Arul L, Rajan S, Sai Sandhya VK
… +3 more, Madhu M, Manikandan MS, Sreekumar G
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181266
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BACKGROUND AND AIMS: Left head rotation (LeHeR) maneuver improves the glottic view in patients with difficult airway. We aimed to assess whether rotating the head to the left side to 45° improved Cormack-Lehane (CL) glot...BACKGROUND AND AIMS: Left head rotation (LeHeR) maneuver improves the glottic view in patients with difficult airway. We aimed to assess whether rotating the head to the left side to 45° improved Cormack-Lehane (CL) glottic view during direct laryngoscopy compared to the classic sniffing position. Ease of intubation in the LeHeR position, number of attempts, time taken for intubation, and hemodynamic changes were also assessed. MATERIAL AND METHODS: This prospective, observational study was performed in 130 surgical patients aged 18-70 years, of American Society of Anesthesiologists Physical Status 1 and 2. Patients with CL grade 1 on initial direct laryngoscopy and those with restricted mouth opening were excluded. Following induction and neuromuscular blockade, direct laryngoscopy was initially attempted with the patient's head in sniffing position and CL grade was documented. Then, the head of the patient was rotated 45° to the left side, glottic view was graded, and the trachea was intubated. RESULTS: Of the patients, 76.9% showed improvement in CL grade in the LeHeR position. Significantly higher percentage of patients had CL grade 1-2B in the LeHeR position compared to that in sniffing position (95.38% vs. 73.8%). Intubation was performed in the LeHeR position in 73.8%, 26.2% patients were intubated in a supine position, and 20% required bougie for intubation. Mean heart rate remained comparable with baseline values throughout the study period. Compared to baseline values, mean blood pressure values were significantly lower. CONCLUSIONS: LeHeR to 45° improved the glottic view during direct laryngoscopy compared to the classic sniffing position. Intubation was easy with good first-attempt success without desaturation or adverse hemodynamic effects.
Kurdi MS, Abinaya K, Ladhad DA
… +2 more, Theerth KA, Mitragotri MV
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181262
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BACKGROUND AND AIMS: Rebound pain (RP) is a distressing, yet not much explored, entity. This study aimed to evaluate and compare how adjuvants like dexamethasone and dexmedetomidine added to 0.5% ropivacaine for peripher...BACKGROUND AND AIMS: Rebound pain (RP) is a distressing, yet not much explored, entity. This study aimed to evaluate and compare how adjuvants like dexamethasone and dexmedetomidine added to 0.5% ropivacaine for peripheral nerve block (PNB) can impact RP. MATERIAL AND METHODS: In this randomized, double-blinded study, 72 patients posted for elective upper limb surgeries under brachial plexus block were randomly divided into three groups of 24 each. Group A received 28 ml 0.5% ropivacaine +2 ml normal saline, Group B received 28 ml 0.5% ropivacaine + 8 mg dexamethasone (2 ml), and Group C received 28 ml 0.5% ropivacaine +50 µg dexmedetomidine (2 ml). The incidence and onset of RP, as well as the duration of sensory and motor block, were compared between the groups. The distribution of variables was compared using appropriate statistical tests. RESULTS: On postoperative days 1 and 2, the RP incidence was significantly lower in the dexmedetomidine group (12.5%, 16.67%) and dexamethasone group (25%, 20.83%), compared to the control group (54.17%, 58.33%) ( = 0.006 and 0.003 respectively). Patients in the dexmedetomidine group had a significantly delayed onset of RP ( = 0.0475). The motor and sensory block duration was prolonged in both, the dexmedetomidine group (410.83 ± 116.17 min, 442.5 ± 116.4 min) and dexamethasone group (375 ± 90.7 min, 418.54 ± 97.84 min) compared to the control group (321.25 ± 69.85 min, 358.33 ± 75.9 min). There was no significant difference between the two adjuvants in prolongation of sensory ( value 0.676) and motor blockade ( value 0.390). CONCLUSIONS: The incidence of RP is significantly reduced when dexmedetomidine and dexamethasone are added as adjuvants to 0.5% ropivacaine in upper limb PNBs, with dexmedetomidine being superior in this regard.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181261
