, thereby contributing to a prognostic uncertainty (gray zone analysis). CONCLUSIONS: IJV ultrasound measurements are not strong predictors of post-spinal anesthesia hypotension in elderly patients. Anesthesiologists should pursue the prediction of post-spinal anesthesia hypotension by using additional monitoring methods.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181279
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BACKGROUND AND AIMS: Opioids are known to reduce the propofol dose required to blunt movement and hemodynamic responses to noxious stimuli. However, the optimal propofol dosage for smooth induction remains unclear, parti...BACKGROUND AND AIMS: Opioids are known to reduce the propofol dose required to blunt movement and hemodynamic responses to noxious stimuli. However, the optimal propofol dosage for smooth induction remains unclear, particularly in the Indian population where pharmacokinetic data is limited. This study aims to evaluate the effect site concentration of propofol in conjunction with varying fentanyl doses, with relation to loss of consciousness and bispectral index (BIS) values during anesthesia induction using target-controlled infusion (TCI). MATERIAL AND METHODS: Sixty patients aged 20-50 years, with American Society of Anesthesiologists physical status I and II, scheduled for elective surgeries under general anesthesia were included. Anesthesia induction was performed using a TCI pump with propofol based on the Schnider model, starting at 1.5 µg/ml and increasing at 0.5 µg/ml until loss of verbal response, followed by 0.2 µg/ml till the final clinical endpoint was reached. Patients received either 1 or 2 µg/kg fentanyl or no fentanyl. Endpoints were assessed using the BIS monitor and Modified Observer Assessment of Alertness/Sedation Scale score. RESULTS: Hemodynamic parameters were stable across groups. The effect site concentration of propofol for loss of response to noxious stimuli was significantly lower in the fentanyl groups (fentanyl 1 µg/kg- 2.90 ± 0.1947 µg/ml, fentanyl 2 µg/kg- 2.445 ± 0.23 µg/ml) compared to the propofol alone group (4.205 ± 0.909 µg/ml) ( = 0.0001). Similar results were observed for loss of response to verbal commands. The effect site concentration at BIS 60 corresponded to loss of response to noxious stimuli. CONCLUSIONS: Propofol effect site concentrations were significantly higher without fentanyl. The findings contribute valuable data for refining pharmacokinetic models tailored to individual patient needs.
Kurdi MS, Anusha MS, Ladhad DA
… +3 more, Theerth KA, Bhuvanvijay D, Abinaya K
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181275
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BACKGROUND AND AIMS: There is limited evidence to suggest that routine testing of serum electrolytes, blood urea, and serum creatinine in low-risk patients significantly improves surgical outcomes or reduces complication...BACKGROUND AND AIMS: There is limited evidence to suggest that routine testing of serum electrolytes, blood urea, and serum creatinine in low-risk patients significantly improves surgical outcomes or reduces complications. This study aimed to evaluate the need of these investigations in patients of American Society of Anesthesiologists physical status (ASA-PS) I and II scheduled to undergo elective surgeries of minor and intermediate risk. MATERIAL AND METHODS: We conducted a prospective, observational study at a tertiary care hospital, involving 1166 patients aged 18-60 years with ASA-PS grades I and II, undergoing elective minor and intermediate-risk surgeries. Comprehensive preoperative evaluation included documentation of demographic data, medical history, medications, pre- and postoperative values of blood urea, serum creatinine, and serum electrolytes. The study design incorporated assessment of changes in anesthetic management, including ordering of repeat tests, specialist referrals, and surgery postponements or cancelations. Postoperative complications related to electrolyte disturbances were monitored. Statistical analysis included Chi-squared test for categorical variables and dependent -test for comparing pre- and postoperative changes in biochemical parameters. Data was entered in Excel and analyzed using Statistical Package for the Social Sciences (IBM, Bangalore, India) version 23. RESULTS: A total of 148 (12.69%) patients underwent repeat tests preoperatively; none of them experienced any postponements/cancelations or changes in anesthetic management. Statistically significant changes were observed in blood urea, serum creatinine, and serum electrolyte values across all anesthesia types and comorbidities ( < 0.05). However, these changes remained within clinically acceptable limits and did not necessitate alterations in patient management. Notably, only 0.26% of patients required postoperative repeat tests, and no patients needed referral to superspecialty care. CONCLUSIONS: Our study provides substantial evidence indicating that routine preoperative assessment of blood urea, serum creatinine, and serum electrolytes may not be necessary for ASA-PS I and II patients undergoing elective minor and intermediate-risk surgeries.
