bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative evaluation of the effect of addition of 8 mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study
Authors: Poorna P. , Shetty Premalatha , Kalyani Veerbhadra , Shetty Sameep , Upadya Madhusudan , Mithra Prasanna 
Published: February 2024

BackgroundImpacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially.AimTo evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars.MethodologyA controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures.ResultsTest group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p &lt; 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p &lt; 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p &lt; 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7.ConclusionThe addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.
Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections
Authors: Karam Rozheen Shukri , Mohammad Fouad K. 
Published: February 2024

Background & Objective: There is an increased ratio of cesarean sections (CS) compared to normal deliveries the world over. Both general and regional anesthetic techniques are in practice for CS. Limited information is available on the determination of blood cholinesterase (ChE) activity in conjunction with oxidative stress biomarkers after the CS. The purpose of the present study was to determine and compare the plasma and erythrocyte ChE activity as well as malondialdehyde (MDA) level and total antioxidant status in pregnant women before anesthesia and after the use of general anesthesia (GA) or spinal anesthesia (SA) for elective CS.
Methodology: A pre-post study was conducted on 102 full-term pregnant women, who underwent elective CS in four hospitals at Duhok (Iraq) from January 2022 to July 2022. GA with propofol and SA with bupivacaine 0.5% were administered to 52 and 50 women, respectively. Maternal blood samples before anesthesia and after the completion of operation were assayed for the ChE activity in the plasma and erythrocytes, and plasma oxidative stress biomarkers malondialdehyde and total antioxidant status.
Results: Plasma ChE activity significantly decreased in the GA and SA groups after the cesarean-deliveries compared to the corresponding pre-anesthetic values. The plasma MDA level in both GA and SA groups, but not the total antioxidant status, was significantly reduced. Estimation of the odds ratio and the relative risk indicated that a risk factor is associated with the reduced plasma ChE activity in women after the CS when the general anesthetic propofol is used.
Conclusion: Both general anesthesia with propofol and spinal anesthesia with bupivacaine inhibited plasma cholinesterase activity and reduced oxidative stress biomarker malondialdehyde after the cesarean sections.
Abbreviations: CS - Cesarean section; ChE: Cholinesterase; EChE: Erythrocyte Cholinesterase; MDA: Malondialdehyde; OS: Oxidative Stress; PChE: Plasma ChE; TAS: Total Antioxidant Status.
Key words: Anesthesia, Spinal; Cesarean section; General anesthesia; Malondialdehyde; Oxidative stress
Citation: Karam RS, Mohammad FK. Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections. Anaesth. pain intensive care 2023;27(3):396−404; DOI: 10.35975/apic.v27i3.2244
Received: March 23, 2023; Reviewed: May 06, 2023; Accepted: May 09, 2023
Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries
Authors: Sethi Sameer , Kathuria Rahul , Samra Tanvir , Saini Vikas , Toshkhani Dheemta , Kushal Pankaj 
Published: February 2024

