Comparative study of the effect of inhalational anaesthetic agents: sevoflurane, isoflurane and desflurane on the blood glucose levels in non-diabetic patients under general anaesthesia: a randomised controlled trial
Chandini K, Nandkishore Agrawal
AIIMS, Raipur.
Email: chandiniamar01@gmail.com
Background and Aims: Surgery induces the stress response- a state of hypermetabolism, hypercatabolism and insulin resistance. The size of this response reflects the severity of the surgery and depends on the mode of surgery. Maintenance of normal blood glucose levels intraoperatively improves the perioperative outcome. Inhalational agents, such as sevoflurane, isoflurane and desflurane, are commonly used to induce and maintain general anaesthesia (GA).[1,2] This study was undertaken to compare the effect of sevoflurane, isoflurane and desflurane on intraoperative blood glucose levels in non-diabetic patients. We hypothesised that all volatile anaesthetic agents increase intraoperative blood glucose levels.
Methods: After institutional ethical clearance and registration in the Clinical Trials Registry-India (CTRI/2021/12/038579), we conducted a randomised controlled study in patients undergoing surgery under GA. Based on randomisation, we studied 105 patients, 35 in each group, who received sevoflurane, isoflurane and desflurane. The vital parameters and capillary blood glucose were measured at set time points.
Results: We observed a steady rise in the blood glucose levels in all three groups at regular intervals, with the maximum increase at 60 min after induction. The highest rise in intraoperative blood glucose levels was seen with desflurane, whereas isoflurane had the least increase. Although the increase in blood glucose levels was statistically significant at certain time intervals, this increase was not clinically significant enough to necessitate insulin administration.
Conclusion: All volatile anaesthetic agents in this study have been shown to increase intraoperative blood glucose levels, with the maximum increase seen with desflurane and the least with isoflurane. Further research is required in diabetic patients as this study was done in non-diabetic patients.
Keywords: Blood glucose, stress response, volatile anaesthetics
References:
1. Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ 2020;20:321–8.
2. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care 1999;2:69–78.
Comparison of succinylcholine, rocuronium, and rocuronium with magnesium on time of onset of paralysis in adult patients undergoing rapid sequence induction: A double-blinded randomised controlled trial
George Paul, Shagufta Naaz, Umesh Kumar Bhadani, Nishant Sahay, Rajnish Kumar
AIIMS, Patna.
Email: georgepopen@gmail.com
Background and Aims: The drug of choice for rapid sequence induction(RSI) is still succinylcholine, but succinylcholine comes with many adverse effects. As an alternative, rocuronium has been used at a high dose of 1.2 mg/kg.[1,2] There is limited evidence assessing the time of onset of paralysis while combining rocuronium with magnesium in RSI. Hence, this study aimed to compare the efficacy of succinylcholine, rocuronium, and rocuronium with magnesium sulphate for endotracheal intubation.
Methods: After institutional ethical committee clearance and trial registration, 135 American Society of Anesthesiologists physical status I and II patients scheduled for elective surgeries under general endotracheal anaesthesia with a duration of more than 1 h were recruited and randomised into three groups to receive the following for muscle relaxation: Group S - succinylcholine (1mg/kg), group R - rocuronium (0.9 mg/kg), group MgR - magnesium sulphate(60 mg/kg) followed by rocuronium (0.9 mg/kg). The primary outcome was comparing the time of onset, evidenced by a train of four values. Secondary outcomes were a comparison of intubating conditions and haemodynamic response to intubation.
Results: A significant difference was observed in the median (interquartile range) time of onset of paralysis in the three groups: group S – 65 (61 – 70) sec, group R – 102 (98 – 108) sec, and group MgR – 82 (79 – 85) sec (P<0.05). On comparing the intubation conditions and the haemodynamic response to laryngoscopy, there was a significant difference among the groups (P < 0.001), rocuronium, with magnesium being the best among them.
