bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngeal Mask Airway Cuff Pressure and its Influence on the Incidence of Pharyngolaryngeal Adverse Effects: Need for Regular Monitoring
Authors: Metange Harish , Kadam Sandeep
Published: October 2024

Background: During general anesthesia with laryngeal mask airway (LMA), cuff pressure needs to be maintained at an optimal level in order to prevent endothelial lesions and postoperative pharyngolaryngeal side effects, like cough, sore throat, hoarseness and even mucosal bleeding. This study evaluated the changes in the LMA cuff pressure after insertion with the passage of time and the effect of the increased pressure on the incidence of pharyngolaryngeal adverse effects.
Methodology: Sixty patients (18-60 y) belonging to American Society of Anesthesiologists (ASA) I or II, meeting the inclusion and exclusion criteria were included in the study and were randomly grouped into Groups A and B (n=30 each). They were evaluated and educated about LMA insertion, its advantages and side effects, following which written informed consent was obtained. Pre-anesthetic evaluation was carried out. For Group A, the cuff pressure was monitored every 10 min intra-operatively from the start of surgery and maintained at 60 cmH2O throughout the surgery. In Group B the cuff was inflated to 60 cmH2O initially and the cuff pressure was recorded at the end of surgery. The volume of air removed from the cuffs was measured and any postoperative complications immediately after removal of LMA and after 24 h were recorded and tabulated.
Result: The mean cuff pressure in Group A was 61.07 cmH2O. The mean cuff pressure in Group B was 108.42 cmH2O and was significantly higher than Group A (p < 0.001). The volume of air removed was also significantly higher in Group B than Group A (p < 0.001). No association of age, gender and ASA classification on the cuff pressures was observed. There were also significantly more postoperative complications in Group B than in Group A, both immediately after and 24 h after removal of LMA.
Conclusion: The results of our study show that while using a laryngeal mask airway during anesthesia, continual monitoring of cuff pressure and its maintenance within the allowable limits is essential in preventing postoperative complications and reducing pharyngolaryngeal morbidity.
Key words: Anesthesia, General; Insufflation; Laryngeal mask airway; Morbidity
Abbreviations: LMA – laryngeal mask airway; LMA-S – Laryngeal mask airway supreme; SAD – supraglottic airway devices; ETT – endotracheal tube; PVC – polyvinylchloride
Citation: Metange H, Kadam S. Laryngeal mask airway cuff pressure and its influence on the incidence of pharyngolaryngeal adverse effects:  need for regular monitoring. Anaesth. pain intensive care 2021;25(4):494–499.
DOI: 10.35975/apic.v25i4.1447
Received: February 01, 2021; Reviewed: April 2, 2021; Accepted:  April 27, 2021
Concise Handbook of Anaesthesia Pharmacology
Authors: Fatima Mishal
Published: October 2024

Dr. Sudhanshu Bajaj is a well-known figure in the academic circles of anesthesiology in India. In fact he also has a deep interest in intensive care as well as pain management, as shown by the list of his qualifications. During his residency days, he was a keen learner, and in the pursuit of gaining more and more knowledge, he used to make smart notes of every subject he read. He found that these notes were especially useful to memorize all about a plethora of drugs, which filled the books of anesthesiology. Most of these drugs were also used in the intensive care units as well as in the practice of pain management. His notes soon became famous amongst his fellow residents, and were copied by them. This book is a compilation of the same notes with a lot of editing and amendments.
Professor Dr. Mehdi Hassan Mumtaz
Authors: Batool Kaneez
Published: October 2024

Professor Dr. Mehdi Hassan Mumtaz is a name that stands out amongst others as the most significant anesthesiologist and intensivist of the country. He was the first to commission an intensive care unit (ICU), at Nishtar Hospital Multan (Pakistan) in 1981. It was first such unit in the country He was the founder president of Pakistan Society of Intensive Care.
He innovated the technique of combined spinal epidural (CSE-SST), also called Epispinal, in 1982. This technique has been used all over the world now. Dr. Mehdi is one of the finest teachers in anesthesiology today. He trained a lot many anesthesiologists who are holding key positions in anesthesiology departments in the country as well as abroad, and continuing his hard work.
Comparison of standard versus a new technique for classic laryngeal mask insertion
Authors: Salman Jasim M.
Published: October 2024

Background & Objective: With the extensive use of the laryngeal mask airway (LMA) for anesthesia as well as in emergency airway management, learning alternative techniques of insertion is essential for the safe and quick use of the device in some cases. The smooth and quick insertion of LMA leads without repeated attempts reduce the consequent complications. We compared standard technique with 180° rotation with inflated cuff technique for LMA Classic insertion.
Methodology: This study was done in Basrah University Medical Center from 1st January 2019 to 31st December 2019. During this period, in 397 patients LMA was used for general anesthesia. Out of these, in 197 patients we used 180° rotation technique of insertion of LMA with fully inflated cuff and in 200 patients the standard method was used as a control group. The patients’ ages ranged between 15 and 45 y, and they were scheduled to undergo short surgical procedures and to require general anesthesia.
Results: Three hundred and ninety-seven (397) participants were enrolled in this study with a mean age of 35.7 ± 14 y. Of those, 154 (38.8%) were males. The new method showed higher sensitivity and accuracy rate (97.4%, 95.9%, respectively) compared to the standard method.
Conclusion: The new method is a suitable technique that enhanced the ease of LMA insertion and successfully placed the device within a shorter time without complications compared to the standard method of insertion.
Key words: Laryngeal mask airway; LMA; BMI; Mallampati grading system; Airway management; Anesthesia, general.
 
