bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale of modified paraspinous / paramedian technique for spinal anesthesia in prevention of post dural puncture headache after cesarean section
Authors: Mohamed Zenat Eldadamony , Selim Mohamed Fouad
Published: October 2024

Background & Objective: The spinal anesthesia in cesarean sections is still marred by post dural puncture headache (PDPH) and low backache. Both complaints sometimes becomes very troublesome for the patient and the anesthesiologists. This study evaluated the incidence of PPDH with modified paraspinous paramedian and median traditional approaches for spinal anesthesia during cesarean sections.
Methodology: For this randomized, controlled double-blind study, 60 primigravida parturients undergoing cesarean section under spinal anesthesia were randomized into 2 groups (30 each). Group 1 received spinal anesthesia with the classic median approach and Group 2 received spinal anesthesia with the modified paraspinous paramedian approach. All the patients were followed up to 7 days postoperatively. The incidence of PDPH and low backache was observed in each group.
Results: The present study showed a statistically significant lower incidence and lower severity of PDPH in Group 2 in which a modified paraspinous paramedian approach was used, compared to Group 1 (p < .05) in which median classic approach was used. The difference in the incidence of back pain was non-significant.
Conclusion: Spinal anesthesia with the modified paraspinous/ paramedian approach for cesarean section is associated with a lower incidence of PDPH when compared to the standard median approach.
Key words: Post Dural Puncture Headache; Spinal anesthesia; Median classic approach; Modified paraspinous paramedian approach
Citation: Mohamed ZE, Selim MF. Rationale of modified paraspinous / paramedian technique for spinal anesthesia in prevention of post dural puncture headache after cesarean section. Anaesth. pain intensive care 2021;25(4): 487-493. DOI: 10.35975/apic.v25i4.1574
Received: August 19, 2020, Reviewed: December 22, 2020, Accepted: February 18, 2021
Incidental finding of left sided superior vena cava in a patient for tunneled central venous line insertion and review of literature
Authors: Imtiaz Danish , Sadaqat Sadia , Rehman Saad -Ur-
Published: October 2024

Left sided superior vena cava (SVC) is a rare anatomic variant of the normal anatomy of the heart and the venous system that has clinical implications. The presence of this variant is relevant to central venous catheter placement, cardioverter defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of left sided SVC, which was diagnosed during central venous catheter insertion. We also discuss the vascular and anesthetic considerations for individuals with this uncommon variant.
Key words: Superior vena cava; Anatomical anomaly; Central venous catheter
Citation: Imtiaz D, Sadaqat S, Rehman SU. Incidental finding of left sided superior vena cava in a patient for tunneled central venous line insertion and review of literature. Anaesth. pain intensive care 2021;25(4):547–549 DOI: 10.35975/apic.v25i4.1577
Received: April 29, 2021, Reviewed: June 1, 2021, Accepted: June 4, 2021
Comparison of two techniques in quality chest compressions
Authors: Moradi Abbas , Heidarzadeh Hamid
Published: October 2024

Key words: Chest compression; Quality; ROSC; Resuscitation
Citation: Heidarzadeh H, Moradi A. Comparison of two techniques in quality chest compressions. Anaesth. pain intensive care 2021;25(4):552–553 , DOI: 10.35975/apic.v25i4.1579
Evaluation of risk factors for postoperative ICU admission in a tertiary care hospital – A case control study
Authors: Huda Anwar Ul , Rabbani Unaib , Yasir Mohammad
Published: October 2024

Background & objective: Appropriate decisions regarding admission of potential patients to intensive care unit (ICU) postoperatively are considered very important for the patient care. We evaluated the reasons and the risk factors for postoperative ICU admissions in our hospital.
Methodology: This is a case-control study, that was done at Security Forces Hospital, Riyadh, during the period from July 2019 to December 2019. We included all patients who needed ICU admission postoperatively in the study as cases. The controls were the patients who had any surgical procedure during the same study period. Patients’ demographics, ASA status, medical co-morbidities and operation details were recorded. We then did univariate and multivariate logistic regression to analyze the data. A p-value of less than 0.05 was considered as significant.
Results: We enrolled a total of 140 patients in the study, with 46 cases and 94 controls. In univariate analysis, age, ASA status, presence of hypertension, diabetes, ischemic heart disease, respiratory disease, renal dysfunction and neurological abnormalities were found to be statistically significant predictors for postoperative ICU admission. In multivariate analysis, ASA status and perioperative neurological abnormalities were the most significant risk factors for ICU admission.
Conclusion: ASA status and presence of neurological abnormalities are the most significant risk factors associated with ICU admission in the postoperative period.
Key words: Risk factors; ICU; ICU admission; Postoperative period; ASA status
Citation: Huda AU, Rabbani U, Yasir M. Evaluation of risk factors for postoperative ICU admission in a tertiary care hospital – A case control study. Anesth. pain intensive care 2021;25(4):501–504. DOI: 10.35975/apic.v25i4.1581
Received: December 23, 2020, Reviewed: January 25, 2021, Accepted: July 7, 2021
A narrative review of mental health landscape of survivors, healthcare workers, and general public in the Post-COVID world
Authors: Majeed Amer , Afzal Saad , Amer Momina
Published: October 2024

