bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analgesic efficacy of ultrasound guided quadratus lumborum block versus ilioinguinal/iliohypogastric nerve block following pediatric open inguinal hernia repair: A prospective randomized controlled trial
Authors: Mostafa Shaimaa F. , Abdelghany Mohamed S. , Elyazed Mohamed M. Abu 
Published: March 2023

Background and Aims:
Inguinal hernia repair is a common surgical procedure. We compared the analgesic efficacy of ultrasound-guided anterior quadratus lumborum (QL) block versus ilioinguinal/iliohypogastric (II/IH) nerve block in pediatric patients undergoing open inguinal hernia repair.

Material and Methods:
It was a prospective randomized study in which 90 patients of 1-8 years of age were randomly assigned into control (general anesthesia only), QL block, and II/IH nerve block groups. Children’s Hospital Eastern Ontario Pain Scale (CHEOPS), perioperative analgesic consumptions, and time to first analgesic request were recorded. The normally distributed quantitative parameters were analyzed by one-way ANOVA with post-hoc Tukey’s HSD test while parameters that did not follow a normal distribution and the CHEOPS score were analyzed using the Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferonni correction for post-hoc analysis.

Results:
In the 1st 6h postoperative, the median (IQR) CHEOPS score was higher in the control group than II/IH group (P = 0.000) and QL group (P = 0.000) while comparable between the latter two groups. CHEOPS scores were significantly lower in the QL block group than the control group and II/IH nerve block group at 12 and 18h. The intraoperative fentanyl and postoperative paracetamol consumptions in the control group were higher than II/IH and QL groups while lower in QL than II/IH group.

Conclusion:
Ultrasound-guided QL and II/IH nerve blocks provided effective postoperative analgesia in pediatric patients undergoing inguinal hernia repair with lower pain scores and less perioperative analgesic consumptions in the QL block group compared to II/IH group.
Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis
Authors: Hussein Kareem , Black Colin 
Published: March 2023

Background and Aims:
Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children.

Material and Methods:
A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days.

Results:
Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion.

Conclusion:
A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.
Analgesic effect of ketorolac as an adjuvant to bupivacaine in ultrasound-guided pectoral nerve block (I + II) for patients undergoing modified radical mastectomy: A randomized controlled clinical trial
Authors: Al-Touny Shimaa A. , Abd Elnasser Amira G. , Al-Taher Ezzat M. , El-lilly Ahmed A. 
Published: March 2023

Background and Aims:
Many drugs have been tried as adjuvant to local anesthetic in different nerve blocks. Ketorolac is one of them, but it has never been used in pectoral nerve block. In this study, we evaluated its adjuvant effect with local anesthetic on postoperative analgesia in ultrasound (US)-guided pectoral nerve (PECS) blocks. The aim was to assess the quality and the duration of analgesia by the addition of ketorolac in the PECS block.

Material and Methods:
46 patients who underwent modified radical mastectomies under general anesthesia were randomized into two groups: control group, where pectoral nerve block was given with bupivacaine 0.25% only; and ketorolac group, where the block was given with bupivacaine 0.25% and ketorolac 30 mg.

Results:
Patients who needed postoperative supplemental analgesia were significantly less in the ketorolac group (9 vs 21 patients, P = 0.00) and that first-time analgesic requirement was significantly later in the ketorolac group (14 hrs) postoperatively compared to the control group (9 hrs) postoperatively.

Conclusion:
Adding ketorolac to bupivacaine in pectoral nerve block safely increases postoperative duration of analgesia.
Shivering and changes in body temperature in patients undergoing caesarean section under spinal anaesthesia with bupivacaine vs bupivacaine and fentanyl: A randomized clinical study
Authors: Thakur Niraj , Balachander Hemavathi , Rudingwa Priya , Panneerselvam Sakthirajan 
Published: March 2023

Background and Aims:
Shivering is common after spinal anesthesia in patients undergoing cesarean section. Various drugs have been used for its prevention. The primary aim of this study was to assess the efficacy of adding a small dose of fentanyl intrathecally (12.5 μg) in reducing the occurrence of intraoperative shivering and hypothermia and note any significant side effects in this subset of patients.

Material and Methods:
In this randomized controlled trial, 148 patients undergoing cesarean section under spinal anesthesia were included. In 74 patients, spinal anesthesia was administered with 1.8 mL of hyperbaric bupivacaine (0.5%), and the remaining 74 patients received 12.5 μg of intrathecal fentanyl with 1.8 mL of hyperbaric bupivacaine. Both were compared to find the incidence of shivering and change in nasopharyngeal and peripheral temperature along with the temperature at the onset of shivering and the grade of shivering.