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BACKGROUND AND AIMS: Blockbuster laryngeal mask (LM), a newer supraglottic airway device, is claimed to be an efficient conduit for blind tracheal intubation. It comes with a specialized Blockbuster tube. A conventional...BACKGROUND AND AIMS: Blockbuster laryngeal mask (LM), a newer supraglottic airway device, is claimed to be an efficient conduit for blind tracheal intubation. It comes with a specialized Blockbuster tube. A conventional silicone wire-reinforced tube can be an alternative to the Blockbuster tube. This study was conducted to compare the first pass success rate of endotracheal intubation with Blockbuster tube and silicone wire reinforced tube through Blockbuster laryngeal mask in children. MATERIAL AND METHODS: This study was carried out in 90 children, aged between 3 and 12 years, belonging to ASA- I and II randomized into two groups. After induction, group I was intubated with a Blockbuster tube and group II with a silicone wire-reinforced tube through Blockbuster laryngeal mask. First pass success rate, maneuvers needed, number of attempts, time for intubation, hemodynamic changes, and complications were recorded. RESULTS: Group I had a higher first-pass success rate than group II (73.3% vs. 37.8%, = 0.002), need for maneuvers was less in group I as compared to group II (26.7% vs. 62.2%, = 0.000). The need for subsequent attempts for successful intubation was less in group I as compared to group II (24.5% vs. 57.7%, = 0.002). The time taken to intubate in group I was 28.0 ± 2.2 s and in group II was 36.6 ± 2.3 s ( < 0.001). The two groups were comparable with respect to hemodynamic changes and complications. CONCLUSION: Silicone wire reinforced tube may not be a suitable alternative to Blockbuster ETT for endotracheal intubation through Blockbuster laryngeal mask in children.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181257
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BACKGROUND AND AIMS: Postoperative delirium (POD) is a prevalent and serious complication in elderly patients undergoing surgery, contributing to prolonged hospital stays and increased morbidity. While the exact mechanis...BACKGROUND AND AIMS: Postoperative delirium (POD) is a prevalent and serious complication in elderly patients undergoing surgery, contributing to prolonged hospital stays and increased morbidity. While the exact mechanism remains elusive, growing evidence suggests the involvement of the cholinergic system in delirium pathogenesis. MATERIAL AND METHODS: This observational study aimed to investigate the association between cholinergic biomarkers and POD in elderly patients under regional anesthesia. Eighty-seven patients scheduled for surgery under regional anesthesia were enrolled. Baseline cognitive function was assessed using the Mini-Mental State Examination preoperatively. POD assessment was conducted in the postoperative care unit on days 1, 2, 3, and 7 by using the Confusion Assessment Method. Severity of delirium was evaluated using the Memorial Delirium Assessment Scale. Plasma levels of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), and butyrylcholinesterase (BuChE) were measured preoperatively and 24 hours postoperatively. RESULTS: Fourteen patients were diagnosed with POD. Compared to the non-POD group, the POD group exhibited significantly higher levels of ChAT and lower levels of AChE and BuChE both pre- and postoperatively ( < 0.0001). Receiver operating characteristic (ROC) curve analysis revealed that AChE, BuChE, and ChAT concentrations had high diagnostic values for POD, with BuChE being the most sensitive but least specific among the three markers. CONCLUSIONS: This study concludes that alterations in postoperative activity of AChE, BuChE, and ChAT are associated with the development of POD in elderly patients undergoing surgery under regional anesthesia. BuChE activity showed the greatest diagnostic value among the cholinergic biomarkers assessed. These findings underscore the potential importance of cholinergic dysfunction in POD pathogenesis and highlight the diagnostic utility of assessing cholinergic biomarkers in predicting POD risk.
