bluuebunny/crossref_metadata_2025_split huggingface dataset:
8: Ultrasonographic assessment of diaphragmatic parameters for predicting weaning outcome in patients on mechanical ventilation in the intensive care unit setting.
Authors: Gupta Sakshi 
Published: September 2024

Background and Aims:
The aim of this study was to ultrasonographically assess diaphragmatic parameters for predicting weaning outcome in patients on mechanical ventilation in the intensive care unit ( ICU ) setting. The primary objective was to assess the diagnostic accuracy of diaphragmatic excursion(DE) and diaphragmatic thickness fraction(DTF) by ultrasonography to predict weaning outcome in patients on mechanical ventilation. The secondary objectives were:

To correlate diaphragmatic dysfunction with re-intubation within 48 hours of extubationTo assess which of the two - DE) or DTF is a better predictor of weaning.To compare diaphragmatic rapid shallow breathing index (RSBI) with clinical RSBI.

Methods:
This cohort study was conducted on 50 adult patients of either sex, admitted in the ICU and scheduled to undergo extubation. The patient’s readiness to wean was assessed by clinical judgment. When the patient was ready to be weaned, he/she was put on pressure support ventilation (PSV). The pressure support was gradually reduced to 6cm H2O. If the patient remained stable and extubation was planned, T-piece trial was given. Baseline parameters (Heart rate, non invasive blood pressure, respiratory rate, tidal volume, RSBI, SpO2, signs of respiratory distress- nasal flaring, sweating, agitation, use of accessory muscles,arterial blood gas analysis, Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure(MEP) were recorded.

Results:
DE and DTF were assessed ultrasonographically and diaphragmatic RSBI was later calculated. DE andDTF were found to have similar sensitivity (94.12% and 97.06%), specificity (75%), positive predictive values(88.89 and 88.19% respectively) and negative predictive values (85.71% and 92.31% respectively). Overall DTF was comparable to DE in terms of diagnostic accuracy (88% and 90% respectively). (p value=1)

Conclusion:
DE and DTF are rapid and non invasive ultrasonographic indices with a high diagnostic accuracy for predicting weaning outcome. They provide objective and accurate results and are comparable to each other for predicting weaning outcome. Diaphragmatic RSBI is a good predictor of weaning outcome and is comparable to clinical RSBI.

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10: Efficacy of premixed versus sequential administration of fentanyl and bupivacaine in subarachnoid block for lower limb tibial surgeries: A randomised double blind clinical Study
Authors: Bevisetti Sagar 
Published: September 2024

Background and Aims:
Opioids are most commonly used as adjuvants in subarachnoid block. The drug and its mode of administration affects the various block characteristics. Intrathecal administration of bupivacaine and fentanyl as premixed is compared to sequential administration in two separate syringes.

Methods:
Total eighty patients were randomly allocated into two groups of 40 each: Group M (Mixed) received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25µg ) of fentanyl in a single 5.0 ml syringe, Group S (Sequential) received 0.5 ml (25 microgram) of fentanyl in a 2.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 5.0 ml syringe. Double blinding was ensured in all the cases performed. The onset and duration of sensory and motor blockade and haemodynamic parameters were observed. Data analysis was done using MedCalc software.

Results:
The mean time for onset of sensory and motor block was less in group S (P<0.0001). The duration of sensory and motor block was prolonged in group S (P<0.0001). Patients in group M experienced more hypotension as compared to group S (P<0.05). Need for rescue analgesia was less in Group S in 24 hours (P<0.05).

Conclusion:
Administering fentanyl first followed by hyperbaric bupivacaine leads to an early onset and prolonged duration of sensory and motor block and better haemodynamic stability and less need of rescue analgesia in 24 hours.
11: Comparison of intraperitoneal dexamethasone, dexmedetomidine and dexamethasone-dexmedetomidine combination on postoperative nausea, vomiting and analgesics requirement after gynaecological laparoscopy: A randomised clinical trial.
Authors: Srivastava PoojaShree Vinit Kumar 
Published: September 2024

Background and Aims:
Female patients undergoing laparoscopic gynaecological surgery are more prone to postoperative nausea and vomiting (PONV). We hypothesised that an intraperitoneal administration of dexamethasone, dexmedetomidine and combination would reduce the incidence of PONV and analgesics requirement after laparoscopic hysterectomies.