The coronavirus disease 2019 (COVID–19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), is still unravelling, and is expected to last for an indefinite time. The historical experience with similar pandemics in the past, and the nature of the viral illnesses as such, explains that not only the mental illnesses worsen in the existing patients during pandemics the new diagnoses increase as well and outlive the pandemic itself. This not only has profound effect on the wellbeing of the survivors of pandemics, the healthcare workers, and the general public alike, the financial implications and restructuring of the social fabric cannot be over stated. There is an urgent need to identify these risks and start planning to devise and implement strategies for effective mental health damage prevention and control.
Key words: COVID–19; Pandemic; Anxiety; Depression; Mental health; Healthcare workers; Post–traumatic stress; Psychological distress, Artificial intelligence, Emotional intelligence, Substance abuse, Self–harm.
Citation: Majeed A, Afzal S, Amer M. A narrative review of mental health landscape of survivors, healthcare workers, and general public in the post–COVID19 world. Anaesth. pain intensive care 2021;25(4):513–518.
DOI: 10.35975/apic.v25i4.1583
Received: July 10, 2021, Reviewed: July 15, 2021, Accepted: July 20, 2021
‘Resuscitation Council UK Guidelines 2021’ – a short commentary
Authors: Amjad Muhammad Ammar , Ahmad Faizan , Rai Razi , Durrani Romana S.
Published: October 2024

New Resuscitation guidelines have been published this year by Resuscitation Council UK (RCUK). Its the commentary and comparison of changes to the previous guidelines of BLS, ALS, PLS and PALS The new topics are also added in new guidelines and details are in full text
Key words: OHCA: out of hospital cardiac arrest, IHCA: in hospital cardiac arrest. BLS: Basic life support, ALS : advanced life support PLS: Pediatric life support PALS: pediatric advanced life support
Abbreviations: CPR–Cardiopulmonary resuscitation; OHCA–Out-of-hospital cardiac arrest; IHCA–In-hospital cardiac arrest; PEA–Pulseless electrical activity; ROSC–Return of spontaneous circulation; ILCOR–International Liaison Committee on Resuscitation; NICE–National Institute for Health and Care Excellence
Citation: Amjad MA, Ahmad F, Rai R, Durrani RS. ‘Resuscitation Council UK Guidelines 2021’ – a short commentary. Anaesth. pain intensive care 2021;25(4):519–522. DOI: 10.35975/apic.v25i4.1584.
Received: June 13, 2021, Reviewed: June 26, 2021, Accepted: June 31, 2021
Oxford Textbook of Pediatric Pain
Authors: Gharaei Helen
Published: October 2024

Pain is a universal human experience. By virtue of its complex and variable nature, it is perceived differently by different individuals, over time, and among the different populations. To understanding pediatric pain requires considerable judgment, integration of different sources of information, such as self-report and nonverbal expression.
The effects of fullerenol nanoparticles on erythrocyte deformability in sevoflurane applied rats
Authors: Sivgin Volkan , Kucuk Aysegul , Comu Faruk Metin , Yalcin Ayse Gulfem , Arslan Mustafa
Published: October 2024

Background & objective: Oxidative damage causing alterations in erythrocyte deformability due to anesthesia might be one of the factors responsible for the deterioration of the tissue and organ perfusion. The antioxidant properties of fullerenol nanoparticles, used in medical field together with the developing technology, have been shown in the literature. We investigated the effects of fullerenol nanoparticles, used before sevoflurane anesthesia, on the erythrocyte deformability in the rats.
Methodology: Twenty-four male Wistar Albino rats were used in this study and randomly divided into four groups, six in each group; Group C (Control Group), Group S (Group Sevoflurane), Group F (Group Fullerenol), Group FS (Group Fullerenol-Sevoflurane). Fullerenol was given to the Group F and Group FS at a dose of 100 mg/kg. Sevoflurane was administered to rats in the Groups S and FS at 3% concentration. Erytrocytes deformability was measured by the constant-current filtrometre system and the deformability index was interpreted. All the data were processed by variance analysis in SPSS 22.0 for Windows statistical software. Variance analysis and Kruskal-Wallis test were used to evaluate the data. Mann–Whitney U test with Bonferroni correction were used to evaluate the variables with significance.
Results: Relative resistance increased in all groups due to sevoflurane administration (p < 0.0001). The erythrocyte deformability index was significantly higher in the sevoflurane group than in the control and fullerenol groups (p < 0.0001, p = 0.002, respectively). Fullerenol administration, before 30 min of sevoflurane treatment, was found to decrease erythrocyte deformability index significantly compared to sevoflurane group (p = 0.017).
Conclusion: Administring 100 mg/kg fullerenol nanoparticles intraperitoneally 30 min before sevoflurane reduces erythrocyte deformability.
Key words: Animals; Rats; Sevoflurane; Fullerenol; Fullerenes* / pharmacology; Nanoparticles; Oxidative Stress; Erythrocyte deformability
Citation: Sivgin V, Kucuk A , Comu FM , Yalcin SG, Arslan M. The effects of fullerenol nanoparticles on erythrocyte deformability in sevoflurane applied rats. Anaesth. pain intensive care 2021;25(5):602–606
DOI: 10.35975/apic.v25i5.1619
Received: March 28, 2021, Reviewed: July 9, 2021, Accepted: August 20, 2021
Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study
Authors: Naz Arshi , Baig Mirza Shahzad , Kumar Vijai , Khan Samita S. , Javed Sidra
Published: October 2024

