ABS0036
Comparison of magnesium sulphate, dexamethasone and lignocaine nebulisation in the prevention of postoperative sore throat following endotracheal intubation
Praveen Aggarwal, Akhilesh Pahade, Vishwadeep Singh, Juhi Saran
SRMS- IMS, Bareilly
Email: praveenagg93@gmail.com
Background and Aims: Post-operative Sore throat (POST) is a common complaint causing patient discomfort. Various pharmacological/non-pharmacological methods are employed to overcome this problem.[1,2] This study compares the efficacy of nebulised magnesium sulphate, dexamethasone, and lignocaine in preventing POST.
Methods: Two hundred and twenty-five patients of the American Society of Anesthesiologists physical status I/II undergoing elective surgeries under general anaesthesia were randomly allocated into group A: nebulised magnesium sulphate(2ml), group B: nebulised dexamethasone(2ml) or group C: nebulised lignocaine 2%(2ml). Anaesthesia was maintained using oxygen, nitrous oxide, and isoflurane. Response to laryngoscopy/intubation and side effects were noted. Sore throat, hoarseness and cough were assessed at 0, 2, 4, 6, 8, 12 and 24 h post-extubation. The chi-square test, student t-test and analysis of variance (ANOVA) were used for analysis.
Results: The three groups were comparable regarding demographics, surgical and anaesthesia duration, post-operative sedation, and pain scores. Intra-operatively, no significant difference was observed in terms of haemodynamics. The lowest incidence (25/75) and severity of POST were noted in the group receiving nebulised magnesium sulphate. The remaining groups had a similar incidence of POST (74/75 vs 75/75), although the severity in the dexamethasone group was significantly lower than in the lignocaine group. Side effects such as bradycardia and nausea/vomiting were observed, though the incidence was comparable amongst the groups.
Conclusion: Pre-operative nebulised magnesium is a safe and effective alternative to attenuating postoperative sore throat with negligible haemodynamic derangements compared to dexamethasone and lignocaine nebulisation.
Keywords: Dexamethasone, general anaesthesia, lignocaine, magnesium sulphate, postoperative sore throat
References:
1. Ashwini H, Kumari SK, Lavanya R. Comparative study of dexamethasone nebulisation with magnesium sulphate nebulisation in preventing post-operative sore throat following endotracheal intubation. Indian J Clin Anaesth 2018;5:341-347.
2. Yu J, Ren L, Min S, Yang Y, Lv F. Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis. PLoS One 2020;15: e0237174. doi: 10.1371/journal.pone.0237174.
ABS0055
Comparison of the efficacy of dexamethasone with levobupivacaine, clonidine with levobupivacaine and levobupivacaine alone in ultrasound-guided transversus abdominis plane block for postoperative analgesia in lower abdominal surgeries: A randomised controlled study
Kareena Popat
Rohilkhand medical college and hospital, Bareilly.
Email: kareenapopat@gmail.com
Background and Aims: Many adjuvants to local anaesthetics have been advocated to prolong the transversus abdominis plane(TAP) block duration.[1,2] This study aimed to establish the role of clonidine and dexamethasone as adjuvants to levobupivacaine for TAP block in patients undergoing lower abdominal surgery.
Methods: This was a prospective randomised double-blind controlled study involving 90 adult patients between 18 and 60 years of age of the American Society of Anesthesiologists physical grades I and II. Patients were divided into three groups and received a TAP block with 20 ml of 0.25% levobupivacaine with the following additives. Group A received 8mg of dexamethasone (2 ml), group B received 50µg of clonidine (diluted with distilled water to a volume of 2 ml)) and group C received normal saline as a placebo (2 ml). The objectives were to compare the duration of analgesia, time of the first onset of pain and time of the first requirement for analgesia, and post-operative rescue analgesic requirements in the first 24 hours.
Results: Visual analogue scale (VAS) scores were significantly (P < 0.001) lower in group B than in group A and group C at 6 h,12 h and 24 h. The time of the first request for analgesia(min) was significantly (P < 0.001) earlier in group C, 480.0(172.61) than in group A, 512.0(88.67) and group B, 1080.33 (117.49). The duration of analgesia(min) was significantly (P < 0.001) lower in group C, 262.0 (43.1) than in group A, 480.0 (94.54) and group B, 1036.0 (119.93).
