Malhotra N, Anand R, Kumar A
… +3 more, Sinha N, Phogat V, Charan N
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635814
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BACKGROUND AND AIMS: Neck pain resulting from various cervical spine disorders ranks second among the leading cause of musculoskeletal disorders. This prospective study was conducted to compare the efficacy of suprascapu...BACKGROUND AND AIMS: Neck pain resulting from various cervical spine disorders ranks second among the leading cause of musculoskeletal disorders. This prospective study was conducted to compare the efficacy of suprascapular nerve block (SSNB) using a local anaesthetic and two different doses of dexamethasone in patients with cervical radicular pain. MATERIAL AND METHODS: Forty participants were randomised into Group I (n = 20), in which patients received a SSNB with 6 ml of a drug solution comprising 0.25% bupivacaine (4 ml) and 8 mg of dexamethasone (2 ml), and Group II (n = 20), in which patients received SSNB with 6 ml of a drug solution comprising 0.25% bupivacaine (4 ml), 4 mg of dexamethasone (1 ml), and normal saline (1 ml). Patients were followed for a period of six months. The numeric rating scale (NRS), patient global impression of change (PGIC), need for repeat injections, and side effects were compared between the two groups. RESULTS: NRS and PGIC scores were found to be comparable between the two groups at all time intervals ( > 0.05). There was no significant difference amongst the two groups in terms of the number of repeat injections ( > 0.05). None of the patients reported any serious side effects. CONCLUSIONS: A SSNB with a local anaesthetic and either 8 mg or 4 mg of dexamethasone is an equally effective technique for managing patients with cervical radicular pain. Hence, a SSNB with 4 mg of dexamethasone can be utilised to reduce the steroid dose without compromising the efficacy and safety of the treatment in patients with cervical radicular pain.
Sivakumar R, Ramachandran R, Trikha A
… +3 more, Kumar S, Laxmi B, Rewari V
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635813
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BACKGROUND AND AIMS: Both dexmedetomidine and midazolam-ketamine are known for their minimal respiratory depressant effects. While many studies have documented the use of dexmedetomidine in providing conscious sedation d...BACKGROUND AND AIMS: Both dexmedetomidine and midazolam-ketamine are known for their minimal respiratory depressant effects. While many studies have documented the use of dexmedetomidine in providing conscious sedation during awake fiberoptic-guided nasal intubation (AFNI), the use of midazolam-ketamine combination for this procedure has not been reported. The aim of this study was to compare the efficacy of dexmedetomidine with midazolam-ketamine combination for AFNI in patients with difficult airways undergoing oromaxillofacial surgery. MATERIAL AND METHODS: This study involved 60 patients undergoing oromaxillofacial surgery. They were randomized to receive either dexmedetomidine (1 μg/kg) (group D) or a combination of midazolam (0.02 mg/kg) and ketamine (0.5 mg/kg) (group MK) for sedation during awake fiberoptic nasotracheal intubation. Both groups received topical local anesthesia during the procedure using the spray-as-you-go technique. The primary outcome measured was cough score during intubation. Secondary outcomes included overall intubation, post-intubation, and sedation scores. Incidences of side effects such as hypoxemia and bradycardia were also measured. RESULTS: The cough score (group D: 1.33 ± 0.61, group MK: 1.3 ± 0.53; = 0.822), overall intubation score, and post-intubation score were comparable between the two groups. Patients receiving dexmedetomidine were significantly more sedated than patients receiving midazolam-ketamine. Patients receiving dexmedetomidine had significantly lower heart rates and blood pressure than patients receiving midazolam-ketamine. Four patients in group D had hypoxemia, while no patient in group MK developed hypoxemia. CONCLUSIONS: Both dexmedetomidine and midazolam-ketamine combinations were equally effective for sedation during AFNI in patients with difficult airways scheduled for orofacial maxillary surgery. Patients receiving dexmedetomidine were more sedated, but the incidence of side effects was similar in both groups.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635811
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Erector spinae muscle extends throughout the cervical, thoracic, lumbar and sacral regions. Sacral erector spinae block is performed by depositing the local anaesthetic in the fascial plane deep to erector spinae muscle...Erector spinae muscle extends throughout the cervical, thoracic, lumbar and sacral regions. Sacral erector spinae block is performed by depositing the local anaesthetic in the fascial plane deep to erector spinae muscle at sacral level. Local anaesthetic gets distributed in craniocaudal fascial plane and exerts its effect on ventral and dorsal rami of spinal nerves. Block at sacral level provides excellent postoperative analgesia. This block has been used as a sole anaesthetic technique as well. The rationale and focus of this narrative view are to provide an overview of the effectiveness and indications of sacral erector spinae block in addition to techniques used for this block. Sacral erector spinae block provides many advantages. It covers many dermatomes using longitudinal midline technique. It is safe as it is a superficial block. The block does not cause hypotension and bradycardia, hence there is no haemodynamic instability. The block is an excellent modality for postoperative analgesia, chronic pain relief as well as surgical anaesthesia. It works effectively for both children as well as adults and can prove a new era for postoperative analgesia in future.
