bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Comparative Evaluation of Noninvasive and Invasive Mechanical Ventilation in Patients of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure Type II
Authors: Sohal Amartej Singh , Anand Asha , Kaur Prabhjot , Kaur Harpreet , Attri Joginder Pal 
Published: August 2021

Introduction:
Acute respiratory failure is a potential complication of chronic obstructive pulmonary disease (COPD) that severely affects the health of the patient and may require mechanical ventilation. We compared noninvasive and invasive mechanical ventilation in COPD patients with acute respiratory failure type II to validate clinical outcome based on biochemical analysis of arterial blood gases (ABGs) and pulmonary parameters in terms of duration of mechanical ventilation, period spent in intensive care unit (ICU) and mortality.

Materials and Methods:
After approval of institutional ethical committee 100 patients were selected for randomized prospective controlled trial and divided into two groups of 50 each according to mode of mechanical ventilation. Group-I patients managed with noninvasive ventilation (NIV) Group-ll managed with invasive ventilation.

Results:
Demographic data between two groups were comparable. ABG parameters were better at 2 h and 6 h interval in NIV as compared to invasive ventilation (P < 0.05). The duration of ventilation and total time spent in ICU was 106±10 hours and 168±8 hours respectively in NIV group and 218 ± 12 and 280 ± 20 in invasive group. On intergroup comparison these were significantly less in noninvasive group (P < 0.05). Hospital acquired pneumonia occurred in 10% of patients in invasive group whereas no incidence of pneumonia found in noninvasive group. Mortality rate was 12% in invasive groups and 2% in noninvasive groups.

Conclusion:
NIV leads to significant improvement in ABG and pulmonary parameters and it reduces duration of ventilation and total period of hospital stay so it can be used as an alternative to invasive ventilation as first-line treatment in COPD.
Comparison of Intrathecal Fentanyl and Buprenorphine as an Adjuvant to 0.5% Hyperbaric Bupivacaine for Spinal Anesthesia
Authors: Dhawale Tanvi A. , Sivashankar K. R. 
Published: August 2021

Purpose:
This study was designed to evaluate and compare three groups, that is, (1) normal saline 0.5 mL with 15 mg of 0.5% hyperbaric bupivacaine normal (BN), (2) intrathecal fentanyl 25 μg (0.5 mL) as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine fentanyl (BF), and (3), 150 μg buprenorphine with 15 mg of 0.5% hyperbaric bupivacaine buprenorphine (BB) with respect to the onset and duration of sensory and motor spinal block, level of anesthesia, effects on hemodynamic parameters, requirement of postoperative analgesia, and side effects in patients aged 16–60 years undergoing surgical and orthopedic procedures requiring spinal anesthesia.

Methods:
A prospective, observational study was performed at a single center with 90 consecutive patients enrolled as per the inclusion criteria. Patients were divided into three groups of 30 each based on drugs administered, BN, BF, and BB groups, and outcome measures were recorded. The three groups were compared with the analysis of variance test for the continuous variables, with P < 0.05 considered statistically significant.

Results:
The groups were similarly matched with respect to age. The earliest onset of sensory block was in the BF group (2.87 min), P < 0.05. Similarly, the mean time to achieve the highest sensory level was least in the BF group (9.63 min), P < 0.05. The onset of motor blockade was earliest in the BB group (7.65 min), P < 0.05. The mean time for two segment regression was maximum in the BB group (126.03 min), P < 0.05. The mean time for regression to L1 was the longest in the BB group (200.83 min), P < 0.05. Maximum duration of analgesia after spinal drug administration was the highest in the BB group (412.17 min), P < 0.05.

Conclusion:
The addition of both buprenorphine 150 μg and fentanyl 25 μg to 0.5% hyperbaric bupivacaine 15 mg enhances the quality and duration of sensory block for spinal anesthesia providing better postoperative analgesia, while decreasing the incidence of complications associated with each drug alone.
Effect of Gelfoam Soaked Epidural Dexmedetomidine or Bupivacaine for Postoperative Analgesia in Lumbar Laminectomy
Authors: Prakash Ajay , Giri Manoj Kumar , Kumar Suraj , Pandey Chandra Kant , Malviya Deepak , Mishra Smarika 
Published: August 2021

Background and Aims:
Postoperative pain is spine surgery can last for an average of two to three days. Epidural catheter management are difficult in spine surgery for postoperative pain. Still, there have been not much studies on epidural administered gelfoam soaked dexmedetomidine or bupivacaine, to enhance postoperative analgesia.

