J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248797
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BACKGROUND AND AIMS: Desflurane helps in prompt awakening when discontinued. Since desflurane has a lesser blood: gas solubility than nitrous oxide, we hypothesized that use of air with desflurane would result in a rapid...BACKGROUND AND AIMS: Desflurane helps in prompt awakening when discontinued. Since desflurane has a lesser blood: gas solubility than nitrous oxide, we hypothesized that use of air with desflurane would result in a rapid recovery compared to desflurane with nitrous oxide. MATERIALS AND METHODS: After approval from the institutional ethical committee was obtained, this prospective, nonrandomized study (CTRI/2017/11/010558) was conducted. This study included 110 American Society of Anesthesiologists I-II patients aged 18-60 years, of either sex, undergoing general anesthesia using desflurane with air or nitrous oxide for elective surgery. The primary objective was to compare the time taken to achieve a modified Aldrete score of 9/10. The secondary objectives were to compare time to spontaneous respiration, time to extubation, time to verbal response, time to orientation, intraoperative opioid consumption, and incidence of explicit recall between groups. <0.05 was considered significant. RESULTS: The time required to achieve modified Aldrete score of 9/10 was higher in those who received nitrous oxide (899.09 ± 426.85 s) compared to those who received air (464.27 ± 190.28 s; < 0.01). Time taken for spontaneous respiration, extubation, verbal response, and orientation was significantly higher with the use of desflurane with nitrous oxide compared to use of air. The intraoperative opioid requirement was statistically significant, but clinically not significant. Explicit recall was not seen in any of the patients. CONCLUSION: Nitrous oxide delays the elimination of desflurane compared to air, thus delaying extubation and recovery and mitigating the beneficial effects of desflurane.
Jaiswal S, Singh P, Waindeskar V
… +3 more, Karna ST, Pushpalatha K, Mandal P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248796
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BACKGROUND AND AIMS: Enhanced recovery after surgery recommends preoperative consumption of carbohydrate within 2 hours before elective surgery to reduce perioperative discomfort and improve patient outcome. MATERIAL AND...BACKGROUND AND AIMS: Enhanced recovery after surgery recommends preoperative consumption of carbohydrate within 2 hours before elective surgery to reduce perioperative discomfort and improve patient outcome. MATERIAL AND METHODS: This prospective interventional study included 105 adult patients, undergoing elective open gynecological surgery under neuraxial anesthesia. Groups I, II, and III were administered commercially available preoperative carbohydrate drink, oral rehydration solution (ORS), and mineral water, respectively, at night and 3 hours before surgery. The primary objective was to assess the difference in hunger, thirst, anxiety, nausea, and fatigue using visual analog scale, postoperative blood sugar levels, and quality of recovery (QoR) 40 questionnaire among groups. RESULTS: Severe hunger (22.9%), thirst (31.4%), and anxiety (34.3%) were experienced more in group III, while in group I and II, no patient had severe discomfort. The mean blood sugar levels in group III (111.3 ± 12.3, 129.4 ± 7.3) were higher compared to group I and II at both 1 hour and 24 hours after initiation of anesthesia. The mean QoR score was the highest in group I compared to group II and group III ( < 0.001). The majority of the patients in group I (77.1%) had an early return of gastrointestinal function and a shorter length of hospital stay. CONCLUSIONS: The overall effectiveness of commercially available preoperative carbohydrate solution was more compared to ORS and mineral water. The consumption of ORS drink resulted in less thirst and satisfactory outcomes due to its higher electrolyte content, making it a suitable option for low resource setting.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248795
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BACKGROUND AND AIMS: Preclinical studies in rodents and primates have shown that anesthesia was neurotoxic to the developing brain after exposure in the neonatal period. Sevoflurane a commonly used inhalational anestheti...BACKGROUND AND AIMS: Preclinical studies in rodents and primates have shown that anesthesia was neurotoxic to the developing brain after exposure in the neonatal period. Sevoflurane a commonly used inhalational anesthetic, especially in pediatric surgery, might cause behavioral impairment in the developing brain. Although favored for its rapid onset and minimal airway disturbance, sevoflurane has been implicated in neurotoxic effects such as anesthesia-induced developmental neurotoxicity in rodents, through various mechanisms. One of the mechanisms was disturbances in methylation metabolism which can be easily treated if it is proved. This study aims to evaluate the levels of S-adenosylmethionine [SAM] following sevoflurane anesthesia in neonates and to correlate the duration of sevoflurane exposure and S-adenosylmethionine levels. MATERIAL AND METHODS: Sixty neonates were included in the study under general anesthesia. Pre- and postsevoflurane exposure arterial blood samples were collected in ethylenediamine tetraacetic acid vacutainers. Each sample was centrifuged at 1000 rpm for 10 min. Plasma was separated and stored at -80°C, then subjected to S-adenosylmethionine enzyme-linked immunoassay test for preand postsevoflurane exposure levels of SAM. RESULTS: The difference between the pre- and post-SAM values is not statistically significant and also with increasing the duration of sevoflurane exposure there was no reduction in the SAM levels ( = 0.17), and the correlation was not significant ( = 0.18). CONCLUSION: Single exposure to sevoflurane does not impact SAM levels in neonates undergoing general anesthesia.