Conclusion: Although succinylcholine had a significantly faster onset time of paralysis, the administration of magnesium sulphate before rocuronium provided better intubating conditions and a more stable haemodynamics
Keywords: Magnesium sulphate, neuromuscular monitor, rapid sequence induction, rocuronium, succinylcholine
References:
1. Moustafa M, Deifallah A, El-Kobbia N, Doghaim M. Comparative study between succinylcholine, rocuronium and magnesium sulphate with rocuronium in rapid sequence induction. Res Opin Anesth Intensive Care 2015;1:57
2. Czarnetzki C, Albrecht E, Masouyé P, Baeriswyl M, Poncet A, Robin M, et al. Rapid sequence induction with a standard intubation dose of rocuronium after magnesium pretreatment compared with succinylcholine: a randomized clinical trial. Anesth Analg 2020;133:1540-1549.
Appraisal of clinical criteria for evaluation of extubation readiness: A prospective observational study.
Kanupriya Nigam, Ashish Sethi, Neeraj Narang
NSCB Medical college, Jabalpur.
Email: kanupriyanigam@gmail.com
Background and Aims: Persisting neuromuscular blockade after anaesthesia, commonly referred to as ‘residual paralysis’, is a well-recognised entity and an anaesthetic complication that should be avoided by careful management.[1,2] This study aimed to estimate the incidence of premature extubation (train of four ratios (TOFR) <0.9) with persisting neuromuscular block.
Methods: This prospective observational study was conducted in the American Society of Anesthesiologists physical status I and II patients undergoing elective surgery under general endotracheal anaesthesia. After surgery, the anaesthesiologist, blinded to the objective measurement of TOFR, judged the degree of neuromuscular blockade only using clinical parameters and performed extubation. TOFR and clinical parameters at the time of extubation were noted and compared.
Results: Out of 135 patients evaluated, 117 were extubated at a TOFR < 0.9. At a TOFR < 0.9, 70 patients demonstrated sustained head lift for over 5 sec. Eighty-six patients satisfied a tongue depressor test, 125 patients demonstrated tongue protrusion, and 132 patients demonstrated eye-opening. The Z values for various tests were calculated and were found to be harmful to tongue protrusion, eye-opening, and tongue depressor tests (-9.39, -10.97, and -3.71, respectively). The head lift had a positive Z value of 1.98.
Conclusion: Most patients (>75%) extubated based on clinical evaluation had a TOFR of <0.9. Neuromuscular reversal and tracheal extubation based on subjective criteria are not equivalent to objective or quantitative methods of extubation.
Keywords: Endotracheal tube, general anaesthesia, train of four monitoring
References:
1. Murphy GS, Brull SJ. Residual neuromuscular block: Lessons unlearned. Part I: Definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010;111:120-8.
2. Cammu G, De Baerdemaeker L, den Blauwen N, de Mey JC, Struys M, Mortier E, et al. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur J Anaesthesiol 2002;19:129-34.
Efficacy of high flow nasal cannula oxygenation versus conventional oxygenation in patients undergoing rigid bronchoscopy: A randomised controlled study
Manisha S
Email: sivashankaranmanisha@gmail.com
Background and Aims: The high-flow nasal cannula (HFNC) has recently been introduced for oxygen therapy during bronchoscopy. This study aimed to assess the efficacy of apnoeic oxygenation using an HFNC in patients undergoing rigid bronchoscopy and foreign body removal.
Methods: Sixty adult patients, aged 18-60 years, of American Society of Anesthesiologists physical status I - III with body mass index <30 kg/m2 undergoing assessment bronchoscopy and foreign body removal were randomised using computer-generated randomisation into two groups. Group H (n = 30) received oxygenation via HFNC (heated humidified) at 30 L/min, and group A (n = 30) received oxygenation via the side port of the bronchoscope with the flow at 6 L/min. The primary outcome was incidence and time to desaturate to SpO2 < 94% for more than 10 seconds. The secondary outcome was to compare end-tidal carbon dioxide (EtCO2) and end-tidal oxygen (EtO2) (measured by an O2 sensor connected to the expiratory limb of the closed circuit) at baseline, immediately, 5, 10 min post-procedure and several interruptions during the procedure for oxygenation.
