DR. KOP’S NATIONAL AWARD

CARDIAC ANAESTHESIA

ABS0530

Congenital cardiac surgery with cardiopulmonary bypass using supraglottic airway in paediatric patient: A new horizon

Nihal Srivastava, Alok Kumar

Armed Forces Medical College Pune

Email: nihaltmc365@gmail.com

Background and Aims: Supraglottic airway devices have been used in paediatric patients.^[1,2] So far, no published literature describes using a supraglottic airway while conducting major open-heart surgery (CHS) under cardiopulmonary bypass (CPB) in paediatric patients.

Methods: Acyanotic heart disease patients with normal airway anatomy and non-reactive airway and coagulation disorders were included. Balanced general anaesthesia with a high thoracic epidural was the anaesthesia technique of choice. A weight-appropriate I-gel was inserted and secured after confirming accurate positive pressure ventilation. The right internal jugular vein was catheterised, and the epidural was placed in the lateral decubitus position. The supraglottic airway did not demonstrate any leak, and CPB was conducted under standard normothermic conditions. On table removal of the supraglottic airway device did not report any cough or haemodynamic change. Patients had an uneventful postoperative stay.

Results: This case series comprises data from 6 males and two females. Patients underwent cardiac surgery, out of which 5 had atrial septal defects, and three patients had ventricular septal defects. The mean age was 68.9(43.8) months, weight was 20.6(14.9) kg, haemoglobin was 11.3(1.2) g/dL, and STS score was 0.13(0.05). 5 minutes post I-Gel insertion, peak airway pressure was 14.6(4) cm of water and air leak % was 1.3(0.6). During surgery, the mean CPB time was 60.3(13.4) min, activated clotting time aortic cross-clamp time 30.3(8.8) min and minimum temperature was 4.5(1.2)℃. The mean vasoactive inotropic score on the intensive care unit arrival was 8.6(3.9). Post-operative length of stay was 1.6(0.7) days with mean mechanical ventilation duration zero and without complications.

Conclusion: I-gel is well-tolerated and efficacious, enabling ultra-fast tracking, smoother extubation, and superior haemodynamic stability in the paediatric population undergoing CHS with CPB.

Keywords: i-gel airway, paediatric, ultra-fast

References:

1. Elgebaly AS, Eldabaa AA. Is the I-gel airway better than an endotracheal tube airway for sevoflurane-fentanyl anaesthesia during cardiac surgery? Anesth Essays Res 2014; 8:216- 22.

2. Orhan T, Tufek A, Gokhan S, Yuksel MU. Comparison of the efficacies of I-gel and LMA ProSeal for airway management in pediatric patients. Turk J Med Sci 2013; 43:208-13.

ABS0583

Jugular venous oxygen and lactate indices to predict postoperative cognitive dysfunction in patients undergoing elective off-pump coronary artery bypass grafting: A prospective observational study

Pooja Singh, Ramees Ahamad Anchukandan, Zainab Ahmad

AIIMS, Bhopal

Email: pooja.anesth@aiimsbhopal.edu.in

Background and Aims: Postoperative cognitive dysfunction (POCD) is lower after off-pump coronary artery bypass grafting (CABG) compared to on-pump CABG. Oxygen and lactate indices are suggestive of inadequate cerebral oxygenation and are studied for association with postoperative neuropsychological dysfunction after off-pump CABG.^[1,2]

Methods: A prospective study was conducted on 30 patients aged 18- 70 years who were scheduled for elective off-pump CABG. Four neuropsychological tests assessed baseline cognitive evaluation. The jugular bulb was cannulated under ultrasound guidance. Blood gas analysis from the jugular venous catheter and arterial catheter was done at the incision, after each grafting, and 6 and 24 hours after surgery to calculate derived variables. The infusion assessment method for intensive care unit (CAM-ICU) score and neuropsychological tests were calculated on the 3rd and 7th postoperative days, respectively. Jugulo-venous oxygen and lactate indices were compared between the Normal (N) group and the Decline (D) group (>20% decline in neuropsychological test score).

Results: Significant cognitive decline was seen in 3 patients. The incidence of POCD on the 7^th day was 11.11%. The incidence of POCD on 3^rd day was 18.51%. Among derived variables, only the jugular-arterial carbon dioxide gap (JV-ACO2) was significantly different at T2; almost all variables were significantly different at T3, while arterio-jugular lactate difference (AJDL) and modified lactate oxygen index (mLOI) was significantly different at T5. The mLOI has the highest sensitivity (72.22%), and AJDL has the highest specificity (90.7%).

Conclusion: The values of mLOI and AJDL have the highest sensitivity and specificity for predicting POCD in patients undergoing elective off-pump CABG.

Keywords: Cerebral metabolism, cognition, coronary artery bypass grafting, off-pump

References:

1. Yuan SM, Lin H. Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2019;34: 76-84.

2. Vu T, Smith JA. An update on postoperative cognitive dysfunction following cardiac surgery. Front Psychiatry 2022; 13.

ABS0804

Diagnostic accuracy of diaphragmatic excursion and rapid shallow breathing index for predicting successful weaning from mechanical ventilation in adult patients after cardiac surgery

Tony E Joseph, Vishal, DV Bhargava, VS Joshi

Armed Forces Medical College, Pune

Email: tonyjoseph3333@gmail.com

Background and Aims: Diaphragmatic excursion (DE) and the rapid shallow breathing index (RSBI) predict extubation failure, except in patients with post-cardiac surgery.^[1,2]

Methods: This was a prospective observational study where RSBI and DE point of care ultrasound (POCUS) were determined after weaning from mechanical ventilation after cardiac surgery. The investigators did not have the decision to commence weaning from mechanical ventilation. After the anaesthesiologist-in-charge decided to wean the patient from ventilation, various demographic parameters (EuroSCORE2, age, gender, comorbidities, etc.), RSBI and DE (POCUS) were determined and recorded. The study observed the accuracy of DE and RSBI in predicting reintubation, non-invasive ventilation (NIV), or oxygen support in adult post-cardiac surgery patients. Also, the correlation between DE and RSBI during ventilator weaning was recorded.

Results: In this study, 74 adults were assessed on weaning from ventilation after cardiac surgery. The area under the receiver operator curve (AUROC) for DE and RSBI was 0.561 and 0.535 for predicting the need for NIV within 24 h, while the AUROC for predicting reintubation within 24 h for DE and RSBI was 0.84 and 0.69, respectively. Of 72 patients, 2 (2.7%) were reintubated, and 18 (25%) required NIV support. There was no correlation between RSBI and DE (p=0.273).

Conclusion: DE and RSBI are useful for predicting reintubation incidence and NIV support on weaning from mechanical ventilation post-cardiac surgery. Other demographic factors were not associated with reintubation or the need for NIV support within 24 h.

Keywords: Diaphragmatic excursion, rapid shallow breathing index, weaning

References:

1. Karthika M, Al Enezi FA, Pillai L V, Arabi YM. Rapid shallow breathing index. Ann Thorac Med 2016;11:167–76.

2. Qian Z, Yang M, Li L, Chen Y. Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: A systematic review and meta-analysis. BMJ Open 2018;8:1–10.

ABS0890

Prospective, observational study to evaluate the outcomes of cytokine haemadsorption during aortic surgery

Mandeep Singh, Mandeep Singh, Yatin Mehta, Ajmer Singh

Medanta The Medicity, Gurugram

Email: mandeepsingh059@gmail.com

Background and Aims: This study aimed to assess the impact of the treatment with the CytoSorb 300 ml device on the course of hyperinflammation, haemodynamic stability, and multi-organ failure in patients undergoing cardiopulmonary bypass (CPB) assisted surgery for aortic diseases.

Methods: This was a single-centre, prospective controlled trial conducted in patients undergoing surgery for aortic disease. Patients had a CytoSorb adsorber installed at the beginning of CPB. The flow through the CytoSorb adsorber was driven by a roller pump with a constant flow of 400-500 mL/min. Intra and postoperative haemodynamic stability was observed in the pre and postoperative periods, as evidenced by the relative difference in the vasopressor requirement. Interleukin-6 (IL-6), total leukocyte count (TLC), procalcitonin (PCT) and lactate levels were measured at preinduction, 2, 24 and 48 h after discontinuation of CPB and 15 days after surgery.

Results: The IL-6 was lower (p<0.01) among patients of CytoSorb than controls at preinduction, post-CPB and 48 h postoperatively. The procalcitonin was lower (p=0.005) among patients of CytoSorb than controls at the post-CPB timepoint. The mean PaO₂/FiO₂ ratio (P/F) was significantly higher (p<0.001) among patients of CytoSorb than Controls at post-CPB, at 24 and 48 h after surgery. The mean SOFA score was lower (p<0.001) among patients of CytoSorb than controls at the post-CPB timepoint[Figure 1].

Figure 1.

Study parameters at preinduction, postoperative, at 24h and 48h postoperatively

Conclusion: The present study demonstrated that CytoSorb® use during CPB can be a safe and feasible adjuvant therapy that might improve postoperative outcomes in patients with aortic cardiac disease.

Keywords: Bentall, cardiopulmonary bypass, cytosorb

References

1. Hawchar F, László I, Öveges N, Trásy D, Ondrik Z, Molnar Z. Extracorporeal cytokine adsorption in septic shock: A proof of concept randomised, controlled pilot study. J Crit Care 2019;49:172–178.

2. Ball L, Costantino F, Pelosi P. Postoperative complications of cardiac surgery patients. Curr Opin Crit Care 2016;22:386–392.

ABS0946

Comparison of after-effects of protamine-heparin in two different ratios in patients undergoing cardiac surgery

Anthi Sree Yedurupaka, Agha Deepti Kilambi

NRI Medical College and General Hospital, NRIGH, Chinakakani

Email: chilling.santhi@gmail.com

Background and Aims: In cardiac surgery, protamine is administered to eliminate the effect of heparin, which can have an anticoagulant effect when administered in large doses and under-dosing leaves unbound heparin in the circulation and may increase bleeding post-operatively.^[1,2] The study aimed to evaluate the optimal protamine: heparin ratio.

Methods: This cross-sectional observational study was conducted among 60 patients willing to undergo cardiac surgery. The study had two groups: Group A: Protamine/heparin ratio of 1:1; Group B: Protamine /heparin ratio of 1.3:1. Data was collected as Preoperative, postoperative, and intraoperative activated clotted time are all measured as secondary outcome variables. Statistical analysis included continuous variables expressed as mean, standard deviation, median, and interquartile range. Categorical variables were presented as frequency and percentage. A p-value < 0.05 was considered statistically significant.

Results: Median 12 h postoperative blood loss in groups A and B was significant (p=0.002). Intraoperative whole blood (WB) transfusions were lower in group A than in group B (p=0.04). Pre- and post-operative blood investigations within groups were significant except for platelet count in almost all measured parameters. Post-operative haematocrit within six h postoperatively was lower in group B.

Conclusion: A 1.3: 1 ratio of protamine to heparin significantly increased intra-operative whole blood transfusion and 12-h post-op blood loss compared with a 1:1 ratio. Therefore, it is better not to exceed the 1:1 ratio.

Keywords: Cardiac surgery, cardiopulmonary bypass, heparin, protamine

References:

1. Goedhart ALM, Gerritse BM, Rettig TCD, van Geldorp MWA, Bramer S, van der Meer NJM, et al. A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products. Interact Cardiovasc Thorac Surg 2020;31:391-397

2. Radulovic V, Laffin A, Hansson KM, Backlund E, Baghaei F, Jeppsson A. Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study. PLoS One 2015;10:e0130271. doi: 10.1371/journal.pone.0130271.

ABS0959

Comparative study of caudal dexmedetomidine versus morphine on postoperative pain in paediatric cardiac surgery patients.

Shrilekh Mankhair, Prasad Panbude, Jui Jadhav

JNMC, DMIHER, Wardha, Maharashtra

Email: dr.shrilekh@gmail.com

Background and Aims: The study aimed to compare the analgesic effects of dexmedetomidine versus morphine in caudal analgesia in paediatric cardiac surgery. It also measured the effects of caudal dexmedetomidine versus morphine on haemodynamics, the postoperative FLACC scale, time to extubation, and stay in the paediatric intensive care unit (PICU).

Methods: In this study, 60 patients, 1-10 years old and 5-15 kg, were enrolled. Patients with bleeding diathesis, anomalies or active infection in the spinal cord, and any allergy to study drugs were excluded. The institutional ethics committee approved the study. The sample size was calculated using the Open Epi open-source calculator. Out of these, 30 patients were allocated to either caudal dexmedetomidine (dexmedetomidine group) or morphine (morphine group) for postoperative pain relief in paediatric patients undergoing cardiac surgery.

Results: Heart rate (HR) was recorded before induction (Baseline [BL]), 10 min after caudal injection (T1), 5 min after sternotomy (T2), after cardiopulmonary bypass (CPB) (T3), at PICU admission (T4) and extubation (T5). The heart rate was lower in the dexmedetomidine group. HR was comparable and markedly lower in the dexmedetomidine group. The mean blood pressure did not show variation between the two groups except during extubation and at the time of PICU admission. Oxygen saturation (SpO₂) variation was significant during extubation and PICU transfer. The morphine group showed a significant fall in SpO₂ compared to the other group. The fall in SpO2 was not significant enough, though, which needed intervention. Post extubation, the FLACC score was recorded in all patients every 6 h. The FLACC score was significantly lower in the dexmedetomidine group till the first 4 h, implying good analgesia compared to the morphine group. The mean time required for extubation in the dexmedetomidine group was significantly lower than in the morphine group. The analgesia was better in dexmedetomidine, needing rescue analgesia much later compared to the morphine group.

Conclusion: Caudal dexmedetomidine, when used as a sole analgesic agent in paediatric open-heart surgeries, performed better than morphine in attenuating the haemodynamic stress response of sternotomy and cardiopulmonary bypass. It has better intraoperative haemodynamic control and provides adequate and more prolonged postoperative analgesia. It also has a shorter time to extubation with fewer complications.

Keywords: Caudal block, dexmedetomidine, morphine

References:

1. Hammer GB. Regional anaesthesia for pediatric cardiac surgery. J Cardiothorac Vasc Anesth 1999;13:210-3.

2. Iwasaki M, Edmondson M, Sakamoto A, Ma D. Anesthesia, surgical stress, and “long-term” outcomes. Acta Anaesthesiol Taiwan 2015;53:99-104.

ABS1033

Accuracy of a two-step echocardiography algorithm using elastic recoil signal of mitral annulus to stratify left ventricular diastolic dysfunction for perioperative management

Jyotsna Sharma, DV Bhargava

AFMC Pune

Email: jyotsnasharma286@gmail.com

Background and Aims: Elastic recoil signal on tissue Doppler imaging of the mitral annulus as a qualitative test to identify left ventricular diastolic function.^[1,2]To determine the accuracy of a two-step algorithm to stratify left ventricle diastolic dysfunction (LVDD) using elastic recoil signal (ERS) and E/A ratio by transthoracic echocardiography (TTE) into normal/mild dysfunction or significant dysfunction group and to compare its efficacy with American Society of Echocardiography (ASE) 2016 diastolic dysfunction guidelines.

Methods: This was a prospective, cross-sectional observational study of adults scheduled for elective coronary revascularization. LVDD was assessed by ASE 2016 guidelines—further, a two-step algorithm using ERS and transmitral E/A ratio < 0.8 by TTE. The presence of ERS denotes normal diastolic function. Absent ERS with an E/A ratio < 0.8 was considered mild LVDD (grade 1), whereas any E/A ratio > 0.8 denoted significant LVDD (grades 2 and 3). Normal function and grade 1 LVDD with hypotension would respond to fluid therapy, while significant LVDD would require vasoactive medications with careful fluid monitoring. The inter-rater agreement was determined using Cohen’s kappa statistic.

Results: The echocardiographic data of 30 patients was analysed. Classification into the normal/mild LVDD group and significant LVDD (grade 2 or 3) was compared from results obtained by the ASE algorithm, and the proposed method using ERS and transmitral E/A ratio showed substantial agreement (kappa statistic 0.698 (95% CI 0.48-0.9). The proposed two-step method provided a diagnosis of the diastolic function into average or various grades of LVDD just by visual assessment without the need for calculations.

Conclusion: The therapy for perioperative hypotension in adults with diastolic dysfunction can be decided by this simple visual two-step assessment of echocardiographic parameters that can be performed quickly to decide between fluids and vasoactive medications.

Keywords: Elastic recoil, diastolic dysfunction, ultrasound

References:

1. Borde DP, Venkata DB, Joshi S, Jasapara A, Joshi P, Asegaonkar B. Elastic recoil signal on tissue Doppler imaging of the mitral annulus as a qualitative test to identify left ventricular diastolic function. Ann Card Anaesth 2023; 26:42- 50.

2. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H Edvardsen T, et al. Recommendations for evaluating left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277314.

ABS1063

A study of variations in near-infrared spectroscopy cerebral tissue oxygenation during hypothermic cardiopulmonary bypass in adults undergoing cardiac surgery - a prospective observational study

Vishnu K, DV Bhargava, Vishal, Rahul Yadav

Armed Forces Medical College, Pune

Email: vishnu.k.velan@gmail.com

Background and aims: Cardiopulmonary bypass (CPB) related variations (non-pulsatile flow, hypothermia, haemodilution) may affect cerebral oxygenation.^[1,2] To determine the variations in cerebral tissue oximetry measured by near-infrared spectroscopy (NIRS) and the associated factors (patient demographics, European system for cardiac operative risk evaluation [Euro SCORE], CPB duration, haemodilution, minimum temperature) and incidence of postoperative delirium.

Methods: In this prospective, observational study, adult patients undergoing elective cardiac surgery under hypothermic CPB were included after written informed consent and institutional ethics committee approval. Patients with prior neurological illness were excluded. Along with baseline and patient characteristics (EuroSCORE), NIRS was recorded at four time periods (baseline, at the onset of CPB, on CPB at minimum temperature and after weaning off CPB), along with other related oxygenation indices and CPB parameters. Postoperative delirium was monitored using the confusion assessment method for the intensive care unit (CAM-ICU) score for 72 h. The association between postoperative delirium and various factors was determined using the Mann-Whitney U test, and regression modelling was performed.

Results: Prospective data was recorded from 50 included patients. The incidence of delirium was 22% in the study population. Age (p=0.011) and EuROSCORE (p=0.011) significantly differed among patients developing delirium. NIRS values were similar at baselines but were significantly different at the onset of CPB (p=0.013), weaning off CPB (p<0.001). The NIRS values varied considerably from baseline at a minimum temperature of hypothermic CPB (0.002) among patients who subsequently developed postoperative delirium. Oxygen delivery indexed to body surface area delivery of oxygen (DO₂) was not associated.