Background and objectives: Post-anesthetic shivering (PAS) is a common complication following general and regional anesthesia. It is important to identify centrally-acting analgesic drugs that can effectively prevent and treat shivering with fewer side effects other than opioid agonists. Our study compared the effect of addition of low dose ketamine to tramadol for the prevention of shivering under spinal anesthesia.
Methodology: This randomized controlled trial study was conducted for six months, from May 01, 2016 to October 10, 2016, at Department of Anesthesiology, Surgical ICU and Pain Management, Civil Hospital Karachi, Pakistan.
All patients with ages between 18 to 50 y, of both genders, American Society of Anesthesiologist physical status I and II, scheduled for inguinal hernia surgeries were included. The patients were randomly allocated to Group T (inj. tramadol 0.5 mg/kg) and Group KT (inj. ketamine 0.25 mg/kg plus Tramadol 0.25 mg/kg). Shivering was graded 1–5, and was labeled as positive if the grade was 2–5. Time to shivering was noted from the administration of spinal anesthesia to onset of shivering. Perioperative complications such as nausea, vomiting, hypotension or bradycardia, were recorded
Results: The study included 190 patients, with 95 in each group. Demographic characteristics, ASA classification, and perioperative vitals of both groups were comparable (p > 0.05). The frequency of shivering in patients of Group KT was lower as compared to Group T [65(68.4%) vs. 81(85.2%); (p < 0.05)] respectively. Group T had earlier onset of shivering than Group KT [24.01 ± 1.9 min vs. 33.1 ± 2.8 min; (p < 0.05) respectively. Perioperative complication such as nausea, vomiting, hypotension and bradycardia were also less in the Group KT.
Conclusion: The prophylactic use of low-dose ketamine plus tramadol for the prevention of shivering is better than tramadol alone under spinal anesthesia.
Abbreviations: PAS Post-anesthetic shivering; NMDA N-methyl-d-aspartate; bmi Body mass index
Key words: Intravenous; Tramadol; Ketamine; Shivering, Postoperative; Anaesthesia, Spinal
Citation: Baig MS, Naz A, Kumar V, Khan SS, Javed S. Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study. Anaesth. pain intensive care 2021;25(5):596–601;
DOI: 10.35975/apic.v25i5.1626
Received: June 02, 2021, Reviewed: June 22, 2021, Accepted: June 27, 2021
Comparison of caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children undergoing lower abdominal surgeries
Authors: Zubair Muhammad , Ali Hasan , Javed Shahid
Published: October 2024

Background & objectives: Postoperative pain needs to be relieved with minimum side-effects and as cheaply as possible. A combination of drugs may be the best way to treat postoperative pain. Caudal block has been conveniently used by the anesthesiologists in pediatric surgery for this purpose. This study compared the use of bupivacaine alone with bupivacaine plus tramadol for a single shot caudal block to find out whether tramadol can be an effective adjuvant to bupivacaine for providing better postoperative analgesia in children undergoing lower abdominal surgery.
Methodology: This randomized controlled trial was conducted at Department of Anesthesiology, Shifa International Hospital, Islamabad, for six months. A total of 150 children undergoing lower abdominal surgery were randomly allocated into two groups using a lottery method; 75 children in Group B were treated with bupivacaine-with tramadol, and 75 patients in Group A were treated with bupivacaine only. A caudal epidural block was performed immediately after induction of anesthesia. Study outcomes were monitored in terms of duration of analgesia using TPPPS pain score. Results: - The average age of the patients was 5.14
Anesthetic management of a patient with known Dubin Johnson Syndrome – a case report
Authors: John Ajinu Achi , Shibli Khalil Ullah , Soliman Mohamed Hasan , Elboursaly Ibrahim , Ramanathan Lakshmi
Published: October 2024

This is a case report of the anesthetic management of a 20-year-old woman, a known case of Dubin Johnson syndrome (DJS). The patient underwent laparoscopic appendicectomy under general anesthesia.  Aside from elevated serum bilirubin levels, other routine laboratory tests were normal.
As it is a rare and uncommon disease, the anesthetic management was considered a challenge. Liver being the organ affected, the drugs, which increases bilirubin, were to be avoided. Selection of drugs to provide analgesia, anesthesia and to reduce perioperative stress was a priority and to prevent the rise in bilirubin levels.
Key words: Dubin Johnson syndrome; Anesthesia management; Liver enzymes
Citation: John AA, Shibli KU, Soliman MH, Elboursaly I, Ramanathan L. Anesthetic management of a patient with known Dubin Johnson Syndrome – a case report. Anaesth. pain intensive care 2021;25(5):676–679;
DOI: 10.35975/apic.v25i5.1636
Received: April 25, 2021; Reviewed: May 6, 2021; Accepted: June 11, 2021
Opioid free versus opioid based anesthesia in abdominal gynecological surgery: a prospective randomized controlled trial
Authors: Aboelela Mohamed Adel , Alrefaey Alrefaey K.
Published: October 2024

Background & objective: Opioids have been in use by the anesthesiologists in almost all major surgical cases since ages, but these are not without side effects. During the recent past, opioid free anesthesia–a wonderful technique, has gained rapid popularity as it saves the patient from the side effects. Many drugs and drug combinations have been advocated. Ketamine–lidocaine combination produces central desensitization of the pain pathways, and an anti-inflammatory and anti-hyperalgesic effect in a synergistic manner. We compared opioid free versus opioid based anesthesia in abdominal gynecological surgery regarding analgesic efficacy and the side effects.
Methodology: After trial registration (PACTR202007844671903), 68 patients enrolled in this study were divided into two groups (34 each) according to the analgesics used. Under GA, Group O received loading dose of fentanyl 1 µg/kg followed by infusion at a rate of 1 μg/kg/h. Group OF received ketamine 0.5 mg/kg as a bolus, a loading dose of lidocaine 1.5 mg/kg followed by infusion 1.5 mg/kg/h. The primary outcome objective was postoperative pain assessed for 24 h using VAS score.
Results: The VAS score was significantly lower in Group OF during the first 4 postoperative hours; at immediate postoperative time–VAS0 (p 0.001), after one hour–VAS1 (p 0.001), 2h after–VAS2 (p = 0.001), and 4 h after–VAS4 (p = 0.001). Also, Group OF showed significantly lower recovery time (p = 0.001), higher RASS score (p = 0.001), less rescue analgesic consumption, no bowel dysfunction with stable peri-operative hemodynamics.
Conclusion: Opioid free anesthesia is a promising technique, using ketamine–lidocaine combination in abdominal gynecological surgeries enhanced patients recovery with better analgesia profile and stable hemodynamics.
Abbreviations: HR–heart rate; MABP–mean arterial blood pressure; NIBP–non–invasive blood pressure; NMDA–N-methyl D-aspartate; NSAIDs–non steroidal anti-inflammatory drugs; OFA–opioid free anesthesia; PACU–post anesthesia care unite; RASS–Richmond agitation sedation score; RR–respiratory rate; VAS–visual analogue score; VCV–volume controlled ventilation
Key words: Anesthesia; Anesthesia, Opioid free; Analgesia; VAS; Gynecological surgery; Lidocaine; Ketamine
Citation: Aboelela MA, Alrefaey AK. Opioid free versus opioid based anesthesia in abdominal gynecological surgery: a prospective randomized controlled trial. Anaesth. pain intensive care 2021;25(5):653–659; DOI: 10.35975/apic.v25i5.1642
Received: January 7, 2021, Reviewed: May 18, 2021, Accepted: September 10, 2021
Anesthesiologist as a perioperative physician, clinician, administrator, educator and researcher
Authors: Shibli Khalil Ullah , Shibli Sabina
Published: October 2024

