Saini R, Sindwani G, Garg N
… +3 more, Arora MK, Pamecha V, Mohapatra N
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635834
·
Full text
BACKGROUND AND AIMS: Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepat...BACKGROUND AND AIMS: Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepatectomy. MATERIAL AND METHODS: Patients were divided into two groups. In the epidural (EPI) group, a bolus dose of 0.125% levobupivacaine (5-6 mL) with 3 mg of preservative-free morphine (diluted in 5 mL of 0.9% normal saline) was injected. In the postoperative period, infusion of levobupivacaine 0.125% at a rate of 5-8 mL/hour was continued for 3 days. In the intrathecal group (ITM), 0.3 mg morphine with 1.5 mL of 0.5% bupivacaine heavy was injected. General anesthesia was administered. Postoperatively, both groups received intravenous fentanyl patient-controlled analgesia. Numerical rating score (NRS) scores were recorded at 0, 2, 4, 12, 24, 36, 48, and 72 hours postoperatively. Data were analyzed using the Student -test, Mann-Whitney U test, and Fisher's exact test. < 0.05 was considered significant. RESULTS: A total of 60 patients were enrolled. The postoperative fentanyl consumption for the first 24 hours was significantly higher in the EPI group compared to the ITM group (162.5 mcg vs. 75 mcg, respectively; = 0.023). NRS up to 12 hours in the postoperative period at rest, on movement, and for shoulder pain were significantly lower in the ITM group compared to the EPI group ( = 0.000). CONCLUSIONS: ITM significantly decreased fentanyl consumption in the first 24 hours when compared to the epidural group in patients undergoing open donor hepatectomy.
Rajan S, Mathew J, Sreekumar G
… +3 more, Arul L, Amin KN, Paul J
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635831
·
Full text
BACKGROUND AND AIMS: Left head rotation maneuver improves the glottic view during direct laryngoscopy. We assessed whether rotating the head to the left side to 45° in supine position improves the glottic view as assesse...BACKGROUND AND AIMS: Left head rotation maneuver improves the glottic view during direct laryngoscopy. We assessed whether rotating the head to the left side to 45° in supine position improves the glottic view as assessed with the percentage of glottic opening (POGO) score during video laryngoscopy compared to sniffing position. Ease of intubation, time to intubate, and hemodynamic changes were also assessed. MATERIAL AND METHODS: This prospective, observational study was conducted in 41 patients with difficult airway requiring video laryngoscope-aided nasotracheal intubation. Following intravenous induction and neuromuscular blockade, indirect laryngoscopy was attempted with C-MAC videolaryngoscope with the patient's head in sniffing position. Best glottic view was graded as per the POGO scoring system. In patients having partial or no glottic view, patient's head was rotated to the left side to 45° and the best glottic view was obtained and scored. Intubation was attempted in this position, and ease of intubation was documented. RESULTS: Majority of patients showed improvement of >25% POGO score following left head rotation compared to sniffing position (85.37% vs. 14.63%). Significantly higher number of patients in sniffing position had a POGO score of 0-25%, while it was >50-100% in left head rotation position. Median POGO score was significantly higher in left lateral position compared to sniffing position (75% vs. 25%). Intubation was easy in 69.29% of patients. There was no significant change in hemodynamic parameters during intubation. CONCLUSION: Rotating the head to the left side to 45° in supine position improved the glottic view during indirect laryngoscopy using C-MAC videolaryngoscope compared to sniffing position.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635829
·
Full text