Conclusion: Significant variations in cerebral NIRS, a continuous non-invasive technique for measuring cerebral tissue oxygenation, are associated with the incidence of postoperative delirium. Age and EuroSCORE2 are significantly associated with postoperative delirium.

Keywords: Cardiopulmonary bypass, cerebral tissue oximetry, postoperative delirium

References:

1. Kunst G, Gauge N, Salaunkey K, Spazzapan M, Amoako D, Ferreira N, et al. Intraoperative Optimization of depth of anesthesia and cerebral oxygenation in elderly patients undergoing coronary artery bypass graft surgery—A randomized controlled pilot trial. J Cardiothorac Vasc Anesth 2020;34:1172–81.

2. Al Tayar A, Abouelela A, Mohiuddeen K. Can cerebral regional oxygen saturation be a perfusion parameter in shock? J Crit Care 2017;38:164–7.

ABS1067

Variations in intracranial pressure during cardiopulmonary bypass assessed by serial measurements using derived optic nerve sheath diameter (ONSD) and its association with postoperative delirium

Diksha Lakhotra, Dr D V Bhargava, Dr VS Joshi, Dr Rahul Yadav

Armed Forces Medical College, Pune

Email: Dikshalakhotra@gmail.com

Background and Aims: Cardiopulmonary bypass (CPB) associated hypothermia, haemodilution, acid-base changes, and non-pulsatile flow could be related to variations in intracranial pressure.^[1,2] We aimed to assess intracranial pressure (ICP) changes among patients during the hypothermic phase of CPB for cardiac surgery using optic nerve sheath diameter (ONSD) by ultrasound (USG) as a surrogate.

Methods: In this prospective, observational study, adults undergoing elective cardiac surgery using CPB at tertiary care centres were enrolled. Baseline demographic characteristics were noted after institutional ethics committee approval and informed written consent. Optic nerve sonography was performed using a standard technique described in the literature at various points during the CPB (pre-CPB, on CPB at minimum temperature, after rewarming on CPB, and after the post-CPB period). Postoperative Delirium was assessed up to 48 h by Confusion assessment method for intensive care unit (CAM-ICU) score. Variations in ONSD at various phases of CPB between patients who subsequently developed delirium and others were analysed using the Wilcoxon test. Other perioperative characteristics were analysed using the Mann-Whitney U test.

Results: Of 26 patients included, 15% developed delirium. Preoperative characteristics (Age (p=0.234), gender (p = 0.5), European system for cardiac operative risk evaluation score 2 (p=0.049), CPB time (p=0.89), and ONSD at baseline were similar in patients developing delirium and others. A significant change in ONSD mean (standard deviation [SD]) was noted during hypothermic CPB when compared to pre-CPB values (baseline) 0.483(0.001) vs 0.52(0.001); P<0.001) in patients developing postoperative delirium. Similar changes in mean (SD) were observed at rewarming when compared to baseline (0.54(0.001) vs 0.52(0.001); p<0.001).

Conclusion: We found that significant changes in ICP occur during the hypothermic CPB period of cardiac surgery. These changes, especially at minimum temperature and rewarming, significantly differ among patients developing delirium in the postoperative period.

Keywords: Cardio-pulmonary bypass, optic nerve sheath diameter, postoperative delirium

References:

1. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension: I. Experimental study. Pediatr Radiol 1996; 26: 701–5.

2. Nollert G, Reichart B. Cardiopulmonary bypass and cerebral injury in adults. Shock 2001;16:16-9.

NEURO ANAESTHESIA

ABS0108

Comparison of propofol and dexmedetomidine on intracranial pressure changes by measuring optic nerve sheath diameter during laparoscopic surgery

Santhosh Kumar, Vidhu Bhatnagar, RS Rajput

INHS ASVINI (Navy Hospital)

Email: drssanthosh189@gmail.com

Background and Aims: Laparoscopic surgery involves creating a carbon dioxide pneumoperitoneum to facilitate a clear surgical view, which results in elevated intracranial pressure (ICP).^[1,2] The study aimed to find if any difference exists in the effects of propofol and dexmedetomidine on intracranial pressure during pneumoperitoneum.

Methods: A randomised, double-blind clinical trial was conducted on 60 adult patients scheduled for elective laparoscopic surgery. Institutional ethics committee approval was obtained. Administration of dexmedetomidine 0.5 µg/kg/h infusion to 30 patients and propofol 100 µg/kg/min infusion to 30 patients, post pneumoperitoneum, and balanced anaesthesia (minimum alveolar concentration 0.6-0.9). Optic nerve sheath diameter (ONSD) was measured with ultrasonography (USG) at four time points: after induction and before the creation of pneumoperitoneum (baseline value), the second time point was 0-15 min interval after the creation of pneumoperitoneum, third time point was 15-60 min interval after the creation of pneumoperitoneum and final time point was after insufflation of pneumoperitoneum.

Results: The demographic characteristics and baseline ICP levels were comparable. Paired t-test was applied to the readings, and results were drawn. During laparoscopic surgery, the dexmedetomidine group demonstrated significantly lower intraoperative ICP values than the propofol group (p < 0.05).

Conclusion: Dexmedetomidine decreased ICP better than propofol in patients undergoing laparoscopic surgery. However, further studies with larger sample sizes and longer follow-up periods are warranted to confirm these findings and explore dexmedetomidine’s safety and long-term effects on ICP.

Keywords: Dexmedetomidine, intracranial pressure, propofol

References:

1. Geng W, Chen C, Sun X, Huang S. Effects of sevoflurane and propofol on the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a randomized controlled clinical studies. BMC Anesthesiol 2021;21:30.

2. Sujata N, Tobin R, Tamhankar A, Gautam G, Yatoo AH. A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anaesthesia in robot-assisted laparoscopic pelvic surgery. J Robot Surg 2019;13:267–273.

ABS0402

Anaesthetic management for intraoperative neural monitoring in head and neck surgeries: an observational study

Remi Sebastian, Kumara AB

Shimoga Institute of Medical Sciences, Shimoga

Email: remisebastian2013@gmail.com

Background and Aims: Intraoperative neural monitoring (IONM) can prevent iatrogenic nerve injuries following head and neck surgeries. During IONM, neuromuscular blocking agents can interfere with electromyography signals.^[1,2] The study aimed to evaluate the effectiveness of various regimes of neuromuscular blocking agents (NMBAs) and sedative-hypnotics with train of four (TOF) monitoring to facilitate IONM.

Methods: This observational study was conducted at our institute after ethics committee approval and written informed consent. General anaesthesia (GA) was induced, tracheal intubation was performed with an initial dose of muscle relaxant, and GA was maintained with inhalational agents and analgesic (propofol/dexmedetomidine/fentanyl/ketamine infusions) without using a maintenance dose of NMBA. The level of neuromuscular blockade was assessed using TOF monitoring. IONM was measured using Medtronic NIM-Neuro®3.0 nerve monitoring systems. After adequate reversal, the patient was extubated and observed for residual paralysis, depth of sedation (Ramsay sedation score), post-operative pain (visual analogue scale [VAS] score), incidence of postoperative nausea/vomiting (PONV), surgeon satisfaction score, and other adverse effects.

Results: The study enrolled 40 patients with a mean age of 33.51 years. A higher incidence of hypotension was recorded with propofol and dexmedetomidine infusion (17/25 cases that had intraoperative hypotension) as compared to dexmedetomidine and fentanyl infusion. Approximately 40% of patients reported a VAS score ≥ 4 at 30 min. Almost 55% of patients reported a Ramsay sedation score > 2 at 30 minutes. Post-extubation bronchospasm was observed in one case. There was no incidence of PONV or residual muscle paralysis. The average surgeon satisfaction score was 4.25 on a scale of 5.

Conclusion: Propofol and dexmedetomidine maintenance infusion following an initial NMBA dose with TOF monitor provided better IONM surgical conditions. Depth of anaesthesia monitoring was beneficial in optimally dosing maintenance anaesthetic agents.

Keywords: Dexmedetomidine, general anaesthesia, propofol

References:

1. Mangia LRL, Santos VM, Mansur TM, Wiemes GRM, Hamerschmidt R. Facial Nerve Intraoperative monitoring in otologic surgeries under sedation and local anaesthesia - A Case Series and Literature Review. Int Arch Otorhinolaryngol 2020;24:e11-e17.

2. Choe WJ, Kim JH, Park SY, Kim J. Electromyographic response of facial nerve stimulation under different levels of neuromuscular blockade during middle-ear surgery. J Int Med Res 2013;41:762-70.

ABS0567

Anaesthetic management of patients undergoing constructive repair for craniosynostosis

Sabitha R, Prabha Udayakumar

Sri Ramakrishna Hospital, Coimbatore

Email: sabitharamasamy06@gmail.com

Background and Aims: Craniosynostosis, premature fusion of skull sutures, results in an abnormally shaped head. Presentations include raised intracranial pressure (ICP) due to hydrocephalus, craniocerebral disproportion, and abnormal cerebral venous drainage.^[1,2] This study was undertaken to analyse challenges associated with the induction and maintenance of anaesthesia for corrective repair.

Methods: This retrospective case series study was performed to observe the constructive repair for craniosynostosis over six years. Data was collected after getting institutional ethics committee approval and informed written consent. Preoperative anaesthesia assessment, including clinical evaluation and laboratory investigations, was noted. Intraoperative mode of anaesthesia and haemodynamic monitoring documented in the case sheets were recorded. Details about the postoperative follow-up in the intensive care unit (ICU) and the postoperative ward were also recorded. All these data were analysed.

Results: A total of 10 cases were analysed in this study. Two children required cranial vault reconstruction, and eight children underwent cranioplasty. The raised ICP was not seen. All cases were taken in endotracheal general anaesthesia (ETGA). Difficult airways were seen in two patients, managed by proper positioning and inhalational induction of anaesthesia. The mean duration of surgery was 5 h 15 min. None required postoperative ventilatory support. Blood transfusion was needed in children who underwent cranial vault reconstruction. Intraoperative haemodynamic changes were minimal and managed with crystalloids.

Conclusion: Craniosynostosis requires a neurological intervention and a prolonged duration of general anaesthesia. The primary anticipated complications were managed by efficient preoperative assessment, intraoperative monitoring and fluid management.

Keywords: Anaesthesia, craniosynostosis, intracranial pressure

References:

1. Thomas K, Hughes C, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: A review. Part 1 Paediatr Anaesth 2012;22:1033–41.

2. Lionel KR, Moorthy RK, Singh G, Mariappan R. Anaesthetic management of craniosynostosis repair - A retrospective study. Indian J Anaesth 2020;64:422-5.

ABS0933

Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumours: a randomised controlled exploratory study

Shivam Shekhar, Nishant Goyal, Anissa Atif Mirza, Sanjay Agrawal

AIIMS, Rishikesh

Email: shivam171987@gmail.com

Background and Aims: Stable cerebral haemodynamics during neuroanaesthesia gives surgeons a relaxed brain. Dexmedetomidine and lignocaine as adjuvants can fulfil these criteria, but literature comparing the two is lacking.^[1,2] The study’s primary objective was to compare intraoperative haemodynamic variation, response to the noxious stimulus of surgery and postoperative pain. The secondary objectives were brain relaxation score, the incidence of postoperative cognitive dysfunction, quality of recovery scores and effects on extubation criteria.

Methods: The institutional ethics committee approved the study and registered it with the Clinical Trials Registry-India (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients, fulfilling inclusion criteria. They were divided into three groups to receive intravenous infusion of dexmedetomidine 1 µg/kg over 15 minutes followed by infusion at rate of 0.5 µg/kg/h (Gr D), intravenous injection of lignocaine 2mg/kg over 15 min followed by infusion at rate of 1.5 mg/kg/h (Group L) and intravenous infusion of normal saline at rate of 4-8 ml/h till skin suturing (Group N). Standard anaesthesia technique was employed for all cases. SPSS v23 (IBM Corp.) was used for data analysis.

Results: There was a significant difference between groups regarding intraoperative haemodynamic variations, brain relaxation score, extubation criteria, postoperative pain and quality of recovery. The difference between the change in preoperative and postoperative (12 h and 24 h) stress hormone values was statistically insignificant[Figure 1].

Figure 1.

Change in mean systolic blood pressure with intravenous infusion of dexmedetomidine (Group D), lignocaine (Group L) and normal saline (Group N) during the perioperative period

Conclusion: Dexmedetomidine has a better profile than lignocaine for preventing haemodynamic variations and improving post-operative recovery scores.

Keywords: Craniotomy, dexmedetomidine, lignocaine

References:

1. Soliman RN, Hassan AR, Rashwan AM, Omar AM. A prospective, randomised controlled study to assess the role of dexmedetomidine in patients with supratentorial tumours undergoing craniotomy under general anaesthesia. Middle East J Anaesthesiol 2011;21:23-33.

2. Kothari D, Tandon N, Singh M, Kumar A. Attenuating circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space-occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res 2014;8:78-82.

CHRONIC PAIN

ABS0248

Comparison of pre-emptive ultrasound-guided thoracolumbar interfascial plane block with c-arm guided dorsal ramus nerve block in lumbar spine surgeries - a randomised controlled trial

R Venkatraman, K Karthik, KY Aravindhan, L Gayathri

SRM Medical College Hospital and Research Centre

Email: drvenkat94@gm

Background and Aims: This study compared ultrasound-guided thoracolumbar interfascial plane (TLIP) block and C-arm guided dorsal ramus nerve (DRN) block in lumbar spine surgeries.

Methods: This prospective, observer-blinded, randomised controlled trial involved 90 patients divided into three groups: Group U (TLIP block), Group X (DRN block), and Group C (no block). All groups received standardised general anaesthesia. Morphine was administered via patient-controlled analgesia (PCA). Morphine consumption within the first 24 h, time to first morphine request, and the need for intraoperative fentanyl were recorded. Statistical analysis was performed using appropriate statistical tests.

Results: Demographics and surgical characteristics were similar among the groups. Group U and Group X showed significantly lower morphine consumption, 6.43 (2.84) mg and 6.20 (2.82) mg, respectively, compared to Group C, 14.23(1.14) mg, P<0.001, indicating better pain control. Group U and Group X also had a significantly longer duration of postoperative analgesia, 433.02(181.01) min and 451.67(161.61) min, respectively, compared to Group C 151.11(31.02) min, P<0.001. Fewer patients in Group U and Group X required additional intraoperative fentanyl compared to Group C. Heart rate and blood pressure were stable in Groups U and X.

Conclusion: Both Ultrasound-guided TLIP Block and C-Arm guided DRN Block demonstrated superior postoperative analgesia, with reduced morphine consumption, prolonged analgesia duration, and fewer intraoperative fentanyl requirements compared to local infiltration. Groups U and X also exhibited better haemodynamic stability at specific time points.

Keywords: Block, postoperative pain, thoracolumbar interfascial plane

References:

1. Pavithran P, Sudarshan PK, Eliyas S, Sekhar B, Kaniachallil K. Comparison of the thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries – A prospective double-blinded randomised controlled trial. Indian J Anaesth 2022; 66:436-41.

2. Xu JL, Tseng V, Delbello D, Pravetz MA. Thoracolumbar dorsal ramus nerve block using continuous multi orifice infusion catheters: A novel technique for postoperative analgesia after scoliosis surgery. Int J Spine Surg 2020;14:222-5.

ABS1105

Comparative evaluation of efficacy and safety of intra-articular injection of platelet-rich plasma with bupivacaine and steroid combination in osteoarthritis knee

Amit Kumar, Aditi, Naveen Malhotra, Neha Sinha

Pt. B D Sharma, PGIMS, Rohtak

Email: amitrana.mbbs@gmail.com

Background and Aims: Osteoarthritis (OA) of the knee causes chronic pain and adversely affects the individual’s functioning or well-being. Treatment aims to relieve symptoms, improve joint mobility and function, and optimise the quality of life.^[1,2]

Methods: Fifty patients (>50 years) diagnosed with OA knee not responding to conservative treatment were randomised to receive fluoroscope guided 8ml of 0.5 % bupivacaine plus 1 ml of triamcinolone (40 mg) in Group I and fluoroscopic-guided 6 ml of platelet-rich plasma prepared by collecting 20 ml of patient’s blood in Group II. Outcome measures were assessment of pain score using the Numeric Rating Scale (NRS, 0-10), Western Ontario and McMaster Universities Arthritis (WOMAC) index, patient satisfaction and side effects, if any.

Results: There was a significant improvement in the numeric rating scale (NRS) in both groups at all time intervals (p < 0.05). Substantially lower pain scores and WOMAC Score were observed at the half hour, 2 weeks and 1 month in group I while at 2 months and 3 months in group II. Patient satisfaction was both clinically and statistically better in Group II.

Conclusion: Fluoroscope-guided intra-articular injection of corticosteroids with bupivacaine and platelet-rich plasma are safe and effective techniques for managing symptomatic osteoarthritis knee. Both these techniques provide good pain relief and improved physical disability to the patients. Intra-articular injection of platelet-rich plasma provides a sustained and longer improvement.

Keywords: Intraarticular injection, osteoarthritis, platelet-rich plasma

References:

1. Glynn LG, Mustafa A, Casey M, Krawczyk J, Blom J, Galvin R, et al. Platelet-rich plasma (PRP) therapy for knee arthritis: a feasibility study in primary care. Pilot Feasibility Stud. 2018; 4:93. doi: 10.1186/s40814-018-0288-2.

2. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 2001;45:453-61.

ABS0323

A randomized controlled trial to compare the conventional and revised anatomical landmarks for ultrasound-guided cooled radiofrequency ablation of genicular nerves in patients with chronic knee osteoarthritis

Divya V, Nitin Hayaran, Preeti Goyal Varshney

Lady Hardinge Medical College

Email: divyavelu777@gmail.com

Background and Aims: Cooled radiofrequency ablation targeting the genicular nerves is a successful minimally invasive treatment for chronic knee osteoarthritis.^[1,2] This study compares revised anatomical landmarks over conventional landmarks to better capture the nerves.

Methods: The study was carried out in 100 patients, age ≥ 45 years, of either sex, with chronic knee osteoarthritis≥grade II, randomised into two groups of 50 each, namely group C (conventional landmarks) and group R (revised landmarks). The superior medial, superior lateral and inferior medial genicular nerves were targeted using a high-frequency linear ultrasound probe and a cooled radiofrequency thermocouple cannula. Baseline Oxford Knee Score (OKS) and Numerical Rating scale (NRS) scores were taken before the procedure and at 1, 4, and 12 weeks after.

Results: Both groups were comparable in demography and baseline scores. The median OKS of group R at 1, 4 and 12 weeks after the procedure was better than group C, which was also statistically significant (p<0.001). The median NRS of both the groups was comparable at 1 and 4 weeks, while it was better and statistically significant (p<0.001) at 12 weeks for group R.