Powers PA, Babu S, Sreedhar R
… +3 more, Gadhinglajkar SV, Dash PK, Sukesan S
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181274
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BACKGROUND AND AIMS: No studies have assessed the pre-emptive analgesic efficacy of pecto-intercostal fascial plane block (PIFB). We evaluated the pre-emptive analgesic efficacy of PIFB by comparing with the routine in-h...BACKGROUND AND AIMS: No studies have assessed the pre-emptive analgesic efficacy of pecto-intercostal fascial plane block (PIFB). We evaluated the pre-emptive analgesic efficacy of PIFB by comparing with the routine in-hospital analgesic protocol for sternotomy pain in patients undergoing cardiac surgery. MATERIAL AND METHODS: This prospective, randomized, double-blinded study was conducted on 90 patients undergoing elective coronary artery bypass grafting surgery. The patients were randomized into two groups as follows: 1. PIFB group ( = 45): received bilateral ultrasound-guided bilateral PIFB with 0.5% levobupivacaine and 2. no PIFB (NPIFB) group ( = 45): received routine in-hospital perioperative analgesic protocol. The primary outcome of the study was to assess the effectiveness of PIFB on the requirement of intraoperative and postoperative fentanyl. The secondary outcomes were to assess the postoperative pain score, sedation alertness, side effects, and cooperation with incentive spirometry exercises. The Chi-square test and Student's -test were used to compare the data. RESULTS: The total intraoperative fentanyl consumption was significantly less in the PIFB group (587.8 ± 165.7 µg) than in the NPIFB group (935.6 ± 157.2 µg) ( < 0.0001). The postoperative pain scores, the need for rescue fentanyl, and the incidence of nausea and vomiting at different time points were significantly lower in the PIFB group. Patients in the PIFB group cooperated well with incentive spirometry exercises at various time points. There was no difference in sedation score at different time points between the two groups. No complications were noted in either group. CONCLUSIONS: Ultrasound-guided PIFB is very effective as a pre-emptive analgesic adjunct for sternotomy pain in patients undergoing cardiac surgery.
Anjaleekrishna K, Baidya DK, Garg H
… +1 more, Choudhury AR
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181273
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Melanocytic neuroectodermal tumor of infancy (MNTI) is a rare, benign neoplasm involving the jaw. It is characterized by a high rate of recurrence and locally aggressive enlargement. This condition often leads to facial...Melanocytic neuroectodermal tumor of infancy (MNTI) is a rare, benign neoplasm involving the jaw. It is characterized by a high rate of recurrence and locally aggressive enlargement. This condition often leads to facial asymmetry and difficulty in airway management during surgical excision. Due to its rarity, there are no established guidelines for the perioperative management of MNTI. We describe the successful airway and anaesthetic management of three paediatric cases of MNTI. These cases highlight the complexities of airway management in paediatric patients with limited oral space and facial asymmetry. The anaesthetic approach prioritized meticulous preparation for potential difficult airway scenarios, including obtaining high-risk consent, assembling appropriate equipment, and premedication with ketamine and glycopyrrolate. Inhalational induction with sevoflurane was employed, and video laryngoscopy was used to aid intubation. Muscle relaxation and analgesia were carefully managed intraoperatively, with an emphasis on minimizing opioid usage postoperatively. The cases illustrate the importance of teamwork and multidisciplinary collaboration in managing challenging paediatric airway scenarios. This series contributes to the understanding of anaesthetic considerations in MNTI cases and underscores the significance of thorough preparation and coordination in optimizing patient outcomes.
Rajan S, Bhuyan M, Sreekumar G
… +3 more, Madhu M, Arul L, Roy RA
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181272
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BACKGROUND AND AIMS: For facial nerve monitoring during parotidectomy, neuromuscular blockers should be avoided. Assessment of depth of anesthesia based on clinical signs or end-tidal anesthetic gas concentration is unre...BACKGROUND AND AIMS: For facial nerve monitoring during parotidectomy, neuromuscular blockers should be avoided. Assessment of depth of anesthesia based on clinical signs or end-tidal anesthetic gas concentration is unreliable. We compared intraoperative dexmedetomidine requirement with and without bispectral index (BIS) monitoring in patients undergoing total parotidectomy under general anesthesia (GA) without muscle relaxants. MATERIAL AND METHODS: This was a prospective, randomized study conducted in 60 patients undergoing total parotidectomy under GA with nerve conduction studies. Following induction and intubation, all patients received dexmedetomidine 1 µg/kg bolus. In Group A, BIS values were continuously monitored. Following initial bolus, only when the BIS value was >50, dexmedetomidine infusion was restarted at 0.5 µg/kg/h and adjusted to maintain BIS between 40 and 50. In Group B, dexmedetomidine 1 µg/kg bolus was given, followed by 0.5 µg/kg/h initially and infusion. Infusion rate was titrated based on hemodynamic variables and patient immobility. If patients in any group moved intraoperatively, propofol 0.5 mg/kg, not >30 mg, was given, and dose of dexmedetomidine infusion was increased by 0.1 µg/kg/h increments to a maximum dose of 0.7 µg/kg/h. RESULTS: Rate of dexmedetomidine infusion was significantly lower in Group A compared to Group B (0.058 ± 0.011 vs. 0.547 ± 0.133 µg/kg/h). Extubation time was significantly lower in Group A (14.40 ± 8.845 vs. 30.27 ± 9.903 min). Hemodynamic responses, sevoflurane and propofol consumption, incidence of intraoperative patient immobility, hypotension, and use of vasopressors were comparable in both groups. CONCLUSIONS: Use of BIS monitoring in patients undergoing total parotidectomy under GA without muscle relaxants resulted in significant reduction in intraoperative dexmedetomidine consumption with significantly shorter extubation time.