Results:
The incidence of shivering was 9.46% in the intrathecal bupivacaine plus fentanyl group, which was significantly less than the group with intrathecal bupivacaine alone (41.89%). The nasopharyngeal and peripheral temperature showed a decreasing trend in both groups but were greater in the plain bupivacaine group.

Conclusion:
The addition of 12.5 μg of intrathecal fentanyl to bupivacaine in parturient undergoing cesarean section under spinal anesthesia significantly reduces the occurrence and intensity of shivering without its adverse effects such as nausea, vomiting, and pruritus, etc.
Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial
Authors: Kamel Yasmeen Abdelsalam , Sasa Noura Adel Ghareeb , Helal Safaa Mohamed , Attallah Hatem Amin , Yassen Khaled A. 
Published: March 2023

Background and Aims:Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups.Material and Methods:This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO240% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded.Results:IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ2(Y) (df = 1)= 0.88,P(Y)= 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12–0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85–0.97] mL/min propofol with TCI. The cost was higher with TCI,P< 0.00.Conclusions:Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier.
Low-dose propofol as a solo agent for sedation in postoperative ventilated liver transplant recipients: A preliminary observational study
Authors: Jaju Rishabh , Prakash Kelika , Arora M. K. 
Published: March 2023

Background and Aims:
Propofol is a commonly used sedative agent, in a dose of 1.5–4.5 mg.kg–1.h–1. Following liver transplantation (LT), drug metabolism may be altered due to liver mass, altered hepatic blood flow, reduced levels of serum proteins, and liver regeneration. Thus, we hypothesized that propofol requirements in this group of patients would be different as compared to the standard dose. This study evaluated the dose of propofol used for sedation in electively ventilated living donor liver transplantation (LDLT) recipients.

Material and Methods:
After patients were shifted to the postoperative intensive care unit (ICU) following LDLT surgery, propofol infusion was started at a dose of 1 mg.kg–1.h–1 and titrated to maintain a bispectral index (BIS) value of 60–80. No other sedatives such as opioids or benzodiazepines were used. Dose of propofol, noradrenaline, and arterial lactate levels were noted 2 hourly.

Results:
The mean propofol dose required in these patients was 1.02 ± 0.26 mg.kg–1.h–1. Noradrenaline was gradually tapered off and stopped within 14 h of shifting to ICU. The mean duration between the time of cessation of propofol infusion till extubation was 2.06 ± 1.44 h. Propofol dose did not correlate with respective lactate levels, ammonia levels, or graft-to-recipient weight ratio.

Conclusion:
The dose range of propofol required for postoperative sedation in LDLT recipients was lower than the conventional dose.
Current practice of Rapid Sequence Induction (RSI) in pediatric anesthesia: A survey from India
Authors: Hussain Sana Yasmin , Panjiar Pratibha , Jain Dhruv , Khanooja Samiksha , Batt Kharat Mohammad 
Published: March 2023

Background and Aims:
Rapid Sequence Induction (RSI) is an established technique to secure the airway in patients who are at risk of aspiration. The practice of RSI in the pediatric population is highly variable due to numerous patient factors. We conducted a survey to find the prevalent practices and adherence of anesthesiologists to the practice of RSI in different pediatric age groups and whether it differs with the experience of the anesthesiologist or the age of the child.

Material and Methods:
The survey was conducted among residents and consultants attending the pediatric national anesthesia conference. The questionnaire consisted of 17 questions on anesthesiologist’s experience, adherence, conduct of pediatric RSI, and the reason for nonadherence.

Results:
The response rate was 75% (192/256). Anesthetists having less than 10 years of experience adhered to RSI more often as compared to respondents with more experience. Succinylcholine was the most commonly used muscle relaxant for induction, with use increasing in higher age groups. The application of cricoid pressure increased with increasing age groups. Anesthetists with >10 years of experience used cricoid pressure more often in age groups of <1 year (P < 0.05). In a scenario of intestinal obstruction, adherence to RSI was low in pediatrics as compared to adults, with 82% of respondents agreeing to this.

Conclusion:
This survey on the practice of RSI in the pediatric population demonstrates wide variation in the practice among individuals and the reasons for nonadherence as compared to adults. It highlights the need felt by almost all the participants for more research and protocol in the practice of pediatric RSI.
A comparison of efficacy of parenteral and perineural dexmedetomidine with 0.25% ropivacaine for post-thyroidectomy analgesia using bilateral superficial cervical plexus block
Authors: Jain Neena , Mathur Pooja R. , Lakhina Kriti , Patodi Veena , Jain Kavita , Garg Deepak 
Published: March 2023

Background and Aims:
Opioids are conventionally used for post-thyroidectomy pain, regional anesthesia is becoming popular due to its feasibility and efficacy in minimizing use of opioids and hence its side effects. This study compared analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) using perineural and parenteral dexmedetomidine with 0.25% ropivacaine in thyroidectomy patients.