Methods:
One hundred ninety-two female patients undergoing laparoscopic hysterectomies were randomly assigned to four groups. Anaesthesia technique was identical in all the groups. Patients in group D1 received dexamethasone 8 mg, group D2 received dexmedetomidine 1 µg/kg, group D3 received dexamethasone 8 mg + dexmedetomidine 1 µg/kg combination and group D4 received 20 ml normal saline intraperitoneally at the end of the procedure, before withdrawal of trocar. The primary outcome was the incidence of PONV experienced by the patients within the 24 h postoperative period. The secondary outcome was the analgesic consumption during the first 24 h after surgery, and the need for rescue antiemetic drugs.

Results:
The incidence of PONV within first 24 h postoperatively was significantly decreased in D1, D2 and D3 group compared to group D4 (p=0.001), however, there was no significant difference among patients in the D1, D2 and D3 groups. The consumption of paracetamol and rescue antiemetic were significantly higher in the group D4 compared to other intervention groups.

Conclusion:
Intraperitoneal administration of dexamethasone, dexmedetomidine and combination of dexamethasone-dexmedetomidine in laparoscopic hysterectomies significantly reduces the incidence of PONV and also reduces the postoperative analgesics requirement as compared to control group.

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12: Comparison of the effects of propofol and sevoflurane on postoperative cognitive functions and memory in patients undergoing general anaesthesia
Authors: Shrivastav Priyal , Mehrotra Shikha , TriptiVatsalya  
Published: September 2024

Background and Aims:
Aim of the study was to compare the effects of propofol and sevoflurane on cognitive functions and memory in terms of psychometric test pre and post general anaesthesia.

Methods:
60 patients of age group 18– 40 years and of American Society of Anesthesiologists ( ASA) grade I and II scheduled for general anaesthesia were included in this study. According to anaesthetic considerations and patients’ needs, they were given either propofol infusion or sevoflurane for maintenance of general anaesthesia. Intraoperatively, depth of anaesthesia was monitored by clinical assessment. Assessment of cognitive functions and memory of patients was done preoperatively by following: MMSE score, CVLT, DST, RBMT and Recalling the names of surgeon and anaesthetist. After extubation, patients were observed for recovery by Aldrette recovery score up to 1 hour and assessed for pain by visual analogue scale up to 2 hours postoperatively. Cognitive function and memory was assessed postoperatively upto 2 hours.

Results:
The recovery characteristics were better with sevoflurane than propofol up to 60 minutes.

Sevoflurane had less impact on cognitive function as compared to propofol up to 30 minutes postoperatively.Effect on verbal and numerical memory was less with sevoflurane as compared to propofol up to 30 minutes.Effect on semantic memory was less with sevoflurane as compared to propofol up to 5 minutes except recall memory.

RIVERMEAD BEHAVIOURAL MEMORY TEST.

MINI MENTAL STATE EXAMINATION:

Conclusion:
Sevoflurane is more favourable than propofol for a faster recovery and emergence from anaesthesia, where rapid recovery of cognitive function and memory are desired.

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Surprise evidence of a bronchial rent in a case of pulmonary Koch’s posted for lung decortication using the one-lung ventilation protocol
Authors: Aishwarya Pingley 
Published: September 2024

