bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lack of influence of dexmedetomidine on rat glomus cell response to hypoxia, and on mouse acute hypoxic ventilatory response
Authors: O’Donohoe Peadar B. , Turner Philip J. , Huskens Nicky , Buckler Keith J. , Pandit Jaideep J. 
Published: January 2022

Background and Aims:
There is a lack of basic science data on the effect of dexmedetomidine on the hypoxic chemosensory reflex with both depression and stimulation suggested. The primary aim of this study was to assess if dexmedetomidine inhibited the cellular response to hypoxia in rat carotid body glomus cells, the cells of the organs mediating acute hypoxic ventilatory response (AHVR). Additionally, we used a small sample of mice to assess if there was any large influence of subsedative doses of dexmedetomidine on AHVR.

Material and Methods:
In the primary study, glomus cells isolated from neonatal rats were used to study the effect of 0.1 nM (n = 9) and 1 nM (n = 13) dexmedetomidine on hypoxia-elicited intracellular calcium [Ca2+]i influx using ratiometric fluorimetry. Secondarily, whole animal unrestrained plethysmography was used to study AHVR in a total of 8 age-matched C57BL6 mice, divided on successive days into two groups of four mice randomly assigned to receive sub-sedative doses of 5, 50, or 500 μg.kg-1 dexmedetomidine versus control in a crossover study design (total n = 12 exposures to drug with n = 12 controls).

Results:
There was no effect of dexmedetomidine on the hypoxia-elicited increase in [Ca2+]i in glomus cells (a mean ± SEM increase of 95 ± 32 nM from baseline with control hypoxia, 124 ± 41 nM with 0.1 nM dexmedetomidine; P = 0.514). In intact mice, dexmedetomidine had no effect on baseline ventilation during air-breathing (4.01 ± 0.3 ml.g-1.min-1 in control and 2.99 ± 0.5 ml.g-1.min-1 with 500 μg.kg-1 dexmedetomidine, the highest dose; P = 0.081) or on AHVR (136 ± 19% increase from baseline in control, 152 ± 46% with 500 μg.kg-1 dexmedetomidine, the highest dose; P = 0.536).

Conclusion:
Dexmedetomidine had no effect on the cellular responses to hypoxia. We conclude that it unlikely acts via inhibition of oxygen sensing at the glomus cell. The respiratory chemoreflex effects of this drug remain an open question. In our small sample of intact mice, hypoxic chemoreflex responses and basal breathing were preserved.
Comparative evaluation of glidescope videolaryngosocope and conventional macintosh laryngoscope for nasotracheal intubation in patients undergoing oropharyngeal cancer surgeries: A prospective randomized study
Authors: Kumar Abhishek , Gupta Nishkarsh , Kumar Vinod , Bharti Sachidanand Jee , Garg Rakesh , Kumar Rajeev , Bhatnagar Sushma 
Published: January 2022

Background and Aims:
Nasotracheal intubation in oropharyngeal cancer patients is challenging owing to anatomical alterations. Various videolaryngoscopes have been compared to conventional laryngoscope and also amongst each other in different clinical scenarios; the supremacy of videolaryngoscopes over conventional laryngoscope in oropharyngeal cancer patients is yet to be established. We compared the efficacy of glidescope videolaryngoscopes and Macintosh laryngoscope for nasotracheal intubation in patients posted for routine oropharyngeal cancer.

Material and Methods:
120 ASA I and II oropharyngeal cancer patients scheduled for elective surgery were randomized to undergo nasotracheal intubation after induction of general anesthesia with glide scope video laryngoscope (Group GVL, N = 60) or Macintosh laryngoscope (Group L, N = 60) as per group allocation. Time to glottic view, total intubation time (primary objective), hemodynamic fluctuations, and additional manoeuvres to aid intubation were recorded.

Results:
Time to visualize the glottic opening (9.20 ± 4.6 sec vs 14.8 ± 6.3 sec) (P = 0.000) and the total intubation time was significantly less in group GVL (35.6 ± 9.57 sec vs 42.2 ± 11 sec) (P = 0.001). Glidescope videolaryngosocpe provided better glottic views and resulted in significantly fewer manoeuvres to facilitate NTI (P = 0.009). The median numeric rating scale (NRS), hemodynamic parameters and complications were similar in both the groups.