Introduction: Robot-assisted laparoscopic pelvic surgeries are minimally invasive techniques that require the patient to be placed in the steep Trendelenburg position. Pneumoperitoneum further increases the risk of postoperative pulmonary complications. We used lung ultrasound score (LUSS) to detect post-operative atelectasis in this subset of patients.
Methodology: Patients aged 18 to 70 y with ASA physical status I/II undergoing robot assisted pelvic surgeries in steep Trendelenburg position were enrolled. Patients were mechanically ventilated with 50% oxygen in air with a tidal volume of 6 to 8 ml/kg in volume control mode to maintain an end tidal carbon dioxide at 35−45 mmHg with positive end-expiratory pressure (PEEP) of 5 cmH2O. Ultrasonographic assessment was done; before induction (A), after extubation (F), 12 h (G) and 24 h after surgery (H) by dividing chest into 12 regions.
Results: A total of 1152 cine-loops acquired during the study period in 32 patients were analyzed. Incidence of postoperative atelectasis was 87.5% and each lung ultrasound examination required 12.35 ± 4.68 min. Statistically significant fall in PaO2 was recorded at extubation from baseline and intra-operative values (P < 0.0001). Statistically significant difference was established between change in baseline and post-extubation LUSS to the total volume of fluid given (P = 0.002).
Conclusion: A high incidence (87.5%) of atelectasis in adults after robot assisted laparoscopic pelvic surgeries was detected using lung ultrasound score. Lung oxygenation decreased significantly after steep Trendelenburg position and extubation. The observed statistical difference in total IV fluids administered between patient subgroups who showed increased ultrasound signs of lung edema from the A period to the F period, although suggestive of association, is no evidence of causation.
Abbreviations: ARISCOT- Assess Respiratory Risk in Surgical patients in Catalonia; LUS- Lung Ultrasound; LUSS- Lung Ultrasound Score; OR- Operating room; PEEP- Positive End-Expiratory Pressure
Key words: LUSS; Lung ultrasound score; Pneumoperitoneum; Robotic Surgery; Ultrasonography
Citation: Sethi S, Kathuria R, Samra T, Saini V, Toshkhani D, Kushal P. Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries. Anaesth. pain intensive care 2023;27(4):573−578; DOI: 10.35975/apic.v27i4.1503
Received: October 28, 2021; Reviewed: June 06, 2022; Accepted: September 17, 2022
Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial
Authors: Alkonaiesy Ramy M. , Amin Shereen Mostafa , Abdallah Nasr M. , Muhammad Sherif Ismail , Hassan Haitham 
Published: February 2024

Background: An adequate dose of spinal anesthetic is very crucial in elderly surgical patients. The routine method to calculate the dose in a particular patient is usually based upon the weight of the patient, but the effect cannot always be predictable. We evaluated the efficacy and safety of the height-based dose of spinal anesthetic versus the conventional dose on intraoperative hemodynamics and spinal block characteristics in geriatric patients scheduled for lower limb surgeries.
Methodology: This single-blinded, parallel-group, randomized, clinical trial enrolled 56 patients, aged 60 y or above who were scheduled for lower limb orthopedic surgeries under spinal anesthesia. The patients were randomly divided into two groups. In the height-based group, 0.06 mg of 0.5% hyperbaric bupivacaine/cm height of the patient was administered intrathecally. The control group received a fixed dose of 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. All patients received 25 µg of fentanyl (0.1 mg / 2 ml) intrathecally. The incidence of hypotension was the primary outcome. The incidence of bradycardia, highest sensory level, onset and duration of sensory and motor block, incidence of shivering, the total dose of bupivacaine, total amount of fluid infused, vasopressors needed, and blood loss were the secondary outcomes.
Results: The incidence of hypotension was significantly reduced in patients receiving height-based spinal dose compared to those in which standard dose was administered (57.1% vs. 82.1%, P = 0.042). The duration of sensory blocks was significantly shorter in height-based group compared to the control group (116 ± 32.77 vs. 90.59 ± 19.66 min; P = 0.001) as was the duration of the motor block (153.18 ± 42 and 117 ± 25.37 min; P < 0.001).
Conclusion: In geriatric patients undergoing orthopedic lower limb surgery, the height-based dose of spinal anesthesia was effective and safe in reducing the incidence of hypotension with fast recovery from sensory and motor block.
Abbreviations: ASA- American Society of Anesthesiologists; COPD- Chronic Obstructive Pulmonary Disease; CSF- Cerebrospinal Fluid; DVT- Deep Venous Thrombosis; IQR- Interquartile range- n: Numbers; SD- Standard Deviation; SA- Spinal Anesthesia
Key words: Bromage scale; Elderly; Height; Hypotension; Orthopedics; Anesthesia, Spinal
Citation: Alkonaiesy TM, Amin SM, Abdallah NM, Sherif Ismail Muhammad SI, Hassan H. Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial. Anaesth. pain intensive care 2023;27(4):565−572; DOI: 10.35975/apic.v27i4.2160
Received: February 20, 2023; Reviewed: May 16, 2023; Accepted: June 16, 2023
Mortality among patients with subarachnoid hemorrhage: a retrospective study
Authors: Sindi Anees A. , Abushoshah Ibrahim , Bokhary Diyaa H. , Banser Sultan M. , Bedaiwi Wejdan H. , Bajuneid Khalid M. , Algethamy Haifa M. 
Published: February 2024