Devrajan G, Chhabra PH, Guria S
… +1 more, Gupta K
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248794
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BACKGROUND AND AIMS: Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0....BACKGROUND AND AIMS: Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0.5% ropivacaine for erector spinae plane block (ESPB) in patients undergoing modified radical mastectomy (MRM). MATERIAL AND METHODS: This prospective, double-blind, randomized study was conducted on 60 American Society of Anesthesiologists (ASA) physical status I/II adult females undergoing MRM under general anesthesia. Patients were divided into three groups: ropivacaine perineural dexamethasone (RPD), ropivacaine IV dexamethasone (RID), and ropivacaine normal saline (RNS). Time to rescue analgesia and morphine consumption over various time points (4, 8, 12, 24, and 48 h) were recorded postoperatively. Pain was assessed using the numeric rating scale (NRS). RESULTS: The median time to first rescue analgesia was significantly higher in the RPD group (n = 20) 720 min [interquartile range (IQR: 465-1440), 95% confidence interval (CI): 638.78-1564.21)] in comparison to the RID group (n = 20) 435 min (IQR: 405-480, 95% CI: 284.8-811.1) and control (RNS) group (n = 20) 360 min (IQR: 240-415, 95% CI: 297.6-376.36) ( = 0.01). The median total morphine consumption in 24 h was least in the RPD group 2.0 mg (IQR: 1.0-3.0, 95% CI: 2-3) compared to the the RID 6.0 mg (IQR: 3.2-6.0, 95% CI: 6-8) and RNS groups 7.5 mg (IQR: 6.0-9.5, 95% CI: 6-8) ( = 0.01). The NRS scores both at rest and at physical activity were also lowest in the RPD group compared to other groups at various time points (4, 8,12, 24, and 48 h). CONCLUSIONS: Perineural dexamethasone added as an adjuvant to 0.5% ropivacaine to ESPB prolongs the duration of analgesia, reduces morphine consumption, and reduces NRS scores at rest and physical activity as compared to IV dexamethasone in patients undergoing MRM.