Material and Methods:
In this double-blind study, 60 American Society of Anesthesiologists (ASA) physical status I and II thyroidectomy patients, aged 18–65 years were randomized into two groups. Group A (n = 30) received BSCPB with 0.25% ropivacaine, 10 mL on each side with dexmedetomidine 0.5 μg/kg IV infusion. Group B (n = 30) received 0.25% ropivacaine plus dexmedetomidine 0.5 μg/kg, ten mL on each side. Duration of analgesia by measuring pain visual analog scores (VAS), total dose of analgesic requirement, Haemodynamics parameters and adverse events were recorded for 24 h. Categorical variables were analyzed using Chi-square test and continuous variables were computed as mean with standard deviation and analyzed using independent sample t-test. Mann-Whitney U test was used for analysis of ordinal variables.

Results:
Time to rescue analgesia was longer in Group B (18.6 ± 3.27 h) as compared to Group A (10.2 ± 2.11 h) (P < 0.001). Total analgesic dose required was also found to be lesser in Group B (50.83 ± 20.37 mg) as compared to Group A (73.33 ± 18.27 mg) (P < 0.001). No significant hemodynamic changes or side effects were observed in both groups; (P > 0.05).

Conclusion:
Perineural dexmedetomidine with ropivacaine in BSCPB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement.
A prospective, randomized, triple-blind comparative study of ropivacaine-dexmedetomidine versus ropivacaine alone in peribulbar blocks
Authors: Moolagani Ramanareddy Venkata , Prathi Sunita , Bandaru Sriushaswini , Arepalli Narasimha Rao , Neethipudi Bhaskara Rao 
Published: March 2023

Background and Aims:
Bupivacaine and lidocaine mixtures are the commonly used local anesthetic drugs for the peribulbar blocks. Because of its safe anesthetic profile, ropivacaine is being investigated as an alternative agent. Several centers have evaluated the effect of the addition of an adjuvant like dexmedetomidine (DMT) to ropivacaine in enhancing the block characteristics. We proposed to evaluate the effect of the addition of DMT to ropivacaine versus a control group not having DMT as adjuvant.

Material and Methods:
A prospective, randomized comparative study was conducted on a total of 80 patients attending our hospital for cataract surgeries. Patients were allocated into four groups of 20 each (n = 20) and peribulbar blocks were given 6 mL of 0.75% ropivacaine in group R and 6 mL of 0.75% ropivacaine plus 10 μg, 15 μg, and 20 μg DMT, respectively, in groups RD1, RD2, and RD3.

Results:
When DMT was used as an adjunct to ropivacaine, there was a prolongation of the duration of the sensory block.

Conclusion:
In peribulbar blocks, 6 mL of ropivacaine 0.75% produces satisfactory block characteristics, and the addition of 10 μg, 15 μg, or 20 μg of DMT as an adjuvant to ropivacaine 0.75% had the effect of significantly prolonging the duration of the sensory block, which is directly proportional to the dose of DMT employed. However, 20 μg of DMT added as an adjuvant to ropivacaine 0.75% appears to be the optimal dose, as this anesthetic drug mixture provides maximum prolongation of the sensory block besides providing satisfactory operating conditions, acceptable sedation levels, and stable hemodynamic parameters.
The respiratory and hemodynamic effects of alveolar recruitment in cirrhotic patients undergoing liver resection surgery: A randomized controlled trial
Authors: Halawa Naglaa Moustafa , El Sayed Amani Mamdouh , Ibrahim Ezzeldin Saleh , Khater Yehia H. , Yassen Khaled Ahmed 
Published: March 2023

Background and Aims:
Extensive surgical retraction combined with general anesthesia increase alveolar collapse. The primary aim of our study was to investigate the effect of alveolar recruitment maneuver (ARM) on arterial oxygenation tension (PaO2). The secondary aim was to observe its effect on hemodynamics parameters in hepatic patients during liver resection, to investigate its impact on blood loss, postoperative pulmonary complications (PPC), remnant liver function tests, and on the outcome.