Tracheobronchial injury is a potentially life-threatening clinical scenario. In the case of surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and post-operative management pose a challenge to the anaesthesiologist. We present a case of a 16-year-old girl, a known case of pulmonary Koch’s taking anti-Koch’s treatment, admitted with hydropneumothorax, who was posted for left lung decortication. She presented with complaints of left-sided chest pain and cough since 3 months and a weight loss of 13 kg in 3 months. An inter-costal drain was inserted on the left side.
Her high-resolution computed tomography thorax showed multiple cavitatory lesions with ground glass opacities in right lung parenchyma,
Hydropneumothorax from the upper lobe to lower lobe of the left lung; consolidation, calcification in the left lower lobe; mediastinal shift toward the right.
In the Operation theatre, the patient was pre-oxygenated, induced with Inj Propofol + Inj Fentanyl + Inj Suxamethonium according to the patient’s weight, and intubated with a 28 Fr’ left-sided double lumen tube (DLT). Left-sided decortication was performed uneventfully. On conclusion of surgery, while checking for leaks, it was noted that the exhaled tidal volume was unacceptably low and a rent on the left main bronchus of around 2 x 2 cm with scarred borders was detected, which was repaired with tissue patch suturing by the surgeons. After closure, the DLT was removed and re-intubation was performed with endotracheal tube no. 6. The patient was shifted to the intensive care unit, electively ventilated, and gradually weaned off in 2 days. Then, the patient was discharged in a week.

To conclude, meticulous planning, vigilant monitoring of vital parameters, and close communication between the surgeons and the anaesthesiologists are essential to timely manage a life-threatening complication.
Comparison of two external manoeuvres with the conventional technique on glottic visualisation using a C-MAC® videolaryngoscope in children for elective surgery
Authors: A Yazhini 
Published: September 2024

Background and Aims:
Glottic visualization is a pre-requisite for successful intubation. We compared the effect of backward upward rightward pressure (BURP) and jaw thrust manoeuvres with the conventional technique on glottic visualisation using a C-MAC® videolaryngoscope in children of 3 to 10 years.

Methods:
Ninety children of either gender of 3 to 10 years with normal airways and of the American Society of Anesthesiologists grade I or II for elective surgery under general anaesthesia with endotracheal intubation using a C-MAC® videolaryngoscope were enroled. Glottic views with the conventional technique (C), BURP (B), and jaw thrust (J) manoeuvres in three groups were assessed by modified Cormack Lehane grade (MCL) grade, percentage of glottic view (POGO) score, and a new two-dimensional metric – approximate glottic opening area in pixels squared. Approximate glottic opening area calculations were performed using tool pencil in horos medical imaging software.

Results:
Jaw thrust had statistically significant superiority over the conventional technique and BURP on glottic visualisation (a p value of C vs J < 0.0001 and B vs J < 0.05 for all the three parameters). BURP was comparable to the conventional technique in MCL grade and POGO score (a p value of C vs B > 0.05) but was superior to the conventional technique in glottic area (a p value of C vs B = 0.013).

Conclusion:
Jaw thrust enhanced glottic visualisation by maximising all the glottic view parameters as compared to the BURP manoeuvre and the conventional technique and should be considered the primary manoeuvre to aid intubation in children.

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Retrospective study of association of haematological parameters with disease severity in COVID patients admitted in Burdwan Medical College and Hospital
Authors: Roy Sougata 
Published: September 2024

Background and Aims:
Since December 2019, an increasing number of pneumonia cases of unknown reasons emerged in Wuhan, China. Deep-sequencing analysis from nasopharyngeal swabs, sputum, lower respiratory tract samples, and blood indicated a novel coronavirus, known as 2019-nCoV. Our aim was to determine the association of haematological parameters such as haemoglobin (Hb%), total leukocyte count (TLC), platelet count (Plt) with severity of coronavirus disease 19 (COVID 19) infection among patients admitted in the COVID intensive care unit (ICU) and COVID ward, and our objectives were to estimate haemoglobin (Hb), TLC, differential leukocyte count (DLC), and platelet count of patients admitted in the COVID ward and ICU; to derive neutrophil lymphocyte ratio (NLR) from the DLC of the patients admitted in the COVID ward and ICU; and to determine the correlation between Hb, platelet count, TLC, and NLR with severity of disease among COVID patients.

Methods:
After receiving approval from institutional ethics committee, data were collected according to our study parameter (age, weight, height, Hb%, TLC, platelet, NLR) from the medical record section for ICU-admitted (Group A) and ward-admitted (Group B) patients and compared. Here, SPSS version 22 was used for analysis, and a p value <0.05 was considered significant.