Citation: Salman JM. Comparison of standard versus a new technique for classic laryngeal mask insertion. Anaesth. pain intensive care 2021;25(5):569-574: DOI: 10.35975/apic.v25i5.1621 Received: May 21, 2021, Reviewed: August 25, 2021, Accepted: September 5, 2021
Asynchrony index during noninvasive neurally adjusted ventilatory assist (NIV NAVA) in pediatrics: a systematic review
Authors: De Souza João Marcos Feliciano , Rebello Celso Moura , De Oliveira Carlos Augusto Cardim , Troster Eduardo Juan
Published: October 2024

Background: Noninvasive ventilation (NIV) is considered as the first preferred treatment of pediatric acute respiratory failure (ARF). Conventional NIV (CNIV) modes have a higher asynchrony index (AI) when compared to Noninvasive Neurally Adjusted Ventilatory Assist (NIV NAVA) mode. The present study aimed to compare the AI and clinical outcomes during NIV NAVA vs. CNIV in pediatric patients aged between one month and 18 y.
Methodology: This is a systematic review of clinical trials conducted between April and May 2020 in the electronic databases, Cochrane Library, Embase, Lilacs, Pubmed/Medline, Scopus and Web of Science.
Results: Four out of 184 studies were eligible for qualitative synthesis, presenting 50% “high risk” of bias in the randomization, allocation, and other bias. The sample analyzed 39 participants, aged between 35 days and 15 y, with male predominance (61.5%). The primary outcome analyzed in three out of four studies was the significant decrease (p < 0.001) in the AI during NIV NAVA. Clinical outcomes were inconclusive due to methodological limitations.
Conclusion: We conclude that NIV NAVA decreases the AI when compared to CNIV in pediatric patients with ARF. However, the association of the AI reduction and favorable clinical outcomes were inconclusive. Further studies with different methodological formats and larger sample sizes are required to offer definitive conclusions.
Registration: The study protocol was registered in PROSPERO: International Prospective Register of Systematic Reviews (ID: 181785).
Abbreviations: AI – Asynchrony index; ARF – Acute respiratory failure; AT – Automatic trigger; AVB – Acute viral bronchiolitis; DT – Double trigger; EAdi – Electrical activity of the diaphragm; ET – Expiratory time; IE – Ineffective effort; IT – Inspiratory time; LC – Latte cycling; MV – Mechanical ventilation; NCPAP – Nasal continuous positive airway pressure; NIPPV – Nasal intermittent positive pressure ventilation; NIV NAVA – Noninvasive neurally adjusted ventilatory assist; NIV – Noninvasive ventilation; CNIV – Conventional NIV; OI – Oxygenation index; PAC – Pressure assist control; PC – Premature cycling; PS – Pressure support; RoB – Risk of bias; SNIPPV – Synchronized nasal intermittent positive pressure ventilation; TcCO2 – Transcutaneous carbon dioxide; VILI – Ventilation induced lung injury
Keywords: Noninvasive Ventilation, Child, Support, Interactive Ventilatory, Neurally Adjusted Ventilatory Assist
Citation: de Souza JMF, Rebello CM, Oliveira CACD, Troster EJ. Asynchrony index during noninvasive neurally adjusted ventilatory assist (NIV NAVA) in pediatrics: a systematic review. Anaesth. pain intensive care 2021;25(5): 575-582; DOI: 10.35975/apic.v25i5.1622
Received: March 31, 2021, Reviewed: May 23, 2021, Accepted: May 24, 2021
A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery
Authors: Jain Payal , Shahid Razi , Prasad Mukesh Kumar , Alam Md Alauddin , Reddy Macha Niranjan , Jheetay Gurdeep Singh
Published: October 2024

Background: Brachial plexus block utilizing ultrasound imaging has now become either adjuvant to general anesthesia (GA) or as a mainstay anesthesia modality. There are fewer studies comparing the effects of ropivacaine and levobupivacaine for supraclavicular brachial plexus block. This prospective randomized study compared 0.5% Levobupivacaine and 0.5% Ropivacaine in patients undergoing forearm orthopedic surgeries under Ultrasound Guided Supraclavicular Brachial Plexus Block.
Methodology: A total of 56 patients were enrolled and randomized into two groups of 28 patient each. Group R was given 30ml of 0.5% Ropivacaine and Group L was given 30 ml of 0.5% Levobupivacaine in supraclavicular block under ultrasound guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia, and any adverse events. After administration of block, the block characteristics were assessed every 5 min till onset of complete blockade, then hourly till the effect of block. Data between the groups were analyzed using with SPSS 25.0 software.
Results: The study shows that there was statistically significant difference in onset of sensory and motor block between Levobupivacaine and Ropivacaine (7.54 min 2.10 vs 8.55 min 2.08) and (12.95 min 2.30 vs 14.07 min 2.22) respectively. The duration of analgesia was more in Levobupivacaine group (9.98 hours 4.88) as compared to Ropivacaine (8.03 hours 3.58).
Conclusion: The onset of action of sensory and motor was early with Levobupivacaine and can be a better choice when postoperative analgesia is prime concern. However, where faster recovery of motor function is required Ropivacaine is preferred choice.
Key words: Brachial plexus block, ropivacaine, levobupivacaine, supraclavicular brachial plexus block, ultrasound guidance
Citation: Shahid R, Prasad MK, Alam MA, Jain P, Reddy MN, Jheetay GS. A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery. Anaesth. pain intensive care 2021;25(5): 613–619; DOI: 10.35975/apic.v25i5.1629
The effect of methylphenidate on the level of consciousness and weaning from the ventilator in patients with brain injury in the intensive care unit
Authors: Kamali Alireza , Mahmodiyeh Behnam , Jamalian Seyed Mohammad , Kishani Anahita , Dalvandi Mohsen
Published: October 2024