Material and Methods:
Adult patients scheduled for liver resection were randomized into two groups: ARM (n = 21) and control (C) (n = 21). Stepwise ARM was initiated after intubation and was repeated post-retraction. Pressure-control ventilation mode was adjusted to deliver a tidal volume (Vt
) of 6 mL/kg and an inspiratory-to-expiratory time (I:E) ratio of 1:2 with an optimal positive end-expiratory pressure (PEEP) for the ARM group. In the C group, a fixed PEEP (5 cmH2O) was applied. Invasive intra-arterial blood pressure (IBP), central venous pressure (CVP), electrical cardiometry (EC), alanine transaminase (ALT, U/L), and aspartate aminotransferase (AST, U/L) blood levels were monitored.

Results:
ARM increased PEEP, dynamic compliances, and arterial oxygenation, but reduced ventilator driving pressure compared to group C (P < 0.01). IBP, cardiac output (CO), and stroke volume variation were not affected by the higher PEEP in the ARM group (P > 0.05) but the CVP increased significantly (P = 0.001). Blood loss was not different between the ARM and C groups (1700 (1150–2000) mL vs 1110 (900–2400) mL, respectively and P = 0.57). ARM reduced postoperative oxygen desaturation; however, it did not affect the increase in remnant liver enzymes and was comparable to group C (ALT, P = 0.54, AST, P = 0.41).

Conclusions:
ARM improved intraoperative lung mechanics and reduced oxygen desaturation episodes in recovery, but not PPC or ICU stay. ARM was tolerated with minimal cardiac and systemic hemodynamic effects.
Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study
Authors: Kamel Yasmin A. , Elmoniar Mahmoud M. , Fathi Yasser I. , Lotfi Mamdouh E. , Alwarraky Mohamed S. , Yassen Khaled A. 
Published: March 2023

Background and Aims:
Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and spontaneous breathing patients. Secondary aims??

Material and Methods:
Adult consecutive hepatic patients scheduled for elective TIPS were included. Patients were sedated with bispectral index-guided propofol infusion + fentanyl boluses. EC parameters, i.e., cardiac output (CO) and systemic vascular resistance (SVR) were noted. Noninvasive blood pressure, heart rate, central venous pressure (CVP, cmH2O), and portal venous pressure (PVP, cmH2O) were measured pre- and post-TIPS.

Results:
Thirty-six people were enrolled (n = 25 included) from Aug 2018 to Dec 2019. Data (expressed in median (IQ)) were: age 33 (27–40) years, body mass index 24 (22.0–27) kg/m2, child A 60%, B 36%, and C 4%. Post-TIPS, PVP decreased (from 40 [37–45] to 34 [27–37] mmHg, P < 0.001), whereas CVP increased (from 7 [4–10] to 16 [10.0–19.0] mmHg, P < 0.001). The CO increased (P = 0.03) and SVR reduced (P = 0.012).

Conclusion:
The reduction in PVP following successful TIPS insertion elevated the CVP abruptly. EC was able to monitor an immediate increase in the CO and a reduction in SVR in association with the above PVP and CVP changes. The results of this unique study indicate that EC monitoring is promising; however, further evaluation in a larger population and in correlation with other gold-standard CO monitors is still indicated.
Comparison of aerosol box intubation with styletted endotracheal tube and intubation over bougie: A randomized controlled trial
Authors: Puthenveettil Nitu , Vijayaraghavan Sundeep , Rahman Sajan , Rajan Sunil , Paul Jerry , Kumar Lakshmi 
Published: March 2023

Background and Aims:
Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is an infectious disease. The use of video laryngoscopes is recommended for intubation of patients with COVID-19. But in resource-poor countries, it is rare to have video laryngoscopes available. In this trial, we have compared the ease of oral intubation by direct laryngoscopy with styletted endotracheal tube and intubation over the bougie, with the use of the aerosol box. The secondary objectives were comparison of the incidence of airway loss, attempts taken to intubate, time for intubation and hemodynamic changes.

Material and Methods:
80 non-coronavirus infected patients coming for an elective procedure under general anesthesia were recruited in this randomized control trial. Participants were assigned into groups S and B using a computer-generated random sequence of numbers by closed envelope technique. In both groups, aerosol box was used. In Group S, participants were intubated by direct laryngoscopy with a styletted endotracheal tube and in group B, after direct laryngoscopy, the endotracheal tube was railroaded over the bougie.

Results:
Ease of endotracheal intubation was good (67.5%% vs. 45%), satisfactory (32.5%% vs. 37.5%), and poor (0% vs. 17.5%) in group S and B respectively (P < 0.011). The attempts required for intubation were similar in both groups. The time for intubation was significantly less in group S than B (23 vs. 55 s).

Conclusion:
The use of a styletted endotracheal tube made intubation easier and faster than tracheal intubation with bougie when the aerosol box was used in patients without known or predicted difficult airway and significant medical comorbidities.