Conclusion: The addition of clonidine as an adjuvant to levobupivacaine in TAP block for lower abdominal surgeries during anaesthesia improved quality, increased duration of postoperative analgesia, and decreased analgesic requirements with no side effects.
Keywords: Clonidine, dexamethasone, levobupivacaine, transversus abdominis plane
References:
1. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth 2012; 109:679-87.
2. Rafi AN. Abdominal field block: A new approach via the lumbar triangle. Anaesthesia 2001; 56:1024-6.
ABS0095
Sciatic and femoral nerve block in a patient with large retrosternal goitre and ischaemic heart disease for a case of below-knee amputation: A case report
Chandan Chandargi, Sameer Desai, Ravi Bhat
SDM college of medical sciences and hospital, Dharwad.
Email: chandargichandan@gmail.com
Background: Peripheral nerve blocks are increasingly preferred where conservative techniques like general anaesthesia must be avoided to prevent complications.
Case report: A 56-year-old known hypertensive and diabetic female patient with hyperthyroidism and injury to the left lower limb due to a road traffic accident presented in haemorrhagic shock. The patient had a large midline neck swelling with compressive features, suggestive of goitre and was a known case of ischaemic heart disease post percutaneous transluminal coronary angioplasty on ticagrelor and aspirin. She belonged to the American Society of Anesthesiologists physical class III with a metabolic equivalent score>4 and New York Heart Association dyspnoea grade 1. Given the anticipated difficult airway, the ultrasound-guided sciatic and femoral nerve block was administered for below-knee amputation. The intraoperative and postoperative periods were uneventful, with adequate analgesia.
Conclusion: Ultrasound-guided peripheral nerve block facilitates rapid block onset with prolonged block duration and reasonable patient satisfaction.
Keywords: Antiplatelets, ischaemic heart disease, peripheral nerve block
References:
1. Shilpa Munirama, Graeme McLeod, Ultrasound-guided femoral and sciatic nerve blocks, Continuing Education in Anaesthesia Critical Care & Pain 2013; 13: 136- 140.
2. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med 2008; 33:259-65.
ABS0144
Ultrasound-guided regional anaesthesia as a sole anaesthetic technique for simple mastectomy in a comorbid patient: A case report
Sonia Naorem, L Chaoba, V Vasantharajan
Regional Institute of Medical Sciences, Imphal
Email: sonianaorem7@gmail.com
Background and Aims: Thoracic epidural analgesia with general anaesthesia is considered to be the standard means of anaesthesia and postoperative analgesia for any significant breast surgery.[1,2] Our paper highlights the successful management of simple mastectomy for Phyllodes tumours by ultrasonography (USG)-guided regional block.
Methods: A 52-year-old female of the American Society of Anesthesiologists, physical status IV, with a lump in the left breast with skin breakage and bleeding, diagnosed as Phyllodes tumour with pseudoaneurysm, was planned for a simple mastectomy. She had hypertension, severe anaemia, severe hypothyroidism, moderate pericardial effusion and mild bilateral pleural effusion. Considering immediate intervention for ongoing bleeding and lack of time for prompt optimisation, USG-guided regional block was considered a better alternative over general anaesthesia. Under the aseptic conditions, the serratus anterior plane block, pecto-intercostal fascial plane block [Figure 1] and cervical plexus block were performed on the left side. Oxygen via facemask and butorphanol 1mg was supplemented intravenously. Surgery was done in 1h, and she did not complain of pain and discomfort. The haemodynamics were stable throughout the surgery, and blood loss was minimal. Postoperatively, the pain was assessed by visual analogue scale score; she was completely pain-free for 48 hours and was very much satisfied with the anaesthesia and analgesia process. She was monitored for five days and discharged on the 6th day.
Figure 1.
Pecto-intercostal fascial block
Conclusion: Ultrasound-guided regional nerve blocks with or without adjuvant sedation provide perfect anaesthesia and reduce post-operative pain and opioid consumption in a unilateral simple mastectomy.