Results: Compared to conventional technique, use of HFNC was associated with significantly higher intraoperative SpO2 94.13(2.90)% versus 98.14(1.09) %, P<0.001, fewer number of interruptions in the procedure for oxygenation 1.03(0.70) versus 0.06(0.25), P < 0.001 and significantly lower EtCO2 immediately post-procedure 56.26(6.56) mmHg versus 48.44(4.50) mmHg, P=0.04. The mean duration of the procedure, EtO2, and intraoperative haemodynamics were comparable in both groups.
Conclusion: HFNC is superior to conventional apnoeic oxygenation for bronchoscopy in maintaining oxygen saturation with fewer interruptions for oxygenation, thus improving surgeon satisfaction and patient safety.
Keywords: Apnoeic oxygenation, bronchoscopy, high flow nasal cannula
References
1. Lucangelo U, Vassallo FG, Marras E, Ferluga M, Beziza E, Comuzzi L, et al. High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy. Crit Care Res Pract 2012;2012:506382.
2. Min JY, Jo H, Roh K, Chung MY. Preventing deoxygenation with high flow nasal cannula oxygen during induction of general anaesthesia for rigid bronchoscopy: Two case reports. Medicine (Baltimore) 2019;98:e159982. doi: 10.1097/MD.0000000000015998.
Effect of intravenous versus nebulised dexmedetomidine on intubating conditions during awake fibreoptic intubation: A randomised double-blinded comparative study
Prakriti Singh, Sandeep Sharma, Anush Jain
R.N.T Medical College, Udaipur.
Email: prakritis170993@gmail.com
Background and Aims: Awake fibreoptic intubation (AFOI) tends to be safer than conventional laryngoscopy for difficult airway conditions. Dexmedetomidine can be used for sedation as it ensures spontaneous breathing with airway patency during these procedures.[1,2] This study aimed to compare the effect of intravenous versus nebulised dexmedetomidine on intubating conditions during AFOI.
Methods: In this randomised double-blind comparative study, after institutional ethics committee approval (RNT/ACAD/IEC/2023/621) and registration in the clinical trial registry of India (CTRI/2023/08/056201), with informed written consent, the American Society of Anesthesiologists’ physical status I, II patients of either gender aged 18-60 years, with Mallampati grade I and II, undergoing elective surgery under general anaesthesia were allocated into two groups to receive dexmedetomidine 1µg/kg via nebulisation or intravenous route (group N and I respectively). Patients were intubated with a fibreoptic bronchoscope. The primary outcome assessed was a cough score. Secondary outcomes were intubating conditions, vocal cord positions, post-intubation score, Ramsay sedation scale scores, haemodynamic parameters, and postoperative satisfaction. Students’ t-tests, Mann Whitney U, and Chi-square tests were applied.
Results: The majority % of patients in group I, 56.66%, showed lower cough severity than group N 10%, P = 0.001. Group I also reported a faster intubation time 176(58.54) versus 245(84.14) sec, P = 0.001, better vocal cord position, P < 0.001, better sedation scores and more stable haemodynamic parameters.
Conclusion: Compared to the nebulised route, dexmedetomidine administered through the intravenous route provides better intubating conditions for AFOI with reduced cough severity.
Keywords: Bronchoscope, dexmedetomidine, laryngoscopy
References:
1. Sancheti AG, Swami SS, Konnur SL, Amin N. A comparative study between local dexmedetomidine and intravenous dexmedetomidine during awake fiberoptic nasotracheal intubation. Anesth Essays Res 2022; 16:407-11.