Conclusion:
Glidescope videolaryngosocpe is better than conventional Macintosh laryngoscope for intubation times and need of manoeuvres to facilitate intubation and should be a preferred device for NTI in patients with oropharyngeal cancer.
C5 ventral ramus block for clavicle surgery: How low concerning the volume can we go?
Authors: Diwan Sandeep , Feigl Georg , Nair Abhijit 
Published: January 2022

Background and Aims:
Clinical case reports mention 3-5 ml of local anesthetic (LA) at the cervical root 5 (C5) for surgical anesthesia essential for clavicle surgeries with reasonable success. A volume of 5 ml LA has been shown to cause hemidiaphragmatic paresis.

Material and Methods:
We implement the 3–5 ml LA for awake clavicle surgeries along with a supraclavicular nerve (SCN) block with another 2 ml. To understand the spread of injectate, we conducted anatomic macroscopic dissection on Theil based cadavers. Post ultrasound injection of 3 ml of blue latex in one cadaver and green latex in the other, we dissected one cadaver and the other cadaver underwent a cross-section.

Results:
Dissection confirmed a vertical spread of dye more caudad than cephalad. There was no neuraxial spread visualized in the cross-section. The phrenic nerve (PN) was not stained in both cadavers, but a possibility exists depending on its course.

Conclusion:
Based on this limited study we recommend a volume of LA of 3 ml at the level of C5 and another 2 ml at the level SCN of LA for clavicle surgeries.
Preoperative oral carbohydrate loading: Effects on intraoperative blood glucose levels, post-operative nausea and vomiting, and intensive care unit stay
Authors: Rajan Sunil , Rahman Ahlam Abdul , Kumar Lakshmi 
Published: January 2022

Background and Aims:
Preoperative fasting imparts safety to patients from aspiration of gastric contents, but undue fasting may predispose to hypoglycemia and dehydration. Preoperative carbohydrate drink reduces postoperative nausea and vomiting (PONV). Primary objective of the present study was to assess effect of carbohydrate drink given 2h before surgery on intraoperative blood glucose levels as compared to those who did not receive it. Secondary objectives included assessment of incidence and severity of PONV and duration of Intensive Care Unit (ICU) stay.

Material and Methods:
It was a prospective randomized study done in 52 non-diabetic patients undergoing thyroidectomy. Group A received 39gm of carbohydrate in 250 mL of apple juice (tetrapack) and Group B patients were given equivalent volume of plain water 2 h prior to surgery. Random blood glucose (RBS) levels were checked before fluid administration, preinduction, 1 h postinduction, and at the end of surgery. PONV was assessed using PONV Impact Scale Score (ISS) and rescue drugs, if needed, were noted. Paired t-test, sample t-test, Mann–Whitney U test, and Fisher’s exact test were used as applicable.

Results:
The fasting, preinduction, and postoperative RBS values were comparable in both groups. Group B had significantly higher RBS at 1h intraoperatively. Group A patients had less vomiting, dry retching, or nausea and required less rescue therapy compared to Group B.

Conclusion:
Compared to patients who received carbohydrate drink 2 h before surgery, those who did not receive it had significantly higher blood glucose values intraoperatively with a higher incidence and severity of PONV and comparable ICU stay.
Does cerebral oximetry always measure brain tissue oxygen saturation? An anatomical study utilizing computed tomography
Authors: Naftalovich Rotem , Chyu Darrick , Denny John T. , Hasan Aysha , Pantin Enrique J. 
Published: January 2022

Background and Aims:
to quantify the scalp-cortex distance and determine its variation among patients. We hypothesized that in a significant number of patients, this distance is greater than the maximum penetration depth of current cerebral oximeters.

Material and Methods:
A retrospective anatomic study using transverse head CT images selected randomly from 102 patients over the age of 18 years without brain swelling, intracranial mass effect, or brain hemorrhage. Scalp-cortex distances were determined at two separate locations along the craniocaudal axis; most cephalad to the frontal sinus (I0) and also 2 cm cephalad to that location (I2). Multiple measurements were obtained bilaterally at 1, 3, 5, 7, and 9 cm from midline.

Results:
The average scalp-cortex distance was 14.3 mm and 15 mm at I0 and I2 respectively. Distances varied more in I2 than in I0; from the measurements, 12.8% vs. 6.8% were over 20 mm, 4.4% vs. 2.2% over 25 mm, 1.1% vs. 0.6% over 35 mm and 0.6% vs. none over 40 mm at I2 and I0, respectively. 1.5% of the measurements at I2 were over 30 mm.