Keywords: Breast surgery, regional anaesthesia, nerve blocks
References:
1. Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia 2011; 66:847-8.
2. Qian B, Huang S, Liao X, Wu J, Lin Q, Lin Y. Serratus anterior plane block reduces the prevalence of chronic postsurgical pain after modified radical mastectomy: A randomised controlled trial. J Clin Anesth 2021; 74:110410.
ABS0156
Effect of bilateral infratrochlear and infraorbital nerve block combined with general anaesthesia for nasal surgeries: A prospective randomised study
Garima Yadav, Anuj Dubey, Nupur Chakravorty
LN Medical College and JK Hospital
Email: drgarima531@gmail.com
Background and Aims: Pain and agitation are the most typical symptoms after nasal surgeries, which affect the patient’s recovery and also increase the hospital stay. We assessed the utility of bilateral nasal nerve blocks along with general anaesthesia (GA) in reducing pain and agitation after nasal surgeries.
Methods: Sixty patients posted for routine nasal surgeries were divided into two groups, with 30 patients each. In group NB(nerve block + general anaesthesia), we gave bilateral nerve blocks (infratrochlear and infraorbital) using 0.5% bupivacaine 5ml after general anaesthesia; in group GA (General anaesthesia), we did not give any nerve block after general anaesthesia. We observed the intraoperative and postoperative analgesic requirements of the patient.
Results: Total analgesic requirements were significantly less in group NB than in group GA in the intraoperative and early postoperative period. The patient spent less time in the post-anaesthesia care unit in group NB than in group GA.
Conclusion: Bilateral infratrochlear and infraorbital nerve blocks, using 0.5% bupivacaine during general anaesthesia for nasal surgeries will decrease intraoperative and postoperative analgesic requirements and discomfort.
Keywords: Bilateral nasal blocks, general anaesthesia, nasal surgeries
References:
1. Boselli E, Bouvet L, Augris-Mathieu C, Bégou G, Diot-Junique N, Rahali N, et al. Infraorbital and infratrochlear nerve blocks combined with general anaesthesia for outpatient rhino septoplasty: A prospective randomised, double-blind, placebo-controlled study. Anaesth Crit Care Pain Med 2016;35:31–6.
2. Gray ML, Fan CJ, Kappauf C, Kidwai S, Colley P, Iloreta AM, et al. Postoperative pain management after sinus surgery: A survey of the American Rhinologic Society. Int Forum Allergy Rhinol 2018; 8:1199–203.
ABS0409
Pre-anaesthetic ultrasound assessment of subclavian vein collapsibility for predicting hypotension following induction of general anaesthesia: A prospective observational study
Vridhi Rajan, M Salim Iqbal, Reshma B Muniyappa
BR Ambedkar Medical College, Bangalore
Email: vcvishnu007@gmail.com
Background and Aims: Perioperative hypotension has been associated with increased complications and longer recovery times following surgery. Passive leg raising (PLR) test has been used to predict post-anaesthesia hypotension.[1,2]This study assessed whether the PLR test and changes in subclavian vein diameter (DSCV) could be reliable predictors of post-anaesthesia hypotension.
Methods: After ethics committee clearance, the study was conducted on 74 patients aged 18-50 scheduled for elective surgeries under general anaesthesia. Ultrasonographic measurements of the subclavian vein were taken using a high-frequency probe (6-15 MHz). The patients were divided into groups: group H, experiencing post-induction hypotension, and Group N, without hypotension. The study used receiver operating characteristic (ROC) curve analysis and logistic regression to evaluate the predictability of subclavian vein measurements and other parameters for predicting pre-incision hypotension.
Results: A total of 25.2% of patients experienced hypotension. The changes in diameters in supine and on passive leg rising are shown in Tables 1 and 2. Area under the ROC curve of ΔDSCV was 0.75 (P < 0.001) with a 95% confidence interval (CI) of 0.63-0.87, while DSCV and DSCV-collapsibility index were less than 0.7. The odds ratio of ΔDSCV was 1.18 (P < 0.001, 95%CI 1.09-1.27) for predicting the development of hypotension.
Table 1.