2. Srinivas C, Tiwari T, Prakash R, Prabha R, Raman R, Arshad Z. A randomised comparison of intravenous versus nebulised routes for administering dexmedetomidine and ketamine combination to facilitate awake fiberoptic intubation. Cureus 2023;15(4): e38322. doi: 10.7759/cureus.38322.
Role of the perfusion index as a predictor of hypotension in patients with carcinoma cervix undergoing brachytherapy under spinal anaesthesia: A prospective observational study
Dubey P, Rachana ND, Arathi BH, Gowda VB, Ranganath N.
Kidwai Memorial Institute of Oncology, Bengaluru
Email: dr.pranjaldubey18@gmail.com
Background and Aims: Prediction of hypotension post-spinal anaesthesia is difficult.[1,2] This study aimed to determine the use of perfusion index (PI) as a predictor of hypotension following the administration of spinal anaesthesia in carcinoma cervix cases posted for brachytherapy.
Methods: This study was conducted on 50 patients diagnosed with carcinoma cervix, posted for brachytherapy under spinal anaesthesia (SA). All patients ‘ baseline haemodynamic parameters and PI were recorded, and SA was administered. Intraoperative haemodynamic parameters and PI were recorded every 5 minutes. PI was recorded using a Philips Efficia CM12 monitor attached to the index finger in all patients. Hypotension was defined as a fall in mean arterial pressure of >25 % from baseline. We performed logistic regression to predict the likelihood of hypotension based on baseline PI values.
Results: Among the 50 patients enroled, 23 had hypotensive episodes. Patients who had hypotension up to 30 minutes after SA had a mean baseline PI of 2.19. Based on the ROC curve constructed for the data, a cutoff baseline PI value of 1.7 was found, with an AUC of 0.87. The results suggest that PI is significantly associated with the likelihood of developing hypotension (P < 0.001). The log odds of hypotension increased as PI values increased.
Conclusion: PI with a cutoff value 1.7 can be used as a simple, noninvasive modality to predict hypotension post-spinal anaesthesia. A rising trend in PI can also be utilised to predict impending hypotension, and early steps may be taken to prevent it.
Keywords: Brachytherapy, hypotension, perfusion index
References:
1. Nandini MG, Srinivasaiah M, Prabhat K S J, V C, Kuradagi M, Mulla R, et al. Peripheral perfusion index: a predictor of post-spinal hypotension in caesarean section. Cureus 2022;14:e25699. doi: 10.7759/cureus.25699.
2. Duggappa DR, Lokesh M, Dixit A, Paul R, Raghavendra Rao RS, Prabha P. Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section. Indian J Anaesth 2017;61:649-54.
Effect of perioperative administration of normal saline versus lactated Ringer’s solution on the urinary level of Neutrophil Gelatinase Associated Lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1) in preeclamptic women undergoing caesarean section: A randomised controlled trial
Saahithya V
JIPMER, Puducherry.
Email: sahithyavijayan0@gmail.com
Background and Aims: Preeclampsia, caused by pathophysiological changes like glomerular endothelins and endothelial dysfunction, predispose to kidney injury. Intravenous fluids are administered cautiously in preeclamptic women during the perioperative period.[1,2] We investigated whether normal saline could affect renal function in preeclampsia by measuring urinary biomarkers.
Methods: We conducted this double-blinded, randomised study in 120 preeclamptic women planned for elective and emergency caesarean section. Pre-operative orders and spinal anaesthesia were carried out as per departmental protocol. After co-loading, 2 to 3 ml/kg/h of the allocated fluid was given as maintenance fluid till the end of surgery. Our primary outcome was determining any difference in urinary Neutrophil gelatinase-associated lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1) levels measured 6- and 12 hours postoperatively between the two groups. The total amount of fluids administered, blood loss, urine output and blood gases were analysed.
Results: The urinary NGAL and KIM-1 values were comparable between the two groups. Repeated measures analysis of variance (ANOVA) revealed that median NGAL values did not differ significantly at all time intervals. There was a weak correlation between urinary NGAL and KIM-1 levels and the total amount of fluids. Although the pH values were statistically low in the regular saline group, they did not have much clinical relevance.