Khademi S, Baghban P, Khalili F
… +3 more, Kanaani Nejad F, Asmarian N, Banifatemi M
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181270
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BACKGROUND AND AIMS: This study aimed to compare the prophylactic effect of intravenous ondansetron versus ephedrine on hypotension related to spinal anesthesia of cesarean section. The primary outcome was the incidence...BACKGROUND AND AIMS: This study aimed to compare the prophylactic effect of intravenous ondansetron versus ephedrine on hypotension related to spinal anesthesia of cesarean section. The primary outcome was the incidence of maternal hypotension; secondary outcomes were the incidence of nausea and vomiting, the number of vasopressors required, and surgeon satisfaction. MATERIAL AND METHODS: This randomized, double-blind clinical trial study included 120 parturients with ASA physical status I or II who were eligible for elective cesarean section. They were randomly assigned to two groups: receiving ephedrine (10 mg in 10 mL normal saline 0.9% IV) and ondansetron (8 mg in 10 mL normal saline 0.9% IV). The patients were monitored for changes in hemodynamic parameters during surgery and recovery. RESULTS: Among 120 parturients included in this clinical trial, the incidence of hypotension (20% decrease in systolic blood pressure) was significantly lower in the ephedrine group (21.7%) than in the ondansetron group (60%) ( < 0.001). In addition, the incidence of fall of mean arterial pressure to below 60 mmHg was significantly lower in the ephedrine group (3.3%) than in the ondansetron group (18.3%) ( = 0.016) during surgery. Prophylactic administration of ephedrine also significantly decreased the need for rescue vasopressor compared to ondansetron group ( < 0.001). No difference was observed in the rate of complications and surgeon satisfaction among groups ( = 0.228 and 0.36, respectively). CONCLUSIONS: We found that 10 mg IV ephedrine has a significantly greater prophylactic effect than 8 mg IV ondansetron on spinal-induced hypotension during elective cesarean section.
Tah A, Agrawal N, Gupta A
… +2 more, Bairagi S, Ayub A
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181268
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BACKGROUND AND AIMS: Neuraxial anesthesia, including subarachnoid block (SAB), is the preferred technique for the hip surgeries. Positioning of these patients in lateral or sitting position for spinal anesthesia can be v...BACKGROUND AND AIMS: Neuraxial anesthesia, including subarachnoid block (SAB), is the preferred technique for the hip surgeries. Positioning of these patients in lateral or sitting position for spinal anesthesia can be very painful due to hip fracture. This often requires systemic opioids or pre-emptive regional techniques. There is a dearth of literature comparing efficacy of two such regional techniques: pericapsular end nerve group (PENG) block and femoral nerve block (FNB). Our study compares analgesic efficacy of PENG block and FNB to facilitate positioning for SAB in patients undergoing hip surgery. MATERIAL AND METHODS: We conducted a prospective randomized interventional comparative study over a period of 18 months in 60 adult patients scheduled for surgery for hip fracture under SAB. Patients were randomly assigned to receive either ultrasound (US)-guided FNB, Group F ( = 30) or PENG block, Group P ( = 30) for reducing pain associated with positioning for spinal anesthesia. VAS scores were assessed every 5 min for 30 min after the block. Subjective assessment of quality of positioning by an anesthetist, requirement of fentanyl, and patient satisfaction level were also assessed and compared between the groups. RESULTS: FNB while resulted in pain relief (VAS <4) within 10 min, effective pain relief required 20 min for PENG block. The onset of pain relief was faster with FNB as significantly lower VAS scores were observed in patients in FNB group as compared to those in the PENG block group on dynamic movement of hip joint at 10 min after the block ( = 0.023). No statistically significant difference in VAS score was observed in both PENG and FNB block group at 30 min after the block administration on dynamic movement of hip and during the positioning of patient. There was also no significant difference in the quality of positioning, fentanyl boluses, and patient satisfaction between the groups. CONCLUSIONS: USG-guided FNB and PENG block, both regional techniques provided sufficient, comparable, good quality analgesia for positioning the patient for SAB.