Shrivastava N, Taneja R, Kumari M
… +2 more, Sood R, Grover N
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248791
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BACKGROUND AND AIMS: Postoperative pain is a major cause of discomfort after laparoscopic surgeries and thus necessitates prevention and treatment. This study aims to evaluate and compare two different doses of intraperi...BACKGROUND AND AIMS: Postoperative pain is a major cause of discomfort after laparoscopic surgeries and thus necessitates prevention and treatment. This study aims to evaluate and compare two different doses of intraperitoneally nebulized (aerosol size: 0.4-4.5 micrometers) dexamethasone for the prevention of postoperative pain. MATERIAL AND METHODS: In this double-blind, randomized control study, 135 patients undergoing laparoscopic surgeries were randomly assigned to three groups after obtaining ethical committee clearance and CTRI registration. Intraperitoneal nebulization was performed using the Aeroneb device, with group A receiving 16 mg dexamethasone, group B receiving 8 mg dexamethasone, and group C receiving 0.9% normal saline. The primary outcome was assessed by measuring visceral, somatic, and referred pain using a visual analog scale (VAS) at 6 hours postoperatively. Secondary outcomes included VAS at 1 and 24 hours, the hemodynamic response to pneumo-peritoneum, 24-hour anti-emetics, and opioid consumption. RESULTS: VAS score at 6 hours was 0.9 ± 1.06 in group A, 1.7 ± 1.45 in group B, and 2.3 ± 1.87 in group C for referred pain; the values were statistically significant ( = 0.01). VAS score was 0.7 ± 0.76 in group A, 1.7 ± 1.82 in group B, and 2.2 ± 2.06 in group C for dull aching pain; the results were statistically significant at 24 hours ( = 0.001). None of the values at any time point were statistically significant ( < 0.05) for incisional pain. The rise in heart rate after 5 minutes of pneumoperitoneum was the least in group A compared to group C ( = 0.01). Group C had the highest consumption of anti-emetics and rescue analgesics ( = 0.001). CONCLUSIONS: Intraperitoneal dexamethasone nebulization of 16 mg and 8 mg both are equi-effective in decreasing the severity of pain after laparoscopic surgeries compared to normal saline nebulization ( = 0.001).
Malhotra N, Charan N, Budhwar D
… +3 more, Kumar A, Sinha N, Phogat V
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248790
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BACKGROUND AND AIMS: Coronavirus infectious disease 2019 (COVID-19) pandemic is one of the most important global health-care challenges to have emerged in the recent past. Just like most other medical specialties, the fi...BACKGROUND AND AIMS: Coronavirus infectious disease 2019 (COVID-19) pandemic is one of the most important global health-care challenges to have emerged in the recent past. Just like most other medical specialties, the field of chronic pain was one of the hardest hit from the COVID-19 pandemic, leaving many patients overburdened with their chronic pain and their ongoing treatment delayed. We aimed at studying the effects of COVID-19 pandemic on the management of chronic pain patients. MATERIAL AND METHODS: This prospective observational study was conducted on 150 patients of either sex, aged >18 years, presenting to pain management center with chronic pain conditions for >3 months. Responses were recorded against a designed questionnaire, and data was analyzed. RESULTS: Majority of the patients were females, with the mean age of 50 ± 13 years, belonging to the middle socioeconomic status, with the most common sites of pain being low back, knee, and neck. There was significant increase in the intensity and frequency of pain, which also affected sleep, working capacity, and mental health of the individuals. More than half of the interventional pain procedures were delayed. Fear of contracting infection decreased follow-up in the outpatient department, and most of the patients continued taking over-the-counter drugs and few took teleconsultation. CONCLUSION: There is an urgent need to develop various training programs for health-care providers and patients to have better utilization of resources to provide uninterrupted and safe treatment services for chronic pain patients during a pandemic.
Singh N, Ponde V, Jagannathan B
… +3 more, Agarwal G, Roy R, Dixit A
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248789
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BACKGROUND AND AIMS: Regional anesthesia plays a crucial role in perioperative medicine, influencing both immediate and long-term outcomes. However, there is a lack of data regarding the utilization and practices of plex...BACKGROUND AND AIMS: Regional anesthesia plays a crucial role in perioperative medicine, influencing both immediate and long-term outcomes. However, there is a lack of data regarding the utilization and practices of plexus and peripheral nerve blocks. We attempted to investigate the practices of plexus and peripheral nerve blocks using a validated questionnaire. MATERIAL AND METHODS: A questionnaire was validated by 14 experts and was distributed online for the response. There were 1020 responses, and the data are expressed as frequencies and percentages. There were 58.2% females and 41.8% males, including 32.3% of the respondents with more than 20 years of experience and 27.5% having 10-20 years of experience. Participants from teaching hospitals, government, and private college comprised 49.7%, while those from the corporates and private practitioners constituted 50.2%. RESULTS: Most participants fell into the age range of 31-40 years, followed by 41-50 years. The regional blocks were performed daily by 21.8%, weekly by 23.8%, every 15 days by 38.4%, and monthly by 16% of the participants. Furthermore, 43.6% of the participants discussed the block plan with the patients. The most common blocks of the upper limb and lower limb were the supraclavicular approach of the brachial plexus block (90.8%) and the fascia iliaca (82.5%), respectively. CONCLUSIONS: The present survey highlights the details about the present practices, advantages, and limiting factors for using plexus and peripheral nerve blocks. This is the first data acquired with a validated survey from a South Asian Country, which can be used to compare changes in future practices.