Background & Objective: Subarachnoid hemorrhage (SH) accounts for 50% of hemorrhagic strokes. Few individuals present with ‘thunderclap headaches’, resulting in delayed diagnoses of aneurysmal SH (aSH). We conducted this retrospective study to explore factors for predicting the risk, severity and mortality patterns of aSH and traumatic SH (tSH).
Methodology: A retrospective study was conducted on 68 SH patients admitted to Intensive Care Units (ICUs) of a Middle East tertiary care hospital. Medical history, demographics, risk factors, outcome and the type of SH were evaluated.
Results: The mean age of the patients was 47.84 ± 18.24 y, and 38 (55.8%) were males, showing most SH cases occur in middle-age and in males. Majority 59 (86.7%) of the patients presented with risk factors such as trauma (35%), hypertension (37%), anti-thrombotic use (15.25%), alcoholism (3%) and smoking (1.5%). The regression model showed age and risk factors significantly influence the type and severity of SH (P < 0.05). The mortality was significantly higher in those suffering from traumatic SH compared to non-traumatic SH (84.6% versus 10.5%, P < 0.0061).
Conclusion: Age, male gender and risk factors predispose the type and severity of SH. Mortality rates are higher among traumatic SH in comparison to non-traumatic SH patients.
Abbreviations: SH - Subarachnoid Hemorrhage; aSH - Aneurysmal Subarachnoid Hemorrhage; tSH - Traumatic Subarachnoid Hemorrhage; WFNS - World Federation of Neurological Surgeons; MRI - Magnetic resonance imaging
Key words: Subarachnoid hemorrhage; Risk Factors; Severity; Classification; WFNS
Citation: Sindi AA, Abushoshah I, Bokhary DH, Banser SM, Bedaiwi WH, Bajuneid KM, Algethamy HM. Mortality among patients with subarachnoid hemorrhage: a retrospective study. Anaesth. pain intensive care 2023;27(4):545−552; DOI: 10.35975/apic.v27i4.2161
Received: February 27, 2023; Reviewed: May 15, 2023; Accepted: May 16, 2023
Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report
Authors: Andiantoro Dirgo Suseno , Sedono Rudyanto , Jennefer Jennefer 
Published: February 2024

The kidneys is the most commonly injured organs in sepsis, which might manifest as acute kidney injury (AKI). Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy (RRT), especially in the developing countries. Furthermore, the COVID-19 pandemic has made hemodialysis (HD) unavailable due to infection concerns. We present a critically-ill 16-year-old male with morbid obesity (BMI 43.3 kg/m2), diabetic ketoacidosis, acute pancreatitis, acute kidney injury, and COVID-19 pneumonia. The patient looked somnolent on admission with very high random blood glucose and hypernatremia. Blood gas analysis showed metabolic acidosis. The patient was treated with 1 g/day Meropenem, 0.5 µg/kg/min norepinephrine, 0.04 unit/kg/h vasopressin, and correction of electrolyte imbalance and metabolic acidosis. After 48 h, the diuresis and the creatinine levels worsened. We placed a Tenckhoff catheter and started PD. The patient showed improvement after 72 h of peritoneal dialysis.
This case report highlighted the use of PD as a modality of RRT in sepsis-induced AKI, multi-organ failure, and COVID-19. Although it remains controversial, we observed an improvement in diuresis and creatinine levels following PD. PD is more cost-effective and provides a similar outcome compared to other modalities.
Abbreviations: AKI - Acute Kidney Injury; BMI- Body Mass Index; CRRT- Continous Renal Replacement Therapu; GCS- Glasgow Coma Scale; HD- Hemodialysis; ICU- Intensive Care Unit; PD- Peritoenal Dialysis; RRT- Renal Replacement Therapy; S-AKI- Sepsis-Associated Acute Kidney Injury; SIRS- Systemic Inflammatory Response Syndrome
Key words: Septic shock; Acute kidney injury; Peritoneal dialysis
Citation: Andiantoro DS, Sedono R, Jennefer J. Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report. Anaesth. pain intensive care 2023;27(4):600−603.
DOI: 10.35975/apic.v27i4.2163
Received: February 14, 2023; Reviewed: April 17, 2023; Accepted: April 22, 2023
A randomized prospective comparative study between intrathecal chloroprocaine 1% and ropivacaine 0.5% for short duration surgery
Authors: Prakash Vivek , Jain Payal , Prasad Mukesh Kumar 
Published: February 2024