Sangamala VPK, Syal R, Kumar R
… +3 more, Bhatia P, Mohammed S, Kamal M
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635810
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BACKGROUND AND AIMS: In traditional nasotracheal intubation (NTI), the tracheal tube is inserted through the nostril and manipulated in the pharynx to guide it into the trachea using additional maneuvers such as BURP (ba...BACKGROUND AND AIMS: In traditional nasotracheal intubation (NTI), the tracheal tube is inserted through the nostril and manipulated in the pharynx to guide it into the trachea using additional maneuvers such as BURP (backward upward rightward pressure) maneuver, neck movement, tube rotation, the use of a bougie, or Magill's or Boedeker forceps under laryngoscopy guidance. These maneuvers often increase the time required for intubation, the risk of cuff rupture, and hemodynamic stress. The cuff inflation technique is an alternative NTI approach, where the cuff of the tube is inflated with air to help align with the tracheal opening. MATERIAL AND METHODS: All surgical patients requiring NTI were randomly allocated into two groups (n = 53 each): Group C, using the conventional intubation technique, and Group I, using the cuff inflation-deflation technique. Intubation time, types of maneuvers, number of maneuvers, hemodynamic response, percentage of glottic opening (POGO) score, and complications were evaluated. RESULTS: The cuff inflation technique required significantly less time for successful NTI compared to the conventional group (27.86 ± 4.47 s vs. 41.11 ± 10.98 s, respectively; < 0.0001). Additionally, the number of accessory maneuvers required, hemodynamic stress responses, and complications were significantly reduced ( < 0.00277) with the cuff inflation technique compared to the conventional technique. CONCLUSIONS: The cuff inflation method requires significantly less time for NTI compared to the conventional method. Additionally, the cuff inflation method facilitates faster alignment with the glottis inlet, reduces hemodynamic responses, minimizes the need for maneuverability, and results in fewer complications.
Chandrakar S, Agarwal A, Jain G
… +3 more, Udhayachandhar R, Cherian D, Patel NB
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635808
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BACKGROUND AND AIMS: Medical oxygen (O) is a lifesaving therapy in the intensive care unit (ICU). However, overzealous use and poorly defined O targets in ICU patients can increase the risk of hyperoxemia. We aimed to as...BACKGROUND AND AIMS: Medical oxygen (O) is a lifesaving therapy in the intensive care unit (ICU). However, overzealous use and poorly defined O targets in ICU patients can increase the risk of hyperoxemia. We aimed to assess the administration and titration of O therapy in ICU patients requiring invasive mechanical ventilation (IMV) support. MATERIAL AND METHODS: In this prospective observational study, all adult patients requiring IMV for more than 24 hours were included over 1 year (December 2020-November 2021). Patients who refused to give consent or required IMV support for less than 24 hours, did not have arterial blood gas data, were at risk for imminent death, or required extracorporeal membrane oxygenation or hyperoxemia therapy were excluded. We calculated the incidence of hyperoxemia (SpO > 98%), physicians' response to hyperoxemia, and factors associated with hyperoxemia. Multivariable logistic regression (MLR) analysis was done to assess factors associated with hyperoxemia. RESULTS: Among 400 recruited patients and 4631 observations, 211 patients and 1669 observations had hyperoxemia. In 398 observations, oxygen was decreased. Physicians were reluctant to decrease oxygen when hyperoxemia was observed at lower inspired oxygen (χ2 = 182.1, value < 0.001). On MLR analysis, the duration of IMV, minute ventilation, and inspired and partial pressure of oxygen were statistically significantly associated with hyperoxemia. CONCLUSIONS: Hyperoxemia was observed in approximately one-third of observations noted in mechanically ventilated patients. Physicians were reluctant to decrease oxygen when hyperoxemia was encountered at lower inspired oxygen.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40635807