Guerra-Londono CE, Vasquez ET, Riveros E
… +7 more, Noori E, Greiver D, Pillai S, Schiff T, Soetedjo J, Wu M, Serrano JG
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248788
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BACKGROUND AND AIMS: Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aime...BACKGROUND AND AIMS: Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aimed to develop and validate a multivariable, prognostic model for postoperative hypotension in patients receiving epidural analgesia. MATERIAL AND METHODS: We retrieved retrospective cohort data of adults undergoing abdominal or thoracic surgery at five hospitals between 2014 and 2023 who received epidural analgesia for at least 24 hours after surgery. A systematic literature search helped define candidate exposures. The primary outcome was postoperative hypotension during the first 72 hours after surgery. Multiple logistic regression was performed to evaluate a multivariable model. Exposures identified as statistically significant were used for logistic regression, linear discriminant analysis, and decision-tree model of random forest. Classification error was used to compare models, and variable importance was used for random forest analysis. RESULTS: In total, 829 participants were included. The incidence of postoperative hypotension was 38.8%. Multivariable analysis identified the following independent prognostic factors: male sex, white race, body mass index, intraoperative hypotension, use of arterial line, bupivacaine concentration of 0.125% (vs. lower concentrations), and anesthesia duration. The error misclassification rate was 67% for multiple logistic regression, 27% for linear discriminant analysis, and 33.4% for random forest model. CONCLUSION: Using retrospective cohort data, a prognostic model of hypotension produced the best performance results using linear discriminant analysis, with an error misclassification rate of 27%. Further studies are required to perform model optimization for future clinical use.
Okbaz V, Turktan M, Gulec E
… +3 more, Hatıpoglu Z, Bahcecı C, Karacaoglu IC
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248787
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BACKGROUND AND AIMS: Postoperative pain is one of the most common problems after thoracic surgery. In this study, we aimed to investigate the analgesic effects of two different doses of intrathecal morphine (ITM) based o...BACKGROUND AND AIMS: Postoperative pain is one of the most common problems after thoracic surgery. In this study, we aimed to investigate the analgesic effects of two different doses of intrathecal morphine (ITM) based on ideal body weight in patients who underwent video-assisted thoracoscopic surgery (VATS). MATERIAL AND METHODS: Forty-six patients scheduled for elective lung resection were included in this study. Patients were allocated to receive 10 μg/kg (Group I) and 7 μg/kg (Group II) ITM according to the ideal body weight for postoperative analgesia. Intraoperative and postoperative hemodynamic variables, postoperative morphine consumption, pain scores (at rest and effort), side effects, and additional analgesic requirements were recorded. RESULTS: Postoperative pain scores did not differ in the first 12 h between the groups, but were significantly lower in Group I compared with Group II at 18 and 24 hours ( = 0.024 and = 0.017 at rest, and = 0.025 and = 0.002 at effort, respectively). Postoperative morphine consumption was statistically significantly lower in Group I at all time periods ( < 0.05). The incidence of side effects was similar for both groups ( > 0.05). CONCLUSIONS: The use of 10 μg/kg ITM according to the ideal body weight provides more effective analgesia without increasing the side effects compared to 7 μg/kg ITM after VATS.
Ray S, Parmar U, Dias R
… +3 more, Saxen V, Mujpurwala F, Anu KA
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248786
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BACKGROUND AND AIMS: Laparoscopic surgery involves creation of carbondioxide (CO) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed...BACKGROUND AND AIMS: Laparoscopic surgery involves creation of carbondioxide (CO) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO (EtCO), intrabdominal pressure (IAP), and a change in patient position (P). MATERIAL AND METHODS: Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired -test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient. RESULTS: Mean ONSD showed a significant change ( < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO(correlation coefficient = 0.629, = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19). CONCLUSIONS: Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO may help mitigate changes in ICP in children undergoing laparoscopic surgery.