Introduction: Brain injury is the one of the leading cause of death and disability in the most active sections of society, especially in people under 45 y. The prevalence and severity of traumatic brain injury is rising in the Iranian population. The clinical effects of methylphenidate in improving treatment outcomes and cognitive function in this set of patients have been demonstrated in some studies. We conducted this clinical trial to assess the efficacy of methylphenidate in improving the level of consciousness and weaning from the ventilator in patients with brain injury in the intensive care unit.
Methodology: This clinical trial study was performed on 90 intubated patients admitted to the intensive care unit of Valiasr Hospital in Arak, Iran. The patients were randomly divided into two groups. Patients in the intervention group (Group M) received methylphenidate 0.3 mg/kg twice daily, in addition to the routine drugs that the control group (Group C) received. All patients were compared for ventilator isolation, Glasgow Comma Scale (GCS) and APACHE II. The results were compared and analyzed in the two groups using SPSS software version 22.
Results: The mean age of the patients in methylphenidate and control groups was 34.20 ± 7.87 y and 34.53 ± 8.31 y, respectively. There was no significant difference between the two groups in terms of age and gender (p > 0.05). The mean  APACHE II score on the first and third day in Group M was 15.98 ± 1.70 and 13.73 ± 1.72, while in the Group C it was 16.02 ± 1.75 and 13.87 ± 1.84, respectively (p > 0.554). The GCS in the Group M was significantly and rapidly normalized (p < 0.0001). The mean duration of intubation in methylphenidate and Group Cs was 7.18 ± 0.83 and 9.8 ± 1.04 days, respectively. This time was significantly lower in the Group M (p < 0.0001).
Conclusion: The use of methylphenidate in patients with traumatic brain injury on mechanical ventilation in the intensive care unit is associated with a reduced duration of intubation and early return of the level of consciousness to normal.
Abbreviations: TB I– traumatic brain injury; GCS – Glasgow Comma Scale; APACHE – Acute Physiology and Chronic Health Evaluation
Key words: Methylphenidate; Brain Injury; Intensive Care unit; Glasgow Comma Scale; .APACHE II score
Citation: Kamali A, Mahmodiyeh B, Jamalian SM, Kishani A, Dalvandi M. The effect of methylphenidate on the level of consciousness and weaning from the ventilator in patients with brain injury in the intensive care unit. Anaesth. pain intensive care 2021;25(5):643–646;  DOI: 10.35975/apic.v25i5.1633
Received: November 26, 2020, Reviewed: March 30, 2021, Accepted: May 15, 2021
Efficacy of amitriptyline and duloxetine in post-chikungunya neuropathic pain; a randomized, open-label, cross-over clinical trial
Authors: AKM Akhtaruzzaman , Kamal Md Mostafa , Rahman Md Mizanur , Sharmin Shahrina , Bhowmick Dilip Kumar , Islam Md Shafiqul
Published: October 2024

Background: A significant number of chikungunya virus infected people develop neuropathic pain lasting for months to years. Patients with neuropathic pain are difficult to treat with conventional analgesics and frequently require antidepressant and anticonvulsant medications. The current study compared the efficacy of amitriptyline and duloxetine in the treatment of post-chikungunya neuropathic pain.
Methodology: In this randomized, cross-over, clinical trial, a total of forty patients were enrolled and randomly assigned to either amitriptyline or duloxetine for four weeks followed by a two-week washout period. Then the patients were crossed-over to the next phase which lasted for another four weeks. Amitriptyline was given in doses of 10, 25, and 50 mg and duloxetine was given in 20, 30, and 60 mg once daily at 8.00 PM respectively with optional dose up-titration. Pain relief was measured by VAS (visual analogue scale) after one, two, three, and four weeks in each phase as a primary outcome, and improvement of quality of life was assessed by SF-36 (short form-36) at the beginning and end of each phase as a secondary outcome.
Results: A total of twenty one patients completed both treatment phases out of forty patients. The reduction of pain intensity was significant in both amitriptyline and duloxetine groups compared with their baseline values (p < 0.001), with no significant difference between the groups (p > 0.336). The quality of life (SF-36) was significantly improved with both amitriptyline and duloxetine (p < 0.001) but the difference between the two treatments was not significant (p > 0.324). Regarding adverse events, dry mouth was significantly more common in the amitriptyline group than the duloxetine group (p < 0.013).
Conclusion: Amitriptyline and duloxetine can be used in the treatment of post-chikungunya neuropathic pain effectively, but duloxetine is preferred because of its less adverse effects.
Trial registration: The trial was approved by Institutional Review Board, Bangabandhu Sheikh Mujib Medical University dated January 19, 2020; Trial number: BSMMU/2020/712.
Key words: Chikungunya; Neuropathic pain; Quality of life; Amitriptyline; Duloxetine; DN4; SF-36
Abbreviations: VAS – Visual analogue scale, NSAIDs – Non-steroidal anti-inflammatory drugs, DMARD –   Disease-modifying anti-rheumatic drugs, TCA – tricyclic antidepressants, NICE – National Institute for Health and Care Excellence, SNRI – Serotonin noradrenaline reuptake inhibitor
Citation: Kamal MM, Rahman MM, Sharmin S, Bhowmick DK, Islam MS, Akhtaruzzaman AKM. Efficacy of amitriptyline and duloxetine in post-chikungunya neuropathic pain; a randomized, open-label, cross-over clinical trial. Anaesth. pain intensive care 2021;25(5):647–652; DOI: 10.35975/apic.v25i5.1634
Received: May 02, 2021, Reviewed: July 17, 2021, Accepted: July 20, 2021
Anesthesia for non-cardiac surgery in a patient with left ventricular assist device (LVAD)
Authors: Gulec Handan , Ceran Guzin , Yomen Veysel Yasin , Sahap Mehmet , Ozcan Ayca Tuba Dumanlı , Gogus Nermin , Aydin Eda Uysal , Erkilic Ezgi
Published: October 2024