Methods:
Ninety six adult patients were randomized into three groups. Gelfoam soaked in 0.1 mg dexmedetomidine (0.02 mg. mL-1) in group D, 0.25% isobaric bupivacaine (5 mL) in group B and gelfoam soaked in 0.9% normal saline (5 mL) in group C. The Primary outcome was to compare the total amount of rescue analgesic consumption till 48 hours. The Secondary outcome was to compare time to first dose of rescue analgesia (duration of analgesia), the visual analogue scale and side effects up to 48 hours. Chi-square test, independent t test and analysis of variance test were used, and P < 0.05 was considered significant.

Results:
Ninety patients completed the study. Total dose of rescue analgesic consumed in 48 hours was significantly higher in control group (paracetamol 4.17 ± 0.75 gm with tramadol 205 ± 37.94 mg). Bupivacaine soaked gelfoam group (paracetamol 3.04±0.71 gm with tramadol 151.85 ± 35.31 mg) had more rescue analgesic consumption than dexmedetomidine soaked gelfoam group (paracetamol 1.72 ± 0.57 gm with tramadol 86.11 ± 28.73 mg). Time for first rescue analgesic requirement with dexmedetomidine soaked gelfoam group was significantly longer (14.67 ± 7.76 hours) than in bupivacaine soaked gelfoam group (11.33 ± 6.08 hours) and control group (6.40 ± 2.77 hours). Postoperative mean VAS scores were lower in group D and group B compared with group C along with no significant adverse effects.

Conclusion:
Patients undergoing lumbar laminectomy with gelfoam soaked epidural dexmedetomidine or bupivacaine decreases rescue analgesic consumption, prolongs the duration of analgesia and decreases mean VAS score postoperatively.
Comparison of Perineural and Intravenous Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block
Authors: Veena G. , Pangotra Anshu , Kumar Shailesh , Prakash Jay , Rao Natesh S. , Priye Shio 
Published: August 2021

Background:
The effect of perineural versus intravenous (i.v.) dexamethasone (4 mg) when added to levobupivacaine as an adjuvant has not been well studied.

Aims:
This study was conducted to compare the analgesic efficacy of perineural and i.v. dexamethasone as an adjuvant to levobupivacaine in infraclavicular brachial plexus (ICBP) block.

Settings and Design:
This was a prospective, randomized, double-blind study.

Materials and Methods:
This study was conducted on 68 patients with the ultrasound-guided ICBP block, randomly allocated into two groups (34 each). Four patients had failed block (2 in each group) that was excluded from the study. Group A received 25 mL of levobupivacaine 0.5% and 1 mL of normal saline for the block and i.v. dexamethasone 4 mg. Group B received 25 mL of levobupivacaine 0.5% with 4 mg of perineural dexamethasone for the block. Postoperative vitals and different block characteristics were assessed.

Statistical Analysis Used:
Student's independent sample t-test and Chi-square test were used for statistical analysis.

Results:
The duration of motor block and analgesia in Group A was 1245.94 ± 153.22 min and 1310.16 ± 151.68 min, respectively. However, in Group B, the duration of motor block and analgesia was 1768.13 ± 309.86 min and 1743.59 ± 231.39 min, respectively, which was more when compared to Group A (P < 0.001). The Visual Analog Scale score of ≥3 in Group A was 37% and in Group B was 9% (P = 0.008). Four cases had delayed regression of motor block in the perineural group.

Conclusions:
Perineural dexamethasone significantly prolonged the duration of motor block promoted by levobupivacaine in infraclavicular brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period when compared with the intravenous dexamethasone.
US Residents’ Perspectives on the Introduction, Conduct, and Value of American Board of Anesthesiology's Objective Structured Clinical Examination-Results of the 1st Nationwide Questionnaire Survey
Authors: Goudra Basavana , Guthal Arjun 
Published: August 2021

Introduction:
Passing the Objective Structured Clinical Examination (OSCE) is currently a requirement for the vast majority (not all) of candidates to gain American Board of Anesthesiology (ABA) initial certification. Many publications from the ABA have attempted to justify its introduction, conduct and value. However, the ABA has never attempted to understand the views of the residents.

Methods:
A total of 4237 residents at various training levels from 132 programs were surveyed by asking to fill a Google questionnaire prospectively between March 8th, 2021 and April 10th, 2021. Every potential participant was sent an original email followed by 2 reminders.