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Rheumatic heart diseases (RHDs) impose a substantial global burden, primarily affecting individuals under 25 years of age in low- and medium-income countries (LMICs) and poor and marginalized groups in high-income countr...Rheumatic heart diseases (RHDs) impose a substantial global burden, primarily affecting individuals under 25 years of age in low- and medium-income countries (LMICs) and poor and marginalized groups in high-income countries.[123] The underlying cause is a group A beta-hemolytic streptococcus, which triggers an immune-mediated attack on the heart and joints. Although acute rheumatic fever (ARF) is treatable, its occurrence and complications remain high in impoverished areas.[4] Variations in social structure contribute to differences in the incidence and progression of the disease, even in affluent regions.[5] Administering anesthesia to this patient population presents significant challenges, particularly when early management has been inadequate due to limited medical care and follow-up. Literature shows evidence for anesthetic management of different types of RHDs, mostly focusing on mitral and aortic valvulopathies.[67] This review synthesizes literature from databases such as MEDLINE and PubMed searches from the year 2000 to date, focusing on anesthesia management strategies and the challenges posed by ARF and RHD. Specific topics covered include the diagnosis and management of ARF, acute complications, perioperative care for patients with RHD, and unique considerations for different valvular pathologiesWith this review, we aim to discuss the available evidence, current World Health Organization (WHO) and societal guidelines in the context of perioperative medical and anesthetic management, hemodynamic challenges, and postoperative courses. An emphasis on basic point-of-care ultrasound (POCUS) training is made in this review as the current era of diagnostics and therapeutics is increasingly reliant on echocardiography.
Thaware P, Choudhary P, Ahmad Z
… +4 more, Jangid S, Ahmad R, Kumar A, Waindeskar V
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248806
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BACKGROUND AND AIMS: Point-of-care ultrasound conducted by anesthesiologists plays a crucial role in ensuring the safety of anesthesia. This study aims to evaluate the interobserver reliability of ultrasound measurements...BACKGROUND AND AIMS: Point-of-care ultrasound conducted by anesthesiologists plays a crucial role in ensuring the safety of anesthesia. This study aims to evaluate the interobserver reliability of ultrasound measurements of the inferior vena cava (IVC) and aorta diameters in fasting pediatric patients undergoing spontaneous and controlled ventilation. Despite the prevalent use of indices for intravascular volume assessment, their accuracy varies depending on the observer's expertise, particularly in pediatric cases. This research seeks to provide valuable insights into the interobserver reliability of ultrasound measurements in pediatric patients. MATERIAL AND METHODS: A single-center prospective observational study was conducted involving pediatric patients aged 1-12 years undergoing elective surgery. Ethical approval and written consent were obtained, with exclusions for major cardiovascular issues. Ultrasound measurements of IVC and aorta were performed by two observers during spontaneous and controlled ventilation in the subxiphoid transabdominal long-axis view. Reliability was assessed through statistical analyses, including the intraclass correlation coefficient and Bland-Altman analysis. RESULTS: Mean values of IVC and aorta diameters were summarized for both observers during different ventilation modes. The intraclass correlation coefficient indicated excellent to good agreement between the observers for both spontaneous and controlled ventilation scenarios. Bland-Altman analysis revealed no fixed or proportional errors, confirming the reliability of the measurements. CONCLUSIONS: This study establishes the reliability of ultrasound measurements for assessing IVC and aorta in subxiphoid transabdominal long-axis view. The findings highlight the potential of this technique in pediatric anesthesia, even after brief training, providing valuable insights for clinical practice.