Anesthesia is an acute care specialty with a much wider scope in the current clinical practice. The addition of new clinical subspecialties puts additional pressure on already demanding workload with limited global anesthesia workforce. Doctors’ burnout reports and currently exhausted doctors struggling with their clinical duties during COVID-19 pandemic are ample evidence of it. Due to COVID-19 crisis, a lot of subspecialty crossover care is provided by the anesthetists, and they have to work outside their normal clinical comfort zones. Anesthesiologists have been entrusted with the responsibilities of perioperative physicians in the last two decades. An anesthesiologist has to adopt several roles in a healthcare institution, including ‘administrative’, ‘academic’, ‘clinical’ and ‘research’ attributes. An ideal anesthesiologist is expected to have a fine blend of all of these traits, though the proportion of each will vary according to the work environment and the personal choices and preferences.
Key words: Anesthesia; Anesthesiologist; Administration; Academics; Clinical practice; Research
Citation: Shibli KU, Shibli S. Anesthesiologist as a perioperative physician, clinician, administrator, educator and researcher. Anaesth. pain intensive care 2021;25(5):562-565; DOI: 10.35975/apic.v25i5.1649
General anesthesiologist vs. super–specialist: a phoenix rising from its own ashes?
Authors: Bansal Pranav , . Prateek , Singh Meena
Published: October 2024

Like all other specialties, anesthesiology has evolved from a simple affair of relieving the pain during surgery by ether, chloroform or nitrous oxide, to a wide spectrum of important activities related to making the patient pain free as well as protecting his life for the risks of his primary disease and those arising from the surgery. With the progress made in the surgery into super–specialties, anesthesiology had to evolve itself into allied super-specialties. The diversity is likely to be further enhanced with the further development of newer treatment technologies needing fine skills by the operators. It has led to the general anesthesiologist to be pushed to the more peripheral hospitals, with lower degree of equipment and allied help. Not surprisingly the level of job satisfaction in general anesthesiologists is steadily decreasing. Perhaps the only solution for them to this problem is to evolve themselves as ‘Peri–operative Physicians’.
Key words: Anesthesiology; Anesthesiologist; Super–specialty; Peri–operative Physicians
Citation: Prateek, Singh M, Bansal P. General anesthesiologist vs. super–specialist: a phoenix rising from its own ashes? Anaesth. pain intensive care 2021;25(6):695–697;
DOI: 10.35975/apic.v25i6.1694
Ophthalmological disorders after spinal anesthesia
Authors: Kholod Dmytro A. , Shkurupii Dmytro A.
Published: October 2024

Background & Objective: Spinal anesthesia (SA) administered for non–ophthalmic operative surgeries has been associated with ophthalmological disorders in up to 0.2% cases. However, the incidence of medical lawsuits related to these issues amounts to 2–3%, which suggests a probable higher frequency of such violations.
This study was conducted to find the nature of ophthalmological disorders during SA and risk factors for their development during non–ophthalmic surgical interventions.
 Methodology: A prospective cohort non–intervention study was carried out in 150 adult patients undergone non–ophthalmic surgical interventions under SA for analysis of state of the visual organs during SA.
Results: Ophthalmological disorders after SA were recorded in 6.7% of the patients. These disorders were of a transient nature and were no threat to the development of life–threatening dysfunctions or persistent disablement. They were directly related to the level of systemic arterial pressure. A correlation analysis demonstrated the presence of relation between the reduction in ophthalmotonus and perfusion pressure of the eyes and the administration of 0.5% bupivacaine (R = 0.7, p = 0.01).
Conclusion: The results of our study prove that the individuals with prior visual organ disorders are expected to have a relatively high incidence of ophthalmological complications after spinal anesthesia, requiring the individualization of anesthesia regimes.
Key words: Visual organs; Anesthesia, spinal; Complications
Citation: Kholod DA, Shkurupii DA. Ophthalmological disorders after spinal anesthesia. Anaesth. pain intensive care 2021;25(6):703–706; DOI: 10.35975/apic.v25i6.1696
Received: June 9, 2021, Reviewed: July 27, 2021, Accepted: August 30, 2021
A comparison of sustainable recording between cerebral state index (CSI) and bispectral index (BIS) monitors during total intravenous anaesthesia using target-controlled infusion technique for elective supratentorial craniotomy
Authors: Hasan Delima Radzwa , Hassan Wan Mohd Nazaruddin Wan , Hassan Mohamad Hasyizan , Zaini Rhendra Hardy Mohamad , Omar Sanihah Che
Published: October 2024