Results:
The overall response rate was 17.26% (710 responses to 4112 invitations). On a 5-point Likert scale with 1 as “very inaccurate” and 5 as “very accurate,” the mean accuracy of objective structured clinical examination (OSCE) in assessing communication skills and professionalism was 2.3 and 2.1 respectively. In terms of the usefulness of OSCE training for improving physicians' clinical practice, avoiding lawsuits, teaching effective communication with patients and teaching effective communication with other providers, the means on a 5-point Likert scale with 1 as “Not at all useful” and 5 as “Very useful” were 1.86, 1.69, 1.79, and 1.82 respectively. Residents unanimously thought that factors such as culture, race/ethnicity, religion and language adversely influence the assessment of communication skills. On a 5-point Likert scale with 1 as “not at all affected” and 5 as “very affected,” the corresponding scores were 3.45, 3.19, 3.89, and 3.18 respectively. Interestingly, nationality and political affiliation were also thought to influence this assessment, however, to a lesser extent. In addition, residents believed it is inappropriate to test non-cardiac anesthesiologists for TEE skills (2.39), but felt it was appropriate to test non-regional anesthesiologists in Ultrasound skills (3.29). Lastly, nearly 80% of the residents think that money was the primary motivating factor behind ABA's introduction of the OSCE. Over 96% residents think that OSCE should be stalled, either permanently scrapped (60.8%) or paused (35.8%).

Conclusions:
Anesthesiology residents in the United States overwhelmingly indicated that the OSCE does not serve any useful purpose and should be immediately halted.
Thoracic Epidural Analgesia for Lumbosacral Spine Surgery
Authors: Kour Loveleen , Sharma Nandita , Dogra Disha 
Published: August 2021

Background:
Traditional analgesics such as diclofenac and celecoxib have long been used in lumbosacral spine surgeries. Recently, preemptive single-shot caudal analgesia has been investigated by some workers with favorable results. We hypothesized that the thoracic route would not only allow preemptive but also postoperative analgesia through catheter insertion.

Aim:
We aimed at studying the feasibility and efficacy of thoracic epidural analgesia (TEA) in lumbosacral spine surgeries.

Settings and Design:
This was a prospective, randomized, controlled study that comprised 60 American Society of Anesthesiologist (ASA) Physical Status I and II patients posted for lumbosacral spine surgeries.

Materials and Methods:
Sixty ASA I and II patients were randomly divided into two groups: Group T – TEA was given using 0.2% ropivacaine 10 mL preemptive and postoperatively. Group C patients were given analgesia with intramuscular diclofenac 75 mg. Hemodynamic parameters, postoperative Visual Analog Scale scores, and neurological complications were noted.

Statistical Analysis:
Student's independent t-test for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal–Wallis test was used for postoperative pain data.

Results:
Duration and quality of analgesia were superior in Group T. There were more hemodynamic alterations in Group C but no neurological complication in any patient.

Conclusion:
TEA proves to be an effective analgesic technique for lumbosacral spine surgeries.
Effectiveness and Safety of Extubation before Reversal of Neuromuscular Blockade versus Traditional Technique in Providing Smooth Extubation
Authors: Babu Karthik C. , Rajan Sunil , Sandhya Sai V. K , Raj Renjima , Paul Jerry , Kumar Lakshmi 
Published: August 2021

Background:
Traditional extubation often leads to bucking, coughing, and undesirable hemodynamic changes. Extubation just before administering reversal could reduce force of coughing, bucking and may provide better extubation conditions.

Aim of Study:
The aim of the study was to assess the incidence of bucking with extubation just before administering reversal of neuromuscular blockade compared to traditional technique of awake extubation. Incidence of coughing during extubation, vomiting/regurgitation, aspiration, hemodynamic changes, postoperative bleeding, and extubation conditions were also assessed.

Settings and Design:
This was a prospective randomized study conducted in a tertiary care institute.

Subjects and Methods:
Forty patients were allocated into two equal groups. In Group E, at the end of surgery, extubation was performed and reversal was administered after extubation. In Group L, reversal was given and patients were extubated in the traditional way. Quality of extubation was assessed using extubation quality score.

Statistical Tests Used:
Pearson Chi-square test, Fisher's exact test, and independent sample t-test.

Results:
Group E showed significantly lower incidence of bucking (15% vs. 65%) and coughing (10% vs. 45%). Incidences of desaturation and regurgitation/aspiration were comparable. In Group E, 85% of patients did not cough during extubation compared to 50% in Group L. Extubation quality was significantly better in Group E. Although extubation time was significantly shorter in Group E, recovery time was comparable in both groups.