Measurements of subclavian vein collapsibility using ultrasound following induction after general anaesthesia in the supine position
| Column1 | DSCV MaxS right (cm) | DSCV MaxS Left (cm) | DSCV MinS right (cm) | DSCV MinS left (cm) | DSCV MaxS (Mean in cm) | DSCV MinS (Mean in cm) | DSCV CIS=(DSCV MaxS-DSCV MinS)/(DSVC Max S)* 100 |
|---|---|---|---|---|---|---|---|
| Median | 0.845 | 0.85 | 0.6 | 0.59 | 0.86 | 0.6075 | 28.75 |
| Q1 | 0.75 | 0.7625 | 0.55 | 0.5025 | 0.74 | 0.53 | 22.125 |
| Q3 | 0.89 | 0.9375 | 0.73 | 0.64 | 0.905 | 0.68 | 33.225 |
| IQR | 0.14 | 0.175 | 0.18 | 0.1375 | 0.165 | 0.15 | 11.1 |
Table 2.
Measurements after passive leg raising
| DSCV Max P Right (cm) | DSCV Max P left (cm) | DSCV Min P right (cm) | DSCV Min P left (cm) | DSCV MaxP (Mean in cm) | DSCV MinP (Mean in cm) | DSCV CIP=(DSCVMax P- DSCV Min P)/(DSCV MaxP)* 100 | DELTADSCV=(DSCVmax P-DSCVmaxS)/DSCV maxP*100(%) | |
|---|---|---|---|---|---|---|---|---|
| Median | 0.95 | 0.96 | 0.73 | 0.76 | 0.97 | 0.75 | 21.45 | 11.3 |
| Q1 | 0.8625 | 0.88 | 0.69625 | 0.68 | 0.87875 | 0.67 | 18.125 | 9.725 |
| Q3 | 1.0375 | 1.02 | 0.82 | 0.8275 | 1.015 | 0.7975 | 28 | 15.5 |
| IQR | 0.175 | 0.14 | 0.12375 | 0.1475 | 0.13625 | 0.1275 | 9.875 | 5.775 |
DSCV MAX S R-Maximum of right subclavian vein in supine position, DSCV MIN S R- Minimum diameter of right subclavian vein in supine position, DSCV MAX S MEAN- Mean value of maximum diameter of left and right subclavian veins in supine, DSCV MIN S MEAN- Mean value of minimum diameter of left and right subclavian veins in supine, DSCV CI S- Collapsibility index of subclavian vein in supine position, DSCV MAX P R-Maximum of right subclavian vein in passive leg raising, DSCV MINP R- Minimum diameter of right subclavian vein in passive leg raising, DSCV MAX P MEAN- mean value of maximum diameter of left and right subclavian veins in passive leg raising, DSCV MIN P MEAN- mean value of minimum diameter of left and right subclavian veins in passive leg raising, DSCV CI P- collapsibility index of subclavian vein in passive leg raising
Conclusion: ΔDSCV has predictive value for post-induction hypotension in general anaesthesia.
Keywords: General anaesthesia, hypotension, subclavian vein, ultrasound
References:
1. Yang L, Long B, Zhou M, Yu X, Xue X, Xie M, et al. Pre-anaesthesia ultrasound monitoring of subclavian vein diameter changes induced by modified passive leg raising can predict the occurrence of hypotension after general anaesthesia: a prospective observational study. BMC Anesthesiol 2023; 23:35. doi 10.1186/s12871-023-01989-2.
2. Choi MH, Chae JS, Lee HJ, Woo JH. Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia: A prospective observational study. Eur J Anaesthesiol 2020; 37:474-81.
ABS0480
Antenatal patient with unilateral abducens nerve palsy for lower segment Caesarean section: A case report
Monika Sanghavi, Chandrashekharan Cham
Meditrina Institute of Medical Sciences, Nagpur
Email: monikasanghavi2510@gmail.com
Background: Though lumbar puncture is contraindicated in raised intracranial pressure, it is performed in a controlled manner to diagnose idiopathic intracranial hypertension (IIH).[1,2] We describe a case of spinal anaesthesia administered in a patient with IIH.