Pradhan A, Sarkar A, Haldar S
… +2 more, Chakraborty A, Pal AR
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248802
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BACKGROUND AND AIMS: Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort stud...BACKGROUND AND AIMS: Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort study on Enhanced Recovery After Surgery (ERAS) in liver resection aimed at correlating compliance with ERAS elements to length of stay (LOS) and the incidence of complications in a tertiary-level cancer hospital in Eastern India. MATERIAL AND METHODS: In total, 44 hepatectomy patients were assessed retrospectively from June 2022 to May 2023. Data were collected from electronic medical records and patient charts. RESULTS: The overall compliance was 77.7%. Individual component compliance varied. Lower compliance rates were seen with some aspects such as fasting and carbohydrate loading, minimally invasive surgical techniques used, and avoidance or early removal of the drain. The cohort was divided into two groups. Group 1 had compliance to ≥75% of 21 elements of ERAS, and group 2 had compliance to <75%. Statistical analysis showed higher ERAS compliance and reduced complications, although LOS differences were not statistically significant (group 1 and group 2 with an LOS difference of 1 day). Severe complications such as re-exploration and death were noted in the group of patients with compliance to less than 75% of the components. CONCLUSION: With increased ERAS compliance, the patients benefited clinically and financially.
Kumari P, Kumar A, Sinha C
… +2 more, Kumar A, Singh K
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248800
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Difficult venous access is characterized by non-visible and non-palpable veins; a highly experienced operator is required with the use of technological aids to insert a vascular device. Patients with difficult venous can...Difficult venous access is characterized by non-visible and non-palpable veins; a highly experienced operator is required with the use of technological aids to insert a vascular device. Patients with difficult venous cannulation undergo multiple, painful attempts to gain peripheral venous access. Compared to adults, inserting a central venous cannulation (CVC) is thought to be a more difficult procedure in children, particularly in neonates and young infants. IJV catheterization is perceived as the gold-standard route for CVC but remains difficult for newborn, premature, and critically ill children. Therefore, in recent years, novel ultrasound-guided brachiocephalic venous (BCV) cannulation in neonates has gained popularity. The aim of this narrative review was to assess the success rate. The primary objective of this review was to determine the first-attempt success rate. The secondary objectives were the total number of attempts, cannulation time, overall success rate, and complications. All articles relevant to BCV cannulation were searched in six major databases (PubMed, Embase, Medline, Ovid, PMC, and Google Scholar). A total of 16 records were included in this narrative review. According to Breschan , Merchaoui , and Vafek , the success rate of BCV cannulation in children was 89.1%, 98.4%, and 50%, respectively. Kumar , Erroz , and Breschan . found that the first-attempt success rate was higher in the in-plane left BCV (74%, 73% and 82.9% respectively). Falay . and Erroz . found a lower complication and infection with BCV cannulation. There is evidence that during CVC placement, US-guided BCV cannulation has a higher first-attempt success rate, requires less cannulation time, and has a lower complication rate in comparison to other approaches.
Kaur K, Kaur T, Kumar P
… +5 more, Bhardwaj M, Kaur S, Singhal SK, Talwar S, Sandhu P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248799
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BACKGROUND AND AIMS: The present study was planned to compare two devices, namely LMA Blockbuster and LMA Protector, as a conduit for endotracheal intubation. The study aimed to compare the first-pass success rate of bli...BACKGROUND AND AIMS: The present study was planned to compare two devices, namely LMA Blockbuster and LMA Protector, as a conduit for endotracheal intubation. The study aimed to compare the first-pass success rate of blind intubation, time taken for successful intubation, and ease of intubation through both devices. MATERIAL AND METHODS: This prospective randomized study was conducted on 100 patients of either sex aged 18-60 years, belonging to ASA physical status I-II, with 50 patients in each group (group B - LMA Blockbuster, and group P - LMA Protector). All the patients received general anesthesia. The primary objective was to compare the success rate, ease of blind tracheal intubation, time taken for intubation, and number of attempts. Secondary objectives included assessing the success of supraglottic device (SAD) placement, oropharyngeal seal pressure, and hemodynamic changes. RESULTS: The insertion time of the SAD was 8.18 ± 3.66 and 10.94 ± 6.66 s for groups B and P, respectively. The SAD was placed on the first attempt in 96.0% of patients in group B and 88% of patients in group P. The total time taken for successful intubation was comparable between the groups ( = 0.239). The ETT was placed in the first attempt in 88% and 78% patients in group B and group P, respectively ( = 0.8). CONCLUSIONS: We conclude that LMA Blockbuster and LMA Protector are both comparable and good intubating devices in terms of ease and success rate of intubation. However, LMA Blockbuster outperforms LMA Protector in terms of ease of insertion of SADs.