Conclusion:
Cerebral oximetry manufacturers all claim to measure cerebral tissue up to a depth of 20-25 mm; 20 mm with the EQUANOX and INVOS compared with 25 mm with the FORE-SIGHT. Scalp-cortex distance is within 25 mm in more than 95% of patients. However, even with the probe placed as per the manufacturer’s recommendations, in a small but significant subset of patients, this distance is greater than the maximum penetration depth of current cerebral oximeters and hence may not reflect actual brain tissue oxygen saturation.
Assessment of communication skill during process of preoperative visit and informed consent by anesthesiology residents
Authors: Salgaonkar Sweta V. , Kulkarni Aarti D. , Chapane Sunil P. 
Published: January 2022

Background and Aims:
Anaesthesiologists have few opportunities to communicate with patients especially in preoperative period for various reasons. If these opportunities are not well utilized, anesthesiologists may not be able to educate patients about anaesthesia related issues. The aim of this study was to assess communication skill (CS) exhibited by the anesthesiology residents during the process of preoperative visit and informed consent.

Material and Methods:
This was a pre and post intervention questionnaire based study carried out in a presurgical ward of a tertiary hospital. During the process of preoperative visit and informed consent, fourteen of the second year anesthesia residents were assessed by faculty members for various aspects of CS using validated questionnaire on 3-point Likert’s scale, before and after CS workshop. Residents’ perception about workshop and patient satisfaction with regards to the preoperative visit and process of informed consent was assessed. Results were described in percentage value and a qualitative analysis was carried out.

Results:
While none of the residents exhibited ‘excellent CS score’ in the pre-workshop phase, six (42.86%) achieved the same after the workshop. One resident, who had ‘poor CS score’ moved to higher category score post workshop. The behavioural traits of professionalism, empathy, risk explanation and written consent showed statistically significant improvements post intervention by Wilcoxon Signed Rank Test, with P value < 0.05. All residents felt that good communication can improve patient satisfaction and CS training should be part of the post graduate curriculum.

Conclusion:
Conduct of CS workshop for anesthesia residents improved certain behavioral traits during anaesthesia preoperative visit and informed consent process. This important nontechnical skill of CS, may not be uniformly acquired during clinical training and should be specifically taught and evaluated as part of post graduate curriculum.
Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy
Authors: Lomate Prashant , Jadhav Vasudha R. , Yadav Arvind 
Published: January 2022

Background and Aims:
Erector spinae plane (ESP) block is a simple and safe interfascial plane block reported to provide good analgesia after thoracolumbar surgeries. We compared its efficacy with conventional peritubal local anesthetic infiltration following percutaneous nephrolithotomy (PCNL).

Material and Methods:
A total of 60 adult patients posted for elective PCNL were randomly allocated into two groups. Postoperatively, Group I received ultrasound (US) guided peritubular infiltration block with 20 ml of 0.25% levobupivacaine and Group II received US guided ESP block with 20 ml of 0.25% levobupivacaine. The two groups were compared for the time to first rescue analgesic (Injection tramadol), number of rescue analgesic demands, total analgesic consumption in first 24 hours, VAS (rest and dynamic) scores and the adverse effects. The data were analyzed by unpaired t-test and Mann Whitney U test.

Results:
The time to first rescue analgesic demand was significantly longer in Group II (6.93 ± 2.15 h vs. 16.21 ± 7.53 h). The VAS scores (rest and dynamic) at eight and twelve hours of measurement were significantly lower in Group II (P < 0.05). The number of analgesic demands were less in group II (2.97 ± 0.49 vs. 1.00 ± 1.05). The total analgesic consumption in first 24 hours was less in Group II (148.33 ± 24.51 mg vs. 51.92 ± 45.78 mg).

Conclusion:
ESP block is a very effective and safe technique to provide prolonged duration of postoperative analgesia following PCNL. Peritubal local anesthetic infiltration is also a reliable technique for postoperative analgesia.
Ultrasound-guided costoclavicular vs. axillary brachial plexus block: A randomized clinical study
Authors: Nalini Kadirehally Bheemanna , Bevinaguddaiah Yatish , Thiyagarajan Balaji , Shivasankar Archana , Pujari Vinayak Seenappa 
Published: January 2022

Background and Aims:
Brachial plexus is in a very compact state at the costoclavicular space (CCS) when compared to the axilla, where the individual nerves are separate. This study aimed to test the hypothesis that brachial plexus block (BPB) at the CCS would result in a faster onset of block as compared to the axillary approach of BPB.

Material and Methods:
Fifty patients who underwent surgeries below the level of mid-arm under ultrasound-guided BPB were randomly allocated to any one of the two study groups. Thirty milliliters of local anesthetic (LA), a mixture of 10-mL 2% lidocaine with 5-μg/mL adrenaline and 20-mL 0.5% bupivacaine, was deposited around the axillary artery (25-mL LA) and the musculocutaneous nerve (5-mL LA) or at the CCS, and performance time was noted. Observer blinded to the block procedure recorded the block onset time and success rate.