Left ventricular assist devices (LVADs) are advanced mechanical devices for end-stage heart failure. LVADs are implanted as bridge therapy in the patient awaiting heart transplantation. A 44-year-old male patient was preoperatively evaluated for surgery due to femur fracture. In the medical history of the patient, it was learned that heart failure developed after myocarditis in 2009 and an intracardiac defibrillator (ICD) was implanted in 2014.we administered low-dose local anesthetic and opioid intrathecally, which we thought would affect the hemodynamics at least, and performed the operation with stable hemodynamics of the patient.
Key words: Left ventricular assist device; Anesthesia; Anesthesia, Spinal; Heart transplantation
Citation: Ceran G, Yomen VY, Sahap M, Gulec H, Ozcan ATD, Gogus N, Aydin EU, Erkilic E. Anesthesia for non-cardiac surgery in a patient with left ventricular assist device (LVAD). Anaesth. pain intensive care 2021;25(5):680–681
DOI: 10.35975/apic.v25i5.1637
Received: April 19, 2021, Reviewed: August 17, 2021, Accepted: August 21, 2021
Early postoperative arterial hypoxemia can predict postoperative pulmonary complications
Authors: Pham Minh Quang , Bui Hanh My , Tran Thi Thu Phuong , Nguyen Tu Huu
Published: October 2024

Background & Objective: Postoperative hypoxemia is very common but not unavoidable. It can lead to pulmonary complications through a variety of routes. This study was designed to evaluate changes in arterial blood gases in the initial days after abdominal surgery and to identify the risk factors for postoperative arterial hypoxemia and the prognostic value of arterial hypoxemia to predict pulmonary complications.
Methodology: 215 consecutive patients undergoing laparotomies under general anesthesia with intubation, age ≥ 18 y, ASA I, II,  were enrolled under convenient sampling. The patients with severe preoperative disease, e.g.,  heart failure grade 3 or 4; liver cirrhosis; kidney failure; or COPD were excluded. One day before the surgery, the spirometric values of the patients were measured. Arterial blood sample (T0) for gas analysis was ontained. Anesthesia technique consisted of midazolam, fentanyl, propofol, esmeron, intubaion and epidural catheter. Patients were monitored in the recovery room for signs of lung complications, VAS pain score, X-ray, blood assessment, and sputum culture if indicated. Arterial blood gas was re-tested after 24 h (T1) and 48 h (T2). The criterion for the diagnosis of arterial hypoxemia was PaO2/FiO2 < 300.
Statistical nalysis done in SPSS software (version 16.0). Data presented as mean ± SD or n (%). Student’s t-test, paired t-test and ANOVA test were used as required. Statistical significance was set at P < 0.05.
Results: On the first and second days after surgery, both PaO2 and PaO2/FiO2 decreased significantly compared to the preoperative values. 14 and 30 patients on the first and second day after surgery, respectively had decreased arterial blood oxygen levels. All patients who had hypoxemia on the first day after surgery suffered from hypoxemia on the second day. Decreased arterial blood oxygen level on the second day after surgery is a predictor of postoperative respiratory complications. After the first day of surgery, a Tiffeneau-Pinelli index ≤ 75%, A–aO2 ≥ 20, and anesthesia duration ≥ 150 min were independent risk factors for arterial hypoxia, whereas after day 2, these were a Tiffeneau-Pinelli index ≤ 75%, A–aO2 ≥ 20, fluid balance ≥ 1700 ml and preoperative upper respiratory tract infections.
Conclusion: Postoperative arterial hypoxemia on the second day was a prognostic index for postoperative pulmonary complications. Independent risk factors for hypoxemia were identified.
Key words: Postoperative pulmonary complications; Hypoxemia; PaO2/FiO2 ratio; Tiffeneau-Pinelli index; A–aO2
Citation: Pham MQ, Bui HM, Tran TTP, Nguyen TH. Early postoperative arterial hypoxemia can predict postoperative pulmonary complications. Anaesth. pain intensive care 2022;26(2):137-142 ; DOI: 10.35975/apic.v26i2.1819
Received: June 21, 2021, Reviewed: September 27, 2021, Accepted: February 18, 2022
Dr. Muhammad Kashif Ilyas (1949-2022)
Authors: Khan Jamal Tariq
Published: October 2024

It is announced with profound sadness and anguish that Dr. Muhammad Kashif Ilyas, Anesthetist at Faisalabad Institute of Cardiology and Allied Hospital, Faisalabad (Pakistan) passed away on February 13, 2022.  Apparently enjoying good physical and mental health, he suddenly collapsed and met his Creator before any medical help could be provided to him. The assumed cause of death was sudden cardiac arrest secondary to acute myocardial infarction.
Heart Rate Variation is The Clinical Sign Associated with The Deepest Plane of Anesthesia During Induction: The Novel Finding and Its Clinical Implications
Authors: MD Ting-Hsuan Chiang, , BA Sami Strutner, , MD Adam Moheban, , MD Joseph Rinehart, , Rajan, MD, MBBS, FAACD, FASA Govind R.
Published: October 2024

Background: Premature airway manipulation during induction can lead to adverse patient outcomes. However, there is currently no standardized clinical sign to assess adequate anesthesia depth during induction. With the goal of increasing patient safety during induction, we aim to correlate different clinical signs during induction with the depth of anesthesia using the bispectral index (BIS) monitor and determine the physical metrics corresponding to the deepest plane of anesthesia.
Methodology: This prospective study enrolled 41 subjects scheduled for surgery requiring propofol for induction. A BIS monitor was used for standardized monitoring of anesthesia depth during the induction process. We documented the BIS value and occurrence time of the observed physical metrics: (1) loss of eyelash reflex, (2) loss of response to verbal stimuli, (3) loss of muscle tone, (4) loss of end tidal carbon dioxide (EtCO2) or apnea, and (5) transient heart rate variations.
Results: Apnea, change in heart rate from baseline, and heart rate return to baseline are signs during induction associated with both lower BIS values and later occurrence when compared to other clinical signs such as loss of eyelash reflex, verbal response, and muscle tone (P < 0.001).
Conclusion: Physical signs such as loss of eyelash reflex, verbal response, and muscle tone during induction are associated to lighter planes of anesthesia. A safer and deeper plane of anesthesia occurs later. Relying on these physical signs for assessment of laryngeal mask airway insertion may increase the risk of stimulating the patient’s airway prematurely, which can lead to adverse patient outcomes.
Abbreviations: EtCO2 - End tidal carbon dioxide; BIS - Bispectral index; EEG - electroencephalogram; EKG - electrocardiogram
Key words: Depth of Anesthesia; Patient Safety; Heart rate variation; Induction
Citation: Chiang TH, Strutner S, Moheban A, Rinehart J, Rajan GR. Heart rate variation is the clinical sign associated with the deepest plane of anesthesia during induction: the novel finding and its clinical implications. Anaesth. pain intensive care 2023;27(2):243−249.
DOI: 10.35975/apic.v27i2.1930
Received: October 13, 2022; Reviewed: March 29, 2023; Accepted: March 31, 2023
Acute effect of Kinesiotaping applied to the first finger in patients with rheumatoid hand
Authors: Çopuroğlu Özge Baykan , Narin Selnur , Bayraktar Dilek , Özgül Semiha , Inal Vedat
Published: October 2024