Conclusion: This randomised controlled trial to compare the efficacy of USG-guided cooled radiofrequency ablation of genicular nerves showed that the revised anatomical landmarks provide better capture of the nerves than the conventional landmarks, leading to better pain relief and functional outcome.

Keywords: Cooled radiofrequency, knee osteoarthritis, radiofrequency ablation

References:

1. Fonkoue L, Behets CW, Steyaert A, Kouassi JK, Detrembleur C, De Waroux BL et al. Current versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model. Reg Anesth Pain Med 2020; 45:603-9.

2. Fonkoue L, Steyaert A, Kouame JK, Bandolo E, Lebleu J, Fossoh H et al. A Comparison of genicular nerve blockade with corticosteroids using either classical anatomical targets vs revised targets for pain and function in knee osteoarthritis: a double-blind, randomised controlled trial. Pain Med 2021; 22:1116-26.

ABS1107

To compare radiofrequency thermocoagulation of ganglion impar with the block using a combination of local anaesthetic and steroid in chronic perineal pain

Vaishali Phogat, Naveen Malhotra, Neha Sinha, Charan N

Pt B. D. Sharma, PGIMS, Rohtak

Email: vaishaliphogat019@gmail.com

Background and Aims: Ganglion Impar block has been used in the treatment of chronic intractable pelvic and perineal pain.^[1,2] We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid to manage chronic perineal pain, resultant pain relief, and the patient’s self-reported belief about its efficacy and side effects or complications.

Methods: Forty patients attending the pain management centre, of either sex in the age group 20-70 years, were assessed by history, physical examination and pain pattern consistent with chronic perineal pain, with malignancy ruled out and failure to respond to conservative treatment. The patients were randomly divided into Group-I(n=20): They were administered ganglion Impar block using a drug mixture comprising 8 ml of 0.5% bupivacaine plus 80mg of triamcinolone acetate and Group-II(n=20): Patients received conventional radiofrequency treatment (RFT) of ganglion Impar at 80°C, under fluoroscopic guidance. The outcome was assessed using the numeric rating scale (NRS) and Patient Global Impression of Change (PGI C) scale.

Results: There was a statistically and clinically significant improvement in pain score after ganglion Impar block in both groups at all time intervals during the study period (p<0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II than group I at all time intervals throughout the study period (p<0.05). Four patients in group I required a second ganglion Impar block during the three-month study period.

Conclusion: To conclude, both the techniques of injection, i.e. fluoroscope-guided ganglion Impar block using corticosteroids and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. Concerning improvement in pain relief, patient’s self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation was better as compared to fluoroscopy-guided ganglion Impar block using corticosteroids and local anaesthetic.

Keywords: Chronic perineal pain, ganglion Impar, radiofrequency thermocoagulation

References:

1. Li CB, Fang SP, Chen YL, Huang Y, Yao XY, Ge XY et al. The efficacy and safety of the ganglion Impar block in chronic intractable pelvic and perineal pain: a systematic review and meta-analysis. Int J Clin Exp Med 2016; 9:15746-54.

2. Usmani H, Dureja GP, Andleeb R, Tauheed N, Asif N. Conventional radiofrequency thermocoagulation vs pulsed radiofrequency neuromodulation of ganglion Impar in chronic perineal pain of nononcological origin. Pain Medicine 2017; 18:1–9.

ABS0462

To assess the adequacy of analgesics in cancer pain management- A cross-sectional survey

Shivangi Sharma, Sandip Thorat

Shri Bhausaheb Hire govt medical college

Email: shivangibps@gmail.com

Background and Aims: With the increasing incidence of cancer, pain remains a common symptom. Cancer pain management, an essential component of oncological care, remains suboptimally treated globally.^[1,2] This study aimed to assess analgesic adequacy in cancer pain management and to improve quality of life.

Methods: A sample of 152 patients with cancer aged 19-85 years were recruited, and a questionnaire was administered based on demographics, diagnosis, comorbidities, pain, and treatment. Cancer was classified anatomically. Pain was classified as neuropathic/physical type, which was further classified as totally/partially/poorly controlled. The pain management index was calculated to link the pain severity rating with the grade of analgesics prescribed based on the World Health Organization’s (WHO’s) analgesic ladder. A pain management index of 0 to +3 was considered adequate, and -3 to 0 was regarded as inadequate pain management.

Results: Approximately 53.9% of patients complained of pain, of which 76.9% had physical type. The mean pain score was 2.24, with a range of 0-10 and was higher among genitourinary cancers, followed by head and neck cancers. Patients had moderate severity of pain (28.9%). Of people who complained of pain, the majority (56.1%) were prescribed opioids, and this finding was statistically significant.

Conclusion: Univariate analysis of data revealed that as the severity of pain increased, the percentage of inadequate management also increased, and the difference in proportion was found to be statistically significant. Hence, cancer pain management remains suboptimal in India.

Keywords: Cancer, opioid analgesics, pain management

References:

1. Balakrishnan K, Goswami J, Koshy RC, Hariharan U, Srivastava D, Salgaonkar S. Newer frontiers in onco-anaesthesia and palliative medicine. Indian J Anaesth 2023;67:71-77.

2. Thota RS, Ramkiran S, Singh S, Damani A, Wajekar AS, Koyyalagunta L. A systematic review and quality analysis of cancer pain guidelines. Indian J Anaesth 2023;67:1051-60.

ABS1110

Effect of the COVID-19 pandemic on the management and pain profile of patients with chronic pain

Neha Sinha, Charan, Naveen Malhotra, Deepika Budhwar

PGIMS, Rohtak

Email: dr.nehasinha01@gmail.com

Background and Aims: The COVID-19 pandemic left many patients overburdened with chronic pain and delayed their ongoing treatment.^[1,2] We sought to study the effects of the pandemic on management.

Methods: This prospective, observational study was conducted on 150 patients aged > 18 years, of either gender, presenting to a pain management centre with chronic pain conditions. Responses were recorded against a designed questionnaire, and data was analysed.

Results: Most of the patients were females from the middle socio-economic status, with the most common sites of pain being the lower back, knee and neck. There was a significant increase in the intensity and frequency of pain, also affecting the 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-ups in the outpatient department, and most patients continued taking over-the-counter drugs.

Conclusion: There is an urgent need to develop various training programmes for healthcare providers and patients to use resources better and provide uninterrupted and safe treatment services for chronic pain patients.

Keywords: Back pain, chronic pain, COVID-19, knee

References:

1. Raja S N, Carr D B, Cohen M, Finnerup N B, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020; 161:1976-82.

2. Javed S, Hung J, Huh BK. The impact of COVID-19 on chronic pain patients: a pain physician’s perspective. Pain Manag 2020; 10:275–7.

ABS1152

Impact of opioid-free anaesthesia using multimodal approach on peri-operative pain and patient recovery in laparoscopic surgeries: A prospective randomised comparative study

Shwetha AH, Shwetha AH, Shankar K

Rajarajeswari Medical College And Hospital

Email: ahshwetha@gmail.com

Background and Aims: Opioids are commonly used intravenous analgesics with numerous side effects and significantly impaired sleep.^[1,2] This study assesses the impact of a unique opioid-free analgesic mixture on perioperative pain and sleep quality in patients undergoing laparoscopic surgery compared to anaesthesia with opioids.

Methods: We enrolled 68 patients undergoing elective laparoscopic surgery. The trial was registered CTRI/2023/06/053482. Patients were randomly assigned into either Group-OFA: received tablet Pregabalin 150mg 1-h pre-induction; Intravenous ketorolac 30mg, MgSO4 30mg/kg, lidocaine 1.5mg/kg, dexamethasone 8mg in 100ml saline (physically stable mixture) half-hour preinduction. Inj dexmedetomidine 1µg/kg in 100 mL saline over 10 min preinduction. In Group OA, patients received a placebo capsule 1 hour before pre-induction. 100 mL of normal saline was administered half-hour preinduction over 10 minutes. All patients received ultrasound-guided bilateral transversus abdominis plane block with 20ml 0.125% bupivacaine before extubation. Patients were evaluated for perioperative pain, postoperative sleep, nausea, vomiting, analgesia duration, opioid requirement, patient satisfaction and adverse effects. The rescue analgesia used was intravenous paracetamol.

Results: Intraoperative fentanyl requirement was none in group OFA. The postoperative visual analogue scale (VAS) score was significantly lower in Group OFA than in Group OA (P <0.05). Group OFA had a significantly higher duration of analgesia 10.1(1.73) vs 8.50(1.54), lesser postoperative nausea (P=0.015), vomiting (P=0.039) and paracetamol consumption 2.15(0.44) vs 2.44(0.5). Patients were significantly more comfortable according to the comfort VAS score in the Group OFA (P<0.05). Sleep quality and adverse reactions were comparable in both groups.

Conclusion: The opioid-free multimodal regime is a safe and effective method that has significantly higher postoperative pain relief and fewer side effects than the standard opioid-based anaesthesia in laparoscopic surgeries.

Keywords: Laparoscopic surgery, multimodal analgesia, opioid-free anaesthesia

References:

1. Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anaesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomised, double-blinded study. Braz J Anesthesiol 2015;65:191-9.

2. Chen L, He W, Liu X, Lv F, Li Y. Application of opioid-free general anaesthesia for gynaecological laparoscopic surgery under ERAS protocol: a non-inferiority randomised controlled trial. BMC Anesthesiol 2023;23:34. doi: 10.1186/s12871-023-01994-5.

OBSTETRIC ANAESTHESIA

ABS0115

Comparative analysis of two different doses of phenylephrine with normal saline in prevention of haemodynamic responses of oxytocin during caesarean section under spinal anaesthesia: A prospective randomised study

Supriya Gandotra, Medha Shukla

Govt. Medical College, Jammu

Email: supriyagandotra19@gmail.com

Background and Aims: During caesarean section under spinal anaesthesia, phenylephrine co-administration inhibits oxytocin-induced hypotension, but greater dosages can produce reflex bradycardia.^[1,2] This study compares the efficacy of two doses of phenylephrine 75 and 100 μg to prevent oxytocin-induced haemodynamic responses.

Methods: In this prospective randomised study, 120 singleton full-term pregnant patients of American Society of Anesthesiologists (ASA) physical status II scheduled for elective lower segment caesarean section (LSCS) under spinal anaesthesia were randomly allocated to three groups of 40 each - Group N: oxytocin 3 U and normal saline, Group P75: oxytocin 3U and phenylephrine 75 μg, Group P100: oxytocin 3 U and phenylephrine 100 μg administered intravenously over 30 s after baby extraction. The incidence of hypotension and tachycardia (the primary outcome), rescue vasopressor requirement, fluid administered and side effects were recorded. Analysis of variance, least significant difference test, Chi-square test, or Fisher’s exact test was applied for statistical analysis.

Results: Demographic parameters were comparable among the groups. The incidence of hypotension was Group N- 92.5%, Group P75- 47.5%, Group P100- 25%), total dose of rescue vasopressor (Group N-128.8(91.90) μg, Group P75- 46.3 (57.05) μg, Group P100- 17.5 (33.11) μg and total intra-operative fluid administered (Group N-1352.5(137.42) ml, Group P75-1192.5(114.10) ml, Group P100-1135.0(66.22) ml was significantly lower in group P100 as compared to Group N and Group P75.

Conclusion: Co-administration of phenylephrine 100 µg with oxytocin 3U is better as compared to phenylephrine 75 µg with oxytocin 3 U in maintaining haemodynamic parameters with no increase in the incidence of side effects like bradycardia or hypertensive episodes.

Keywords: Hypotension, oxytocin, phenylephrine

References:

1. Gangadharaiah R, Duggappa DR, Kannan S, Lokesh SB, Harsoor K, Sunanda KM, et al. Effect of co-administration of different doses of phenylephrine with oxytocin on preventing oxytocin-induced hypotension in Cesarean section under spinal anaesthesia: A randomised comparative study. Indian J Anaesth 2017;61:916-22.

2. Mohta M, Kumar V, Agarwal R, Chilkoti G, Duggal S. Efficacy of Phenylephrine in Preventing Hemodynamic Responses of Oxytocin during Elective Cesarean Section: A Randomized, Double-Blind, Controlled Trial. Annals of the National Academy of Medical Sciences (India) 2019; 55:48-53.

ABS0191

Efficacy of single shot spinal block for labour analgesia in multiparous parturient

Sadam Hari Priya, Udaya Bhaskar, Deepak C P, Ohan K

PESIMSR, Kuppam

Email: sadamharipriya1396@gmail.com

Background and Aims: Most women experience moderate to severe pain during labour and delivery, often requiring some form of pharmacological analgesia. Lack of proper psychological preparation combined with fear and anxiety can significantly enhance the patient’s sensitivity to pain and further add to the discomfort. Intrathecal local anaesthetics provide good pain relief with limited motor block and do not limit ambulation when combined with opioids.^[1,2]

Methods: Labour pain is quantified using a visual analogue scale (VAS) score. All participants were randomised to Group A [received intrathecal anaesthetic: 2.5 mg bupivacaine 0.5% (0.5ml) + 25 µg fentanyl (0.5 mL)], and Group B [received 2.5mg bupivacaine 0.25% (1mL)] given through L2-L3 or L3-L4 space using 25 G spinal needle. Regular monitoring included maternal vital signs, uterine contraction and foetal heart rate tracing. Pain scores, sensory level, motor block, side effects and maternal satisfaction were recorded. Satisfactory analgesia was defined as decreased pain scores of 3 within 20 minutes after injection. The number of participants requesting additional analgesia and the duration of the spinal block were recorded.

Results: In this study, 120 participants were randomised into two groups, each with 60 participants. Following spinal injection, 57(95%) in Group A and 54(90%) in Group B experienced a visual analogue scale (VAS) score ≤ 3, and 3 (5%) in Group A and 6 (10%) in Group B experienced a VAS score of 3 - 5. Administration of spinal analgesia did not affect ambulation in 55 (92%) in Group A and 54 (90%) in Group B, with mild effect in 5 (8%) in Group A and 6 (10%) in Group B. Intrathecal analgesia did not severely limit ambulation in any patients. Patient satisfaction was reasonable in 52(87%) in Group A and 50(83%) in Group B, average satisfaction in 5(8%) in Group A and 7(12%) in Group B and poor satisfaction in 3(5%) in Group A, 3(5%) in Group B women.

Conclusion: Bupivacaine with fentanyl provides more effective analgesia with less limitation of ambulation for longer durations compared to plain bupivacaine. Both groups had a low incidence of foetal bradycardia and maternal side effects.

Keywords: Bupivacaine, fentanyl, spinal anaesthesia

References:

1. Viitanen H, Viitanen M, Heikkilä M. Single-shot spinal block for labour analgesia in multiparous parturients. Acta Anaesthesiol Scand 2005;49:1023-9.

2. Minty RG, Kelly L, Minty A, Hammett DC. Single-dose intrathecal analgesia to control labour pain: is it a valuable alternative to epidural analgesia? Can Fam Physician 2007;53:437-42.

ABS0215

Vasopressor effect of norepinephrine and phenylephrine as prophylactic bolus dose for prevention of hypotension following subarachnoid block among women undergoing elective caesarean section: an observational, cross-sectional study

Anindita Debnath, Dr Biswajit Sutradhar

Agartala Govt Medical College and GBP Hospital

Email: debnathanindita88@gmail.com

Background and Aims: Maternal hypotension following anaesthesia can lead to severe sequelae to both mother and foetus. Published literature has shown inconclusive results of the vasopressor effect of norepinephrine and phenylephrine.^[1,2] The study aimed to compare the vasopressor effects of phenylephrine and norepinephrine on maternal haemodynamics and the requirements for supplementary doses.

Methods: A cross-sectional study was conducted in 80 parturients (each group 40 patients) undergoing elective caesarean section under subarachnoid block from July 2022 to June 2023. Data were collected in predesigned proforma and analysed using SPSS 21.0. Both descriptive and inferential statistics were used to express the data. Student’s t-tests and chi-square tests were used to examine the data.

Results: A mean age of 26.7(3.2) years and 24.4(5.8) years in the norepinephrine and phenylephrine groups were enroled in the study, respectively. There was no difference in the heart rate changes (p = 0.084), but mean arterial pressure was significantly different in the norepinephrine group than in phenylephrine (p=0.001). Bradycardia occurred in 2% of patients receiving norepinephrine and 11% in patients receiving phenylephrine (p=0.03). The incidences of nausea/vomiting were comparable between the two groups (p=0.06). The total intermittent bolus dose requirement was similar (1.51(0.79) vs 1.32(0.45) in both groups (p=0.075)[Table 1]

Table 1.

Comparison of haemodynamics and side effects between the study groups

Haemodynamic parameters and side effects	Study group		P
	Norepinephrine	Phenylephrine
Heart rate/min mean (SD)	88.23 (3.48)	91.08 (2.91)	0.08
Systolic blood pressure (mmHg) mean (SD)	112.5 (3.6)	119.1 (1.9)	0.001
Bradycardia (%)	2%	11%	0.03
Nausea/Vomiting (%)	1%	5%	0.06
No. of bolus requirements mean (SD)	1.51 (0.79)	1.32 (0.45)	0.07

SD: Standard deviation

Conclusion: Norepinephrine is as effective as phenylephrine for maintaining blood pressure and heart rate after sub-arachnoid block anaesthesia for caesarean delivery.

Keywords: Norepinephrine, phenylephrine, vasopressors

References:

1. Rai AV, Prakash S, Chellani H, Mullick P, Wason R. Comparison of phenylephrine and norepinephrine for treatment of spinal hypotension during elective cesarean delivery- A randomised, double-blind study. J Anaesthesiol Clin Pharmacol 2022; 38:445-52.

2. Liu P, He H, Zhang SS, Liang Y, Gao ZJ, Yuan H, Dong BH. Comparative efficacy and safety of prophylactic norepinephrine and phenylephrine in spinal anaesthesia for cesarean section: A systematic review and meta-analysis with trial sequential analysis. Front Pharmacol. 2022;13:1015325.

ABS0310

Effect of perioperative normal saline versus lactated Ringer on urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1) in preeclamptic women undergoing caesarean section- A randomised controlled trial

Saahithya. V, Aswini Kuberan, Priya Rudingwa, Anish Keepanaseril

JIPMER, Puducherry

Email: sahithyavijayan0@gmail.com

Background and aims: Intravenous fluids are administered cautiously in preeclamptic women during the perioperative period because of their predisposition to kidney injury. By measuring urinary biomarkers, we investigated whether normal saline versus Ringer lactate could affect renal function in preeclampsia.^[1,2]

Methods: We conducted this double-blinded, randomised study in 120 preeclamptic women planned for caesarean section. Pre-operative management 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 h 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 revealed that median NGAL values did not differ significantly at all time intervals. There was a weak correlation between urinary NGAL, KIM-1 levels and the total amount of fluids. The normal saline group’s pH values were statistically low, but this did not have any clinical relevance.