Case Report: A 29-year-old primigravida, with 37 weeks of gestational age and a history of hypothyroidism and gestational diabetes, came with left orbital pain for five days. After consulting an ophthalmologist and neurologist, she was diagnosed with left abducens nerve palsy. After ruling out common causes, suspecting IIH, cerebrospinal fluid (CSF) manometry was advised before lower segment Caesarean section. A central venous pressure manometer measured CSF pressure, followed by a subarachnoid block through the same puncture. CSF pressures were on the higher side. Intraoperatively, the patient was stable, and a healthy baby was delivered. Oral diamox 250 mg was given to the patient pre- and postoperatively, and she recovered completely in 1 month.
Conclusion: Spinal anaesthesia can be safely administered in raised intracranial pressures.
Keywords: Abducens nerve, caesarean section, idiopathic intracranial hypertension, pregnancy
References:
1. Yousefi SR, Zandi S. Abducens nerve palsy in pregnancy: a case report. J Clin Diagn Res 2016;10(12): QD03-QD04. Doi: 10.7860/JCDR/2016/22035.9060.
2. Fung TY, Chung TK. Abducens nerve palsy complicating pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol 1999; 83:223-4.
ABS0713
Effect of intravenous ondansetron with crystalloid loading on subarachnoid block induced hypotension and other complications in patients undergoing elective Caesarean section: A prospective, randomised and single-blinded study
Mohammad Husain, Om Prakash Suthar, Bhavesh Sharma
Government Medical College, Pali
Email: dr.mhsherani@gmail.com
Background and Aims: This study evaluated the effect of ondansetron with crystalloid co-loading on subarachnoid block-induced hypotension and other complications in patients undergoing elective lower-segment Caesarean section (LSCS).
Methods: We conducted a prospective, randomised and single-blinded study on 60 parturients of single-term gestation undergoing elective LSCS of age group 20-60 years, with American Society of Anesthesiologists physical status I and II. Standard protocol for spinal anaesthesia was followed. All patients were co-loaded with 500 ml crystalloid and randomised into groups A and B. Intravenous (IV) ondansetron 4mg (2ml) was given in group A, and 2 ml saline was administered in group B after co-loading. Incidence of hypotension, bradycardia, nausea, vomiting and shivering was noted in both groups, as defined, and also treated simultaneously.
Results: The incidence of hypotension and shivering was significantly higher in group B (P=0.029 and P=0.001, respectively). Incidence of bradycardia was not statistically significant (P=0.496)
Conclusion: Prophylactic use of IV ondansetron reduces the requirement of mephentermine and the incidence of hypotension and shivering after spinal anaesthesia. Ondansetron showed no significant effect on bradycardia.
Keywords: Hypotension, ondansetron, subarachnoid block
References:
1. Trabelsi W, Romdhani C, Elaskri H, Sammoud W, Bensalah M, Labbene I, et al. Effect of ondansetron on the occurrence of hypotension and neonatal parameters during spinal anaesthesia for elective caesarean section: A prospective, randomised, controlled, double-blind study. Anesthesiol Res Pract 2015; 2015:158061. doi: 10.1155/2015/158061.
2. Gao L, Zheng G, Han J, Wang Y, Zheng J. Effects of prophylactic ondansetron on spinal anaesthesia-induced hypotension: A meta-analysis. Int J Obstet Anesth 2015; 24:335-43.
ABS0754
Tele-pre-anaesthetic check-up versus face-to-face pre-anaesthetic check-up at a tertiary care cancer centre: A prospective randomised controlled trial
Raghav Gupta, Seema Mishra, Sachidanand Jee Bharati, Sushma Bhatnagar
NCI Jhajjar, AIIMS, New Delhi
Email: raghavgupta88@gmail.com
Background and Aims: The aim was to assess the efficacy of tele-PAC (Pre-Anaesthetic check-up) in onco anaesthesia.
Methods: Based on the pilot study results, a prospective randomised study was conducted with 50 patients in each group: tele-PAC (group A) and face-to-face PAC (group B}. Anaesthesiologist satisfaction regarding video audio quality, the thoroughness of the information obtained, and patient satisfaction in avoiding long waiting hours and prevention of travel expenditure were assessed.