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused due to the total or partial occlusion of the pulmonary vasculature due to organized thrombus, leading to severe pulmonary hypertension and eventually right...Chronic thromboembolic pulmonary hypertension (CTEPH) is caused due to the total or partial occlusion of the pulmonary vasculature due to organized thrombus, leading to severe pulmonary hypertension and eventually right heart failure, which makes anesthetic management very challenging. Pulmonary endarterectomy (PTE) is the treatment of choice for patients with operable CTEPH. The objective of the present review is to examine the preoperative evaluation, anesthesia technique, and postoperative management in the intensive care unit (ICU) of patients with CTEPH after PTE. We identified published journal articles in the last 25 years from PubMed and Google Scholar databases with the keywords "chronic thromboembolic pulmonary hypertension,"" anesthetic management of pulmonary thrombo-endarterectomy," and "perioperative management of CTEPH." One hundred fifty-three articles were reviewed, out of which 30 articles were retrieved finally. Based on the articles reviewed, we inferred that a balanced anesthesia technique should be carefully chosen to avoid hemodynamic collapse. Transesophageal echocardiography (TEE) is used to assess biventricular function, peak pulmonary artery pressure, the severity of tricuspid regurgitation, location and extent of thrombus, and guide pulmonary artery catheter insertion. Deep hypothermic circulatory arrest (DHCA) is utilized to perform a complete endarterectomy into segmental and subsegmental arterial branches. This narrative review article highlights the role of anesthesiologists in preoperative evaluation, intraoperative TEE guidance, anesthetic management, and postoperative management of complications such as reperfusion pulmonary edema, residual pulmonary hypertension, intrapulmonary hemorrhage, and the consequences of DHCA in patients with CTEPH undergoing surgical PTE. Future research is required to study the effects of DHCA and free radical injuryon postoperative complications and its prevention.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635828
·
Full text
BACKGROUND AND AIMS: This study compared the dual sub-sartorial block (DSB), which allegedly includes all pain generators of the anterior and posterior compartments of the knee joint, to the routinely used single sub-sar...BACKGROUND AND AIMS: This study compared the dual sub-sartorial block (DSB), which allegedly includes all pain generators of the anterior and posterior compartments of the knee joint, to the routinely used single sub-sartorial bock (SSB), in terms of analgesic efficacy and preservation of motor strength after unilateral total knee arthroplasty (TKA). MATERIAL AND METHODS: Sixty patients aged 18-80 years and ASA grade I-III undergoing unilateral TKA were randomised to two groups postoperatively to receive DSB or SSB. Patients in group DSB received distal femoral triangle block (15 ml) + proximal adductor canal block (20 ml), while group SSB received only proximal adductor canal block (20 ml). Primarily, the changes in pain intensity and pain control in terms of static and dynamic visual analogue score (VAS) with the duration of analgesia and cumulative dose requirement of rescue analgesic in the first 24 hours postoperatively were studied. Secondary outcomes were the postoperative degree of motor blockade, the ability of early ambulation, patient satisfaction and complications. Statistical analysis was done using the student -test and Chi-square test using MedCalc version 12.4.3.0. RESULT: At all time intervals, the static and dynamic VAS scores were lower in the patients with the DSB group ( < 0.001) with longer duration of postoperative analgesia (14.96 ± 5.05 vs 6.03 ± 1.73 hours, < 0.0001) and less requirement of total parenteral analgesic (1.06 ± 0.37 vs 2 ± 0.52, < 0.0001) in first 24 hours postoperatively. A shorter time was required to finish the Timed Up and Go test for patients belonging to the DSB group (53.48 ± 4.06 vs 66.16 ± 6.23 seconds, < 0.0001) in comparison to group SSB. CONCLUSION: DSB provided better pain control with a longer duration of analgesia and required fewer doses of parenteral analgesics in the first 24 hours postoperatively after TKA, as opposed to SSB. Neither block had incidences of motor weakness and other complications.