Conclusion:
Extubation just before reversal of neuromuscular blockade resulted in lesser incidence of bucking and coughing during extubation with lesser postoperative bleeding compared to traditional technique of awake extubation without added risks of regurgitation, aspiration, or delayed recovery.
Efficacy and Safety of Sugammadex versus Neostigmine in Reversing Neuromuscular Blockade in Morbidly Obese Adult Patients
Authors: Subramani Yamini , Querney Jill , He Susan , Nagappa Mahesh , Yang Homer , Fayad Ashraf 
Published: August 2021

Context:
Sugammadex is known to reverse neuromuscular blockade (NMB) more rapidly and reliably than neostigmine. However, data remain limited in bariatric patients. In this review, we systematically evaluated the efficacy and safety of sugammadex versus neostigmine in reversing NMB in morbidly obese (MO) patients undergoing bariatric surgery.

Aims:
Our primary objective was to determine the recovery time from drug administration to a train-of-four (TOF) ratio >0.9 from a moderate or deep NMB.

Settings and Design:
This systematic review and meta-analysis (SR and MA) was conducted in accordance with the Preferred Items for SRs and MAs guidelines.

Subjects and Methods:
A systematic search was conducted within multiple databases for studies that compared sugammadex and neostigmine in MO patients.

Statistical Analysis Used:
We reported data as mean difference (MD) or odds ratios (OR) and corresponding 95% confidence interval (CI) using random-effects models. A two-sided P < 0.05 was considered statistically significant.

Results:
Seven studies with 386 participants met the inclusion criteria. Sugammadex significantly reduced the time of reversal of moderate NMB-to-TOF ratio >0.9 compared to neostigmine, with a mean time of 2.5 min (standard deviation [SD] 1.25) versus 18.2 min (SD 17.6), respectively (MD: −14.52; 95% CI: −20.08, −8.96; P < 0.00001; I
2 = 96%). The number of patients who had composite adverse events was significantly lower with sugammadex (21.2% of patients) compared to neostigmine (52.5% of patients) (OR: 0.15; 95% CI: 0.07–0.32; P < 0.00001; I
2 = 0%).

Conclusions:
Sugammadex reverses NMB more rapidly with fewer adverse events than neostigmine in MO patients undergoing bariatric surgery.
Comparison of Oral versus Intramuscular Clonidine for Prolongation of Bupivacaine Spinal Anesthesia in Patients Undergoing Total Abdominal Hysterectomy
Authors: Mishra Smarika , Gogia Pratiksha , Singh Prachi , Tripathi Manoj , Yadav Sandeep , Malviya Deepak 
Published: August 2021

Background:
Clonidine is a commonly used agent for premedication through oral, intravenous, and intramuscular route. Very few studies mentioned intramuscular clonidine as premedication.

Aims and Objectives:
The aim of the present study is to compare oral and intramuscular clonidine as predication agent in bupivacaine spinal anesthesia patients.

Materials and Methods:
In our study, recruited patients were randomly allocated in three groups of 32 each. All patients received intrathecal bupivacaine heavy 3 mL with oral 150 μg clonidine in Group 1, intramuscular 150 μg clonidine in Group 2, and oral placebo tablet in Group 3 1 h before taking the patient in operation theater. We have assessed for duration of sensory block, duration of motor block, duration of analgesia, sedation score, and hemodynamic changes in groups.

Statistical Analysis:
The parametric data were expressed as mean ± standard deviation. Primary analysis of parametric data between the two groups was done by student's t-test, and among three groups, analysis of variance was used.

Results:
Duration of motor block was found significantly high in Group 2 than Group 1 (208.06 ± 9.48 vs. 200.25 ± 9.42; P < 0.05). Duration of sensory block was also found significantly high in Group 2 than Group 1 (219.69 ± 9.44 vs. 210.25 ± 9.68; P < 0.05). Time to give first dose of analgesia was also found greater in Group 2 than Group 1 (234.66 ± 11.76 vs. 217.75 ± 10.09; P < 0.05). Sedation score and other side effects were found statistically nonsignificant between Group 1 and 2.

Conclusion:
We can conclude that preoperative intramuscular clonidine is a better alternate of oral clonidine for bupivacaine spinal anesthesia in terms of long duration of motor and sensory block and less requirement of analgesic with clinically insignificant side effects.
Ultrasound Guided Adductor Canal Block vs Intra Articular Analgesia for Post-operative Pain Relief after Arthroscopic Knee Surgeries
Authors: Mittal Saurabh , Mehrotra Shreesh , Asthana Veena , Agarwal Atul 
Published: August 2021

Context and Aims:
Our aim was to assess the postoperative analgesia after ultrasound-guided “Adductor canal block” (ACB) and “Intraarticular Analgesia” (IAA) in arthroscopic knee surgeries postoperatively.