Shagufta N, Nishant S, Rajnish K
… +1 more, Adil A
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181256
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BACKGROUND AND AIMS: Hemidiaphragmatic paralysis (HDP) may impair the pulmonary function, which could be a substantial issue in individuals suffering from underlying lung disease or compromised lung function. Hence, seve...BACKGROUND AND AIMS: Hemidiaphragmatic paralysis (HDP) may impair the pulmonary function, which could be a substantial issue in individuals suffering from underlying lung disease or compromised lung function. Hence, several diaphragm-sparing methods have been used to avoid HDP after brachial plexus blocks. Although various studies have reported a lower incidence of HDP with costoclavicular block (CCB) compared to supraclavicular block (SCB), a systematic review and meta-analysis to confirm the potential benefits has not been done. Therefore, we analyzed the association of HDP with CCB and SCB. MATERIAL AND METHODS: The incidence of HDP was the primary outcome, and the change in diaphragmatic thickness fraction (DTF), change in hemidiaphragm excursion, and change in peak expiratory flow rate (PEFR) were the secondary outcomes. Six full texts of the articles were selected in the systematic review and meta-analysis of 263 patients who received CCB and 269 patients who received SCB. RESULTS: The incidence of HDP after CCB was significantly lower than that associated with SCB (16 vs. 115), risk difference: -0.41 (95% confidence interval [CI]: -0.48 to -0.34; < 0.001) without heterogeneity (I = 0%). Contractility was more preserved in CCB, and hence, thickness of the diaphragm was more during inspiration. The mean difference in DTF% between the two groups was 33.58 (95% CI: 20.68-46.48). PEFR was more preserved in CCB when compared to SCB: standardized mean difference: 0.46 (95% CI: -0.20-0.72; = 0.24, = 29%; fixed effect model). CONCLUSION: The incidence of HDP after CCB was significantly lesser than that after SCB.
Kumar A, Srivastava N, Ameta N
… +2 more, Joshi S, Tiwari N
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181255
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Enhanced recovery after cardiac surgery (ERACS) in pediatric patients using regional anesthesia is a well-recognized modality. However, there is no research on the use of supraglottic devices in pediatric patients under...Enhanced recovery after cardiac surgery (ERACS) in pediatric patients using regional anesthesia is a well-recognized modality. However, there is no research on the use of supraglottic devices in pediatric patients under cardiopulmonary bypass. Twelve patients for acyanotic congenital heart surgery were recruited. An appropriately sized I-gel was inserted, and positive pressure ventilation without any leak or increased airway pressure was confirmed. Extubation was performed on the operating table without any airway complications or hemodynamic changes. The mean ICU stay was 1.6 days. With the correct selection of patients and strict vigilance, epidural analgesia and I-gel are well-tolerated and enable ultrafast tracking of patients with smooth extubation and superior hemodynamic stability in congenital cardiac surgery.
Paliwal N, Bihani P, Ramachandra G
… +3 more, Pai D, Jaju R, Chakole V
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181254
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BACKGROUND AND AIMS: Difficult airway management is a critical skill requiring quick decision-making and effective team coordination. However, healthcare workers often lack real-life experience due to rarity of such inst...BACKGROUND AND AIMS: Difficult airway management is a critical skill requiring quick decision-making and effective team coordination. However, healthcare workers often lack real-life experience due to rarity of such instances. The aim of this study was to evaluate the effectiveness of simulation-based training for difficult airway management on real teams. MATERIAL AND METHODS: A prospective quasi-experimental study was conducted with 24 participants divided into six teams, each comprising three resident doctors and one staff nurse. An initial baseline simulation (S0) was conducted, followed by didactic sessions and skill training. Subsequent simulation sessions were carried out two weeks after the skill training (S1) and again six months later (S2). The primary objective was to evaluate the improvement in skills of real teams by comparing checklist scores. Simultaneously, retention of these skills and behaviour changes in real-world clinical practice were also assessed. Data were analyzed using descriptive and inferential statistics. RESULTS: Notable improvement in team performance was observed during post-skill training simulations compared to baseline, as demonstrated by a significant increase in technical and non-technical skill scores [mean (SD): 26.7 (6.3) at S0 to 67.8 (7.3) at S1; < 0.001]. Critical airway management skills, including time to call for help, deliberation time, and cricothyroidotomy time, also showed significant improvement. Skill retention was observed at the six-month simulation session [mean (SD) at S2 66.8 (4.1); = 0.7]. Participants and observers reported increased confidence and situational awareness in real-world settings. CONCLUSIONS: This single-institute multi-professional team training resulted in significant improvement and retention of technical and non-technical skills of real teams in managing difficult airway.