Background & Objective: Rheumatoid arthritis (RA) is a crippling disease characterized by joint pains and joint stiffness. Kinesiotaping (KT) has been advocated to reduce local pressure and increase circulation, resulting in decreased pain in various conditions. We aimed to evaluate the acute effect of KT on pain, function, range of motion (ROM) and grip strength parameters in patients with rheumatoid hand.
Methodology: A total of 34 patients, 27 women and 7 men, diagnosed with RA were included in our study. All patients were divided into two groups; Kinesiotape group (Group KT) and control group (Group C), each consisting of 17 patients. Subjective pain intensity by Visual Analog Scale (VAS), ROM by goniometer, functional evaluation with the Grip Skill Test, hand grip strength by dynamometer, and finger grip strength by pinchmeter were evaluated. The patients in the Group KT were taped with the mechanical correction method and the patients in the Group C were taped with tensionless I tape. Applications were made on both dominant and non-dominant hands.
Results: The mean age of the patients was 54 ± 20 y. VAS score changes at the time of grasping were significant in both groups (P < 0.05), but Group KT was more effective for reducing pain and increasing grip strength. An increase was observed in the wrist and thumb metacarpophalangeal joint ROM in the Group KT (P < 0.05). No change was observed in the groups in hand grip strength and finger grip strength (P > 0.05). In the Grip Skill test, there was a significant difference after the application in both groups (P < 0.05), but there was no difference in between the groups (P > 0.05).
Conclusion: Kinesiotaping applied in rheumatoid hand patients was found to be effective in increasing functionality and joint range of motion, as well as reducing pain during gripping.
Abbreviations: KT – Kinesiotaping; RA – Rheumatoid arthritis; MCP – Metacarpophalangeal joint; ROM - Range of Motion; VAS - Visual Analog Scale
Key words: Hand function; Hand deformities; Kinesiotape; Kinesiotaping; Rheumatoid arthritis; Range of Motion, Articular; Visual Analog Scale
Citation: Çopuroğlu OB, Narin S, Bayraktar D, Özgül S, Vedat Inal V. Acute effect of kinesiotaping applied to the first finger of the patients with rheumatoid hand. Anaesth. pain intensive care 2022;26(6):236−242.
DOI: 10.35975/apic.v27i2.2042
Received: Sep 06, 2022; Reviewed: Oct 09, 2022; Accepted: Oct 21, 2022
Anesthesia and pain management in a pediatric patient with patent ductus arteriosus undergoing repair of recurrent diaphragmatic hernia
Authors: Sudjud Reza Widianto , Tavianto Doddy , Rismawan Budiana , Ramila Hana Nur , Kurniawan Muhammad Budi , Annasya Aria , Pohan Dr. Djoni Kusumah
Published: October 2024

Congenital diaphragmatic hernia is caused by a defect in the closure of the pericardio-peritoneal canal. It is a real challenge for the anesthetists during the perioperative management as serious complications including hypoxia and hypercarbia may threaten the life of the child. Mortality remains high due to associated pulmonary hypoplasia and pulmonary hypertension.
We present a case of a 15-month-old boy, known patient of recurrent congenital diaphragmatic hernia, scheduled to undergo laparotomy to repair his diaphragmatic defect. The patient presented with shortness of breath, and his chest X-ray revealed a diaphragmatic hernia. He was in optimal condition. General anesthesia was chosen with intubation. The patient remained stable and his laboratory tests were within normal limits. We discuss the associated problems during anesthesia and the optimum perioperative management.
Abbreviations: CDH - congenital diaphragmatic hernia; ECMO - Extracorporeal membrane oxygenation; ETT - Endotracheal tube
Key words: congenital diaphragmatic hernia, hypoxia, pulmonary hypoplasia
Citation: Sudjud RW, Tavianto D, Rismawan B, Ramila HN, Kurniawan MB, Annasya A. Anesthesia and pain management in a pediatric patient with patent ductus arteriosus undergoing repair of recurrent diaphragmatic hernia. Anaesth. pain intensive care 2023;27(2):280−284; DOI: 10.35975/apic.v27i2.2177
Received: August 28, 2022; Reviewed: November 05, 2022; Accepted: December 10, 2022
A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries
Authors: Kamal Nouh Mohamed Medhat Moustafa , Elrehiem Elkadi Galal Adel Mohamed Abd , Aboseif Eman Mohamed Kamal , El Hamid Faisal Said Abd , Ali Mowafi Marwa Mostafa Mohamed
Published: October 2024