Background:  This study aimed to compare the sustainability of recording between cerebral state index (CSI) and bispectral index (BIS) monitors during supratentorial craniotomy.
Methodology: A total of 42 patients for elective supratentorial craniotomy, aged 18–60 y, ASA I–II, were randomised into two groups: Group CSI (n = 21) and Group BIS (n = 21). All patients underwent surgery under the target-controlled infusion technique for propofol and remifentanil. CSI and BIS sensors were applied accordingly over the forehead before induction, and the index was continuously recorded. Anaesthesia was maintained between a range of 40 and 60 in the index. The percentage and time of sustainable recording, and association with causes of unsustainable recording were documented.
Results: There were no significant differences in the percentage of sustainable monitoring (66.7% vs. 71.4%; P = 0.739) and mean duration of sustainable monitoring (437.2 ± 221.8 vs. 407.3 ± 174.6 min; P = 0.631) between CSI and BIS. The causes of recording interruption were comparable between the two groups. Within the BIS group, there was a significant association between sustained recording and surgical incision site (p = 0.012) with the most sustainable recording was a frontoparietal incision (73.3%).
Conclusion: CSI and BIS monitors were comparable in their ability to sustain a recording of index during supratentorial craniotomy.
Key words: Intravenous, anesthesia; Cerebral state index monitor; Bispectral index; Neurosurgery; Craniotomy
Citation: Hasan DR, Hassan WMNW, Hassan MH, Zaini RHM, Omar SC. A comparison of sustainable recording between cerebral state index (CSI) and bispectral index (BIS) monitors during total intravenous anesthesia using target-controlled infusion technique for elective supratentorial craniotomy. Anaesth. pain intensive care 2021;25(6):763–770  ;
DOI: 10.35975/apic.v25i6.1700
Received: April 15, 2021, Reviewed: October 3, 2021, Accepted: October 20, 2021
Comparison of visibility and block success between Echoplex+® and Stimuplex®-Ultraline 360○ echogenic needles for ultrasound-guided supraclavicular brachial plexus block for upper limb surgery
Authors: Ismet Suki , Wan Hassan Wan Mohd Nazaruddin , Mazlan Mohd Zulfakar , Mukmin Laila Ab , Chong Soon Eu , Mohamad Zaini Rhendra Hardy
Published: October 2024

Background: Needle visibility is an important factor in the success of ultrasound-guided peripheral nerve block.  This study aimed to compare needle visibility, block performance, time to perform block and the block success by the two echogenic needles, the Echoplex+® and the Stimuplex® Ultraline 360°, during ultrasound-guided supraclavicular brachial plexus block (SBPB).
Methodology: Seventy patients scheduled for upper limb surgery under SBPB were randomised into two groups: Group E (n = 35) was blocked using an Echoplex+® needle and Group S (n = 35) was blocked using a Stimuplex® Ultraline 360° needle. All patients received 20 ml of ropivacaine 0.75% using the same brand of ultrasound machine. The needle visibility, time to perform block and block success were recorded.
Results: Needle visibility was not found to be significantly different between the groups (p = 0.241). The medians of the time to perform block (11.0 [IQR 6] vs. 10.0 [IQR 4] min; p = 0.278) and the percentages of adequate blocks (p = 0.565) were also not found to be statistically significantly different.
Conclusion: No statistically significant differences, in terms of needle visibility, time to perform block and the block success, were found between the Echoplex+® and the Stimuplex® Ultraline 360° block needles during supraclavicular brachial plexus block. Hence, both were equally effective for the performance of the block.
Key words: Echogenic needle; Visibility; Ultrasound-guided; Supraclavicular block; Brachial plexus
Citation: Ismet LA, Hassan WMNW, Mazlan MZ, Mukmin LA, Chong SE, Zaini RHM. Comparison of visibility and block success between Echoplex+® and Stimuplex®-Ultraline 360○ echogenic needles for ultrasound-guided supraclavicular brachial plexus block for upper limb surgery. Anaesth. pain intensive care 2021;25(6):788–792;
DOI: 10.35975/apic.v25i6.1703
Citation: July 26, 2021, Reviewed: August 02, 2021, Accepted: October 03, 2021
Requirement and response pattern for sedatives in COVID-19 patients requiring non-invasive ventilation: A pilot observation
Authors: Karim Habib Reazaul , Nayak Pratyasha
Published: October 2024

Patients in a critical care unit (CCU) are exposed to multiple external stimuli and an unfamiliar environment, in addition to the rigors of their primary disease; all of these are the stress factors for the patient. Titrated sedation has a pivotal role in easing the stress. Sedation also helps patients better tolerate procedural pain and discomfort.
Key words: Sedatives; COVID-19; Ventilation, non–invasive
Citation: Nayak P, Karim HMR. Requirement and response pattern for sedatives in COVID-19 patients requiring non–invasive ventilation: A pilot observation. Anaesth. pain intensive care 2022;26(2):260-262; DOI: 10.35975/apic.v26i2.1809
Received: , Reviewed: , Accepted:
The effect of fluid balance, norepinephrine and blood glucose levels on syndecan-1 level in sepsis patients
Authors: Permana Septian Adi , Harijanto Eddy , Heriwardito Aldy , Arifin Arifin
Published: October 2024