Kumar KM, Joshi A, Nair R
… +2 more, Dhawan M, Madabushi S
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181252
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The intersection of complex airway management and intraoperative venovenous extracorporeal membrane oxygenation (VV-ECMO) presents a unique challenge, demanding a comprehensive understanding of both domains. This study e...The intersection of complex airway management and intraoperative venovenous extracorporeal membrane oxygenation (VV-ECMO) presents a unique challenge, demanding a comprehensive understanding of both domains. This study examines patients undergoing complex airway surgical procedures under anesthesia with concurrent ECMO between January 2023 and May 2024. It focuses on the challenges during surgery, perioperative complications, and critical care outcomes with tailored anesthesia approaches in four clinical scenarios: 1) Tracheal stenosis requiring resection and anastomosis, 2) pulmonary alveolar proteinosis necessitating whole lung lavage, 3) carcinoma esophagus infiltrating the tracheal lumen causing upper airway obstruction and stridor managed with tumor debulking and stenting, and 4) adenoid cystic carcinoma of the trachea causing central airway obstruction with progressive stridor needing intratracheal stent placement. ECMO has become essential in advancing modern-day thoracic surgery's scope and safety. The case series underscores the critical role of ECMO in facilitating surgery by ensuring adequate gas exchange and maintaining hemodynamic stability and contributes to the evolving understanding of perioperative strategies, complications, and outcomes of various airway pathologies and guiding future approaches to enhance overall patient care.
Kumar AMR, Shetty SM, Ramachandragowda AN
… +3 more, Byalal S, Shivashankar A, Marulasiddappa M
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181250
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BACKGROUND AND AIMS: Effective mask ventilation is vital in pediatric patients due to anatomical and physiological differences between the adult and pediatric airways. The classical C-E method has drawbacks, such as soft...BACKGROUND AND AIMS: Effective mask ventilation is vital in pediatric patients due to anatomical and physiological differences between the adult and pediatric airways. The classical C-E method has drawbacks, such as soft tissue compression below the mandible and leaks on the unsupported side. This study evaluates a novel single-handed technique, the C-M method, which aims to improve airway seal and reduce complications. Hence, this study aimed to compare the efficacy of the novel C-M method with the C-E method in generating exhaled tidal volumes (mL/kg) during mask ventilation in pediatric patients. MATERIAL AND METHODS: This prospective crossover study involved pediatric patients aged 1-5 years scheduled for elective surgery under general anesthesia. Each method was tested with the ventilator in pressure control mode at 15 cm HO, a respiratory rate of 20 breaths/min, and an I: E ratio of 1:2 for five breaths each. Data collected included tidal volumes, audible mask leak, need for oropharyngeal airways, failed ventilation instances, ease of performance, and gastric insufflation. RESULTS: The mean tidal volumes generated were 9.89 mL/kg for the C-E technique and 10.43 mL/kg for the C-M technique. A two-tailed -test showed a value > 0.05, indicating no statistically significant difference. No instances of failed ventilation were reported. Analysis of the other variables showed no significant differences. CONCLUSIONS: The C-M method is an equally effective alternative for mask ventilation in pediatric patients. It provides comparable tidal volumes and safety to the C-E method, which may enhance airway management in this age group.