Raj SK, Tripathy DK, Talawar P
… +1 more, Singla D
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635826
·
Full text
BACKGROUND AND AIMS: Judicious use of intravenous fluid therapy can be lifesaving in the intraoperative period. An assessment of fluid responsiveness is important for it. So, our study aimed to study the correlation betw...BACKGROUND AND AIMS: Judicious use of intravenous fluid therapy can be lifesaving in the intraoperative period. An assessment of fluid responsiveness is important for it. So, our study aimed to study the correlation between end-tidal carbon dioxide (EtCO) and transthoracic echocardiography-derived cardiac output for assessing fluid responsiveness in patients undergoing elective surgery under general anesthesia. MATERIAL AND METHODS: Patients who underwent elective lower abdominal or lower limb surgeries in a supine position under general anesthesia with positive pressure ventilation were included in this study. Cardiac output was calculated using transthoracic echo, and by measuring the diameter of the left ventricular outflow tract (LVOT), velocity time integral of LVOT (LVOT-VTI), and heart rate. Cardiac output (CO), EtCO, and hemodynamic and ventilatory parameters were analyzed by the operator before and 1 min after the infusion of 250 mL of normal saline. RESULTS: EtCO variations showed a weak correlation with the changes in CO induced by a fluid challenge (Spearman's correlation 0.3, = 0.005). When fluid responsiveness (FR) is defined as an increase in CO by > 15%, the AUROC of ∆ EtCO was 0.638 (95% confidence interval [CI], 0.507-0.77). At a cut-off of ≥ 1 mmHg, it predicted FR status (responder vs. non-responder) with a sensitivity of 66% and a specificity of 64%. When percentage variation in EtCO (percent ∆ EtCO) was considered, the AUROC was almost similar (0.618) (95% CI, 0.481-0.756), and it was not statistically significant ( = 0.093). CONCLUSIONS: Our study demonstrated a weak positive correlation between volume-induced changes in EtCO and changes in CO in mechanically ventilated patients in the operating room. Variations in EtCO can be used as an adjunct to guide hemodynamic optimization when no COcardiac output monitors are available.
Anupma, Chhabra S, Mohammed S
… +3 more, Kamal M, Kumar R, Bhatia P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635825
·
Full text
BACKGROUND AND AIMS: Airway protection and adequate ventilation are the main aim for the patients undergoing laparoscopic surgeries under general anesthesia. The study intended to compare the oropharyngeal leak pressure...BACKGROUND AND AIMS: Airway protection and adequate ventilation are the main aim for the patients undergoing laparoscopic surgeries under general anesthesia. The study intended to compare the oropharyngeal leak pressure (OLP) and insertion parameters and postoperative complications between Ambu AuraGain and i-gel in laparoscopic hernia repair surgeries. The primary objective was to compare the OLP at insertion and after pneumoperitoneum and positioning. The secondary objectives were to compare the time required for insertion, number of attempts, ease of insertion, and ability to insert gastric tube, grade of fiber-optic glottic view and postoperative complications. MATERIAL AND METHODS: A randomized controlled trial of 50 patients belonging to American Society of Anesthesiologists (ASA) physical status grade I and II, aged between 18-60 years, was randomly divided into group AAG and Group IG. RESULTS: No significant difference was found between the two groups in terms of OLP at insertion and 5 min after pneumoperitoneum. However, OLP at 30 min of pneumoperitoneum was statistically higher with Ambu AuraGain than i-gel (27.72 ± 2.67 cm HO versus 25.50 ± 2.38 cm HO; value = 0.002). The fiber-optic glottic view was better with Ambu AuraGain than i-gel at 5 min and 30 min after pneumoperitoneum ( value = 0.038 and 0.043, respectively). Ambu AuraGain took longer insertion time compared to i-gel which was statistically significant. CONCLUSIONS: The OLP and fiber-optic glottic view of Ambu AuraGain are better than i-gel with longer insertion time, and the rest of the variables were comparable. We conclude that Ambu AuraGain is superior to i-gel in adult patients undergoing laparoscopic inguinal hernia repair under general anesthesia.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635824
·
Full text
BACKGROUND AND AIMS: According to the World Health Organization, climate change represents a threat to global health. Healthcare activities must understand their ecological impact and reduce their environmental footprint...BACKGROUND AND AIMS: According to the World Health Organization, climate change represents a threat to global health. Healthcare activities must understand their ecological impact and reduce their environmental footprint. Decreasing greenhouse gas emissions is a major health priority, to which all healthcare establishments should commit. We sought to understand whether anesthesiologists were aware of the impact of sevoflurane consumption on climate and whether they were inclined to implement eco-friendly strategies. MATERIAL AND METHODS: We assessed the knowledge of anesthesiologists about sevoflurane consumption and its impact on climate change. Overall, 152 anesthesiologists from Belgium, France, and Italy answered our questionnaire in April 2024. The database from the computerized anesthesia protocol was used to evaluate the average annual sevoflurane consumption at our Belgian institution between January 2015 and March 2022. The sevoflurane quantities used were obtained from information provided by the ventilator after each procedure. Potential savings were based on scientific recommendations regarding anesthesia ventilator settings. The analysis was based on the comparison between these data. RESULTS: With optimized sevoflurane consumption conditions, the emission of 36.156 tons of CO could have been avoided, corresponding to 144,623 Km driven per year. The financial impact calculated was a saving of 533,525€ over 8 years. The survey highlighted that anesthesiologists were ready to embrace eco-friendly practices to reduce global pollution. CONCLUSIONS: We must invest in information and awareness-raising for anesthesiologists from the start of their medical training so that we can move toward a more eco-responsible practice to achieve major ecological and economic benefits.