Background & objective. Damage to the endothelium glycocalyx layer can cause sepsis. Several diverse factors have been suggested to worsen the damage, such as high mean fluid balance, high norepinephrine doses, high blood glucose levels, and high baseline levels of syndecan-1 level. This study aimed to show that these components are risk factors for aggravated damage to the endothelium glycocalyx layer, as seen by syndecan-1 levels, and also to find the relation between norepinephrine dose and mortality in sepsis patient.
Methodology: This observational analytic study was conducted using a prospective, cohort approach on sepsis patients aged between 18 to 65 y, who were treated at our intensive care unit (ICU) from March 2021 to June 2021. A total of 40 subjects were assigned into two groups and monitored for three days. On day 0 and day 3, the levels of syndecan-1 were analyzed. Statistical test analysis used chi square and Mann Whitney tests, followed by a multivariate assessment using the logistic regression test to determine the significance with P < 0.05. The patients were followed till they were discharged from the hospital to determine the mortality rate.
Results: Mean fluid balance, mean norepinephrine dose and glucose level had no significant relation with syndecan-1 level (P = 1, P = 0.145, and P = 1, respectively). Meanwhile norepinephrine dose of more than 0.1 µg/kg/min was related significantly with death (P = 0.016).
Conclusion. In septic patients, fluid balance, norepinephrine dose and blood glucose do not associate with syndecan-1 level. However, norepinephrine dose relates to mortality significantly
Keywords. Sepsis, norepinephrine, fluid balance, hyperglycemia, glycocalyx, syndecan-1
Citation: Permana SA, Harijanto E, Heriwardito A, Arifin A. The effect of fluid balance, norepinephrine and blood glucose levels on syndecan-1 level in sepsis patients. Anaesth. pain intensive care 2022;26(2): ;
DOI: 10.35975/apic.v26i2.1812
Received: January 25, 2022, Reviewed: February 9, 2022, Accepted: February 11, 2022
Intraoperative endotracheal tube cuff pressure leak
Authors: Aneejwal Himanshu , Sethi Priyanka , Kaur Manbir
Published: October 2024

Surgeries involving head and neck region require great expertise in handling the compromised airway and pose significant challenges to the anesthetist.1 An abnormality with the already secured airway like leak in the endotracheal tube cuff or its inflation system may be very troublesome. We encountered such a complication during an onco-surgery case and learned an uncommon cause of leak from the endotracheal tube.
Key words: Onco-surgery; Nasotracheal intubation; Intraoperative air leak.
Citation: Aneejwal H, Sethi P, Kaur M. Intraoperative endotracheal tube cuff pressure leak. Anaesth. pain intensive care 2022;26(2):270; DOI: DOI: 10.35975/apic.v26i2.1813
Received: February 22, 2022, Reviewed: February 25, 2022, Accepted: February 25, 2022.
Micropore™ adhesive plaster and contact dermatitis: A rare incidence
Authors: Syal Rashmi , Sethi Priyanka , Onugu Karma , Kaur Manbir
Published: October 2024

Allergic contact dermatitis is an immune reaction to an allergen. Allergy to various surgical dressings and catheters have been reported earlier.1 There are no reports on allergic reaction to micropore at epidural insertion site. We report an adverse skin reaction resulting from the application of Micropore™ frequently used to secure perineural catheters.
Key words: Contact dermatitis; Tegaderm; Epidural analgesia
Citation: Syal R, Sethi P, Onugu K, Kaur M. Micropore™ adhesive plaster and contact dermatitis: A rare incidence. Anaesth. pain intensive care 2022;26(2):269; DOI: 10.35975/apic.v26i2.1816
Received: Feb 19, 2022, Accepted: Feb 27, 2022
A comparative study of intravenous ondansetron and P-6 acupressure for the reduction of postoperative nausea and vomiting in patients undergoing elective laparoscopic colorectal cancer surgeries
Authors: Rehman Shafiq Ur , Imtiaz Danish , Rehman Ghafoor Ateeq Ur , Durrani Romana Shaida , Ashfaq Allah Ditta , Khan Tariq Hayat
Published: October 2024

Background & Objective: Post-operative nausea and vomiting is one of the major problems faced by the anesthesiologists in patients recovering from anesthesia and surgery. A variety of antiemetics have need tried to prevent and control it with variable success. Traditional Chinese Medicine advocates stimulation of P-6, or Neiguan, acupressure point. The aim of this study was to compare the efficacy of intravenous ondansetron with P-6 acupressure stimulation in prevention of post-operative nausea and vomiting after elective laparoscopic colorectal surgery.
Materials and Methods: After approval from the Scientific Review Committee (SRC) and Institutional Review Board (IRB), 80 patients of ASA II and III, aged 18 to 60 y, planned for elective laparoscopic colorectal surgery under general anesthesia were randomly allocated into two groups by the lottery method. Group A (n = 40) received inj. ondansetron 0.15 mg/kg IV and in Group B (n = 40) acupressure was applied on pressure point P-6. Both groups received IV dexamethasone 0.15 mg/kg intraoperatively. Balanced general anesthesia was given and intraoperative vitals were recorded at regular intervals. The incidence and severity of nausea and vomiting was recorded during first 24 h postoperatively.
Results: No significant difference in the number of patients having nausea and vomiting or the severity of vomiting during 24 h post-operative period was found between the two groups (p > 0.05).
Conclusion: In this study we did not find a statistically significant difference between P-6 acupressure stimulation and intravenous ondansetron in the prevention of post-operative nausea and vomiting after elective laparoscopic colorectal surgery.
Abbreviations: PONV - Post-operative nausea and vomiting
Key words: P-6 acupressure point; Acupressure; Ondansetron; Laparoscopic colorectal surgery; Post-operative, nausea and vomiting
Citation: Imtiaz D, Rehman SU, Ghafoor AUR, Durrani RS, Ashfaq AD, Khan TH. A comparative study of intravenous ondansetron and P-6 acupressure for the reduction of postoperative nausea and vomiting in patients undergoing elective laparoscopic colorectal cancer surgeries. Anaesth. pain intensive care 2022;26(2):143–147 ; DOI: 10.35975/apic.v26i2.1820
Received: Sep 22, 2021, Reviewed: February 2, 2022, Accepted: February 8, 2022,
Peripartum cardiomyopathy in the immediate post-operative period
Authors: Preethipriyadharshini R , Vadhanan Prasanna
Published: October 2024