Sen IM, Joshi D, Goel N
… +2 more, Kohli A, Parasher A
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181249
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BACKGROUND AND AIMS: Paediatric burn injuries are distressing and traumatic experiences for children and their families. Managing these patients requires a multidisciplinary approach, with anesthesiologists playing a cru...BACKGROUND AND AIMS: Paediatric burn injuries are distressing and traumatic experiences for children and their families. Managing these patients requires a multidisciplinary approach, with anesthesiologists playing a crucial role in providing pain relief and reducing anxiety during surgical interventions. This prospective observational study aimed to evaluate pain and anxiety levels in children admitted with burns requiring surgical interventions. MATERIAL AND METHODS: Fifty pediatric patients aged 7 to 14 years were enrolled in the study. Perioperative parameters, including a etiology, severity, and total burn surface area involved, were evaluated. Preoperative pain scores were evaluated using the following pain assessment scales: the numerical pain rating scale (NPRS) and revised faces, legs, activity, cry, and consolability (FLACC) scale. Preoperative anxiety was measured using the revised child anxiety and depression scale (RCADS-25). Both the parent and child versions of the RCADS-25 were conducted separately in an understandable language. RESULTS: There was a significant association between pain levels and specific types of burn injuries, with high-voltage burns and deep partial-thickness burns being more distressing. Anxiety levels were higher in children undergoing debridement, superficial skin grafting, and amputation compared to other surgical procedures, emphasizing the importance of addressing the psychological well-being of burn patients. CONCLUSIONS: Significantly higher pain scores were observed in pediatric patients with high-voltage electric burns compared to those with thermal burns. Patients undergoing debridement surgeries reported high pain scores in both the preoperative and postoperative periods. Anxiety scores were significantly higher in patients undergoing amputation, debridement, and skin grafting surgeries.
Bansal T, Singla B, Kadian Y
… +4 more, Jain M, Singh AK, Lal J, Singhal S
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 41181248
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BACKGROUND AND AIMS: The volume and concentration of local anaesthetic are particularly importance for the success of a block in providing analgesia. To improve safety, the goal should be the minimum dose of local anaest...BACKGROUND AND AIMS: The volume and concentration of local anaesthetic are particularly importance for the success of a block in providing analgesia. To improve safety, the goal should be the minimum dose of local anaesthetic capable of providing maximum effectiveness. Interfascial plane blocks are considered volume blocks, and a higher volume of local anaesthetic needs to be injected into the fascial plane to achieve the desired effect. Reducing the local anaesthetic concentration may limit the total dose administered without changing the volume injected. MATERIAL AND METHODS: Sixty children aged 8-12 years undergoing hypospadias repair were included in the study. After the induction of general anaesthesia, Group I (n = 30) was given an ultrasound-guided sacral erector spinae block with 1 ml/kg of 0.125% bupivacaine, and Group II (n = 30) received the same block with 1 ml/kg of 0.25% bupivacaine. Postoperatively, when the visual analogue scale (VAS) score was ≥ 4, rescue analgesia was administered using intravenous paracetamol at 15 mg/kg. The primary objective was to compare the time to the first paracetamol rescue. Secondary objectives included intraoperative hemodynamic parameters, additional fentanyl consumption, postoperative visual analogue scores, and total analgesic consumption (paracetamol and ibuprofen) within 24 h. RESULTS: The mean time to the first paracetamol rescue was 20.0 h (standard deviation [SD]: 3) h in Group I and 22.5 h (SD: 3) h in Group II ( = 0.19) (mean difference 2.5 [95% CI: -6.46, 1.46]), with a Cohen's d value of 0.83. The postoperative VAS scores at different time points were similar between the two groups. Ibuprofen was not required by any patient. The mean postoperative analgesic consumption (paracetamol) was 385 mg (SD: 77.85) in Group I and 427.5 mg (SD: 31.22) in Group II ( = 0.32) (mean difference 42.5 [95% CI: 16.08, 89.96]), with a Cohen's d value of 0.71. CONCLUSIONS: Bupivacaine 0.125% is as effective as 0.25% bupivacaine in terms of the time to first paracetamol rescue for sacral erector spinae block in paediatric patients undergoing hypospadias repair.