Srivastava VK, Raman R, Prabha R
… +3 more, Verma D, Kushwaha BB, Gautam S
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635823
·
Full text
BACKGROUND AND AIMS: Laryngeal Mask Airway Protector (LMPt) and Laryngeal Mask Airway Proseal (LMPs) have a high oropharyngeal leak pressure (OLP) but have not been compared for laparoscopic surgery. It was hypothesized...BACKGROUND AND AIMS: Laryngeal Mask Airway Protector (LMPt) and Laryngeal Mask Airway Proseal (LMPs) have a high oropharyngeal leak pressure (OLP) but have not been compared for laparoscopic surgery. It was hypothesized that LMPs and LMPt have different clinical performances while managing the airway of patients undergoing laparoscopic surgery. The aim of the study was to compare the LMPs and LMPt for managing the airway of patients undergoing laparoscopic surgery. MATERIAL AND METHODS: This was a prospective, single-blind, randomized, comparative trial. It included adult patients of either gender with American Society of Anesthesiologists physical status I/II planned for elective laparoscopic surgery. The airway of the recruited subjects was managed with either LMPs (group R, n = 60) or LMPt (group T, n = 60). OLP was the primary outcome variable. Number of attempts, insertion success, device insertion duration, ease of insertion, hemodynamics, gastric tube insertion, and complications were secondary outcome variables. Numerical data and dichotomous data were analyzed using student's -test and χ test, respectively. RESULTS: The OLP was statistically greater ( < 0.001) in group T before (30.23 ± 1.48 vs. 25.33 ± 1.40 cm HO) and during (31.77 ± 0.65 vs. 27.12 ± 1.11 cm HO) the pneumoperitoneum. The baseline and secondary outcome variables were statistically similar between the groups. CONCLUSIONS: For patients undergoing elective laparoscopic surgery, both LMPt and LMPs are suitable for airway management, but LMPt provides a higher OLP. More trials are required to validate these findings across different surgical settings and patient populations.
Jagath ASA, Bhatia N, Jain K
… +3 more, Kumar D, Prabhakar S, Makkar JK
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635822
·
Full text
BACKGROUND AND AIMS: Ultrasound-guided continuous peripheral nerve block catheter placement greatly aids in providing a prolonged peripheral nerve block. We investigated the effect of patient-controlled continuous infrac...BACKGROUND AND AIMS: Ultrasound-guided continuous peripheral nerve block catheter placement greatly aids in providing a prolonged peripheral nerve block. We investigated the effect of patient-controlled continuous infraclavicular brachial plexus block analgesia on early functional rehabilitation following surgeries around the elbow performed under general anesthesia. MATERIAL AND METHODS: In this prospective, trial patients were randomized to two groups of 15 patients each to receive either patient-controlled IV morphine, using patient-controlled bolus of 1 mg morphine intravenously with a lockout interval of 15 min (control group, Group I) or patient-controlled continuous infraclavicular block with 0.2% ropivacaine at a basal rate of 5 mL/h, with a patient-controlled bolus of 3 mL and a lockout interval of 30 min (study group, Group II). The block was administered before extubation. The primary objective was to assess the Mayo Elbow Performance Score (MEPS) at 3 weeks following discharge from the hospital. Our secondary objectives included MEPS at 3 months following discharge, numeric rating scale (NRS) score at 4 h for an initial 72 h postoperatively and at the time of physiotherapy, a total dosage of rescue analgesic consumed, and time to the first dose of rescue analgesia. RESULTS: At 3 months following discharge from the hospital, the median MEPS was significantly higher in Group II as compared to that in Group I (85 [83.75-90] vs. 80 [80-82.5]; = 0.03). A strong negative correlation ( < 0.05) was found between pain scores during physiotherapy on days 2, 3, and MEPS at 3 weeks in Group II. The median number of analgesic boluses was also significantly higher in Group I (7 [6-8.25] vs. 4 [4-5]; < 0.001). CONCLUSIONS: Ultrasound-guided continuous infraclavicular block resulted in significantly higher MEPS. It also improved baseline analgesia in the postoperative period. This facilitated early functional correction of the elbow joint, thereby promoting better rehabilitation.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635821