ABSTRACT
Background: Currently, there is a lack of an established standard or protocol for the management of post-spinal anesthesia shivering (PSAS). We compared the efficacy of intravenous use of three drugs, e.g., acetaminophen, dexamethasone, and pethidine in prevention of PSAS.
Methodology: We included 108 patients who were randomly assigned to three equal groups of 36 patients each. Group A patients received pethidine infusion at 0.5 mg/kg; Group B patients were infused with acetaminophen 15 mg/kg and Group C was given dexamethasone infusion at 0.1 mg/kg. The degree of shivering at its onset was determined using the Bedside Shivering Assessment Scale (BSAS). Data was analyzed using Statistical Package for Social Science (SPSS) version 22.
Results: PSAS was observed in 10 (27.7 %) patients in Group A vs. 14 (38.8 %) patients in Group B (P = 0.32), and 21 (58.3 %) patients of Group C (P = 0.01). The P-value between B vs C was 0.10, and between all the groups was 0.03. The BSAS score was 26 in Group A (75% patients out of 36 did not develop shivering), 22 in Group B, and 15 in Group C. The P-value between A vs. B was 0.01, A vs. C = 0.01, B vs. C = 0.12, and between all groups was 0.02.
Conclusion: Aacetaminophen was more effective than dexamethasone, while pethidine was more effective than both, acetaminophen as well as dexamethasone, in decreasing the incidence of post-spinal anesthesia shivering.
Trial Registry: ClinicalTrials.gov ID: NCT05284409
Abbreviations:  ASA - American Society of Anesthesiologists; BSAS - Bedside Shivering Assessment Scale; PSAS - Post-spinal anesthesia shivering
Key words: Post spinal, Shivering; Pethidine; Dexamethasone; Acetaminophen
Citation: Kamal Nouh MMM, Abd Elrehiem Elkadi GAM, Aboseif EMK, Abd El Hamid FS, Mowafi MMMA. A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries. pain intensive care 2023;27(1):185−190; DOI: 10.35975/apic.v27i2.2182
Received: January 14, 2023; Reviewed: February 06, 2023; Accepted: February 13, 2023
Comparison of analgesic efficacy and safety of bupivacaine plus ketamine versus bupivacaine alone in rectus sheath block for midline laparotomy
Authors: Hassan Shamsul Kamaruljan , Thang Pooi Yee , Muhd Shukeri Wan Fadzlina Wan , Ismet Suki
Published: October 2024

Background & Objective: Addition of ketamine affects pain modulation through multiple mechanisms and may enhance the analgesic effect of local anesthetics in rectus sheath block (RSB). However, limited studies have evaluated the analgesic efficacy and safety of ketamine added to RSB for midline laparotomy. We aimed to evaluate the analgesic efficacy and safety of ketamine as an adjuvant to 0.25% bupivacaine in ultrasound-guided RSB following major abdominal or gynecological surgery with midline incision.
Methodology: Fifty-four patients of ASA class I−II, aged 18−65 y, who underwent midline laparotomy under general anesthesia were studied. The patients were randomly allocated to two groups: ultrasound-guided RSB was performed in the control group (n = 28) with 40 ml of 0.25% bupivacaine, while in the ketamine group (n = 28) it was performed with 40 ml of 0.25% bupivacaine plus ketamine 1 mg/kg. Postoperatively, both groups received IV morphine patient-controlled analgesia. The Numeric Rating Scale (NRS) pain scores at rest and on movement were assessed at 0, 1, 12 and 24 h postoperatively. The total 24-h postoperative morphine consumption and psychomimetic side effects were recorded.
Results: The mean NRS pain score on movement was significantly lower in the ketamine group at most time points compared to the control group (P < 0.05). The ketamine group had a significantly reduced total 24 h postoperative morphine consumption (14.3 ± 6.55 mg) compared to the control group (21.86 ± 15.46 mg) (P < 0.05). No psychomimetic adverse effects were reported in both groups.
Conclusion: The addition of ketamine to bupivacaine in RSB resulted in effective postoperative analgesia by reducing postoperative pain scores on movement in patients who underwent midline laparotomy. Such combination also reduced postoperative morphine requirement without serious side effects.
Abbreviations: ERAS - Enhanced Recovery After Surgery; LA - Local anesthetics; NRS - Numeric Rating Scale; PAC - Patient-controlled analgesia; RSB - Rectus sheath block;
Key words: adjuvant; Bupivacaine; Ketamine; Laparotomy; Rectus sheath block
Citation: Hassan SK, Thang PY, Wan Shukeri WFWM, Ismet S. Comparison of analgesic efficacy and safety of bupivacaine plus ketamine versus bupivacaine alone in rectus sheath block for midline laparotomy. Anaesth. pain intensive care 2023;27(2):220−226. DOI: 10.35975/apic.v27i2.2188
 
Received: December 21, 2022; Reviewed: January 17, 2023; Accepted: January 19, 2023
STUDI KUALITATIF PENYEBAB KETIDAKLENGKAPAN REKAM MEDIS PASIEN DI KLINIK TA DENPASAR
Authors: Sariyani Made Dewi , Wasita Rai Riska Resti , Ariyanti Kadek Sri , Dinatha Ngurah Mahendra , Oktawijayanti Putu
Published: October 2024

Rekam medis adalah dokumen penting bagi fasilitas pelayanan kesehatan, karena segala bentuk informasi terkait tindakan dan pengobatan tercantum dalam rekam medis. Berbagai  permasalahan  yang  terjadi,  jika  dalam  pengisian  rekam  medis  tidak dilakukan  secara  konsisten  dan  benar.  Klinik TA merupakan salah satu klinik milik swasta yang berada di Denpasar. Hasil studi pendahuluan dengan kordinator klinik, menunjukan bahwa rekam medis di klinik tersebut masih sangat minim sekali pengaturannya, sehingga saat akreditasi tim klinik agak sedikit kesulitan menyiapkannya. Manfaat penelitian ini yaitu sebagai bahan masukan dan evaluasi bagi dokter, perawat dan pimpinan klinik terjadap pentingnya kelengkapan berkas rekam medis pasien di klinik TA. Metode penelitian yang digunakan adalah kualitatif dengan case study. Berdasarkan hasil observasi dokumen rekam medis, ditemukan bahwa belum mempunyai formulir Unit Gawat Darurat (UGD). Pada rekam medis rawat inap terdapat kekurangan formulir yaitu pelayanan lain yang dilakukan oleh tenaga kesehatan tertentu dan formulir kematian. Selian itu, klinik TA belum memiliki SOP pengadaan dan pemusnahan rekam medis. Petugas tidak memiliki buku ekspedisi sebagai alat untuk menegndalikan berkas keluar atau dipinjam. Rekam medis di klinik TA belum elektronik. Adapun simpulan hasil penelitian yaitu ketidaklengakapan rekam medis pasien disebabkan oleh 5M yaitu man, money, methode, machine, dan material. Terdapat faktor penyebab lain yaitu dukungan pimpinan yang kurang terhadap proses rekam medis pasien di Klinik TA.
FEMINISIM REPRESENTATION IN LOUISA MAY ALCOTT’S NOVEL LITTLE WOMEN
Authors: Berutu Achmanuddin , Waradana Fitra Andira , Ikbal Muhammar , Siregar Naufal Karim , Purwarno Purwarno
Published: October 2024