Conclusion: Administration of normal saline or ringer lactate did not affect the values of urinary biomarkers NGAL and KIM-1 in preeclamptic women who underwent caesarean section.

Keywords: Caesarean section, kidney injury molecule-1, preeclamptic, neutrophil gelatinase-associated lipocalin,

References:

1. Anthony J, Schoeman LK. Fluid management in pre-eclampsia. Obstet Med 2013;6:100–4.

2. Prakash J, Ganiger VC. Acute kidney injury in pregnancy-specific disorders. Indian J Nephrol 2017;27:258–70.

ABS0329

Haemodynamic effects of oxytocin and carbetocin during emergency caesarean section under spinal anaesthesia in a district-level hospital: an observational study

Masumi Ahmed, Karuna Kumar Das

Assam Medical College, Guwahati

Email: masumia32@gmail.com

Background and Aims: Carbetocin is a synthetic analogue of oxytocin with a prolonged duration of action.^[1,2] This study compares the haemodynamic effects of oxytocin and carbetocin in patients undergoing emergency lower-segment caesarean section (LSCS) under spinal anaesthesia.

Methods: In this study, 80 patients aged 18-35 were included undergoing emergency LSCS under spinal anaesthesia. By consecutive sampling, 40 patients who received 5 IU oxytocin in 50 mL normal saline over 5 min and 40 patients who received 100 microgram carbetocin in 50 mL normal saline over 5 min were included in groups ‘O’ and ‘C’, respectively. Systolic and diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation were assessed preoperatively at 1,5,10, and 15 minutes after uterotonics were given. In each group, several patients requiring vasopressors intraoperatively and postoperative haemoglobin were recorded.

Results: Based on the intragroup comparison, the oxytocin group experienced a significant increase in heart rate and a decline in blood pressure compared to the carbetocin group. Of these, 17 patients (42.5%) in the oxytocin group and 6 (15%) in the carbetocin group required additional ephedrine or mephentermine.

Conclusion: Carbetocin has minimal effect on patients’ haemodynamics, and its use can be extended as a uterotonic drug in patients susceptible to preeclampsia, haemorrhagic risk factors and hypotension.

Keywords: Caesarean section, carbetocin, oxytocin

References:

1. Bahr MH, Abdelaal Ahmed Mahmoud M Alkhatip A, Ahmed AG, Elgamel AF, Abdelkader M, Hussein HA. Hemodynamic effects of oxytocin and carbetocin during elective cesarean section in preeclamptic patients under spinal anaesthesia: a randomized, double-blind controlled study. Anesth Pain Med 2023;13:e128782. doi: 10.5812/aapm-128782.

2. Rosseland LA, Hauge TH, Grindheim G, Stubhaug A, Langesæter E. Changes in blood pressure and cardiac output during cesarean delivery: the effects of oxytocin and carbetocin compared with placebo. Anesthesiology 2013; 119:541–551.

ABS0362

Comparative evaluation of intravenous bolus of phenylephrine versus intravenous bolus of noradrenaline for treatment of hypotension in patients undergoing elective caesarean section

Kavya D, Shivakumar G, Divakar S R, Kiran A V

Mandya Institute of Medical Sciences

Email: kavyad996@gmail.com

Background and Aims: Hypotension following spinal anaesthesia for caesarean section is common despite adequate fluid loading. Phenylephrine is recommended to treat hypotension during caesarean section.^[1,2] Our study aimed to compare the effectiveness of bolus doses of norepinephrine with phenylephrine to treat spinal hypotension during elective caesarean section.

Methods: This randomised, double-blind study was performed on 160 patients, 20 – 30 years, posted for elective caesarean section. Patients were divided into two equal groups, and in Group P, patients received an intravenous (IV) phenylephrine 50 µg bolus dose. In contrast, Group N received an infusion of noradrenaline 4 µg for treating hypotension. The primary objective was to compare the number of bolus doses of phenylephrine and noradrenaline required to treat spinal hypotension. The secondary objectives were to compare the incidence of adverse outcomes in mother and foetal parameters.

Results: The total dose of vasopressors required to treat hypotension was lower in group P, 8.15(1.57) vs 52.50(10.96) in Group N, and the difference was statistically significant, P = 0.002. The incidence of bradycardia seen in the group was comparable with the groups but statistically not significant. Maternal complications and foetal parameters were similar between the two groups.

Conclusion: Intermittent boluses of phenylephrine are effective in managing spinal hypotension during elective caesarean section. The maternal complications and foetal parameters were comparable in both groups.

Keywords: Noradrenaline, phenylephrine, postspinal hypotension

References:

1. Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomised double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anaesthesia for cesarean delivery. Anesthesiology 2015; 122:736-45.

2. Sharkey AM, Siddiqui N, Downey K, Ye XY, Guevara J, Carvalho JCA. Comparison of intermittent intravenous boluses of phenylephrine and norepinephrine to prevent and treat spinal-induced hypotension in cesarean deliveries: randomised controlled trial. Anesth Analg 2019;129:1312-8.

ABS0412

CoPIT DEXA TRIAL – Comparison of postoperative nausea and vomiting between intravenous vs TAP dexamethasone for Caesarean section patients

Anirudh Elayat, Surendranath Reddy, Suryanarayanan S, Vijay Kumar Naik

Valluvanad Hospital Complex Ltd

Email: anirudhunnie7741@gmail.com

Background and Aims: Patients presenting for lower section caesarean section (LSCS) are at significant risk factor for postoperative nausea and vomiting (PONV).^[1,2] We investigated whether there was any difference in PONV episodes with different routes of administration of dexamethasone, intravenous (IV) vs transversus abdominis plane (TAP) block adjuvant.

Methods: In this study, 400 parturients undergoing LSCS were enrolled and randomised using computer-generated block randomisation. The patients were allocated into two groups (TAP and IV groups) of 200 each (by opaque sealed envelope technique) to receive 0.1mg/kg dexamethasone. Group TAP received dexamethasone and a block (20 ml 0.25% bupivacaine on each side) as an adjuvant, while Group IV received dexamethasone intravenously after administering the TAP block. Both groups were given TAP block as a part of the standard institutional protocol. PONV episodes and visual analogue scale(VAS) scores were documented for the first 24 h following surgery. IV ondansetron 0.1mg/kg was administered as a rescue anti-emetic.

Results: Both groups were comparable in age, weight, co-morbidities, and American Society of Anesthesiologists (ASA) physical status (p>0.05). The two groups had no significant difference in PONV episodes (p>0.05). However, the incidence of PONV was more critical for patients with documented pregnancy-induced hypertension (PIH) across both groups, as well as when carbetocin was used as a uterotonic agent instead of standard oxytocin (p < 0.05). The VAS scores were similar regardless of the dexamethasone administration route in either group.

Conclusion: The dexamethasone 0.1mg/kg is an effective PONV prophylactic, though clinically similar to IV ondansetron, and an effective adjuvant to TAP block, whether given as IV or along with the block.

Keywords: Caesarean section, dexamethasone, lower uterine segment, postoperative nausea and vomiting

References:

1. Akkaya A, Yildiz I, Tekelioglu UY, Demirhan A, Bayir H, Ozlu T, et al. Dexamethasone added to levobupivacaine in ultrasound-guided transversus abdominis plane block increased the duration of postoperative analgesia after caesarean section: a randomised, double-blind, controlled trial. Eur Rev Med Pharmacol Sci 2014;18:717-22.

2. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, Akbarian-Tefaghi N. The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of meperidine. Anesth Analg 2007;104:987-9.

ABS0569

Relationship between abdominal circumference and incidence of hypotension during caesarean section under spinal anaesthesia

Liya Andrews, Harish Kumar P

JSS Medical College and Hospital

Email: liyaandrews8@gmail.com

Background and Aims: Hypotension in pregnant women is an alarming factor.^[1,2] This study explores the potential link between abdominal circumference and post-spinal hypotension, aiming to identify if high abdominal circumference is a predictor requiring tailored management.

Methods: A prospective observational study was conducted on 152 patients fulfilling the inclusion criteria undergoing elective caesarean section under spinal anaesthesia. Preoperative abdominal circumference was measured, and patients were monitored for post-spinal hypotension during surgery. Statistical analysis, adjusting for confounders, explored the correlation between abdominal circumference and post-spinal hypotension.

Results: A significant association was found (p<0.05) between abdominal circumference and post-spinal hypotension. Higher abdominal circumferences correlated with increased incidence; the critical abdominal circumference above, which had an increased hypotension incidence, was 102 cm. Other secondary objectives were observed to be insignificant.

Conclusion: Abdominal circumference is a relevant predictor of post-spinal hypotension. Larger circumferences indicate a need for closer monitoring and tailored interventions during spinal anaesthesia to mitigate hypotension risk.

Keywords: Abdominal circumference, caesarean section, hypotension

References:

1. Thomard P, Morakul S, Wirachpisit N, Ittichaikulthol W, Pisitsak C. Relationship between Abdominal Circumference and Incidence of Hypotension during Cesarean Section under Spinal Anesthesia. Anesthesiol Res Pract 2020; 2020:6547927.

2. Anandani HB, Pandya MJ, Shah DV. Relationship between the abdominal circumference and incidence of hypotension during cesarean section under spinal anaesthesia. NJMR 2021; 11:62-65.

ABS1023

Role of the perfusion index in predicting post-spinal hypotension in patients scheduled for caesarean section: A prospective observational cohort study

Bhavana Jagadeesh, Sunaina Tejpal Karna, Sourabh Saigal, Vaishali Waindeshkar

AIIMS, Bhopal

Email: rinukanatt@gmail.com

Background and Aims: Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section.^[1,2] This study aimed to predict the incidence of post-spinal hypotension and preeclampsia in a standard, uncomplicated pregnancy and to determine the baseline perfusion index that correlates with post-spinal hypotension.

Methods: In this observational prospective cohort study, all the subjects were assessed preoperatively and were explained about the study. The study started once the patient came into the preoperative room. In the preoperative room, a dedicated study investigator noted the demographic data and the presence of comorbidities. The antenatal history was reported, including gravida, parity, alive children, and history of abortion. The standard American Society of Anesthesiologists monitors were attached in the operative room. The pulse oximeter was connected to the right index finger. Intravenous crystalloid (Ringer’s lactate or Normal Saline) was started at the discretion of the attending anaesthesiologist. All haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation, were recorded every three minutes after the start of intravenous fluids. The trend of the pulsatility index (PI)was observed with crystalloid.

Results: In our study cohort of parturients with normal pregnancy, the incidence of post-spinal hypotension was 39.1%. A baseline perfusion index of 3.4 had an area under the curve (AUC) of 0.792, which shows that it is a good predictor of post-spinal hypotension in parturients with normal pregnancy, with a sensitivity of 71.15% and specificity of 90.12% in the prediction of post-spinal hypotension. In our study cohort of parturients with pre-eclampsia, the incidence of post-spinal hypotension (PSH) was 5.7%. Due to the low percentage of PSH occurrence, a receiver operator curve (ROC) could not be plotted. In normal pregnancy, we observed a baseline PI of more than 3.4, a good predictor of post-spinal hypotension, with a sensitivity of 71.15% and specificity of 90.12%.

Conclusion: The incidence of PSH increased by almost five times in patients with normal pregnancy than in pre-eclamptic patients.

Keywords: Hypotension, perfusion index, pregnancy, spinal anaesthesia

References:

1. Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, et al. A pulse oximeter-derived perfusion index can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. Br J Anaesth 2013;111:235-41.

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.

PAEDIATRIC AND NEONATAL ANAESTHESIA, INCLUDING NEONATAL INTENSIVE CARE

ABS0153

Efficacy of intravenous lignocaine to prevent emergence of delirium after sevoflurane anaesthesia in children

Sai Tejaswini Kolachalam, Preethy J Mathew, Aakriti Gupta

PGIMER, Chandigarh

Email: kolachalamtejaswini@gmail.com

Background and Aims: Studies show systemic lignocaine-producing perioperative analgesia attributed to membrane stabilisation in central nervous system (CNS) subcortical areas. Emergence-delirium is ascribed to differential awakening of cortical and auditory centres during emergence.^[1,2] The effects of intravenous (IV) lignocaine on emergence delirium (ED) have not been studied so far.

Methods: A single-centre, randomised, double-blind, placebo-controlled trial was conducted after approval of the institute ethics committee. American Society of Anesthesiologists physical status I/II children of age 2 - 6 years scheduled for the elective procedure under sevoflurane anaesthesia were enrolled, allocated randomly (computer-generated block randomisation) to Lignocaine group (n=42) to receive 1.5 mg/kg IV lignocaine before turning off sevoflurane, or Saline group (n=42) who received an identical volume of 0.9% saline. The primary outcome was the incidence of emergence delirium in the post-anaesthesia care unit (PACU) assessed by the paediatric anaesthesia emergence delirium (PAED) scale. Secondary outcomes were: incidence of delirium-specific symptoms based on ED1 score, use of rescue fentanyl, and postoperative face, legs, activity, cry, and consolability (FLACC) scores and sedation.

Results: The incidence of ED [19 % (8/42) in the Lignocaine group vs 45 % (19/42) in the Saline group, absolute risk reduction=26.2(7.02, 45.36), P= 0.01] and delirium-specific symptoms (9.5% in Lignocaine group vs 35.7% in Saline group, P=0.004) were significantly less after systemic lignocaine. The requirement of rescue fentanyl was considerably lower in the Lignocaine group (16.6% vs 38.09% in the Saline group, P=0.03). The FLACC scores and sedation were similar after 10 minutes in PACU.

Conclusion: Prophylactic systemic lignocaine administered at the end of sevoflurane anaesthesia reduces the incidence of overall and specific emergence delirium in children. It also reduces postoperative pain with minimal sedation and calmer behaviour during the PACU stay.

Keywords: Anaesthesia, emergence delirium, intravenous lignocaine, sevoflurane

References:

1. Jang Y, Oh S. Intravenous Lidocaine does not Reduce Emergence Agitation or Pain after Sevoflurane Anesthesia in Children. Korean Journal of Anesthesiology 2005; 49:S14-S15.

2. Lee JY, Kim CH, Kim SH, Kim JS, Lee KY. Intravenous Lidocaine Prior to Extubation Reduces Emergence Agitation and Cough in Pediatric Adenotonsillectomy under Sevoflurane Anesthesia. Korean J Anesthesiol 2007;53:458-462.

ABS0173

Comparative study on the efficacy of ultrasound-based versus age-based calculation of uncuffed endotracheal tube size in paediatric patients.

Upashana Das, Faiza Ahmed Talukdar, Trina Sen

Gauhati Medical College and Hospital

Email: upashana245@gmail.com

Background and Aims: Age-based formulae for estimating endotracheal tube size in paediatric patients have lower accuracy, whilst airway ultrasound offers an expeditious estimation of the optimal endotracheal tube (ETT), preventing repeated intubation.^[1,2] This study hypothesised that ultrasound-assessed subglottic diameter is superior to the Pennington formula for ETT size estimation.

Methods: 100 patients, aged 2-6 years, American Society of Anesthesiologists physical status I-II, requiring general anaesthesia, were randomly allocated into two equal groups (n=50). Group A used uncuffed ETT outer diameter (OD) nearest to ultrasound assessed subglottic diameter (SD) for intubation. Group B used an age-based formula to predict uncuffed ETT’s internal diameter (ID). ETT was optimal if the air leak test showed a circuit pressure of 10-20 cm of water. A comparison of the optimally sized ETT was used with that of subglottic diameter, and the formula that predicted ETT size was done using Pearson correlation and linear regression.

Results: The mean SD 6.80(0.91) mm and mean OD of optimal ETT 7.03(0.83) mm with 78% accuracy were used in Group A. Group-B, mean ID of ETT by formula 4.71(0.52) mm, and optimal ETT used 5.18(0.52) mm, with 32% accuracy. The highest incidence (46%) of tube change was seen in Group B, with a significant association with extubation complications (P=0.01). A strong positive correlation was seen between SD and OD of optimal ETT (R=0.90) in Group-A, and Bland-Altman analysis showed a bias of 0.23mm with limits of agreement -0.55 to +1.0.

Conclusion: Ultrasound-assessed SD is more predictive of optimal ETT size than the age-based Pennington formula.

Keywords: Paediatric, subglottic, ultrasound

References:

1. Gnanaprakasam PV, Selvaraj V. Ultrasound assessment of subglottic region to estimate appropriate endotracheal tube size in pediatric anaesthesia. J Anaesthesiol Clin Pharmacol. 2017; 33(2):231–5.

2. Makireddy R, Cherian A, Elakkumanan LB, Bidkar PU, Kundra P. Correlation between the correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in the paediatric population. Indian J Anaesth 2020; 64:103–8.

ABS0503

Comparison of paediatric microcuffed endotracheal tube (internal diameter) size estimation by using ultrasound measurement of subglottic diameter versus weight and height-based formula

Summiya Sayeed Khan, G Sunanda, Prerna Bhola, R Gopinath

ESIC Medical College, Snathnagar, Hyderabad

Email: khansummiya123@gmail.com

Background and Aims: Many endotracheal tube (ETT) size estimation methods have been proposed for paediatric airways, considering the anatomical and physiological differences.^[1,2]Here, we sought to compare the ultrasound-guided (USG) sub-glottic diameter formula with a weight and height-based formula in estimating micro-cuffed ETT size.

Methods: A total of 75 paediatric patients of either sex aged between 1 year to 12 years of American Society of Anesthesiologists physical status1 I and II posted for elective surgery under general anaesthesia (GA) requiring endotracheal intubation were grouped into Group U (using ultrasonography to measure the subglottic diameter to estimate microcuffed ETT (internal diameter) size, Group W (using the weight-based formula [ID = weight (kg)/10 + 3.5 mm] and Group H (using the height-based formula [ID (mm) = height (cm)/30 + 2 mm] to compare them in estimating the size of best-fit micro cuffed ETT being used.

Results: The number of tube sizes estimated correctly in Group U was (60%) when compared to Group H (48%) and Group W (52%) with the P value (0.687). There was a strong correlation between the actual ETT size and the ETT size predicted by ultrasound in Group U (r = 0.901) and a moderate correlation in both Group H (r = 0.846) and Group W (r = 0.849). Bland-Altman analysis showed good agreement in all three groups.

Conclusion: All three methods are suitable for estimating the correct size of paediatric ETT. However, the USG estimation correlated better than the other two methods.

Keywords: Endotracheal, endotracheal tube, paediatric, size, ultrasound-guided

References:

1. Putra SR, Senapathi TG, Hartawan IG, Ryalino C, Pradhana AP. Accuracy Comparison between Four Endotracheal Tube Diameter Estimation Methods for Pediatric Patients: An Observational, Cross-sectional Study. Bali J Anaesthesiol 2022;6:177-81.