Background and Objectives: Spinal anesthesia (SA) has recently seen a rapid surge in is popularity due to its edge over general anesthesia, being easier, cost-effective, lack of addictive drugs, reduced analgesic demand in the post anesthesia care unit, less nausea and vomiting within 24 h postoperatively, and a shorter hospital stay. Research continues regarding the best and the safest drug to be used for SA. We compared chloroprocaine 1% and ropivacaine 0.5% for SA in short duration surgery.
Methodology: A total of 70 patient were enrolled and subdivided into two groups; Group R (35 patients), to receive 4 ml of 0.5 % ropivacaine (20 mg) and Group C (35 patients), to receive 4 ml of 1% chloroprocaine (40 mg). Hemodynamic parameters and block characteristics were compared between the two groups.
Conclusion: This study shows that chloroprocaine 1% and ropivacaine 0.5% are equally effective in spinal anesthesia. However, chloroprocaine 1% is better suitable for shorter duration surgeries.
Key words: Chloroprocaine; Ropivacaine; Hemodynamics; Block Characteristics
Citation: Prakash V, Jain P, Prasad MK. A randomized prospective comparative study between intrathecal chloroprocaine 1% and ropivacaine 0.5% for short duration surgery. Anaesth. pain intensive care 2023;27(4):508−513; DOI: 10.35975/apic.v27i4.2260
Received: March 13, 2023; Reviewed: May 22, 2023; Accepted: May 22, 2023
Compliance with the 2016 Surviving Sepsis Campaign Bundle and the 2018 Surviving Sepsis Campaign 1-Hour Bundle and patient outcomes in emergency presentation at a tertiary referral hospital
Authors: Utariani Arie , Semedi Bambang Pujo , Salinding Agustina , Hamzah Hamzah 
Published: February 2024

Background & Objective: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis has always been associated with high morbidity and mortality. Consensus committees of international organizations have recommended packages to reduce the high mortality. We evaluated the 2016 Surviving Sepsis Campaign (SSC) package with 3 and 6-hour sepsis packages and the 2018 SSC with 1-hour sepsis package on the mortality of septic patients who came to a tertiary referral hospital.
Methodology: We enrolled 164 retrospective cohort patients in the tertiary emergency referral general hospital resuscitation ward. The patients were followed up for 48 h of observation. Sepsis and septic shock criteria are based on the Third International Consensus Definition of Sepsis and Septic Shock (Sepsis-3) 2016. Patients were divided into 3 groups, based upon compliance with SSC 16 at 3 h, 6 h, and SSC 18 at 1 h, and the mortality was recorded before 48 h and after 48 h.
Results: Compliance rates at 1 h (27.4%), 3 h (39.6%), and 6 h (43.3%) were significantly associated with patient mortality (P ≤ 0.001). Population patients who met the criteria for SSC, 73.3% had been referred from peripheral hospitals. The mortality rate was 76 (46.34%) for < 48 h and 37 (22.56%) for more than 48 h.
Conclusion: Compliance with sepsis management contributes to improved patient condition and a better prognosis when the Surviving Sepsis Campaign package is adequately implemented.
Abbreviations: SSC - Surviving Sepsis Campaign; SOFA - Sequential Organ Failure Assessment; qSOFA - quick Sequential Organ Failure Assessment; VIS - Vasopressor Inotropic Score
Key words: Sepsis; SSC Sepsis Bundle Compliance-2016; 1 Hour SSC Sepsis Package 2018; Death; Vasopressors; Outcome; Mortality
Citation: Utariani A, Semedi BP, Salinding A, Hamzah H. Compliance with the 2016 Surviving Sepsis Campaign Bundle and the 2018 Surviving Sepsis Campaign 1-Hour Bundle and patient outcomes in emergency presentation at a tertiary referral hospital. Anaesth. pain intensive care 2023;27(5):478−485; DOI: 10.35975/apic.v27i5.1852
Received: March 26, 2022; Reviewed: December 21, 2022; Accepted: August 08, 2023
Serratus anterior plane block for postoperative analgesia in modified radical mastectomy
Authors: . Mochamat , Arifin Johan , Pramadika Taufan , Manapa Chandra Hermawan , Istanto Widya , Wicaksono Satrio Adi , Nugroho Taufik Eko 
Published: February 2024