Louisa May Alcott's Little Women, a seminal work in American literature, profoundly explores the roles, aspirations, and challenges faced by women in the 19th century. Set against the backdrop of the American Civil War and its aftermath, the novel follows the lives of the March sisters—Meg, Jo, Beth, and Amy—as they navigate the complexities of womanhood in a society governed by rigid gender norms. Through rich character development and a compelling narrative, Little Women offers insight into the evolving landscape of women's rights and feminist thought during a pivotal era in American history. This paper aims to analyze the representation of feminism in Little Women, examining how the novel both conforms to and challenges traditional gender expectations. Drawing on liberal, Marxist, existentialist, and radical feminist theories, the paper explores various aspects of the March sisters' experiences, shedding light on their pursuit of autonomy, independence, and self-determination. Through a comprehensive analysis of key passages and character dynamics, the study uncovers the ways in which Alcott's work contributes to the broader discourse surrounding women's rights and gender equality.
Cyber-Bullying in Sophie Mckenzie's "Sweetfreak"
Authors: Naufal Maulana Mochammad
Published: October 2024

This research is about the cyber-bullying in Sophie Mckenzie’s SweetFreak. This research’s objectives are to describe the extrinsic element that are the causes, types and effects of cyber-bullying in the novel. This research used psychological approach in its method and the descriptive qualitative method for its research design. Through the use of the Lifestyle-Routine Activity Theory by Candace et al. (2023) a theory to determine the likelihood of victimization, the researcher found that the cyber-bullying in this novel happened because of three factors: motivated offender, target suitability, absence of guardianship. The motivated offender factor happened because the culprit of the cyber-bullying was driven to do the cyber-bullying, target suitability factor happened because the victim of the cyber-bullying had done something prior that made her suitable to be targeted by the perpetrator, the absence of guardianship happened because no real elders in the novel ever tried to protect or supervised the victim. Then in terms of types of cyber-bullying, the researcher found that there are five types of cyber-bullying that are used in the novel. The types of cyber-bullying are: online harassment, flaming, denigration, photograph & video, fraping. As for the effects, the researcher found there are three kinds of effect from the cyber-bullying, that are displayed by the main character in the novel. They are: academic effect, which disrupts the main character’s school life, the social effect that ruined the main character’s interaction with her peers, and finally the emotional effect that disturbed the psyche of the main character.
حماية الأمن المائي للعراق وفقا لقواعد القانون الدولي
Authors: العبدلي محمد
Published: October 2024

إن الصفة الدولية لنهري دجلة والفرات تجعل استغلال مياههما خاضع إلى عدة مبادئ أساسية ملزمة للدول المشتركة في مجرى النهر الدولي، أهمها العدالة في توزيع المياه والانتفاع المشترك بالمياه والتعاون في تنمية موارده، ومراعاة الحقوق المكتسبة الخاصة بكميات المياه لكل دولة، لذا تحاول الدول المجاورة للعراق، وبالذات تركيا، عدم الاعتراف بالصفة الدولية لنهري دجلة والفرات؛ من أجل تبرير عدم التزامها للمبادئ الاساسية المذكورة آنفاً، رغم عدم قيمة اعترافها أمام قواعد القانون الدولي الخاصة بتصنيف الأنهار. ولمواجهة تلك السياسة المائية التعسفية المخالفة لقواعد القانون الدولي الخاصة باستغلال مياه الانهار الدولية، يتطلب اتخاذ عدة إجراءات قانونية ودبلوماسية وسياسية، واستغلال كافة الملفات والروابط المشتركة مع تلك الدول، وفتح مفاوضات مباشرة معها، وكذلك عرض موضوع الخلاف على المنظمات الدولية، وصولاً إلى حلول نهائية تضمن حق كل دولة على مياه النهرين المذكورين.
الخدمات الحضرية في مدينة الكوفة ضمن التصاميم الأساسية للمدينة 1958-2017
Authors: المظفر رسل
Published: October 2024

إن توزيع الخدمات في مدينة الكوفة قد توزعت بما لا يتناسب مع توزيع سكانها وفق التركيب العمراني للمدينة واحيائها السكنية اذ يتوجب تحديد متطلبات من الخدمات الترفيهية التي تتمثل بالحدائق العامة والمقاهي والمناطق الخضراء كما يتم توزيع الخدمات داخل المناطق السكنية التي يستفيد منها الاطفال بالدرجة الاولى والتي يرتادها يوميا، فلا بد من اقامة وتوزيع الملاعب والحدائق العامة والخدمات الاخرى حسب التعداد السكاني لتلك المناطق ،كذلك يجب النظر في هذه الخدمات واستثمارها بطريقة صحيحة تخدم ابناء المدينة لما لها من تأثير في جلب السياح ،كما يجب ان يتناسب هذا التخطيط مع الواقع الطبيعي السائد في المدينة وتوزيع خدماتها حسب سكان تلك المناطق.
REVIEW ON KNITTED FABRIC IN SPORTS TEXTILE
Authors: Manjuladevi K  , Yuvanigha K.R  , Dr. K.M. Pachiyappan  , Dr. Divya Sathyam  , Saniya A
Published: October 2024