Peripartum cardiomyopathy (PPCM) has a reported incidence of about 10.3 patients per 10,000 live births.1 In India, an incidence of 1 per 1374 live births has been reported.2 PPCM usually presents as left ventricular dysfunction in late pregnancy and immediately after delivery. Symptoms are often confused with that of normal pregnancy. Delay in diagnosis often contributes to poor outcomes. Our case was unique as, although the patient presented during the immediate postoperative period, but there were no symptoms, other than heart rate variation. If echo had not been done, the patient may had landed into heat failure.
Key words: Peripartum cardiomyopathy; Heart failure; Left ventricular ejection fraction; Pregnancy
Citation: Preethipriyadharshini R, Vadhanan P. Peripartum cardiomyopathy in the immediate post-operative period. Anaesth. pain intensive care 2022;26(2): 263-264; DOI: 10.35975/apic.v26i2.1829
Received: December 15, 2021, Accepted: 20 February, 2022
Utility of invasive pressure transducer for endotracheal tube cuff pressure monitoring: Implications during the SARS-CoV-2 pandemic
Authors: Munasinghe B. M. , Subramaniam Nishanthan , Wickramasinghe Ramil
Published: October 2024

Novel use of invasive pressure transducers for endotracheal tube (ETT) cuff pressure (CP) monitoring was first described by Doyle JD1 and later by Kim JB et al.2 With the continuing SARS-CoV-2 pandemic, we have identified several practical uses and advantages of this method in this context.
Key words: Endotracheal cuff pressure, Invasive pressure transducer, Monitoring, SARS-CoV-2
Citation: Munasinghe BM, Subramaniam N, Wickramasinghe R. Utility of invasive pressure transducer for endotracheal tube cuff pressure monitoring: Implications during the SARS-CoV-2 pandemic, Anaesth. pain intensive care 2022;26(2):267–268; DOI: 10.35975/apic.v26i2.1831
Received: January 19, 2022, Reviewed: January 24, 2022, Accepted: February 12, 2022
The outcomes and predictors associated with prolonged weaning of postoperative patients requiring mechanical ventilation in general wards
Authors: Puetpaiboon Asamaporn , Chatmongkolchart Sunisa , Oofuvong Maliwan
Published: October 2024

Background & Objective: Many of the postoperative patients may require ventilatory management. In a resource-limited country, not all of them may find a place in intensive care units (ICUs), and may need to be ventilated in general wards till they are weaned off or shifted to ICU. Our primary objective was to describe weaning outcomes of such patients in the general wards, and the secondary objective was to assess predictors associated with prolonged weaning in these patients.
Methodology: This retrospective study was conducted in a tertiary care hospital in Thailand. From January 2014 to December 2019, we identified 553 patients who received postoperative mechanical ventilation in general wards after non-cardiac surgeries. The weaning characteristics and the factors associated with prolonged ventilation and weaning were recorded.
Results: Incidence of short (≤ 24 h), difficult (> 1, but ≤ 7 days), prolonged (> 7 days) and no weaning were 53.0%, 28.6%, 15.0% and 3.4%, respectively. The predictors of prolonged weaning were postoperative Glasgow Coma Scale ≤ 8 [adjusted odds ratio (OR) 11.34, 95% confidence interval (CI) 5.05-25.47], repeated surgeries (OR 7.38, 95% CI 3.67-14.83), totally dependent functional status (OR 3.22, 95% CI 1.35-7.72), and age more than 65 y (OR 2.35 95% CI 1.29-4.25). Reintubation rate was 5.1%. Accidental extubation rate was 2.3%. Incidence of ventilator associated pneumonia was 11.6%. The 30-day mortality rate was 6%.
Conclusion: Weaning processes in general wards were mostly terminated within 24 h; however, 15% of patients experienced prolonged weaning. Postoperative Glasgow Coma Scale ≤ 8, repeated surgeries, totally dependent functional status, and age more than 65 y were the predictors of prolonged weaning.
 Key words: Mechanical ventilators, ventilator weaning, postoperative care, surgical ward
Abbreviations: ICU - Intensive care units; MV - Mechanical ventilation; PEEP - Positive end-expiratory pressure
Citation: Puetpaiboon A, Chatmongkolchart S, Oofuvong M. The outcomes and predictors associated with prolonged weaning of postoperative patients requiring mechanical ventilation in general wards. Anaesth. pain intensive care 2022;26(2):161–167 ; DOI: 10.35975/apic.v26i2.1832
Received: October 24, 2020, Reviewed: January 19, 2022, Accepted: January 29, 2022,
The effects on mental health of nurses during the COVID-19 pandemic: a systematic review and meta-analysis
Authors: MERMERKAYA Samet , ÇINAR Fadime
Published: October 2024