Malhotra N, Aditi, Kumar A
… +3 more, Sinha N, Gupta D, Bishnoi P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248785
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BACKGROUND AND AIMS: The use of intra-articular injection has been widely accepted as a therapy for pain due to osteoarthritis of the knee. We aimed to compare the efficacy of intra-articular injection of platelet-rich p...BACKGROUND AND AIMS: The use of intra-articular injection has been widely accepted as a therapy for pain due to osteoarthritis of the knee. We aimed to compare the efficacy of intra-articular injection of platelet-rich plasma (PRP) with a combination of bupivacaine and corticosteroid in osteoarthritis of the knee. MATERIAL AND METHODS: Fifty patients (aged more than 50 years) with pain pattern consistent with osteoarthritis of the knee who did not respond to conservative treatment were included in the study. They were randomly divided into two groups of 25 each: group I ( = 25) patients were administered fluoroscope-guided intra-articular knee injection of bupivacaine and steroid, and group II ( = 25) patients were administered intra-articular knee injection of PRP. In group I, patients were administered 9 ml of drug solution comprising 8 ml of 0.5% bupivacaine and 1 ml of triamcinolone (40 mg). In group II, patients were administered 6 ml of PRP. Pain, patient satisfaction, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed at different time intervals before and after the procedure for up to 12 months. RESULTS: Pain score and WOMAC were both clinically and statistically better at 2 weeks and 1 month after injection in group I ( < 0.05). But results were better clinically in group II compared to group I at 2, 3, 6, and 12 months after the procedure. More than 50% of patients in both groups had excellent satisfaction. CONCLUSIONS: Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically higher with PRP for longer duration.
Malhotra N, Phogat V, Sinha N
… +3 more, Kumar A, Charan N, Arun
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248784
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BACKGROUND AND AIMS: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6-18%. The etiology for CPP may be idiopathic, benign, or malignant. We com...BACKGROUND AND AIMS: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6-18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients' self-reported belief about the efficacy of treatment, and side effects or complications, if any. MATERIAL AND METHODS: Forty patients attending the Pain Management Centre of either sex in the age group of 20-70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0-10), patients' self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any. RESULTS: The majority of the patients in our study were in the age group of 40-50 years, and 80% of the patients were females and weighed 60-70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period ( < 0.05). Patients' self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period ( < 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection. CONCLUSIONS: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients' self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.
Lenin D, Kumar R, Sahay N
… +3 more, Kumar A, Kumari P, Singh PK
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248781
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BACKGROUND AND AIMS: This study evaluates the analgesic efficacy of ketamine and dexmedetomidine as an adjuvant with ropivacaine 0.2% in pectoral nerve type II block (PECS-II) in modified radical mastectomy. The primary...BACKGROUND AND AIMS: This study evaluates the analgesic efficacy of ketamine and dexmedetomidine as an adjuvant with ropivacaine 0.2% in pectoral nerve type II block (PECS-II) in modified radical mastectomy. The primary outcome of the study was the time to first rescue analgesia postoperatively. The secondary outcomes were intraoperative and postoperative opioid consumption and postoperative pain on the numerical rating scale. MATERIAL AND METHODS: Seventy-five adult female patients who underwent a modified radical mastectomy participated in this prospective, randomized, double-blinded clinical trial. The patients received 30 ml of 0.2% ropivacaine with or without adjuvants by the ultrasound-guided PECS-II block. Group R ( = 25) received ropivacaine 0.2% without adjuvants. Group RD ( = 25) and group RK ( = 25) received dexmedetomidine 1μg/kg and ketamine 1 mg/kg, respectively, along with ropivacaine 0.2%. RESULTS: Duration of analgesia determined by time to first rescue analgesia was longer in group RD (18.42 ± 02.15 h) compared to group RK (15.91 ± 03.21 h) and group R (14.64 ± 02.85 h), which was statistically significant ( < 0.001). Fentanyl consumption in the first 48 h after surgery was significantly less in the dexmedetomidine group compared to other groups. CONCLUSION: We conclude that dexmedetomidine with 0.2% ropivacaine in the PECS-II block provides better postoperative analgesia and has less sedative effects than ketamine with 0.2% ropivacaine.