In recent years, there has been an increase in the revolution of sportswear to provide maximum comfort and the ideal fit. When creating fabric for sportswear, factors including fabric type, yarn technology, and methods for achieving great performance and comfort are taken into account. Textile science and technology have been used in the production of leisure and sportswear to meet the demands of athletic activities and improve performance. Sports fabrics are technically advanced materials that are designed to improve the wearer's comfort during physical activity. These materials are chosen for their high heat and moisture management capabilities, which include excellent elasticity, rapid drying, and extreme breathability
KEYWORDS: Knitted fabrics, Sportswear, Ommc, Comfort property
Uji Aktivitas Sediaan Hand Sanitizer Ekstrak Etanol Daun Euphorbia milli Terhadap Bakteri Staphylococcus epidermidis
Authors: Sri Budiasih Putu Eka , Sunadi Putra I Made Agus , Santoso Puguh
Published: October 2024

Euphorbia milli merupakan salah satu tanaman yang mempunyai khasiat obat, salah satunya pada daun Euphorbia milli mengandung peroksidase, saponin, kaslsium oksalat, subtasi peptic dan amilum. Sementara itu getahnya mengandung euphorbol, euphol dan cyoartenol. Daun banyak digunakan sebagai oabat bisul (furuncle), radang kulit bernanah (piodermi), tersiram air panas, luka bakar. Daun Euphorbia milli memiliki kandungan saponin, yang memiliki potensi sebagai antibakteri. Penelitian ini bertujuan untuk mengetahui antivitas antibakteri dari ekstrak etanol daun kaktus pakis giwang terhadap pertumbuhan Staphylococcus epidermidis dengan membuat gel hand sanitizer dari ekstrak daun kaktus pakis giwang menggunakan tiga variasi konsentrasi ekstrak yakni 5%,10% dan 15%. Ekstrak tanaman yang digunakan didapat dengan menggunakan metode maserasi menggunakan etanol 70% dengan replikasi sebanyak 3 kali. Metode penelitian ini merupakan penelitian eksperimental laboratorium. Hasil penelitian menunjukan bahwa gel hand sanitizer yang dibuat memiliki daya hambat terhadap pertumbuhan bakteri Staphylococcus epidermidis.
PUBLIC TRANSIT OPERATORS’ RESILIENCE AND SUSTAINABLE DEVELOPMENT AMID THE COVID-19 PANDEMIC: THE CASE OF RICHMOND, VIRGINIA
Authors: CHEN Xueming
Published: October 2024

During the COVID-19 pandemic, the Greater Richmond Transit Company (GRTC) experienced a substantial downturn in its system transit ridership. In response to this emergency, GRTC immediately took bold measures to protect its operators and riders, such as: serving essential trips, adjusting operating schedules, offering free transit services, broadening funding sources, and others. As a result, GRTC successfully overcame the pandemic crises and embarked on the road to full recovery in its transit operation. The successful lessons from GRTC could also be transferable to other similar transit services in the U.S.
Hubungan Self Efficacy dengan Academic Burnout pada Mahasiswa yang Menyusun Skripsi di STIKes Santa Elisabeth Medan Tahun 2021
Authors: N. Lilis , Samfriati  , Rahmatsari L. Mei
Published: October 2024

Tugas akhir sangatlah penting bagi mahasiswa yang sedang menyusun skripsi. Dalam pengerjaan skripsi ini banyak mahasiswa merasa tertekan dan stres, yang kemudian menyebabkan burnout Academic. Dalam mencegah di anjurkan untuk memiliki self efficacy yang tinggi pada setiap  mahasiwa sehingga mampu terlindungi dari academic burnout. Tujuan dari penelitian ini untuk mengetahui adalah hubungan self efficacy dengan burnout academic mahasiswa dalam  mengerjakan tugas akhir di Sekolah Tinggi Ilmu Kesehatan Santa Elisabeth Medan pada Tahun 2021. Deskriptif korelasi dengan pendekatan cross-sectional penelitian yang digunakan peneliti. Responden berjumlah 52 orang  dengan pengambilan sampel menggunakan simple random sampling. Dari uji statistik Spearman rank didapatkan nilai p = 0,000 (p <0,05) dengan r = -0.650, dimana ada hubungan yang  kekuatan sedang serta signifikan dan korelasi bernilai negatif dimana self efficacy meningkat sehingga burnout academic menurun, begitu juga jika self efficacy menurun serta academic burnout dapat meningkat. Diharapkan dengan   meningkatkan self efficacy maka dapat mengurangi academic burnout pada mahasiswa.
Romans and Greeks in Early Imperial Lydia and Phrygia
Authors: Thonemann Peter
Published: October 2024

This paper collects the evidence for corporate groups of “Romans and Greeks living at (village toponym)” in Lydia and western Phrygia in the early Roman imperial period. The author discusses seven honorific inscriptions and dedications, three of them very recently published; four derive from the near vicinity of Akmoneia in western Phrygia, reflecting the large number of resident Romans in the region. The author offers a detailed commentary on a newly published honorific inscription from Kastollos in Lydia, including various new readings and restorations (no. 1). The author discusses the precise meaning of the formula “Romans and Greeks” and the chronological and geographic distribution of the formula. Three of the seven inscriptions honour locals granted Roman citizenship by Mark Antony (no. 6) or Augustus (nos 1 and 3), and the author uses numismatic evidence to discuss the social standing of these newly enfranchised Roman citizens within their Lydian and Phrygian communities.
Detection and identification of contamination in fixed collective protection facilities
Authors: HARMATA Władysław , SZCZEŚNIAK Zbigniew , SOBIECH Marian , BARYŁKA Adam
Published: October 2024

The review article deals with the systems of protection of persons in the entrances to permanent defense facilities from contamination and the concept of organization of detection and identification of contamination in the personnel line of the facility. The requirements and guidelines of NATO doctrinal and standardization documents relating to the problem of detection of contamination in permanent defense facilities were analyzed. The technical solutions used for detection and identification of contamination were characterized in terms of their applicability to fixed defense facilities. A proposal for detection and identification of contamination in fixed defense facilities was presented, taking into account facilities without and with personnel movement.