2. Hao J, Zhang J, Dong B, Luo Z. The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis. BMC Anesthesiol 2020;20:183. doi: 10.1186/s12871-020-01106-7.

ABS0607

Comparison of single-dose erector spinae plane block versus paravertebral block for pyeloplasty surgery in children – A randomised study

Raksha Kundal, Dr Nitin Hayaran, Dr Vishal Kant, Dr Maitree Pandey

AIIMS Vijaypur Jammu

Email: rakshaadi@yahoo.com

Background and Aims: Open pyeloplasty in children is associated with considerable postoperative pain. The paravertebral block (PVB) is commonly performed to control postoperative pain in such surgeries. Erector spinae plane block (ESPB) has recently been described as effective in providing postoperative analgesia in paediatric abdominal surgeries.^[1,2]This randomised, assessor-blinded study compared postoperative analgesic effects between ESPB and PVB in children undergoing pyeloplasty.

Methods: Eighty paediatric patients scheduled for elective pyeloplasty were randomly allocated to receive either ultrasound-guided (USG) ESPB or PVB. Postoperative pain evaluation was done using the face, legs, activity, cry, and controllability (FLACC) scale for children up to 7 years of age and the visual analogue scale (VAS) for children in the age group between 7 and 10 years at 0, 2, 4, 8, 12, and 24 h. The time of first rescue analgesia, the number of doses of analgesic, successful first puncture rate, and block-related complications were noted.

Results: No significant differences were noted in the FLACC/VAS scores, duration of time to first rescue analgesia [575.90 (118.81) vs. 617.05 (144.20), P=0.168], the number of rescue doses once and twice over 24 h was 72.5% versus 67.5% and 27.5% versus 32.5% (P=0.626) between ESPB vs PVB. The incidence of haematoma at the block site was higher in the PVB group (10%) compared to the ESPB group (0%) (P=0.04). The incidence of first puncture success in the block was better in ESPB (P=0.003).

Conclusion: Both ESPB and PVB can effectively control post-pyeloplasty pain in children. The ease of performing the block and the relatively lower incidence of haematoma at the block site make ESPB more advantageous.

Keywords: Child, nerve block, pain

References:

1. Naja ZM, Raf M, El El-Rajab M, Daoud N, Ziade FM, Al Al-Tannir MA, et al. A comparison of nerve stimulator-guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children. Anaesthesia 2006; 61:1064- 8.

2. Xu M, Zhang G, Gong J, Yang J. Comparison of erector spinae plane and paravertebral nerve blocks for postoperative analgesia in children after the Nuss procedure: Study protocol for a randomised controlled non-inferiority clinical trial. Trials 2022; 23:139.

ABS0610

Comparison of the efficacy of varying doses of dexmedetomidine in combination with fixed-dose of fentanyl and 0.25% levobupivacaine for caudal analgesia under ultrasound guidance in paediatric patients scheduled for herniotomy surgeries

Veeramalla Pooja, Sunil Chiruvella, Saya Raghavendra Prasad

Government Medical College, Kadapa

Email: snehabablu25@gmail.com

Background and Aims: Dexmedetomidine has been used as an adjuvant for caudal analgesia in children.^[1,2] We hypothesised that dexmedetomidine 0.75 µg/kg provides similar prolongation of postoperative analgesia as dexmedetomidine 1 µg/kg when used as an adjuvant to 0.25% levobupivacaine and fentanyl. The primary objective of the study was to evaluate the duration of analgesia.

Methods: After institutional ethical committee approval, a total number of 80 children between 2 to 6 years weighing less than 20 kg belonging to the American Society of Anesthesiologists (ASA) physical status I and II posted for herniotomy under general anaesthesia were included in the study. They were randomised into two equal groups using computer-generated random numbers. Group A: received a total volume 1 ml/kg (levobupivacaine 0.25% plus dexmedetomidine 1μg/kg plus fentanyl 1 μg/kg). Group B: received a total volume 1 ml/kg (levobupivacaine 0.25% plus dexmedetomidine 0.75 μg/kg plus fentanyl 1 μg/kg). Postoperative pain was assessed using the face, legs, activity, cry, and consolability (FLACC) scale.

Results: The total duration of analgesia was comparable in both groups (P=0.26). Only one patient in each group required rescue analgesia in 24 h (P=0.48). The differences in mean FLACC score were comparable and not statistically significant. No significant difference was observed in the incidence of haemodynamic changes or side effects.

Conclusion: Dexmedetomidine, along with fentanyl as an adjuvant to levobupivacaine, improves the quality of caudal block, provides good operating conditions and increases the duration of postoperative analgesia. We conclude that 0.75 μg/kg of dexmedetomidine is as effective as 1μg/kg of dexmedetomidine with levobupivacaine in combination with a fixed dose of fentanyl.

Keywords: Caudal analgesia, dexmedetomidine, levobupivacaine

References:

1. Meenakshi Karuppiah NP, Shetty SR, Patla KP. Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries. Indian J Anaesth 2016;60:409-14.

2. Frawley GP, Downie S, Huang GH. Levobupivacaine caudal anaesthesia in children: a randomised, double-blind comparison with bupivacaine. Paediatr Anaesth 2006; 16:754-60.

ABS0948

Compliance and adherence to European Society of Paediatric Anaesthesiology (ESPA) surgical safety checklist at a paediatric surgical operation theatre: A prospective observational cross-sectional study

Abdul Rahman S, Shahna Ali, Mushahid Raza Khan

Jawaharlal Nehru Medical College, AMU

Email: itss.abdul@gmail.com

Background and Aims: The international safety goal is to ensure safe surgery for all. There is every chance of disaster in the operation theatre (OT), especially for paediatric patients.^[1,2] We aimed to assess adherence and compliance to the European Society of Paediatric Anaesthesiology (ESPA) surgical safety checklist in the paediatric surgery operation room.

Methods: A prospective observational cross-sectional study was done from August 2022 to August 2023 in paediatric surgery OT. Newborns to 14 years of age were included. ESPA surgical checklist was utilised. The checklist consists of three phases: Sign-in (9 items), Time-out (11 items), and Sign-out (7 items). Since local modifications are encouraged in the checklist, the signatures of the anaesthesiologist, surgeon and nurse were included, making a total of 30 items. In every phase, the anaesthesiologist was the checklist coordinator, who observed and was obliged to tick the checkbox only if an answer was given to the corresponding question.

Results: Out of the 272 cases enrolled, the completion rate of the checklist was 99.26 % (270/272). These 270 checklists were included to calculate the adherence rate. In our study, the adherence rate to the checklist during sign-in was 92.5%; during time-out, it was 87%; and during sign-out, it was 98.8%. The compliance rate to the checklist in our study was 100%.

Conclusion: The component with the lowest adherence rate during the sign-in period was “all documents necessary for the surgery”, with 52.9%, followed by “Marking site of surgery”, with 81.6%. In the time-out part, the component with the lowest adherence rate was “displaying essential images during surgery” with 30.5%, followed by “mentioning specific anaesthesia concerns” with 40.8%. During the sign-out period, the component with the lowest adherence rate was “Flushing IV lines before shifting out”, with 96.3%. The surgical checklist plays a significant role in children because they look alike and lack communication. The team might miss things if they do not adhere to the checklist. The use of a checklist reduces morbidity/mortality.

Keywords: Adherence, checklist, compliance, paediatrics, surgical

References:

1. Bajracharya J, Shrestha R, Karki D, Shrestha A. Compliance of WHO Surgical Safety Checklist at a Paediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1256-61.

2. Kasatpibal N, Senaratana W, Chitreecheur J, Chotirosniramit N, Pakvipas P, Junthasopeepun P. Implementation of the World Health Organization surgical safety checklist at a university hospital in Thailand. Surg Infect (Larchmt) 2012;13:50-6.

ABS0976

Prospective observational study of postoperative adverse events and discharge characteristics of paediatric surgical patients in post anaesthesia care unit

Sidramayya Puranikmath, Jyothsna M, Srinivasalu D

Vijaynagar Institute of Medical Sciences, Ballari

Email: gmsidram718@gmail.com

Background and Aims: Compared to other age groups, perioperative anaesthetic morbidity is common in paediatric surgical patients. These adverse events require trained staff and a proper post-anaesthesia care unit (PACU) to manage complications.^[1,2] These accidents were observed and discharged from PACU using the appropriate scoring system.

Methods: After approval from the institutional ethical committee and clinical trial registry of India, a prospective observational study was conducted on 100 patients < 16 years who underwent elective/emergency surgery and were shifted to the postanaesthesia care unit (PACU). We excluded patients requiring immediate paediatric intensive care unit(PICU) and neonatal intensive care unit (NICU). Patients were observed for adverse events and managed accordingly, discharged from PACU using a modified Aldrete scoring system.

Results: The prevalence of postoperative adverse events in PACU was 23%, the most common being hypothermia (34.8%), which was frequently seen in the age group < 1 year (P <0.001). Pain was seen in 34.8% 6-10 years and 11-15 years (P <0.005) age group.13% of patients had vomiting, 2% of patients had desaturation noted, and 1% had allergic rashes noted.

Conclusion: The prevalence of adverse events in postoperative care among paediatric surgical patients is high. It is crucial to monitor and act accordingly. Pain and hypothermia were frequently noticed. Desaturation was observed in airway-related surgery.

Keywords: Modified Aldrete score, paediatric

References:

1. Mamie C, Habre W, Delhumeau C, Barazzone Argiroffo C, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Pediatric Anesthesia 2004; 14:218-24.

2. Ames W, Ross AK. Postanesthesia Care Unit Management. Gregory’s Pediatric Anesthesia 2020: p. 386- 405.

3. Wudineh DM, Berhe YW, Chekol WB, Adane H, Workie MM. Perioperative Respiratory Adverse Events Among Pediatric Surgical Patients in University Hospitals in Northwest Ethiopia; A Prospective Observational Study. Front Pediatr 2022;10:827663. doi: 10.3389/fped.2022.827663.

ABS1030

Accuracy of ultrasound measured transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius in predicting the paediatric endotracheal tube size.

Arisa Sai Lohitha, Krishna Prasad

Siddhartha Medical College

Email: lohithasai2896@gmail.com

Background and Aims: In paediatric anaesthesia, clinicians frequently exchange inserted endotracheal tubes (ETT) because of leak/resistance causing morbidity.^[1,2] We studied ultrasound (US) measurements of transverse cricoid and radial epiphyseal diameter to predict ETT size that best fits in children compared to age-based formulas.

Methods: After obtaining approval from the Institutional Ethics Committee and consent from the parents, 50 children (1-8 yrs) undergoing elective surgery under general anaesthesia with an uncuffed ETT were included in this study. The transverse diameter of the cricoid and the epiphyseal diameter of the distal radius were measured by the US. The correlation between the outer diameter of the fit ETT and the transverse diameter of both radius epiphyses and cricoid cartilage was calculated [Figure 1]. Data was noted and analysed with Spearman’s correlation coefficient.

Figure 1.

Measurement of transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius

Results: The Spearman’s correlation coefficient between the ETT size and the distal radius epiphysis was 0.971, whereas the correlation coefficient between the ETT and the transverse diameter of the cricoid cartilage was 0.976. If the age-based formula was applied for the selection of ETT, the correlation coefficient was 0.8942.

Conclusion: Both transverse cricoid diameter and epiphyseal diameter of the distal radius are reliable predictors of best-fit-ETT paediatric ETT size compared to age-based formulas. To save time and effort, we recommend the US measurement of the epiphyseal diameter of the distal radius in the preoperative visit and documenting the predicted tube size with the preoperative assessments.

Keywords: Cricoid cartilage, epiphyses, radius, ultrasonography

References:

1. Liu S, Qi W, Zhang X, Dong Y. The development of cricoid cartilage and its implications for using endotracheal tubes in the pediatric population. Pediatric anaesth 2020;30:63-8.

2. Kim HY, Cheon JH, Baek SH, Kim KH, Kim JK. Prediction of endotracheal tube size for pediatric patients from the epiphyseal diameter of radius. Korean J Anaesthesiol.2017;70:52-7.

ABS0064

Comparison of safety margin of Air-Q versus I-Gel devices as a conduit to microcuff endotracheal tube in paediatric surgeries- A randomised interventional study

Ritesh Kumar Sompura, Pratibha Rathore, Neelam Dogra, Rama Chatterji

S.M.S. Medical College, Jaipur.

Email: dr.riteshsompura@gmail.com

Background and Aims: Airway management is essential to safe anaesthetic practice. A supraglottic airway is a superior alternative when the procedure or the patient need not be subjected to endotracheal intubation. In managing an airway crisis, using a supraglottic airway device has proven to be life-saving as it can also be utilised as a conduit for endotracheal tube (ETT) intubation. When a supraglottic airway device is employed as a conduit for endotracheal intubation, the safety margin (the distance from the vocal cords to the proximal end of the endotracheal tube cuff) must be adequate to avoid laryngeal damage and dislodgement of the tube. In contrast, removal of the supraglottic airway device is attempted after successful intubation.^[1,2] However, very few studies compare the safety margin of different supraglottic airway devices as conduits to the cuffed ETTs in the paediatric population. So, the present study aimed to compare the safety margin of Air-Q versus I-Gel devices as conduits to microcuff ETTs in paediatric surgeries.

Methods: This prospective, randomised, interventional study was conducted on a total of 60 patients of either sex, aged 5-10 years, American Society of Anesthesiologists physical status I-II, who were randomly allocated into two groups (30 in each group): group A- Air-Q, group B- I-Gel. Safety margin (in cm), fibreoptic grade of view (Brimacombe score), and oropharyngeal leak pressure were recorded in each group. Statistical analysis was performed using an independent sample t-test and Chi-square test (significant P= < 0.05).

Results: Significant difference was found in the safety margin of Air-Q and I-Gel groups for the largest ETT (P<0.001), one size small ETT (P<0.001), and two size small ETT (P<0.001). The cuff of tracheal tubes was predicted to be located below the glottis with the largest, one-size and two-size small ETT in both groups.

Conclusion: Based on observations from this study, Air-Q has a better safety margin and fibreoptic grade of view (Brimacombe score) than I-Gel. The oropharyngeal leak pressure of the I-Gel is superior to that of the Air-Q. The Air-Q and I-Gel are both well-tolerated intubating conduits, but the possibility of vocal cord damage is higher with I-Gel.

Keywords: Air-Q, I-Gel, supraglottic airway device

References:

1. Massoudi N, Fathi M, Nooraei N, Salehi A. A comparison between the i-gel® and air-q® supraglottic airway devices used for patients undergoing general anesthesia with muscle relaxation. Biomed Res Int. 2018;2018:5202957.

2. Jagannathan N, Sohn l, Ramsey M, Huang A, Sawardekar A, Sequera-Ramos L, et al. A randomized comparison between the i gel^TM and the air-Q^TMsupraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children. Can J Anesth 2015; 62: 587-94.

ABS1137

Evaluation of difficult airway predictors in paediatric population using bedside anthropometric parameters like the frontal plane to chin distance by weight, the thyromental distance by weight- a prospective observational study

Swathi Ramanarayan, Raghavendra BS

Bangalore Medical College Research Institute

Email: swathijr477@gmail.com

Background and Aims: Various bedside anthropometric parameters have been used to predict difficult airways in children.^[1,2]The objective of this study was to use anthropometric parameters like frontal plane chin distance (FPCD) by weight (Wt), thyro-mental distance (TMD) by Wt, FPCD, sterno-mental distance (SMD), age, gender in predicting difficult laryngoscopy and difficult intubation in the paediatric population.

Methods: This prospective, double-blinded observational study was conducted in non-syndromic paediatric patients under 20 kg and seven years in 200 patients after ethical committee clearance. Preoperatively, a scale along the nasal bridge to the chin and perpendicular to the first scale below the chin, the distance between the two scales is the Frontal Plane to Chin Distance, TMD, FPCD/Wt and TMD/Wt calculated. These data were classified into difficult laryngoscopy if Cormack Lehane (CL) grade 3, 4, easy - CL grade 1, 2. Difficult intubation if Intubation Difficulty Score > 5, easy if 5 or < 5, as observed intraoperatively.

Results: Statistically significant results were obtained for FPCD P = 0.005; TMD/Wt P = 0.001, and FPCD/Wt P=0.0005, sensitivity 75%, specificity 75% in predicting difficult laryngoscopy. The FPCD P=0.005, with a sensitivity of 78.6% and a specificity of 75.8%, and the FPCD/Wt P=0.0005, with a sensitivity of 85.7% and a specificity of 78%, are statistically significant for evaluating difficult intubation. Using the receiver operating characteristics curve, a high area under the curve for FPCD and FPCD/Wt were the best parameters to predict difficult airways.

Conclusion: We concluded that FPCD, FPCD/Wt, and TMD/Wt are simple parameters that can easily be used to evaluate difficult laryngoscopy and intubation preoperatively in non-syndromic paediatric patients.

Keywords: Anthropometric parameters, difficult airway, frontal plane to chin distance, paediatric, thyromental distance

References:

1. D Aparna, Jafra A, Bhardwaj N, Jain D, Luthra A, Malik MA. Evaluation of various anthropometric airway parameters as predictors of difficult airway in neonates: A prospective observational study. Int J Pediatr Otorhinolaryngol 2020; 138:110387. doi: 10.1016/j.ijporl.2020.110387.

2. Mansano AM, Módolo NS, Silva LM, Ganem EM, Braz LG, Knabe Ade C, et al. Bedside tests to predict laryngoscopic difficulty in pediatric patients. Int J Pediatr Otorhinolaryngol 2016; 83:63-8.

CLINICAL PHARMACOLOGY

ABS0100

Comparative evaluation of repeat dose of ropivacaine versus bupivacaine in the subarachnoid block for patients with previous scorpion bite history

Yash Jain, C.S. Mishra, Anuj Dubey, Nupur Chakravarty

JK Hospital and LNMC, Bhopal

Email: therock05911@gmail.com

Background and Aims: In patients with a history of scorpion bites, possible sodium channel mutation may alter the response to local anaesthetic.^[1,2] This study compared the effect of repeat ropivacaine versus bupivacaine doses in the failed subarachnoid block.

Methods: In this study, 40 patients with a history of single or multiple scorpion bites were divided into two equal groups of 20 patients each. Both the groups were given subarachnoid block with 3.5 ml 0.5% bupivacaine heavy. The onset and peak of sensory and motor block were observed with the pinprick method and Bromage scale. After 15 min, if the desired effect of the block was not achieved, then in patients of Group R, 2.5ml of 0.5% ropivacaine heavy was given. In patients of Group B, 2.5 ml of 0.5% bupivacaine heavy was repeated, and the effect was assessed.

Results: Demographically, both groups were comparable. After administering the second dose in Group R, the time of onset and peak of both sensory and motor blocks were significantly prolonged. Two patients had failed sensory and motor blocks in Group R and were then given general anaesthesia. In contrast, in Group B, 18 patients had failed sensory and motor blocks and were then given general anaesthesia.