Jain VK, Seth A, Kumar R
… +2 more, Yazhini AA, Kohli S
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248780
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BACKGROUND AND AIMS: Traditionally various methods have been employed to improve glottic visualization during laryngoscopy, namely backward-upward-rightward pressure (BURP) and jaw trust with promising results. The curre...BACKGROUND AND AIMS: Traditionally various methods have been employed to improve glottic visualization during laryngoscopy, namely backward-upward-rightward pressure (BURP) and jaw trust with promising results. The current study aims to compare these maneuvers for the enhancement of glottic visualization during video laryngoscopy. MATERIAL AND METHODS: In this prospective randomized study in 120 adult patients with normal airways, C-MAC® laryngoscopy was performed under general anesthesia (GA). Images of the glottis with conventional laryngoscopic technique, using BURP maneuver and jaw thrust were acquired, and Cormack-Lehane (CL) grading, percentage of glottic opening (POGO) score, and approximate glottic area were recorded from the images. Subsequently, patients were divided into three equal groups-in group C, the trachea was intubated using conventional laryngoscopic technique, in group B, BURP was used, and in group J, jaw thrust was used. Intubation time, ease of intubation, number of intubation attempts, incidence of airway trauma, and postoperative sore throat were noted. RESULTS: Both jaw thrust and BURP maneuvers improved CL grading, POGO score, and glottic area significantly as compared to the conventional laryngoscopic technique. CL grading and POGO score were better with BURP than with jaw thrust; however, the glottic area improved more with jaw thrust. Jaw thrust also resulted in statistically significant lower intubation time and better ease of insertion score. Intubation was successful in the first attempt in all patients and there was no airway trauma and postoperative sore throat. CONCLUSION: Both BURP and jaw thrust maneuvers result in better glottic visualization. Jaw thrust provides lower intubation times, better ease of intubation scores, as well as a higher visualized glottic area than BURP.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248778
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BACKGROUND AND AIMS: The aim was to analyze the factors associated with intraoperative cardiac arrests at a major US academic center. MATERIAL AND METHODS: In this single-center university hospital setting retrospective...BACKGROUND AND AIMS: The aim was to analyze the factors associated with intraoperative cardiac arrests at a major US academic center. MATERIAL AND METHODS: In this single-center university hospital setting retrospective study, perioperative cardiac arrest data obtained from the clinical quality improvement and local registry from June 1, 2013 to November 19, 2019 was analyzed. Descriptive statistics were used to analyze the findings. RESULTS: A total of 361,152 anesthesia-requiring procedures were performed. At least 49 cardiac arrests occurred in the operating room (at a rate of 1.3 cardiac arrests for every 10,000 surgeries), of which 23 resulted in death (at a rate of 0.6 deaths for every 10,000 surgeries). Twenty-eight cardiac arrests occurred during elective procedures and the remaining were emergencies. Among the causes, hyperkalemia was seen as a likely contributory cause in six patients. PEA (Pulseless electrical activity) was the dominant rhythm and often did not precede other life-threatening arrhythmias. In terms of subspecialty, cardiac surgery witnessed the highest number of cardiac arrests followed by solid organ transplant. Nurse anesthetist/physician anesthesiologist team-delivered care was associated with intraoperative cardiac arrests, with a rate similar to that of all-physician care teams (21 vs. 28), and the death rates were similar (11 vs. 12). Highest number of cardiac arrests belonged to American Society of Anesthesiologists (ASA) 3 category. All patients who sustained cardiac arrests in ASA 2 category also died. Patients with a BMI >30.0 had the highest number of cardiac arrests, although the number of deaths was low. CONCLUSIONS: Hyperkalemia is a major factor in intraoperative cardiac arrests. Majority of the cardiac arrests occur during emergency procedures. Solid organ transplant and cardiac surgery carry the highest risk of cardiac arrests.