Results: Anaesthesiologists’ satisfaction was better in group B. Patient satisfaction was better in group B. Duration of PAC was more in group A.
Conclusion: Anaesthesiologists are yet to adapt and feel comfortable with tele-PAC.
Keywords: Pre-anaesthetic evaluation, teleconsultation, telemedicine
References:
1. Hjelm NM. Benefits and drawbacks of telemedicine. J Telemed Telecare 2005; 11:60-70.
2. Telemedicine Practice Guidelines. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf [last accessed on July 20 2020].
ABS0940
Comparative evaluation of two different doses of nebulised intraperitoneal dexamethasone in laparoscopic surgeries
Niharika Grover, Neha Shrivastava, Rashmi Virmani, Mamta Kumari
ESIC Medical College & Hospital, Faridabad
Email: drniharikagrover@yahoo.com
Background and Aims: Pain relief following laparoscopy can be done using intraperitoneal instillation (aerosol >5µm) of drugs; less evidence exists on the analgesic efficacy of intraperitoneal nebulisation (homogenous aerosols <5µm).[1,2] This study aimed to compare two doses of intraperitoneal dexamethasone for postoperative pain relief in laparoscopic surgeries.
Methods: In this randomised controlled study of 135 patients, the effectiveness of two doses (16mg and 8mg) of dexamethasone and 0.9% normal saline (groups A, B and C) nebulised intraperitoneally using Aerogen Pro-nebuliser system for relieving visceral, somatic and referred pain was assessed and compared. The pain was evaluated post-operatively using a visual analogue scale (VAS) score at 1,6 and 24 h.
Results: The pain was comparable (VAS 0-2) in all groups at 1,6 hours(P>0.05) and was significantly less in group A at 24 h (P<0.05).
Conclusion: Intraperitoneal dexamethasone nebulisation may reduce post-laparoscopic pain.
Keywords: Dexamethasone, intraperitoneal, laparoscopy, nebulisation
References:
1. Asgari Z, Mozafar-Jalali S, Faridi-Tazehkand N, Sabet S. Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy. Int J Fertil Steril 2012; 6:59–64.
2. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002; 195:694–712.
ABS1094
Demystifying ultrasound: A key player in the perioperative period
Pharanitharan Natarajan, Chandini Kukanti
AIIMS, Raipur
Email: pharanitharan@gmail.com
Background and Aims: Ultrasonography (USG) is an important part of the training curriculum during residency, which can be used for various indications in the perioperative period. It is portable, and its availability is increasing even in low-resource settings. More emphasis is being placed on including USG in routine clinical practice to improve diagnostic accuracy by implementing USG as a fifth pillar of clinical examination.[1,2] This cross-sectional online survey was conducted to evaluate the utilisation of USG in the perioperative period and to assess the adequacy of current training.
Methods: A cross-sectional online survey was conducted via Google Forms among anaesthesiologists at various tertiary care centres in India. All anesthesiologists who were willing to fill out the forms were included. The questionnaire consisted of 15 questions regarding the participant’s designation, the availability of ultrasound, and the use of ultrasound in the perioperative period. Statistical analysis was performed with Microsoft Excel (Office 365) software.
Results: The Google forms were distributed via email or other electronic modes. USG was available for routine use at almost all institutes (n=100, 99%). Over half the residents (n=66, 65.3%) used USG daily in the perioperative period for various indications. Even though USG has been utilised more recently, most residents (n=82, 81.2%) felt they needed more training.
Conclusion: Ultrasound has emerged as a valuable tool for anaesthesiologists for various purposes in the perioperative period. A thorough understanding of sonoanatomy and adequate training can enhance patient care. Despite the increasing availability of ultrasound in numerous medical centres over recent years, its integration into perioperative procedures remains limited for diverse reasons.
Keywords: Perioperative care, survey, ultrasonography
References:
1. Stewart KA, Navarro SM, Kambala S, Tan G, Poondla R, Lederman S, et al. Trends in ultrasound use in low and middle-income countries: a systematic review. Int J MCH AIDS 2020; 9:103-120.
2. Jain PN; Ranganathan P. Ultrasound in anaesthesia. Indian J Anaesth 2007; 51:176-83.