Background & Objective: The COVID-19 pandemic has widely spread worldwide, and caused mental health problems for healthcare professionals, especially affecting the frontline nurses of the crisis. There is an immediate requirement to determine the frequency of anxiety, insomnia, and many other negative emotions in the staff to allow efficient measures to be taken. We aimed to analyze and document the existing evidence on the prevalence of mental health issues among nurses during the COVID-19.
Methodology: A literature search was conducted through e-databases, including PubMed, Scopus, Google Scholar, and Web of Science up to December 2020. The search procedure based on using key words for "nurses", "mental health", and "COVID-19 pandemic".
Results: A total of 30 studies were included in this systematic review and meta-analysis. There were 57555 samples in total in the studies. According to the random effects model, it was found that the overall effect size of the pandemic on the mental health of nurses caring for patients diagnosed with COVID-19 was statistically significant with a value of 1,964 (G.A; 1,384-2,787; p < 0.05).
Conclusion: Serious symptoms of negative emotions such as anxiety and depression have emerged in frontline nurses dealing with COVID-19. Policymakers and managers need to take efficient measures for nurses to preserve their mental health status during COVID-19.
Key words: COVID-19; Nurses; Mental health; Meta-analysis
Declaration: This article was produced from the thesis (Covid-19 Pandemisinde Hemşirelerin Ruh Sağlığı: Sistematik Derleme ve Meta Analiz / The Mental Health of Nurses in the COVID-19: Systematic Review and Meta-Analysis) of the first author, Samet Mermerkaya.
Citation: Mermerkaya S, Çinar F. The effects on mental health of nurses during the COVID-19 pandemic: a systematic review and meta-analysis. Anaesth. pain intensive care 2022;26(2):224–236; DOI: 10.35975/apic.v26i2.1837
Received: January 05, 2022, Reviewed: January 06, 2022, Accepted: February 08, 2022
Maj Gen (Retd) Mohammed Anis Ur Rehman Khan (Sept 1922- March 2006)
Authors: Shah Latif , Salim M.
Published: October 2024

Mohammed Anis Ur Rehman Khan was born at Bareilly, Uttar Pradesh, India, on 10th September 1922. His early education started at Mission Public School, Nawabganj. Bareilly, and Islamia High School, Budaun (Uttar Pradesh, India). After completing his premedical education in Christian College Lucknow, he graduated from Lucknow Medical College in 1944.
Professor Cynthia Ruth Goh (1949-2022)
Authors: Khan Jamal Tariq
Published: October 2024

Professor Cynthia Ruth Goh, died of pancreatic cancer on February 13, 2022, at the age of 72 – but not before having a big say on how to spend her remaining days once she knew the end was near. She was born on November 21, 1949, in Hong Kong to a family of doctors. She attended medical school St Bartholomew’s Hospital, University of London, where she met her future husband, Dr Goh, in 1969.
Dr. Mohammad Faheem-alias ‘General’ (1961-2022)
Authors: Khan Jamal Tariq
Published: October 2024

Dr. Mohammad Faheem, alias ‘General’, served as Consultant Anesthesiologist at the Midland Regional Hospital Mullingar, Ireland. He was diagnosed with glioblastoma in 2019, due to which he met his Creator on February 2, 2022.
Professor Muhammad Saeed Minhas
Authors: Khan Tariq H. , Ramzanali Shireen A. A.
Published: October 2024

This year we lost a dedicated academician and a master trainer of trauma and orthopedic surgery. Professor Muhammad Saeed Minhas served in this capacity at the Jinnah Postgraduate Medical Centre Karachi, Pakistan, for more than three decades. He was born at Chakwal (Pakistan) on September 8, 1958, received his early education at his native town, as well as Public School Hyderabad.
Anesthetic management of maternal with rare Myositis ossificans disease undergoing emergency surgery for postpartum hemorrhage
Authors: Awang Mohamad Azlan , Mohd Yusof Mohd Firdaus Bin
Published: October 2024

Myositis ossificans (MO) is a rare disease which involve calcification of the pterygoid muscles leading to severe trismus and limited mouth opening, that is considered as difficult airway when proceeding with general anesthesia (GA). We report a case of 26-year-old parturient with an underlying MO of the pterygoid muscles, who developed postpartum hemorrhage due to retained placenta, and needed emergency manual removal of the placenta in the operating room. Providing anesthesia for these patients can present a significant challenge. Difficulty arises related to combination of airway management for GA, resuscitation and a narrow time window to commence to the surgery. Awake fiberoptic intubation is a safe method to secure the airway for such patient while multidisciplinary team effort of focused planning and resuscitation is crucial to avoid maternal morbidity and airway catastrophe.
Abbreviations: MO - Myositis Ossificans; GA - General Anesthesia; PPH - Postpartum Hemorrhage; TCI – Target Controlled Infusion
Key words: Airway management; Awake fiberoptic intubation; Intubation; Myositis ossificans; Parturient; Postpartum hemorrhage
Citation: Awang MA, bin Mohd Yusof MF. Anesthetic management of a parturient with myositis ossificans undergoing emergency surgery for postpartum hemorrhage. Anaesth. pain intensive care 2022;27(2):266−268; DOI: 10.35975/apic.v27i2.1977
Received: August 19, 2022; Reviewed: January 25, 2023; Accepted: January 31, 2023
Importance of Clinical Practice Guidelines (CPGs) in Anesthesia: Who is responsible for implementing it?
Authors: Khan Fazal Hameed , Sohail Yamna
Published: October 2024

Clinical practice guidelines (CPGs) incorporate and support clinical decisions. CPGs can improve clinicians’ and patients’ decision-making by explicitly describing and evaluating the scientific evidence, based on the potential benefits and risks underpinning clinical recommendations, making them relevant to the specific patient encounter. The number of clinical research publications have increased to the point that new medical knowledge is expected to be double every 72 days. Consequently, clinicians depend heavily on the available evidence that has been condensed into clinical CPGs by the representative institutions or societies. 
CPGs can have potential benefits and harms. Different groups have different opinions on whether clinical recommendations are useful or bad for medicine considering these contradictory effects.  Though guidelines that are carefully prepared and supported by research reduce the potential risks; however, in our country CPGs have not yet been used in full potential and it is still a gray area.
Key words: Anesthesia; Healthcare professional; Clinical practice guidelines; Evidence based practice; Decision making
Citation: Khan FH, Sohail Y. Importance of clinical practice guidelines in anesthesia: Who is responsible for implementing it? Anaesth. pain intensive care 2023;27(2):147−149; DOI: 10.35975/apic.v27i2.2155
Received: March 04, 2023; Revised: March 24, 2023; Accepted: March 24, 2023