Conclusion: We concluded that 0.5% ropivacaine, when given as a repeat dose in patients with scorpion bites and failed spinal anaesthesia, achieved adequate block and prolonged sensory and motor block compared to 0.5% bupivacaine heavy.

Keywords: Ropivacaine, scorpion bite, subarachnoid block

References:

1. Kavlock R, Ting PH. Local anesthetic resistance in a pregnant patient with lumbosacral plexopathy. BMC Anesthesiol 2004;4:1. doi: 10.1186/1471-2253-4-1.

2. Panditrao MM, Panditrao MM, Sunilkumar V, Panditrao AM. Effect of previous scorpion bite(s) on the action of intrathecal bupivacaine: A case-control study. Indian J Anaesth 2013;57:236-40.

ABS0315

Effect of intraoperative dextrose infusion on remnant hepatic function in right living donor hepatectomy: a randomised controlled study

Wafa Osman, Raman Raina, Meera Kharbanda, Nidhi Sinha

Indraprastha Apollo New Delhi

Email: wafausman6123@gmail.com

Background and Aims: Living donor hepatectomy is a significant surgery associated with postoperative liver dysfunction.^[1,2] In this study, we attempted to improve postoperative liver functions in living liver donors undergoing right hepatectomy.

Methods: We conducted this study on 174 patients randomly divided into groups G (study group) and N (control group). Group G was given 25% dextrose at 70 mg/kg/h, while Group N was given normal saline at the same rate. Insulin was administered to both groups once the blood sugars exceeded 150 mg/dl. Random blood sugar was monitored hourly while insulin was administered and titrated as per the blood sugars. Intraoperative lactate levels were measured. Values of serum bilirubin and other biochemical liver function tests were noted preoperatively and postoperatively.

Results: We observed that the levels of intraoperative serum lactate were significantly better in the study group. Postoperatively, serum bilirubin levels, aspartate transaminases and gamma-glutamyl transferases were substantially better in the study group.

Conclusion: The administration of 25% dextrose in living liver donors undergoing right hepatectomy improves postoperative hepatic functions.

Keywords: Dextrose, donor hepatectomy, lactate

References:

1. Althausen TL. Dextrose therapy in liver diseases. J Am Med Assoc 1933; 100: 1163-7.

2. Han S, Ko JS, Jin SM, Park HW, Kim JM, Joh JW, Kim G, Choi SJ. Intraoperative hyperglycemia during liver resection: predictors and association with the extent of hepatocytes injury. PLoS One 2014;9:e109120.

ABS0367

Comparative evaluation of nebulised and intravenous dexmedetomidine on attenuation of haemodynamic response to laryngoscopy

Deeksha BG, Reshma BM, Salim Iqbal, Harsoor S S

Dr.B.R.Ambedkar Medical College and Hospital

Email: deekshambbs@gmail.com

Background and Aims: Laryngoscopy and intubation incite sympathetic activity, causing significant haemodynamic disturbances. Intravenous (IV) dexmedetomidine, an alpha-2 adrenergic agonist, blunts these responses. Nebulised dexmedetomidine was found to have effects similar to IV administration.^[1,2] We compared the haemodynamic response to laryngoscopy by preoperative administration of dexmedetomidine intravenously and through nebulisation.

Methods: After obtaining institutional ethics committee clearance and registration of the study in the Clinical Trials Registry, India, written informed consent was taken in 60 patients aged 18 to 60 years belonging to the American Society of Anesthesiologists physical status I-II. This prospective randomised double-blinded study was conducted in elective surgeries under general anaesthesia with endotracheal intubation. Group A (30 patients) received nebulisation with dexmedetomidine 1 µg/kg in 1 ml of 0.9% Normal Saline (NS) and 10 ml of 0.9% NS as IV infusion over 10 min. Group B (30 patients) received nebulisation with 1ml of 0.9% NS and dexmedetomidine 1µg/kg in 10 ml of 0.9% NS intravenous infusion over 10 min. Haemodynamic parameters were monitored for 30 minutes preoperatively and later for 10 minutes following endotracheal intubation.

Results: In Group A, the mean difference in mean arterial blood pressure (MAP) was 81.53(7.99) mmHg, 95% CI (78.55, 84.52), and the mean difference in heart rate (HR) was 70.60 (9.48) beats/min, 95% CI (67.06, 74.14). In Group B, the mean difference in MAP was 79.93 (7.45) mmHg, 95% CI (77.15, 82.72), and the mean difference in HR was 71.23(10.49) beats/min,95% CI (67.31, 75.15).

Table:

Demographic Characteristics and Propofol Dose

	Group A (n=30)	Group B (n=30)	P
Mean age (y)	36.60 (8.63)	38.07 (11.34)	0.575
Height (cm)	161.60 (8.27)	156.17 (7.21)	0.009
Weight (kg)	64.57 (9.58)	62.70 (8.28)	0.423
Body Mass Index (kg/m2)	24.33 (1.64)	25.15 (2.60)	0.153
Propofol Dose (mg)	80.00 (10.43)	73.53 (10.14)	0.018

Conclusion: Pressor response to laryngoscopy and tracheal intubation was equally attenuated in both IV and nebulisation groups, and no statistical significance was noted between the two groups.

Keywords: Dexmedetomidine, intravenous, nebulisation

References:

1. Niyogi S, Biswas A, Chakraborty I, Chakraborty S, Acharjee A. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with dexmedetomidine: A comparison between intravenous and intranasal route. Indian J Anaesth 2019;63:915-23.

2. Singh V, Pahade A, Mowar A. Comparison of intravenous versus nebulized dexmedetomidine for laryngoscopy and intubation-induced sympathoadrenal stress response attenuation. Anesth Pain Med 2022;12:e132607. doi: 10.5812/aapm-132607.

ABS0469

Rotational thromboelastometry (Rotem) based comparison of coagulation parameters in transurethral resection of the prostate surgery using saline versus glycine as an irrigate fluid – a randomised observational study.

Sumayyah Lateef, P.Ravikanth, Ananya Nanda, R. Gopinath

ESIC Medical College And Hospital

Email: sumayyahlateef120@gmail.com

Background and Aims: This study aims to assess the impact of glycine and normal saline as irrigation fluids on coagulation parameters using rotational thromboelastometry (ROTEM) in transurethral resection of the prostate (TURP) surgery.^[1,2] By comparing these solutions, we seek to identify any differences that may contribute to perioperative bleeding.

Methods: Venous blood samples were collected from both groups preoperatively and 30 min post-surgery for ROTEM analysis, haemoglobin, haematocrit, platelet count, electrolyte levels, and prothrombin time. ROTEM analysis automatically generated results for four parameters: clotting time (CT), clot formation time (CFT), and maximum clot firmness (MCF). The extrinsic and intrinsic coagulation cascades were assessed using EXTEM and INTEM, while Fibrin polymerisation and fibrinogen concentration were evaluated using FIBTEM.

Results: Statistical analysis revealed significant differences in INTEM CT (P=0.013), MCF (p = 0.015), FIBTEM CT (P=0.013), CFT (P=0.023), and platelet count (P=0.044). Notably, ML (P=0.003) showed significant differences. In contrast, EXTEM CT (P=0.119), CFT (P=0.352), and MCF (P=0.804) did not demonstrate statistical significance[Table1, Figure1].

Table 1.

FIBTEM Clotting Time Saline vs Glycine

FIBTEM Clotting Time	Group Glycine	Group Saline	P
Preoperative	61.25 (15.118)	69.03 (20.33)	0.056
Postoperative	73 (23.31)	62.43 (12.40)	0.013

Figure 1.

FIBTEM Clotting Time

Conclusion: The CT and CFT increased significantly between both the groups, with more changes seen in the glycine group compared to the saline group. There were no significant changes in electrolytes, haemoglobin, or platelet count.

Keywords: Bladder irrigation, ROTEM, TEG sample, TURP syndrome

References:

1. Shin HJ, Na HS, Han JY, Hwang JW. A Comparison of Hemostatic Properties between Monopolar and Bipolar Hysteroscopic Surgery using Rotational Thromboelastometry: A Randomized Trial. Gynecol Obstet Invest 2019;84: 568-574.

2. Shin HJ, Na HS, Jeon YT, Park HP, Nam SW, Hwang JW. The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate: A prospective observational study using rotational thromboelastometry. Medicine (Baltimore) 2017;96(2):e5468. doi: 10.1097/MD.0000000000005468.

ABS0616

Comparison of recovery profile in spine surgeries with continuous infusion versus intermittent boluses of cisatracurium – a prospective comparative study

Srinidhi HS, Geetha CR

MS Ramaiah Medical College

Email: dr.srinidhi.h.s@gmail.com

Background and Aims: Spine surgeries often require precise neuromuscular blockade management to optimise surgical conditions and patient recovery.^[1,2] Our study aimed to compare recovery characteristics and total intraoperative dose between continuous infusion versus intermittent boluses of cisatracurium in spine surgeries.

Methods: 60 patients undergoing spine surgeries were randomly divided into Group A and Group B. All patients were premedicated with intravenous (IV)fentanyl 2 µg/kg and induced with IV propofol 2 mg/kg and muscle relaxation by IV cisatracurium 0.2 mg/kg. At train of four (TOF) count 1, Group A received cisatracurium as a continuous infusion of 2 µg/kg/min, and Group B received cisatracurium as intermittent boluses of 0.02 mg/kg. Reversal Time: Stoppage of constant infusion in group A and last bolus dose of cisatracurium in group B till TOF ratio 70% and extubation time from stoppage till TOF ratio >90%. Total intraoperative dose noted.

Results: Reversal time in Group A 28.96(1.69) was significantly shorter (P=0.001) than in Group B 31.91(2.29). Time for extubation was also significantly higher (P=0.001) in Group B 34.65(2.35) than in Group A 31.63(2.10). The total dose in Group A, 20.99(4.06), was significantly less (P=0.002) compared to Group B, 24.81(5.08).

Conclusion: Our study showed that continuous infusion of cisatracurium reduced recovery time and the total dose compared to intermittent boluses in spine surgeries.

Keywords: Cisatracurium, continuous infusion, spine surgery

References:

1. Patil S, Prasad AK, Negi R, Gogna RL. Comparison between recovery profile of repeated bolus dose and continuous infusion of cisatracurium in patients undergoing prolonged surgeries using a train of four: a prospective study. International Journal of Academic Medicine and Pharmacy 2022;4;228-31.

2. Ma XD, Yan J, Dai BZ, Kong DQ, Du SY, Li BP. Comparative study: efficacy of closed-loop target-controlled infusion of cisatracurium and other administration methods for spinal surgery of elderly patients. Eur Rev Med Pharmacol Sci 2017;21:606-11.

ABS0722

Preoperative pregabalin with intraoperative lignocaine infusion versus placebo for haemodynamic stability in hypertensive patients undergoing abdominal surgeries under general anaesthesia: a prospective randomised double-blinded comparative clinical study

Manisha Roy, Vinod Kumar Verma

Indira Gandhi Institute of Medical Sciences

Email: roymanisha910@gmail.com

Background and Aims: Hypertensive patients generally exhibit exaggerated responses during laryngoscopy, intubation and surgical stimulus.^[1,2]This study aimed to compare preoperative pregabalin with intraoperative lignocaine infusion versus placebo for haemodynamic stability in hypertensive patients undergoing abdominal surgeries under general anaesthesia.

Methods: Sixty adult patients with diagnosed hypertension undergoing open abdominal surgeries under general anaesthesia were randomly divided into two groups of 30 each. All patients receive pregabalin 150 mg orally 1 h before surgery. Group A patients received a lignocaine infusion of 1.5 mg/kg diluted in 50 ml normal saline at the rate of 50 ml/h, which started 3 min before anaesthesia induction and continued till skin closure. Group B patients received regular saline infusion at the rate of 50 ml/h, starting 3 minutes before anaesthesia induction and continuing till skin closure. Perioperative heart rate (HR) and mean arterial pressure(MAP) were recorded in both groups.

Results: Group A showed significantly lower post-induction MAP than Group B, 97.40(20.14) vs. 106.06(11.80) mmHg, respectively, P=0.023. Post-induction HR was lower in Group A than B 83.13(13.81) vs 89.33(13.12) beats/min respectively, P=0.039). Post-skin incision MAP was lower in group A than B 89.90(13.61) vs. 96.23(14.08) mmHg respectively, P=0.04) [Table1].

Table 1.

Perioperative mean arterial pressure (mm Hg) and heart rate (beats/min)

	Group A		Group B
	Mean Arterial Pressures	Heart rate	Mean Arterial Pressures	Heart Rate
Baseline	110.76 (12.67)	93.76 (14.86)	110.90 (11.90)	91.70 (18.12)
Before induction	98.5 (14.17)	88.66 (12.52)	103.36 (15.86)	90.95 (16.97)
After induction	97.4 (20.14)	83.13 (13.81)	106.06 (11.81)	89.33 (13.12)
Post skin incision	89.9 (13.61)	86.56 (14.43)	96.23 (14.08)	86.80 (14.20)
30 min	95.16 (13.12)	81.53 (11.74)	97.50 (14.00)	84.13 (12.54)

Data presented as mean (standard deviation)

Conclusion: Pregabalin combined with lignocaine has a synergistic effect and is more effective than pregabalin used alone in minimising the pressor response to intubation and surgical stress in hypertensive patients.

Keywords: Pregabalin, hypertension, lignocaine

References:

1. Vadhanan P, Narendren G, Revathy. Comparison of oral pregabalin and intravenous lignocaine for attenuating stress response during intubation in hypertensive patients: A randomised controlled trial. Anaesth pain intensive care 2020;24: 225-229.

2. Shal SE. A comparative study of the effect of intravenous lidocaine infusion, gabapentin and their combination on postoperative analgesia after thyroid surgery. Open Journal of Anesthesiology; 7:296-314.

ABS0815

Comparison of dexmedetomidine and fentanyl for prevention of emergence agitation in adult patients after laparoscopic surgeries under sevoflurane anaesthesia: a randomised double-blinded study

Phalguni, Phalguni, Mamta Patel, JC Vasava

Government Medical College, Vadodara

Email: phalgunisrivastava@gmail.com

Background and Aims: Emergence agitation is a disruptive phenomenon characterised by restlessness, disorientation, and excitation. It poses challenges to postoperative care and leads to various complications.^[1,2]We aim to compare dexmedetomidine and fentanyl for preventing emergence agitation (EA) in adult laparoscopic surgery patients under sevoflurane.

Methods: In this study, patients aged 18 to 60 years undergoing elective laparoscopic surgery with American Society of Anesthesiologists physical status I-II were randomly divided into two groups using computer-generated randomisation. One group received dexmedetomidine 1 µg/kg (n=36), while the other group received fentanyl 1 µg/kg (n=36) during induction of anaesthesia. All the patients were monitored for haemodynamics, end-tidal carbon dioxide and bispectral index. Patients’ levels of agitation using the Riker sedation agitation score were noted immediately after extubation and up to 24 h postoperatively. The scores between the two groups (D and F) were assessed using the chi-square test.

Results: This study shows that the Riker Sedation-Agitation Score between the two groups observed was 3.25(0.77) in dexmedetomidine and 4.44(0.91) in fentanyl, with the highest emergence agitation reported in the fentanyl group. Group D has the maximum Riker-sedation agitation score of 3 (sedated), whereas Group F reports a maximum score of 5 (agitated). A statistically significant association was observed between the groups D and F with P<0.001[Table1, Figure1].

Table 1.

Sedation Agitation Score

Drug Given	Riker-Sedation Agitation Score		P
	<5	≥5
Group D	35 (48.6%)	1 (1.4%)	<0.001
Group F	17 (23.6%)	19 (26.4%)

Figure 1.

Incidence of agitation among patients receiving fentanyl vs dexmedetomidine

Conclusion: This study demonstrated that the dexmedetomidine group experienced lower levels of agitation than those in the fentanyl group; hence, dexmedetomidine is better at preventing emergence agitation in adult laparoscopic surgery patients under sevoflurane anaesthesia.

Keywords: Dexmedetomidine, emergence agitation, fentanyl, sevoflurane

References:

1. Sultana SP, Saikia D, Dey S. Fentanyl Versus Dexmedetomidine for the Prevention of Emergence Agitation in Children After Sevoflurane Anaesthesia: A Comparative Clinical Study. Cureus 2022;14:e28587.

2. Ramroop R, Hariharan S, Chen D. Emergence delirium following sevoflurane anesthesia in adults: prospective observational study. Braz J Anesthesiol 2019;69: 233-41.

ABS0880

Comparison of ultrasonic nebulisation with dexmedetomidine versus clonidine for postoperative sore throat –A prospective observational study

Vandana Mehra, Ashutosh Kaushal, Vaishali Waindeskar

AIIMS Bhopal

Email: vandanamehra353@gmail.com

Background and Aims: Postoperative sore throat (POST) is a common complication of endotracheal intubation.^[1,2] There is a literature deficit in preventing POST. This study aims to compare the effect of ultrasonic nebulisation with dexmedetomidine and clonidine on POST in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia.

Methods: This prospective, observational, comparative cohort study was started after getting institutional ethical clearance and registration in the Clinical Trials Registry-India. Written informed consent was taken after a thorough explanation of the procedure. In one group, including 40 patients, ultrasonic nebulisation was done with dexmedetomidine 50 mcg with 4ml saline, whereas in another group, including 38 patients, ultrasonic nebulisation was done with clonidine 100 mcg with 4ml saline. The primary outcome was to compare the analgesic efficacy of nebulised dexmedetomidine and clonidine in relieving post-operative sore throat. The secondary outcome was to compare the effect of nebulised dexmedetomidine and clonidine on the haemodynamic parameters.

Results: The demographic data of the study were comparable. The incidence of sore throat was less in the patients nebulised with dexmedetomidine compared to clonidine, which was more evident at 6 h(P < 0.001), 12h(P <0.001)and 24 h after surgery(P=0.0274). The overall changes in systolic blood pressure, diastolic blood pressure, and mean arterial pressure over different time points were comparable in the two groups except at 5 minutes after intubation (P=0.002), at the time of intubation(P=0.004) and 5 min after intubation (P=0.02), at the time of intubation (P=0.03) when it was statistically significant respectively.

Conclusion: The study’s findings suggest that nebulisation with dexmedetomidine resulted in a lower incidence and less severe sore throat in postoperative patients compared to clonidine.

Keywords: Clonidine, dexmedetomidine, post-operative sore throat

References:

1. Thomas D, Chacko L, Raphael PO. Dexmedetomidine nebulisation attenuates postoperative sore throat in patients undergoing thyroidectomy: A randomised, double-blind, comparative study with nebulised ketamine. Indian J Anaesth 2020;64:863–8.