Conclusion: The type of fluid administered, either normal saline or Ringer lactate, did not affect the values of urinary biomarkers NGAL and KIM-1 in preeclamptic women who underwent cesarean section.
Keywords: Preeclampsia, pregnancy, ringer lactate, sodium chloride, temperature-induced lipocalins
References:
1. Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis 1999;33:1004–10.
2. Han WK, Bailly V, Abichandani R, Thadhani R, Bonventre JV. Kidney Injury Molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int 2002;62:237–44.
Predictive values of preoperative airway assessment for difficult laryngoscopy and tracheal intubation: Comparison of thyromental distance, the ratio of height to thyromental distance, modified Mallampati score and upper lip bite test
Sumedha Dhar, Debasish Saha, Suman Sarkar, Mousumi Datta Roy
Bankura Sammilani Medical College, Bankura.
Email: sumedhadhar17091995@gmail.com
Background and Aims: This study aimed to compare the predictive value of the ratio of height to thyromental distance (RHTMD), modified Mallampati score (MMS) and upper lip bite test (ULBT) for prediction of difficult airway intubation either by a single test or combinations of test.
Methods: This prospective observational study was conducted on 248 patients undergoing elective surgeries under general endotracheal anaesthesia. Thyromental distance (TMD), RHTMD, MMS and ULBT were examined preoperatively. All patients received premedications; anaesthesia was induced with intravenous anaesthetic agents, and succinylcholine was given intravenously to facilitate tracheal intubation. Direct laryngoscopy was performed with the patient in the sniffing position, and the glottic view was graded using Cormack and Lehane classification. Cormack and Lehane Grades 3 and 4 were considered difficult laryngoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy are calculated to understand which method better predicts difficult intubation.
Results:
RHTMD has better sensitivity, NPV, and diagnostic accuracy than others, and ULBT has the highest specificity and PPV. The diagnostic accuracy of TMD with ULBT and RHTMD with ULBT is highest compared with other combinations of tests.
Conclusion: During preoperative airway assessment, one should not rely upon any single test; a combination of tests is recommended.
Keywords: Airway, Cormack-Lehane, endotracheal intubation
References:
1. Krishna H, Agarwal M, Dali J, Rampal P, Dua C. Prediction of difficult laryngoscopy in Indian population: Role of the ratio of patient’s height to thyromental distance. J Anaesthesiol Clin Pharmacol 2005;21:257–60.
2. Rao KV, Dhatchinamoorthi D, Nandhakumar A, Selvarajan N, Akula HR, Thiruvenkatarajan V. Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, inter incisor gap, thyromental distance, neck circumference, and neck extension. Indian J Anaesth 2018;62:603–8.
Evaluation of the efficacy of telemedicine for pre-anaesthetic check-ups in paediatric patients undergoing elective surgery
Yukti Shah
Maulana Azad Medical College, New Delhi
Email: yuktishah95@gmail.com
Background and Aims: Recently, telemedicine has been commonly used for pre-anaesthetic consultation (PAC) in adults.[1,2] This study aimed to evaluate and compare the efficacy of telemedicine with in-person pre-anaesthetic evaluation for paediatric patients undergoing elective surgery.
Methods: This randomised, comparative study was conducted after obtaining institutional ethics committee approval. Children aged 3-12 years of either gender, scheduled to undergo elective surgical procedures, were recruited. These patients were assigned to either group T (undergoing pre-anaesthetic evaluation using telemedicine) or group C (undergoing conventional pre-anaesthetic evaluation in pre-anaesthetic clinics). The primary objective was to assess the number of visits/video calls required to get preliminary anaesthesia clearance and delay of surgery. The secondary objectives were to determine the rate of cancellation of surgery, the concordance of pre-anaesthetic checkup, airway examination findings of video consultation with preliminary pre-anaesthetic evaluation on the day of admission(using concordance scale), assess the time required for each consultation and assess parents/guardian satisfaction (using 5-point Likert scale).