Results:
A decreasing trend in Hb%, TLC, and platelet count was seen in both the groups but more in group A than group B, which is statistically significant; NLR got an increasing trend in these two groups, and the increase in group A is more and statistically significant compared to group B.

Conclusion:
Our study tries to explore the feasibility of such parameters in this regard and found that a combination of NLR, Hb%, TLC, and platelet count can be considered together as an effective prognostic indicator in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Abstract No. : ABS0107 : Ultrasound guided lower thoracic erector spinae plane block for postoperative analgesia following gynaecologic oncology surgery - A randomised controlled trial
Authors: Solanki Rekha 
Published: September 2024

Background and Aims:
Erector spinae plane (ESP) block is a relatively novel block which provides local and visceral analgesia for abdominal surgery. The present study is aimed to assess the efficacy of ESP block for postoperative analgesia following major open gynaecologic oncology surgery.

Methods:
Sixty female patients posted for elective open gynaecologic oncology surgeries were enroled in this prospective, double blind study and randomised to B and C group. Group B patients received general anaesthesia plus ultrasound guided bilateral ESP block at T9 level at the end of surgery while group C patients received general anaesthesia only. Primary outcome was postoperative visual analogue scale (VAS) scores. Secondary outcomes were time to first rescue analgesic, 24 hours tramadol consumption, and side effects. Chi square and student t tests were used and P < 0.05 was considered significant.

Results:
Postoperative pain scores were lower in B group compared to C group at rest and on movement . Time to first rescue analgesic was prolonged in B group (8.10 ± 1.48 hours) as compared to C group (0.7 ± 0.38 hours) [P < 0.0001]. Total 24 hours tramadol consumption was less in B group (68 ± 48.55 mg) than C group (210 ± 52.65 mg)(table 1) [P < 0.0001].

Conclusion:
Ultrasound guided ESP block with general anaesthesia provides superior postoperative analgesia compared to general anaesthesia alone following major gynaecologic oncology surgeries without any side effects. It can be used as an alternative to epidural analgesia.

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Abstract No. : ABS0260: Comparison of phantom cadaver based simulations with blue phantom model for teaching ultrasound guided regional anaesthesia: a randomised controlled trial
Authors: Dang Deepanshu 
Published: September 2024

Background and Aims:
Various methods of simulation have different advantages and disadvantages.This study was aimed to compare the block performance of novice post-graduate students of anaesthesiology after teaching them ultrasound guided regional anaesthesia on blue phantom model or cadaver-based phantom model.

Methods:
This study was conducted in the Department of Anaesthesiology and Critical Care and Department of Anatomy at a tertiary medical college hospital.
Video lecture on ultrasound knobology and transducer movement was given to all study participants. In group BP, participants trained on blue phantom model. In group CP, participants trained on fresh human cadaver model. After training, participants were shown video of supraclavicular brachial plexus block,and finally performance was assessed on patients.

Results:
The median block performance time was 525.0 seconds in group BP with an interquartile(IQR) of (494-552.5) and 440.0 seconds in group CP with an IQR of (419.5-487.5)(table 1).
This difference was statistically significant (p<0.001). The median image quality score was 3.0 in group BP with an IQR of 2-3, and it was also 3.0 in group CP with an IQR of 3-4, and it was statistically significant (p = 0.00398) (table 2).

JOURNAL/ijana/04.03/01762628-202203001-00090/inline-graphic1/v/2022-09-30T091728Z/r/image-tiff

JOURNAL/ijana/04.03/01762628-202203001-00090/inline-graphic2/v/2022-09-30T091728Z/r/image-tiff

Conclusion:
Time taken to perform brachial plexus block was less in the cadaver phantom group compared to the blue phantom group. The image quality scores and number of attempts required to perform brachial plexus block were statistically significant between groups. Novices trained on cadavers had better transducer target orientation and were able to identify ultrasonographic artifacts better than those trained on the blue phantom.
Abstract No.: ABS0279: Retrospective analysis of acute dialysis in ICU setting in a tertiary care hospital
Authors: SindhuriPulipaka Kavya 
Published: September 2024

Background and Aims:
To study the clinical profile and evaluate in-hospital and 30-day mortality in patients undergoing acute dialysis in the intensive care unit (ICU) in a multi-disciplinary hospital.