2. Shekhar S, Gupta A, Gunjan, Gupta S, Singh K. Comparison of Nebulized Ketamine and Ketamine with Clonidine in Postoperative Sore Throat. Anesth Essays Res 2019;13:313-31.

ABS0997

Effect of remifentanil vs fentanyl on primary haemodynamic parameters during general anaesthesia

Roheet Rathod, Indrani Kumar, Ashok Swain, Suresh Menon

KEM Hospital

Email: roheet.rathod@gmail.com

Background and Aims: Opioids are commonly used during surgery to control nociception-induced surgical stress response that causes changes in the haemodynamic parameters.^[1,2] We are presenting the data from a randomised control trial showing the effect of remifentanil as compared to fentanyl.

Methods: In this observer-blind, randomised control trial, 105 patients received remifentanil, and 104 patients received fentanyl. The primary efficacy endpoint was haemodynamic response during specific activities, and the secondary endpoints were safety parameters.

Results: Both remifentanil and fentanyl provided adequate intraoperative analgesia. Heart rate and blood pressure responses were consistently lower in remifentanil groups compared to fentanyl during endotracheal intubation, skin incision, and extubation. Remifentanil established better haemodynamic stability during skin closure than fentanyl. Three subjects experienced muscle rigidity in both groups. The need for vasopressor and anticholinergic drugs was similar between groups, and no subject required naloxone administration.

Conclusion: Remifentanil showed better haemodynamic stability than fentanyl. Its ultrashort half-life with a context-sensitive half-life of only 3 min, independent of the duration of infusion, and organ-independent elimination offers advantages in terms of ease of titration, rapid emergence from sedation, and preferred option for patients with hepatic or renal impairment, making it a preferred choice compared to fentanyl.

Keywords: Fentanyl, haemodynamic changes, remifentanil

References:

1. Mahmoud M, Mason KP. Recent advances in intravenous anesthesia and anesthetics. F1000Res 2018;7:F1000 Faculty Rev-470. doi: 10.12688/f1000research.13357.1.

2. Lee SK, Jeong MA, Sung JM, Yeon HJ, Chang JH, Lim H. Effect of remifentanil infusion on the hemodynamic response during induction of anesthesia in hypertensive and normotensive patients: a prospective observational study. J Int Med Res 2019;47:6254-67.

ABS1006

Comparison of the effect of 20% mannitol and dexmedetomidine for prevention of the raised intracranial pressure by evaluating optic nerve sheath diameter (ONSD) during laparoscopic surgery in Trendelenburg position: a randomised controlled trial

Vivek Vishal, Bibha Kumari, Swati Singh

Indira Gandhi Institute Of Medical Science

Email: vivekvishal999@gmail.com

Background and Aims: Laparoscopic surgery in the Trendelenburg position can cause increased intracranial pressure (ICP), affecting patient safety. Medications such as diuretics, hypertonic saline and dexmedetomidine have been used to decrease the ICP by ultrasonographic measurement of optic nerve sheath diameter (ONSD).^[1,2]

Methods: This prospective, double-blind, randomised controlled trial was conducted on 56 American Society of Anesthesiologists physical status I-II patients with normal ocular anatomy and physiology posted for laparoscopic surgery in the Trendelenburg position. Patients were randomly assigned to receive either Mannitol (Group M, n=28) or Dexmedetomidine (Group D, n=28) after patient positioning. The primary outcome measured was ONSD at various time points (from before induction of anaesthesia to 1 hour after extubation). Haemodynamic parameters (heart rate, mean arterial pressures, end-tidal carbon dioxide) and any postoperative adverse effects were recorded.

Results: The findings indicated that mannitol and dexmedetomidine effectively reduced ONSD during laparoscopic surgery in the Trendelenburg position. The ONSD was most significantly reduced 30 minutes after the respective drugs were administered in both groups (P= 0.001). There was a sustained reduction in ONSD in Group D compared to Group M. Haemodynamic parameters were comparable between the groups. The complications were 28.57% and 21.42% in group D and M patients, respectively.

Conclusion: Both dexmedetomidine and mannitol can effectively decrease raised ICP in patients undergoing laparoscopic surgery in the Trendelenburg position. However, mannitol is associated with postoperative side effects such as dryness of mouth and headache.

Keywords: Dexmedetomidine, intracranial pressure, mannitol, optic nerve sheath diameter

References:

1. Zhu T, Yuan C, Qian M, Zhao L, Li H, Xie Y. Effect of dexmedetomidine on intracranial pressure in patients undergoing gynaecological laparoscopic surgery in Trendelenburg position through ultrasonographic measurement of optic nerve sheath diameter. Am J Transl Res 2022;14:6349-58.

2. Ali A, Tetik A, Sabanci PA, Altun D, Sivrikoz N, Abdullah T, et al. Comparison of 3% hypertonic saline and 20% mannitol for reducing intracranial pressure in patients undergoing supratentorial brain tumor surgery: a randomized, double-blind clinical trial. J Neurosurg Anesthesiol 2018;30:171-8.

ABS1140

Comparison of intravenous propofol, etomidate and etomidate plus propofol in attenuating the haemodynamic response during laryngoscopy and intubation in laparotomy surgery patients

Priyakshi Borah, Hema Meena, Sarita Janweja, Vikas Rajpurohit

Dr Sampurnanand Medical College, Jodhpur

Email: priyakshi.borah09@gmail.com

Background and Aims: Several drugs have attenuated the haemodynamic response to laryngoscopy and intubation. ^[1,2]Through this study, we compared the efficacy of three approaches of anaesthesia induction: propofol, etomidate and propofol plus etomidate in maintaining haemodynamic stability during induction and following endotracheal intubation in laparotomy surgery.

Methods: A total of 75 patients of both genders in the age groups of 18-60 years, American Society of Anesthesiologists physical status I-II, undergoing laparotomy surgery, were randomised into three groups. Group I received propofol (2 mg/kg), Group II received etomidate (0.3 mg/kg), and Group III received a combination of etomidate (0.2 mg/kg) and propofol (1mg/ kg). The primary outcome was to compare and evaluate the haemodynamic response, primarily heart rate (HR) and blood pressure (BP) during induction and endotracheal intubation in these three groups, and secondary objectives were to compare the incidence of myoclonus, pain on injection and side effects or complications (if any).

Results: Mean HR and BP were significantly decreased after administration of induction agent in Group I compared to Group II and Group III. Despite the stimulus provided by intubation, they remained lower than baseline in Group I. Myoclonus was high in Groups II and III. At the same time, no equivalent sign was observed in Group I. The incidence of pain on injection was significantly higher in Group I in comparison to Group II and Group 3.

Conclusion: The combination of etomidate plus propofol has better haemodynamic stability than etomidate or propofol alone at 1 min after intubation and at other points of time and is also associated with a decreased incidence of pain on injection and myoclonus.

Keywords: Etomidate, haemodynamics, propofol

References:

1. Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325-32.

2. Stevenson AG, Graham CA, Hall R, Korsah P, McGuffie AC. Tracheal intubation in the emergency department: the Scottish district hospital perspective. Emerg Med J 2007;24:394-7.

ABS0732

To compare the haemodynamic impact of intrathecal hyperbaric levobupivacaine and buprenorphine vs hyperbaric bupivacaine and buprenorphine for spinal anaesthesia in patients undergoing infraumbilical surgeries – a double-blind, randomised study.

Kalaivani S, Pushpavathi SH, Madhuri S Kurdi

Karnataka Institute of Medical Sciences, Hubli.

Email: kalaivanisivaramakrishnan@gmail.com

Background and Aims: Levobupivacaine has a better safety profile.^[1,2] Hyperbaric levobupivacaine has been available in India since November 2022. Since data is scarce, we conducted this study to compare the haemodynamic impact of intrathecal hyperbaric levobupivacaine versus hyperbaric bupivacaine in the first 30 minutes of spinal anaesthesia.

Methods: In this randomised, double-blinded controlled trial, 54 American Society of Anesthesiologists physical status I and II patients undergoing elective infraumbilical surgeries under spinal anaesthesia who fulfilled the inclusion criteria were allocated into two groups (27 each). GROUP L received 15 mg of 0.5% hyperbaric levobupivacaine + buprenorphine (2 µg/kg), whereas GROUP B received 15mg of 0.5% hyperbaric bupivacaine + buprenorphine (2 µg/kg) intrathecally. Haemodynamic parameters were noted, mainly systolic and diastolic blood pressure, heart rate, and block characteristics. Our primary objective was to compare the difference in systolic blood pressure between the two groups during the first 30 min of spinal anaesthesia.

Results: Demographics were comparable. Among intraoperative events, the incidence of hypotension was statistically significantly high (P <0.0003) in Group B 109.74 (8.8) compared to Group L 99.93 (9.74) after 10 min of spinal anaesthesia. The duration of the motor block was significantly shorter in Group L, 151.48 (15.86), compared to Group B, 166.67 (22.70) (P=0.006).

Conclusion: As observed, with haemodynamic stability and less intraoperative hypotension, hyperbaric levobupivacaine could be the better drug. The shorter motor blockade duration allows early post-operatively mobilisation, making hyperbaric levobupivacaine a better option for patients undergoing infraumbilical daycare surgeries.

Keywords: Hypotension, levobupivacaine, spinal anaesthesia

References:

1. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean J Anesthesiol 2018;71:220-5.

2. Oraon P, Hembrom B, Kumar M, Ram B, Lakra L. Comparative study between intrathecal 0.5% isobaric levobupivacaine, 0.5% isobaric ropivacaine, and 0.5% hyperbaric bupivacaine in elective lower segment cesarean section: a randomized clinical study. Anesth Essays Res 2022;16:238-43.

ABS1157

Opioid sparing and suppression of haemodynamic response by the preoperative multimodal non-opioid analgesic regime in laparoscopic surgeries under general anaesthesia: a randomised comparative study

Kshethra Subramoniam, Rangalakshmi, Shankar K, Sowmya Mj

Rajarajeshwari medical college and hospital

Email: iamkshethra@gmail.com

Background and Aims: Laparoscopic surgeries produce significant haemodynamic variations in patients requiring opioids.^[1,2] We aimed to assess the efficacy of opioid-free analgesia to prevent adverse haemodynamic changes during intubation and pneumoperitoneum in patients undergoing laparoscopic surgery in comparison with opioid anaesthesia.

Methods: In elective laparoscopic surgeries, 62 patients were randomly assigned into two groups. Group OFA (Opioid Free Anaesthesia) received a tablet of pregabalin 150mg 1 hour before induction. Intravenous ketorolac 30mg, magnesium sulphate 30 mg/kg, lidocaine 1.5 mg/kg, and dexamethasone 8 mg were administered as an analgesic mixture in 100 normal saline 30 min before induction. Dexmedetomidine 1 µg/kg diluted in 100 ml saline) was given over 10 minutes before induction. Group OBA (Opioid Anaesthesia) received a placebo tablet 1 h before induction in 100 normal saline 20 min before. 100ml saline was given over 10 min before induction.

Results: The primary outcome was to compare the efficacy of haemodynamic suppression to intubation and pneumoperitoneum. Other outcome parameters observed were perioperative analgesia. Significant suppression of heart rate and blood pressure following intubation and pneumoperitoneum by OFA multimodal regime was observed compared to opioid-based technique (P ＜ 0.05) along with prolonged duration of postoperative analgesia, 9.45(3.6) vs 4.03(1.6) h.

Conclusion: This opioid-free analgesic mixture in laparoscopic surgeries produces significant haemodynamic suppression to intubation and pneumoperitoneum, better postoperative pain relief with lower visual analogue scale scores, and increased duration of analgesia compared to routine, conventional opioid anaesthesia.

Keywords: Haemodynamic changes, laparoscopic surgery, non-opioid analgesia

References:

1. Rao LN. A clinical study of dexmedetomidine for maintenance during general anaesthesia for laparoscopic surgeries. Int J Med Sci Clin Invent 2015; 2:681-7.

2. Srivastava VK, Agrawal S, Gautam SK, Ahmed M, Sharma S, Kumar R. Comparative evaluation of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in neurosurgical patients. J Anaesthesiol Clin Pharmacol 2015;3:186-90.

TRAUMA AND CRITICAL CARE

ABS0047

Incidence and factors associated with reintubation in intensive care unit in a tertiary cancer centre: A retrospective study

Sonali Opneja, Roopesh Sureshan, Joona Prabhakaran, Namratha Divakaran

Malabar Cancer Centre

Email: sopneja@gmail.com

Background and Aims: The decision to liberate a patient from invasive mechanical ventilation is a two-component process that requires clinicians to assess the continued need for mechanical ventilation. ^[1,2] This study aimed to determine the incidence of reintubation in the intensive care unit (ICU) from 1 January 2020 to 31 December 2022.

Methods: This study was done after the approval of the institutional review board. Details of patients admitted to the postoperative ICU and reintubated within 72 h were collected from the register maintained in the postoperative ICU. Records of these patients were collected from the medical records library and studied in detail. This study included patients more than 18 years of age who had reintubation in the ICU from 1 January 2020 to 31 December 2022. Patients proceeding directly to tracheostomy or extubated for withdrawal of care were excluded from the study.

Results: The incidence rate of reintubation was calculated to be 0.286% for a 3-year study period. The mean age of reintubated patients was 62.74 years. Ten patients were females; the rest were males (56.52%). The rectum was the most commonly affected site. The mean ICU stay post-reintubation was 8.22 days. Seventeen patients (73.91%) were reintubated due to respiratory distress, and 4 and 2 patients were reintubated because of altered mentation and haemodynamic instability, respectively. Post-operative survival was 56.52% (13 patients).

Conclusion: Co-morbidities were present in 17 out of 23 patients. There was no statistically significant difference between mean values of biochemical markers, use of non-invasive ventilation, or number of days in ICU post-reintubation based on co-morbidities.

Keywords: Critically ill, mechanical ventilation, reintubation

References:

1. Hsiung Lee ES, Jiann Lim DT, Taculod JM, Sahagun JT, Otero JP, Teo K, et al. Factors associated with reintubation in an intensive care unit: A prospective observational study. Indian J Crit Care Med 2017;21: 131-7.

2. Whitmore D, Mahambray T. Reintubation following planned extubation: incidence, mortality and risk factors. Intensive Care Med Exp 2015;3(Suppl 1):A684. doi: 10.1186/2197-425X-3-S1-A684.

ABS0052

A comparison of efficacy and safety of quick penetrating solution (QPS) heparin, QPS diclofenac and heparin gel in preventing infusion associated superficial thrombophlebitis: a randomised, double-blind study

Vijeta Bajpai, Priyanka Dwivedi, Ankita Kabi

AIIMS, Gorakhpur

Email: drvijeta86gsvm@gmail.com

Background and Aims: Topical heparin can prevent superficial thrombophlebitis.^[1,2]The present study compared the efficacy and safety of quick penetrating solution (QPS) heparin, QPS diclofenac, and heparin gel in preventing superficial thrombophlebitis (ST).

Methods: This randomised, double-blind controlled trial was conducted after approval from the Institutional Ethics Committee and trial registration. Patients 18-60 yrs of age, American Society of Anesthesiologists physical status I-II and who needed venous cannulation for at least 72 h were included in the study. Patients were randomly divided into three groups receiving study drugs (topical heparin, QPS heparin and QPS diclofenac) every 8 h for 72 h. The venous cannulation site was graded using the visual infusion phlebitis scale. Patients developing no ST, mean time to reach ST grade I-II and prevention of ST probability during the study period were assessed.

Results: Out of 219 included patients, the development of ST in study groups at 72 h of treatment were topical heparin (11%), QPS heparin (9.6%) and QPS diclofenac (2.7%). Mean time (h) to develop any grade ST in study groups were topical heparin [36.2 (11.9)], QPS heparin [40.0 (13.4)] and QPS diclofenac [37.0 (13.2)]. The Kaplan-Meier analysis did not reveal significant differences in preventing any grade ST or severe ST in the three treatment groups[Figures 1,2].

Figure 1.

Prevention of thrombophlebitis probability using Kaplan-Meier Survival Analysis at the end of 72 h in three treatment groups

Figure 2.

Prevention of severe thrombophlebitis (Grade 2 and above) probability using Kaplan-Meier Survival Analysis at the end of 72 h in three treatment groups

Conclusion: Depending on cost-effectiveness and application convenience, topical or QPS heparin can prevent superficial thrombophlebitis due to intravenous cannulation. QPS diclofenac may be administered to people who are allergic to heparin.

Keywords: Diclofenac, heparin, superficial thrombophlebitis

References:

1. Agarwal S, Verma NC, Singam A. Efficacy of topical heparin prevents superficial thrombophlebitis before peripheral venous cannulation. J. Evolution Med Dent Sci 2020;9:1734-8.

2. Pandya JM, Gupta S, Chouhan A, Shah H, Shah S, Jain A. Evaluation of safety and efficacy of quick penetrating heparin solution (1000 IU/ml) in the prevention of intravenous cannula related thrombophlebitis: a prospective, randomized, comparative, parallel-group clinical study. Indian J Anesth Analg 2019;6:2129-2132.

ABS0137

Post-operative stroke after head and neck oncosurgeries-A Retrospective analytic study

Roopesh Sureshan, Sonali Opneja

Malabar Cancer Centre

Email: roopesh14488@gmail.com

Background and Aims: Available literature reports an incidence of stroke after head and neck surgeries ranging from 3.2 to 4.8%.^[1,2]The study aimed to find out the incidence of postoperative stroke after head and neck oncosurgeries and to identify any risk factors.

Methods: The patient’s data was retrieved from January 1, 2019, to December 31, 2022. The study was done in patients who underwent head and neck onco surgeries with neck dissection. The data was obtained from the patient records and registers. All patients received general anaesthesia using propofol, vecuronium/atracurium as the muscle relaxant and volatile agents. Propensity score matching was done to find the associated factors. Data were expressed as mean (standard deviation) or number (%) of patients. Students’ t-tests, Chi-square tests, or Fisher’s exact tests were used wherever appropriate. Statistical analysis was performed with SPSS software. P < 0.05 was considered significant.

Results: A total of 1311 patients were studied. Postoperative stroke was noted in 3 patients (0.2%). The mean age in the post-operative stroke patients was 62.3 (0.5) years, which was significant. The majority of the patients in the study were males. Comorbidities noted were hypertension, diabetes mellitus, ischaemic heart disease, chronic kidney disease, chronic obstructive pulmonary disease and thyroid disorders. There was no statistical significance in the comparison of gender, comorbidities, and mean duration of surgery between the two groups [Table 1].

Table 1.