Results: Seventy patients were planned in this ongoing pilot project, and the data from 30 patients (15 in each group) were analysed. The average number of review PACs required for each patient before admission in the Telemedicine group was 1.6 to avoid any cancellations/delays. Eight out of 15 patients strongly agreed, and five patients decided to opt for telemedicine in future. Two patients were neutral on the idea of telemedicine for future examinations.
Conclusion: Patients using telemedicine consultation strongly agree to participate in this new technology in the future as they were comfortable and confident during their evaluation. There were no case cancellations on the day of surgery due to inadequate assessment in both groups.
Keywords: Paediatrics, telemedicine, virtual airway assessment
References:
1. Hrishi AP, Prathapadas U, Praveen R, Vimala S, Sethuraman M. A comparative study to evaluate the efficacy of virtual versus direct airway assessment in the preoperative period in patients presenting for neurosurgery: a quest for safer preoperative practice in neuroanesthesia in the backdrop of the COVID-19 pandemic! J Neurosci Rural Pract 2021;12: 718–25.
2. Kern D, Bourdaud N, Jaber H, Ezzitouni M, Alacoque X, Larcher C, et al. Teleconsultation in pediatric anaesthesia: First assessment of feasibility, quality, and satisfaction in France. Paediatr Anaesth 2023;33:552-61.
Comparison of the effect of propofol and dexmedetomidine on changes in optic nerve sheath diameter during laparoscopic surgery: A randomised double-blinded trial
Santhosh Kumar S, Vidhu Bhatnagar, Rajput RS
INHS Asvini, Mumbai
Email: drssanthosh189@gmail.com
Background and Aims: Laparoscopic surgery involves creating a carbon dioxide pneumoperitoneum to facilitate a clear surgical view, resulting in an elevated intracranial pressure (ICP). Optic nerve sheath diameter(ONSD) is a noninvasive ultrasonography(USG) based technique that can reflect ICP changes.[1,2] This study aimed to compare propofol and dexmedetomidine’s effect on ONSD changes during laparoscopic surgeries.
Methods: This randomised, double-blind clinical trial was conducted on 60 adult patients undergoing elective laparoscopic surgery. Computer-generated randomisation was done, and patients were allocated to two groups of 30 each to receive either dexmedetomidine infusion at 0.5 µg/kg/h or propofol at 100 µg/kg/min, post pneumoperitoneum and balanced inhalational anaesthesia (minimum alveolar concentration of 0.6-0.9). Baseline vital parameters were recorded, and ended tidal carbon dioxide was maintained in a narrow range to ensure stable physiological conditions. Four readings of ONSD with USG were taken at the following time points: after anaesthetic induction and before the creation of pneumoperitoneum (baseline value), at 0-15 min intervals after the creation of pneumoperitoneum, at 15-60 min intervals after the creation of pneumoperitoneum and after insufflation of pneumoperitoneum. Paired t-test was applied to the readings, and results were drawn.
Results: Demographic characteristics and baseline ONSD values were comparable between the groups. Patients in the dexmedetomidine group demonstrated significantly lower ONSD values than the propofol group (P< 0.05).
Conclusion: Dexmedetomidine decreased ICP better than propofol in patients undergoing laparoscopic surgery, as demonstrated by lower intraoperative ONSD values.
Keywords: Dexmedetomidine, intracranial pressure, laparoscopy, optic nerve sheath, propofol
References:
1. Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth 2016;117:783-91.
2. Yu J, Hong JH, Park JY, Hwang JH, Cho SS, Kim YK. Propofol attenuates the sonographic optic nerve sheath diameter increase during robot-assisted laparoscopic prostatectomy: a randomised clinical trial. BMC Anesthesiol 2018;18:72. doi: 10.1186/s12871-018-0523-7.