Introduction: Serratus Anterior Plane (SAP) block can be used as part of multimodal analgesia, reducing the need for additional analgesia for 24 h postoperatively. The SAP block (SAPB) is easy to apply with a safe technique and low side effects. This study analyzes serratus anterior plane block as postoperative analgesia in Modified Radical Mastectomy (MRM) surgery by assessing the level of pain, side effects, and complications.
Methods: This study was a double-blind randomized control trial (RCT) conducted on patients scheduled to undergo MRM, at Dr. Kariadi Hospital Semarang during August-October 2022. A total of 44 patients were enrolled, and divided into two groups; 22 patients in each group. The treatment group received SAPB and was compared with the control group of morphine 0.1 mg/kg, in terms of the numeric pain rating scale, at 4, 8, 12, and 24 h postoperatively, time and number of analgesic rescue doses, the incidence of PONV and pruritus within 24 h postoperatively. Independent T-test, Mann-Whitney, Chi-square, and Fischer tests were performed to analyze the data. P < 0.05 was considered significant.
Results: The mean NRS at 4, 12, and 24 h postoperatively was lower in the SAPB group than in the control group (2.73 ± 0.77 vs. 3.23 ± 0.53; 1.77 ± 0.61 vs. 2.32 ± 0.48, and 1.45 ± 0.59 vs. 2.09 ± 0.61). The difference was statistically significant, e.g., P = 0.017, P = 0.003, and P = 0.001, respectively. Time to the first request of rescue analgesia was prolonged in the SAPB group than in the control group (398.86 ± 140.6 vs. 100.91 ± 10.3; P = 0.000). The mean rescue analgesic dose in the SAPB group was lower than in the control group (3.59 ± 1.56 vs. 8.55 ± 2.4; P = 0.000). The control group showed a higher incidence of PONV (68.2% vs. 18.2%, P = 0.01). There was no significant difference in the groups regarding the frequency of pruritus (P = 0.073).
Conclusion: Serratus anterior plane block reduced pain significantly up to 24 h postoperatively compared to the control group. The patients in this group needed rescue analgesia after longer duration and needed lower doses of rescue analgesia. There was lower frequency of PONV than the control group.
Abbreviations: MRM - Modified Radical Mastectomy; PONV – Postoperative Nausea and Vomiting; PMPS - Post-Mastectomy Pain Syndrome; PVB – Para Vertebral Block; SAP - Serratus Anterior Plane; VAS - Visual Analog Scale
Key words: Serratus Anterior Plane Block; Breast Cancer; Modified Radical Mastectomy
Citation: Mochamat, Arifin J, Pramadika T, ManapaCH, Istanto W, Wicaksono SA, Nugroho TE. Serratus anterior plane block for postoperative analgesia in modified radical mastectomy. Anaesth. pain intensive care 2023;27(5):486−490; DOI: 10.35975/apic.v27i5.2297
Received: January 05, 2023; Reviewed: January 18, 2023; Accepted: March 31, 2023