bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laryngeal Mask Airway Cuff Pressure and its Influence on the Incidence of Pharyngolaryngeal Adverse Effects: Need for Regular Monitoring
Authors: Metange Harish , Kadam Sandeep 
Published: October 2024

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

Background & Objective: With the extensive use of the laryngeal mask airway (LMA) for anesthesia as well as in emergency airway management, learning alternative techniques of insertion is essential for the safe and quick use of the device in some cases. The smooth and quick insertion of LMA leads without repeated attempts reduce the consequent complications. We compared standard technique with 180° rotation with inflated cuff technique for LMA Classic insertion.
Methodology: This study was done in Basrah University Medical Center from 1st January 2019 to 31st December 2019. During this period, in 397 patients LMA was used for general anesthesia. Out of these, in 197 patients we used 180° rotation technique of insertion of LMA with fully inflated cuff and in 200 patients the standard method was used as a control group. The patients’ ages ranged between 15 and 45 y, and they were scheduled to undergo short surgical procedures and to require general anesthesia.
Results: Three hundred and ninety-seven (397) participants were enrolled in this study with a mean age of 35.7 ± 14 y. Of those, 154 (38.8%) were males. The new method showed higher sensitivity and accuracy rate (97.4%, 95.9%, respectively) compared to the standard method.
Conclusion: The new method is a suitable technique that enhanced the ease of LMA insertion and successfully placed the device within a shorter time without complications compared to the standard method of insertion.
Key words: Laryngeal mask airway; LMA; BMI; Mallampati grading system; Airway management; Anesthesia, general.

Citation: Salman JM. Comparison of standard versus a new technique for classic laryngeal mask insertion. Anaesth. pain intensive care 2021;25(5):569-574: DOI: 10.35975/apic.v25i5.1621 Received: May 21, 2021, Reviewed: August 25, 2021, Accepted: September 5, 2021
A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery
Authors: Jain Payal , Shahid Razi , Prasad Mukesh Kumar , Alam Md Alauddin , Reddy Macha Niranjan , Jheetay Gurdeep Singh 
Published: October 2024

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

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

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

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

It is announced with profound sadness and anguish that Dr. Muhammad Kashif Ilyas, Anesthetist at Faisalabad Institute of Cardiology and Allied Hospital, Faisalabad (Pakistan) passed away on February 13, 2022. Apparently enjoying good physical and mental health, he suddenly collapsed and met his Creator before any medical help could be provided to him. The assumed cause of death was sudden cardiac arrest secondary to acute myocardial infarction.
Acute effect of Kinesiotaping applied to the first finger in patients with rheumatoid hand
Authors: Çopuroğlu Özge Baykan , Narin Selnur , Bayraktar Dilek , Özgül Semiha , Inal Vedat 
Published: October 2024

Background & Objective: Rheumatoid arthritis (RA) is a crippling disease characterized by joint pains and joint stiffness. Kinesiotaping (KT) has been advocated to reduce local pressure and increase circulation, resulting in decreased pain in various conditions. We aimed to evaluate the acute effect of KT on pain, function, range of motion (ROM) and grip strength parameters in patients with rheumatoid hand.
Methodology: A total of 34 patients, 27 women and 7 men, diagnosed with RA were included in our study. All patients were divided into two groups; Kinesiotape group (Group KT) and control group (Group C), each consisting of 17 patients. Subjective pain intensity by Visual Analog Scale (VAS), ROM by goniometer, functional evaluation with the Grip Skill Test, hand grip strength by dynamometer, and finger grip strength by pinchmeter were evaluated. The patients in the Group KT were taped with the mechanical correction method and the patients in the Group C were taped with tensionless I tape. Applications were made on both dominant and non-dominant hands.
Results: The mean age of the patients was 54 ± 20 y. VAS score changes at the time of grasping were significant in both groups (P < 0.05), but Group KT was more effective for reducing pain and increasing grip strength. An increase was observed in the wrist and thumb metacarpophalangeal joint ROM in the Group KT (P < 0.05). No change was observed in the groups in hand grip strength and finger grip strength (P > 0.05). In the Grip Skill test, there was a significant difference after the application in both groups (P < 0.05), but there was no difference in between the groups (P > 0.05).
Conclusion: Kinesiotaping applied in rheumatoid hand patients was found to be effective in increasing functionality and joint range of motion, as well as reducing pain during gripping.
Abbreviations: KT – Kinesiotaping; RA – Rheumatoid arthritis; MCP – Metacarpophalangeal joint; ROM - Range of Motion; VAS - Visual Analog Scale
Key words: Hand function; Hand deformities; Kinesiotape; Kinesiotaping; Rheumatoid arthritis; Range of Motion, Articular; Visual Analog Scale
Citation: Çopuroğlu OB, Narin S, Bayraktar D, Özgül S, Vedat Inal V. Acute effect of kinesiotaping applied to the first finger of the patients with rheumatoid hand. Anaesth. pain intensive care 2022;26(6):236−242.
DOI: 10.35975/apic.v27i2.2042
Received: Sep 06, 2022; Reviewed: Oct 09, 2022; Accepted: Oct 21, 2022
A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries
Authors: Kamal Nouh Mohamed Medhat Moustafa , Elrehiem Elkadi Galal Adel Mohamed Abd , Aboseif Eman Mohamed Kamal , El Hamid Faisal Said Abd , Ali Mowafi Marwa Mostafa Mohamed 
Published: October 2024

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