Impact of capillary refill time and core-to-skin temperature gradient on prognosis in patients with septic shock: A prospective observational study
Somya Tayal
DR RMLIMS, Lucknow
Email: drsomyatayal@gmail.com
Background and Aims: Septic shock is severe sepsis with persistent hypotension and end-organ damage. It is characterised by heterogenous microcirculatory alteration that causes organ hypoperfusion and eventually death. These microvascular changes can be identified bedside by studying peripheral perfusion by capillary refill time (CRT) and skin temperature; therefore, a core-to-skin temperature gradient (CSTG) can be considered an essential parameter for assessing perfusion and microcirculation failure in septic shock patients.[1,2] This study evaluated and compared whether CRT and CSTG represent a predictive factor for prognosis in septic shock patients.
Methods: Fifty-four patients with septic shock admitted to the intensive care unit requiring vasopressor support in the last 24 hours were enroled. CRT and CSTG were assessed at the time of inclusion into the study (H0) and after 6 hours (H6). Patients were followed up for eight days, and 8-day mortality was correlated with CRT and CSTG values.
Results: The site of skin temperature measurement found to yield the best correlation with mortality was the core-to-index temperature gradient. A core-to-index temperature gradient higher than 7°C predicted 8-day mortality with a sensitivity of 87.18%. CRT of the knee and index finger at the 6th hour was statistically insignificant for 8th-day mortality.
Conclusion: CSTG is better in predicting the 8th-day mortality than CRT in septic shock patients.
Keywords: Capillary, microcirculation, septic shock, skin temperature
References:
1. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005;31:1316–26.
2. Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, et al. The mottling score predicts survival in septic shock. Intensive Care Med 2011;37:801–7.
Comparative evaluation of single shot rhomboid intercostal plane block, erector spinae plane block and serratus anterior plane block for perioperative analgesia in modified radical mastectomy: A randomised controlled trial
Marjan Wao Chyrmang, Priyanka Bansal
PGIMS, Rohtak
Email: marjanchyrmang52@gmail.com
Background and Aims: Different regional blocks have been tried to reduce postoperative pain following modified radical mastectomy(MRM), with none serving one purpose.[1,2] We hypothesised that rhomboid intercostal plane (RIB), erector spinae plane block (ESPB), and serratus anterior plane block (SPB), are comparable in terms of total intraoperative and postoperative analgesic consumption after MRM surgeries.
Methods: Sixty patients scheduled for unilateral MRM were divided into three groups of 20 patients, each receiving either RIB, ESPB, or SPB. All were given 20 ml of 0.25% bupivacaine, 10 ml of normal saline and 8 mg (2 ml) of dexamethasone (total 32 ml) for the block. Intraoperative vitals, total fentanyl consumption, postoperative numerical rating scale(NRS) score and paracetamol and tramadol consumption were calculated and compared. The NRS scores were evaluated at 30 minutes, 1, 3, 6, 12, 18 and 24 hours at rest and when active. The primary objective was a comparison of total analgesic consumption postoperatively.
Results: RIB and ESPB group patients had significantly less demand for post-operative analgesics. Intraoperative vitals and fentanyl consumption were comparable among the three groups. Patient satisfaction was much better in the ESP and RIB groups than in the SPB group, but it was similar in the ESP and RIB groups. The NRS scores were comparable in all three groups up to 12 h, but after 18 h, it was significantly better in ESPB and RIB than in the SPB group after 24 h when the patient was active. The scores were comparable in the RIB and ESPB groups.
Conclusion: The ESP, RIB and SAB are suitable analgesic modalities for multimodal analgesia in MRM patients. However, ESP and RIB are much better regarding less analgesic consumption and better postoperative NRS scores.
Keywords: Nerve block, modified radical mastectomy, postoperative analgesia, ultrasonography
References:
1. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med 2017;42:609-31.
2. Altiparmak B, Korkmaz Toker M, Uysal AI, Dere O, Ugur B. Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial. Reg Anesth Pain Med 2020;45:277-82.