Settings and Design:
This experimental, randomized prospective study was conducted in the Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun.

Subjects and Methods:
Sixty patients, who underwent arthroscopic knee surgeries were divided into two groups, with 30 patients each. Each group was given spinal anesthesia using 3 ml of 0.5% hyperbaric Bupivacaine. After completion of surgery, Group I patients were given ultrasound-guided ACB, Group II patients were given IAA. Postoperatively, pain was assessed using the Numeric Rating Scale (NRS). Time of first analgesic requirement and total postoperative tramadol consumption in the 1st 24 h were recorded.

Results:
No significant difference was seen between both groups pertaining to patient's demographic data, type, and duration of surgery. The difference in the median NRS score between both the groups at different time intervals was statistically insignificant (P > 0.05). Total tramadol consumption in Group I (172.85 ± 82.59) mg was more than Group II (157.85 ± 33.83) mg. The duration of first analgesic requirement was 351.43 min, 342.86 min for Group I and II, respectively.

Conclusion:
To conclude, both ACB and IAA provide good postoperative pain control in arthroscopic knee surgeries with no significant difference in pain scores and postoperative analgesic requirement.
A Higher Body Mass Index Means Worse Satisfaction Outcome in Obese Patients Undergoing Varicose Vein Surgery
Authors: Premnath Sivaram , Nour Elafra , Abdelhaliem Amr , Rowlands Timothy E , Kuhan Ganesh 
Published: August 2021

Introduction:
Obesity (body mass index [BMI] >30) and lower limb venous disease (LLVD) is a common problem, yet there is a sparsity of evidence in its management. The aim was to carry out a satisfaction survey on such patients following their venous surgery from a single center.

Methods:
Three hundred and thirty procedures carried out from January 2017 to April 2018. Eighty-seven patients with BMI > 30 were selected and case notes reviewed retrospectively. Data on demography, risk factors, Clinical, Etiology, Anatomy, Pathology (CEAP) status, operative data, and complications were collected. Fifty-three patients had a telephone follow-up to assess satisfaction in terms of symptoms and appearance. Logistic regression analysis was carried out to identify factors contributing to a worse outcome.

Results:
The mean age was 53.1 (50.6% were male). The mean BMI was 36.11 (30–56). CEAP grade of more than 3 was present in 69.8% (44/87). Most patients were treated by radiofrequency ablation (81.6% [71/87]). Significant complications occurred in 3.4% (3/87) after surgery. The median follow-up was 22 months (14–30). Symptoms improvement was reported in 74% (39/53), while 5.6% (3/53) reported worse symptoms. In terms of appearance, 71.6% (38/53) reported improvement, while 7.5% (4/53) reported worse appearance. Logistic regression analysis identified BMI to be a significant risk factor (odds ratio 1.257 (95% confidence interval 1.004–1.575).

Conclusions:
The higher the BMI, the lesser the patient satisfaction after varicose vein surgery. Obese patients with LLVD can be treated successfully with a high satisfaction rate for BMI class 1 and 2.
Operative Management and Outcomes of Peripheral Vascular Trauma in Pediatric and Adolescent Population
Authors: Kumar Madhur , Pramanik Subrata , Gupta Anubhav 
Published: August 2021

Introduction:
Unique characteristics of vascular injuries in children such as pronounced vascular spasm and lack of tissue support over small, thin-walled vessel make vascular repair challenging. This retrospective study was done to evaluate the management and outcome of pediatric and adolescent peripheral vascular trauma.

Methodology:
Fifteen patients with peripheral vascular trauma who met the inclusion criteria during the study period (August 2019-July 2020) were included. Data were analyzed retrospectively.

Results:
Majority, 12(80%) of patients suffered blunt trauma. Primary repair in 13(86.66%) patients was the most common surgical technique employed. All the patients had associated long bone fracture dealt with internal fixation. Four (26.66%) cases had median nerve injury which was amenable to direct repair. Associated venous injury in 5 (33.33%) was also repaired. No mortality, re-operations, or amputation was noted.

Conclusion:
Excellent limb salvage rate was achieved. Initial revascularization without delay should be the norm. Associated neurological involvement determines postoperative functional outcome. Clinical evaluation with Doppler assessment saves time and crucial in vascular injuries prone to spasm.