Methods:
Thirty one consecutive patients who underwent acute dialysis between August 2020 and August 2021 in ICU were included in the study. All patients were evaluated with basic clinical assessment, laboratory investigations, indications for dialysis, the process of dialysis, the time lag for initiation of dialysis following the clinician’s orders, an increase in requirement of vasopressors following dialysis, and access for dialysis. Any other complications occurring during dialysis were also noted. All the patients were further evaluated with sequential organ failure assessment (SOFA) score and all the parameters mentioned above as possible predictors of in-hospital and 30-day mortality with logistic regression analysis.

Results:
Out of 31 patients, 17 had sepsis, six had acute febrile illness, and five had acute myocardial infarction, resulting in dialysis. Common indications were anuria >24 hours, pulmonary oedema, and severe metabolic acidosis. SOFA score was an independent predictor of both in-hospital (p = 0.03) and 30-day mortality (p = 0.048) with an increase of each unit, increasing the 30-day mortality by 1.5 times. Sustained low-efficiency daily dialysis (SLEDD) had 13.5 times higher mortality risk compared to ischaemic heart disease (IHD), inferring that patients with greater haemodynamic lability or vasopressor requirement had higher 30-day mortality.

Conclusion:
Sepsis remains the most common cause of dialysis in ICU, followed by acute febrile illness, including leptospirosis and dengue. Each unit of increase in SOFA score increases the 30-day mortality by 1.5 times in these patients. SLEDD was associated with a 13.5 times increased risk of mortality over IHD, inferring that patients with haemodynamic lability or vasopressor requirement had higher 30-day mortality.
Abstract No.: ABS0288: Comparison of the effect of two balanced crystalloid intraoperative (intravenous) solutions (PlasmalyteTM versus Sterofundin TM) on lactate levels during major cancer surgeries.
Authors: Gupta Deepti 
Published: September 2024

Background &Aims:
Use of balanced fluids as intra-operative fluids substantially decrease the incidence of lactic acidosis; especially after major cancer surgeries. Aim of present study was to compare the effects of two acetate based balanced solutions, PlasmalyteTM and SterofundinTM on lactate, pH, electrolytes and haemodynamics after major onco-surgery.

Methods:
In this prospective randomised parallel group study, 60 patients undergoing major onco surgeries were randomised in one o fthe two groups to receive either PlasmalyteTM (PL) (30 patients) or SterofundinTM (SF) (30 patients) as an intra-operative fluid. Arterial Blood Gas analysis (ABG) was sampled before surgery (Baseline) and at the time of haemostasis (Post surgery). Heart rate and mean blood pressure were noted every 30 minutes. Blood loss during surgery was replaced with either colloid or blood. Descriptive statistical analyses, including mean and standard deviation for continuous variables, and count and percentage for categorical variables was performed. Student t-test was used to compare continuous variables and Fisher’s exact test was used for categorical variables. p <0.05 was considered to indicate statistical significance. Analysis was performed using SPSS Version 23.0 software.

Results:
The patient’s age was found to be comparable in both the groups (p=0.19). There was not any statistically significant difference seen in lactate (p=0.085) or pH (p=0.89) values between the two groups. Electrolyte levels were well maintained within normal limits in both PL and SF groups except calcium which was significantly higher in SF group post surgery(p<0.001). Difference in heart rate and mean blood pressure was found to be insignificant at all time points. Blood loss during the surgery was also similar in both the groups (p=0.937).

Conclusion:
Both PL and SF balanced crystalloid solutions can be safely recommended as an intraoperative fluid in major oncological surgeries. Both the fluids effectively maintain the pH and significantly decrease the incidence of lactic acidosis during cancer surgeries. Calcium levels are better maintained with the infusion of Sterofundin solution.