·
Full text
BACKGROUND AND AIMS: Intravenous magnesium sulfate is known to reduce hemodynamic response of laryngoscopy and intubation. However, it is associated with some systemic side effects. We compared the efficacy of nebulized...BACKGROUND AND AIMS: Intravenous magnesium sulfate is known to reduce hemodynamic response of laryngoscopy and intubation. However, it is associated with some systemic side effects. We compared the efficacy of nebulized and intravenous magnesium sulfate pretreatment on attenuation of hemodynamic response during tracheal intubation. MATERIAL AND METHODS: Sixty-six American Society of Anesthesiologists classification I-II patients aged 18-65 were randomly assigned to two groups: Group IV, which received 30 mg/kg of intravenous magnesium sulfate, and Group IN, which received the same dose via nebulization. Intubation was performed by an experienced anesthesiologist who was blinded to group allocation. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP) during laryngoscopy and intubation. Secondary outcomes included propofol consumption for anesthesia induction, time to achieve a train-of-four (TOF) ratio of 0 after vecuronium administration, and any adverse effects. RESULTS: Both groups showed similar attenuation of hemodynamic responses during laryngoscopy and intubation (HR: =0.139, MAP: =0.40). Propofol consumption (mg) was comparable between the groups (113.64 in Group IN vs. 113.79 in Group IV, = 0.629). However, the time (seconds) to achieve a TOF ratio of 0 was significantly shorter in Group IV compared to Group IN (228.33 vs. 247.09, = 0.035). CONCLUSION: Nebulized magnesium sulfate was as effective as intravenous magnesium sulfate in reducing hemodynamic changes during intubation, offering a noninvasive alternative for managing this response.
Sachidananda R, Malipatil A, Joshi V
… +3 more, Hosamani A, Haranagatti A, Kurugodiyavar MD
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635819
·
Full text
BACKGROUND AND AIMS: Cesarean section is one of the most commonly performed surgeries in obstetrics. Various methods have been employed to assess postoperative pain. Surgical trauma causes acute phase response with neutr...BACKGROUND AND AIMS: Cesarean section is one of the most commonly performed surgeries in obstetrics. Various methods have been employed to assess postoperative pain. Surgical trauma causes acute phase response with neutrophilia and relative lymphopenia. Hence neutrophil lymphocyte ratio (NLR) can be taken as an objective tool to measure acute pain. The primary objective of the study was to evaluate the relationship between postoperative NLR and pain, which was assessed using visual analogue scale (VAS). MATERIAL AND METHODS: A prospective observational study was conducted on 120 pregnant women aged between 18 to 38 years belonging to American Society of Anesthesiologists Physical Status II undergoing elective cesarean section under subarachnoid block, in a tertiary care hospital over 18 months. Postoperatively pain was assessed using VAS. Blood samples were sent and NLR was calculated preoperatively and postoperatively. Injection diclofenac and tramadol was administered for postoperative pain and total doses of respective drugs were noted. The correlation between NLR and VAS was assessed using Spearman's rank correlation analysis. RESULTS: The postoperative NLR was higher than the preoperative NLR. There was significant correlation between VAS score and NLR score at 12, 24 and 48 h [(Spearman's rank correlation coefficient), r = 0.462, < 0.001; r = 0.519 < 0.001; r = 0.455 < 0.001]. The diclofenac requirement was significantly high at 24 h among the repeat cesarean section patients ( = 0.023). CONCLUSION: The postoperative NLR correlated significantly with VAS. NLR can be used as a surrogate marker for pain assessment.