Comparison of demography and study parameters

Variables	Postoperative stroke		P
	Yes (n=3)	No (n=1308)
Age (years)	62.3 (0.5)	55.4 (4.0)	0.04
Gender: Male/Female	1 (33.3%)/2 (66.6%)	891 (68.1%)/417 (31.8%)	0.09
Comorbidities present	2	830	0.4
Mean duration of surgery (hours)	3.5 (0.7)	4.2 (1.0)	0.2

Data expressed as mean (standard deviation) or numbers (percentages)

Conclusion: The incidence of postoperative stroke was 0.2%, which was higher in elderly patients. This is lower than the previously stated risks of 3.2% and 4.8%. Due to the low risk, no special preoperative screening is needed.

Keywords: Anaesthesia, stroke, surgeries

References:

1. Thompson SK, Southern DA, McKinnon JG, Dort JC, Ghali WA. Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis. Ann Surg 2004;239:428-31.

2. Silva DP, Silva JC, Monteiro E. Postoperative stroke in head and neck cancer patients submitted to surgery. Int Otorhinolaryngol Head Neck Surg 2018; 4:886-91.

ABS0603

To evaluate the weaning criteria by adding ultrasonography-guided diaphragmatic indices and lung ultrasound scores in post-surgical intensive care patients-prospective observational study

Rehana Ansari, Satish Kumar, Sunil Kumar Arya

BRD Medical College, Gorakhpur

Email: rehanaansari1002@gmail.com

Background and Aims: Weaning from mechanical ventilation has been difficult for patients on ventilators for a long time.^[1,2] This study was done to predict the chances of extubation/failure using ultrasonography, Diaphragmatic thickening fraction (DTF), diaphragmatic excursion (E), and lung ultrasound (LUS).

Methods: After obtaining the approval of the Ethical Committee and written informed consent from guardians of the patients, 110 critically ill patients aged 18-65 years were studied statistically using the software SPSS 24.0 to evaluate the success in the predictability of the weaning trial. All the patients underwent diaphragmatic ultrasound examination during CPAP mode, T Piece trial, and 2 hours after extubation. LUS score and diaphragmatic study findings were compared in all three groups and statistically analysed.

Results: LUS score on T-piece: Success vs Failure: 8.5(2.1) vs 12.6(2.6), mean:-4.1(0.6), P<0.0001 and 95% confidence interval(CI) -5.4, -2.9. DTF on T piece: Success vs Failure: 33.1(1.4) vs 29.8(1.4), mean3.4(0.4), P<0.0001, 95% CI 2.6, 4.1. Mean diaphragmatic excursion on T-piece: Success vs Failure: 21.7(3.2) vs 13.4 (4.3), mean:8.3(1.0), P<0.0001.

Conclusion: The weaning outcome can be predicted by LUS score, DTF and E in mechanically ventilated patients. A value of LUS score on T- T-piece <10, DTF on T - T-piece>31% and E on T-piece >18 mm predicts a successful weaning outcome. The mean SOFA score was significantly lower in the success group than in the failure group.

Keywords: Mechanical ventilation, ultrasound, weaning,

References:

1. Li S, Chen Z, Yan W. Applying bedside ultrasound in predicting weaning outcome from mechanical ventilation in elderly patients. BMC Pulm Med 2021;21(1):217. doi: 10.1186/s12890-021-01605-4.

2. Mayo P, Volpicelli G, Lerolle N, Schreiber A, Doelken P, Vieillard-Baron A. Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. Intensive Care Med 2016;42:1107-17.

ABS1111

Comparative Study on efficacy of chest x-ray and lung ultrasound in early diagnosis of consolidation, interstitial syndrome, and pleural effusion

Pankaj Kumar

Nehru Shatabdi Chikitsalaya

Email: pankaj_125kumar@yahoo.co.in

Background and Aims: Traditionally, lung imaging in critically ill patients is performed by bedside chest radiography (CXR). Chest X-rays have their limitations, which constrain their usefulness. Although thoracic computed tomography (CT) is the gold standard for lung imaging, it is expensive and cannot be performed routinely. In addition, the transportation of critically ill patients to the radiology department combined with radiation exposure carries a measurable risk. On the other hand, limitations of bedside CXR have been well described and lead to poor-quality X-ray films with low sensitivity. Indeed, it has been shown that more than 30% of the X-ray films are suboptimal, even under carefully controlled exposure conditions. The usefulness of lung ultrasound is increasing due to its ease of learning, efficiently performed, and nil radiation, and it can be done frequently without Hessel.^[1,2]

Methods: Fifty mechanically ventilated patients were selected for the prospective study. The hospital ethics committee approved the study, and informed consent was obtained from each patient or next of kin. Ventilator settings were kept unchanged throughout the study. Patients were evaluated by each imaging method: consolidation, interstitial syndrome, and pleural effusion. For data analysis, each hemithorax was divided into six regions: three in upper fields (anterior, posterior, lateral) and three in lower fields (anterior, posterior, lateral). Three pathologic entities were evaluated at the bedside: consolidation, interstitial syndrome, and pleural effusion. Each hemithorax was assessed for the presence or absence of each abnormality.

Results: Patients were evaluated using imaging techniques. The sensitivity and specificity of CXR were 42, 88, and for consolidation, 44, 83 for interstitial syndrome, and 66, 87 for pleural effusion, respectively. The corresponding values for lung ultrasound were 100, 80% for consolidation, 95, 92% for interstitial syndrome, and 100, 100% for pleural effusion, respectively.

Conclusion: In conclusion, lung ultrasound performs considerably better than bedside CXR in diagnosing the most common pathologies in a general intensive care unit population. It may be used as an alternative to thoracic. CT.

Keywords: Chest x-ray, computed tomography, ultrasound

References:

1. Danish M, Agarwal A, Goyal P, Gupta D, Lal H, Prasad R, Dhiraaj S, Agarwal A, Mishra P. Diagnostic Performance of 6-Point Lung Ultrasound in ICU Patients: A Comparison with Chest X-Ray and CT Thorax. Turk J Anaesthesiol Reanim. 2019;47:307-319.

2. Bajwa SJS, Kurdi MS, Sutagatti JG, Bajwa SK, Theerth KA. Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis. Indian J Anaesth 2021;65:716-730.

ABS1120

Comparison of whole blood potentiometry using an arterial blood gas analyser in the intensive care unit with laboratory-based serum sodium and potassium estimation in critically ill patients.

Jyotsna Sharma, Shamik Paul

Armed Forces Medical College

Email: jyotsnasharma286@gmail.com

Background and Aims: Arterial blood gas analysers and electrolyte analysers can measure electrolyte concentrations.^[1,2] In our study, we aimed to compare two methods of electrolyte concentration measurement: direct ion-selective electrodes (Direct-ISEs) using patient whole blood samples in the intensive care unit (ICU) and indirect ion-selective electrodes (Indirect ISEs) using serum samples in the laboratory.

Methods: A prospective observational study was conducted on 142 paired samples from patients admitted to the ICU. The arterial whole blood was analysed in an arterial blood gas analyser in the ICU to analyse electrolytes by Direct-ISE. In contrast, the blood collected for serum electrolytes was promptly transported to the hospital laboratory, where serum was separated and analysed in an automated analyser using Indirect ISE. Statistical analysis was done by employing the t-test and Bland Altman plots. The Haemolysis Icteric Lipemia Index (HIL index) given by the laboratory analyser and serum total protein value were also recorded.

Results: In our study conducted on 142 paired samples for electrolyte analysis in critically ill patients by direct ISE and Indirect ISE, we observed a statistically significant difference between the average of measurements by the two methods[Table1]. This difference is more important at lower sodium than normal potassium levels. The Bland- Altman Plot shows the agreement between the Direct and Indirect assays, indicating the mean difference of 3.58 mmol/L (95% CI.

Table 1.

Values of potassium as determined by ABG and by laboratory analysis

Determinants	Direct ISE Potassium with whole blood (ABG analyser) mmol/L	Indirect ISE Potassium with serum (Lab analysis) mmol/L
Minimum value	2.440	1.200
Maximum value	5.520	6.700
Mean	3.803	4.124
Standard deviation	0.646	0.816

t-test P<0.0001

Conclusion: Electrolyte monitoring is vital in critically ill patients; direct ISE is a point-of-care test with a shorter turnaround time. Also, it would less interfere with haemolysis of samples and hypoproteinaemia in the critically ill.

Keywords: Arterial blood gases, critically ill patients, electrolytes

References:

1. Gupta S., Gupta AK, Singh K, Verma M. Are sodium and potassium results on arterial blood gas analysers equivalent to electrolyte analysers? J Crit Care Med. 2016; 20;233-237.

2. Jain A, Subhan I, Joshi M. Comparison of the point-of-care blood gas analyser versus the laboratory auto-analyzer for the measurement of electrolytes. Int J Emerg Med 2009;2:117-20.

ABS0302

Role of early tracheostomy in organo-phosphorus poisoning cases on long-term mechanical ventilation

Uttam Ingole

Dhanwantari Hospital and ICU, Degloor

Email: uttamingole@gmail.com

Background and Aims: Organo-phosphorus poisoning patients remain on ventilators for days together. In such patients, early tracheostomy maintains proper oxygenation and avoids lung complications, and early weaning can be done.^[1,2] There are less complications. Hence, mortality is also less.

Methods: A 9-year retrospective study was conducted at Dhanwantari Hospital, Degloor. These patients were initially intubated with a cortex endotracheal tube. After 24-48 h, we performed surgical tracheostomy in all 22 patients. After tracheostomy, we found that patients were more comfortable than on an endotracheal tube. All the parameters were maintained. Occasionally, they needed suction through the tube. Any position could be given to the patient as per requirement. After adequate and spontaneous respiration, the tracheal tube was removed, and strapping was done.

Results: During the study period, out of 340 patients with organophosphorus poisoning cases, surgical tracheostomy was performed on 22 cases. Male patients were more than female M; F ratio was 63.63%; 36.36%. The affected age group was 20-40 years old, 27.27%. The majority of cases were farmers or farm labourers. Financial crises and family matters were the cause of suicide. The majority of patients were from low socioeconomic groups.

Conclusion: Serious organo-phosphorus poisoning patients require prolonged mechanical ventilation. With surgical tracheostomy, the output of these patients is excellent without more complications.

Keywords: Intensive care unit, tracheostomy, ventilator

References:

1. Başoğlu A, Şengül Taslak A, Kefeli M, Yetim Durgun T, Bekdemir Serdar Ö, Kutlu T. The high risk of postintubation tracheal stenosis in patients intubated for organophosphate poisoning. Turk Gogus Kalp Dama 2012;20:567-571.

2. Hulse EJ, Haslam JD, Emmett SR, Woolley T. Organophosphorous nerve agent poisoning: managing the poisoned patient. Br J Anaesth 2019;123:457-63.

ABS1178

Early diaphragmatic dysfunction in acute respiratory distress syndrome - an observational study

Akhilesh M, M. Srilata, J. Kavitha

Nizam’s Institute of Medical Sciences

Email: akhil24.thewall@gmail.com

Background and Aims: Diaphragmatic dysfunction contributes to acute respiratory distress syndrome (ARDS) hypoxia and hence needs adequate ventilation assessment.^[1,2] This study aimed to assess the onset of diaphragmatic dysfunction using ultrasound in patients with ARDS. The study’s objective was to determine the incidence of diaphragmatic dysfunction by serial ultrasound.

Methods: This prospective observational study was conducted on 30 ventilated patients with moderate to severe ARDS after Ethics committee approval and informed consent. Serial diaphragm ultrasound imaging was performed on days 1, 3, and 5 of intubation till the patient was extubated/ discharged from the intensive care unit or hospital/ lost to follow-up due to death. Diaphragm ultrasound measured hemidiaphragm thickness, contractility ratio and thickening fraction bilaterally. Statistical software SPSS version 22 was used.

Results: There was a significant difference in all diaphragmatic variables from day 1 to 3 with a P<0.001. The incidence of diaphragmatic dysfunction was 96.6% on day 3.8(26.6%) were ventilated using pressure control, and the rest used volume control.6(20%) patients were extubated. There was no significant correlation between various laboratory parameters and extubation.

Conclusion: Diaphragmatic dysfunction occurs in ARDS at 72 h following ventilation. This might contribute to the worsening of ARDS, resulting in morbidity and mortality.

Keywords: Acute respiratory distress syndrome, diaphragm, hypoxia

References:

1. Demoule A, Molinari N, Jung B, Prodanovic H, Chanques G, Matecki S, et al. Patterns of diaphragm function in critically ill patients receiving prolonged mechanical ventilation: a prospective longitudinal study. Ann Intensive Care 2016; 6:75. doi: 10.1186/s13613-016-0179-8.

2. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014;69(5):423–7.

PRACTITIONERS FORUM (ORGANISATIONAL FORUM)

ABS0033

Effect of intraoperative lung recruitment vs. no recruitment on pulmonary function in patients undergoing upper abdominal surgery: a randomised clinical trial

Hemalatha Bora, Padmaja Durga, Abhiruchi Patki

Nizam’s Institute of Medical Sciences

Email: borahemalatha@gmail.com

Background and Aims: Mechanical ventilation can cause ventilator-induced lung injury by opening and closing the atelectatic alveoli. This injury can be lessened with low tidal volumes and high positive end-expiratory pressure (PEEP) with intermittent lung recruitment manoeuvre in patients undergoing open abdominal surgeries.^[1,2]

Methods: A randomised open labelled controlled study was conducted on 80 patients.40 patients in Group C were given a low tidal volume of 6ml/kg and PEEP of 5 cm of water, and 40 patients in Group R, i.e., Recruitment group were given low tidal volume, PEEP and intermittent recruitment manoeuvre every half hour during the entire surgery. Respiratory mechanics, blood gas and haemodynamics were measured. Heart rate (HR), blood pressure (BP), and airway pressure were compared between the groups with an independent sample t-test. A comparison of continuous variables with the baseline values within the group with an analysis of variance (ANOVA) with repeated means.

Results: There was no significant drop in partial pressure of oxygen (PaO₂) in Group R in the 1hour post-extubation value compared to the post-intubation value, whereas in Group C, there was a substantial drop in PaO₂ in the 1hour post-extubation value compared to the post-intubation value. P(A-a)O₂ was always crucial from baseline in Group C.

Conclusion: In open abdominal surgery, low tidal volume with PEEP and recruitment manoeuvre can be used as a ventilation strategy to safely improve lung mechanics and blood gases without causing significant haemodynamic changes.

Keywords: Abdominal surgery, lung disease, postoperative complications

References:

1. Pei S, Wei W, Yang K, Yang Y, Pan Y, Wei J, Yao S, Xia H. Recruitment Maneuver to Reduce Postoperative Pulmonary Complications after Laparoscopic Abdominal Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2022;11(19):5841.

2. Salama MEM, El-Taher EM, Al-Touny AHA, Ismail RA, Abdel-Ghaffar MEE. Effect of individualized intraoperative lung recruitment maneuver on postoperative pulmonary complications in patients undergoing upper abdominal surgeries under general anesthesia. Egyptian Journal of Anaesthesia 2023;39:469-501.

ABS0916

Descriptive analytical study on areas of improvement in anaesthesiology corporate, private practice - let us realise the dream of becoming an independent anaesthesiologist

Chashamjot Kaur Bawa, Rashi Sarna, Rajeev Chauhan, Sanjay Kumar

Mehndiratta hospital, Sector 1, Ambala city

Email: Chasham.bawa@gmail.com

Background and Aims: With the surge in corporate hospitals in India, most young Indian anaesthesiologists want to start their journey with corporate hospitals after graduation.^[1,2]

Methods: The perks of corporate practice can be innumerable, such as fixed salary, transparency in revenue, division of work amongst the team, and adequate facilities as per norms laid down by the Private Practitioner’s Forum (PPF). At the same time, factoring in long, exhausting working hours, jealousy and a sense of stiff competition amongst peers, the attitude of certain surgeons considering respect is based on remuneration, youngsters feeling left out in chances for showcasing their talent, pay disparity amongst fields, frequent tiffs and trust issues with the patients, not being able to update oneself academically, complete lack of research and educational activities and last but not the least, no wellness / recreational activities amidst a dire need make a choice a difficult one, often more for female anaesthesiologists.

Results: An idea of an independent anaesthesiologist would be a perioperative, critical care and chronic pain physician, able to make independent clinical decisions in the fields, upholding the highest standards of practice and engaging a multidisciplinary team to prioritise patient outcomes. They shall also demand a revenue equivalent to their counterparts on a global platform through a structured one-year, two-year and five-year plan.

Conclusion: This article attempts to suggest ways to step up the ladder of progress already achieved under the esteemed PPF team, with excerpts from articles published in indexed journals worldwide covering every aspect mentioned above.

Keywords: Academics, anaesthesiology, corporate

References:

1. Bindu B, Bindra A, Kumar S, Kulkarni S, Rath GP, Prabhakar H, et al. Survey of work practices among anaesthesiologists in India. Indian Anaesth Forum. 2019; 20:1–8.

2. Bajwa SJS. Anaesthesiology in India: Remarkable unity in a vast diversity. Indian J Anaesth 2020;64(Suppl 3): S164–7.

ABS0882

Thoracic segmental spinal anaesthesia for breast surgery – a case series

Gauri Arora

Arora Hospital

Email: gauriarora1@yahoo.in

Background and Aims: Breast surgery is mainly done under general anaesthesia, although regional anaesthesia has also been used.^[1,2] In this case series of 6 patients, mid-thoracic segmental spinal anaesthesia was studied as an alternative option to general anaesthesia (GA) for the excision of breast lumps.

Methods: Six patients in the age group of 23-48 years were given segmental spinal block at T5-T6 level for excision of breast lumps using 1-1.2 ml of 0.5% bupivacaine heavy with 15-20µg fentanyl. Adequate analgesia was achieved from T1-T2 to T12-L2. The parameters observed were pulse, blood pressure, oxygen saturation (SpO₂), analgesia adequacy, additional supplementation, post-operative patient satisfaction level, nausea-vomiting, analgesic requirement and cost-effectiveness.

Results: No analgesic supplementation was required in any of the patients. Bradycardia was observed in two patients who were treated with atropine injection, and one patient had associated hypotension. No fall in SpO₂ was observed in any patient. Analgesia was adequate, as axillary dissection was not done in any patients. Two patients were given 1-1.5 mg of midazolam. There was a better patient satisfaction level. There was no postoperative nausea or vomiting. The less analgesic requirement is post-operative cost-effective.

Conclusion: Mid-thoracic segmental spinal anaesthesia was found to be a good alternative option to GA in selected patients for breast surgery.

Keywords: Breast, regional, segmental spinal anaesthesia, thoracic spinal

References:

1. Elakany MH, Abdelhamid SA. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery. Anesth Essays Res 2013;7(3):390-5.

2. Mahmoud AA, Hussein HA, Girgis K, Kamal AM, Nafady HA. The novel use of spinal anaesthesia at the mid-thoracic level: a feasibility study. Egypt J Cardiothorac Anesth 2014; 8:21-6.