Results:
The mean (SD) onset times were comparable between the costoclavicular (CC) and axillary (AX) groups (12.0 ± 3.2 vs. 11.2 ± 2.9 min, respectively; P = 0.367). Group CC demonstrated a reduction in performance time compared to group AX (5.3 ± 1.9 vs. 8.0 ± 3 min, respectively; P < 0.05). All blocks were successful in both groups without any complications except for one patient in group AX who required a rescue block for radial nerve.

Conclusion:
Costoclavicular and axillary ultrasound-guided BPBs resulted in similar onset times. However, the block performance time was longer for AX group compared to CC group. There were no intergroup differences found in terms of success rates.
Flow dynamics of ultrasound-guided lumbar plexus block in adults
Authors: Diwan Sandeep , Nair Abhijit , Gawai Nitin , Sancheti Parag 
Published: January 2022

Background and Aims:
The outcomes of plexus and peripheral nerve blocks depend on needle-nerve contact and the spread of local anesthetic (LA) around the plexus or nerve. Needle-nerve distance and spread of LA could be visualized during US-guided lumbar plexus block (LPB).

Material and Methods:
After Institutional Ethics Committee approval and after obtaining informed consent, 24 American Society of Anesthesiologists’-physical status I–III patients who underwent surgical fixation of fractures of proximal femur were enrolled. Spinal anesthesia was a primary anesthetic in all patients. At the end of the surgery, all patients received US and neurostimulation-aided LPB at the third lumbar nerve root (LNr). The primary aim was to determine the spread of LA in the lumbar plexus area with the relation of the needle tip and LNr contact. The secondary aim was to understand block efficacy in terms of pain scores monitored at regular intervals and 100 mg intravenous tramadol was administered as a rescue analgesic if VAS >4.

Results:
In all 24 patients, we observed an oval and antegrade LA spread after lumbar plexus was identified with neurostimulation at L3. With the needle closer to intervertebral foramina (IVF), a retrograde spread was visualized. Only 2/24 patients received rescue analgesia in the first 24 h.

Conclusion:
The type of spread after the US-guided LPB could predict block success of block and a possible epidural spread.
Perioperative anesthesia management for brachytherapy in cancer patients: A retrospective observational study
Authors: Kumar Vinod , Gulia Abhity , Garg Rakesh , Gupta Nishkarsh , Bharati Sachidanand J. , Mishra Seema , Bhatnagar Sushma 
Published: January 2022

Background and Aims:
Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges.

Material and Methods:
We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples.

Results:
The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period.

Conclusion:
Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient’s factors.
Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL)
Authors: Shankar K. , Rangalakshmi Srinivasan , Priyanka D. , Kailash P. , Deepak Vijaykumar Kadlimatti 
Published: January 2022

Background and Aims:
In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL.

Material and Methods:
A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [n = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [n = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [n = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. P value <0.05 was considered significant.

Results:
Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8th, 12th and 24th hr as compared to peritubal infiltration (P < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups.

Conclusion:
In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects.
A randomized clinical trial comparing the King Vision (channeled blade) and the CMAC (D blade) videolaryngoscopes in patients with cervical spine immobilization
Authors: Chandy Jacob , Pillai Rahul , Mathew Amit , Philip Amitav V. , George Sajan P. , Sahajanandan Raj 
Published: January 2022

Background and Aims:
Cervical spine immobilization renders direct laryngoscopy difficult. The CMAC D blade and the channeled blade of the King Vision videolaryngoscopes, have both been used for difficult airway management. Our hypothesis is that the channeled blade of the King Vision would be superior to the CMAC D blade in terms of ease of intubation. We tested this hypothesis in a randomized comparison of the two videolaryngoscopes in patients with simulated cervical spine immobilization.

Material and Methods:
Hundred patients with no anticipated airway difficulty were randomly allocated to two groups after obtaining informed written consent. Following induction, manual inline stabilization (MILS) was applied to simulate a cervical spine injury and immobilzation. Patients were intubated with either of the two videolaryngoscopes. Time for visualization of the glottis, procedural time, intubation difficulty scale (IDS), and hemodynamic response were recorded.

Results:
The time to visualize the glottis was shorter in the CMAC D group as compared to the King Vision group (P < 0.001). The incidence of external laryngeal manipulation was less in the King Vision group (P < 0.001). The ease of intubation was superior in the King Vision group, based on the IDS (P < 0.001). The haemodynamic response was similar between the groups.

Conclusion:
King Vision channeled videolaryngoscope was difficult to introduce into the mouth of the patient during laryngoscopy. Once introduced into the mouth, the time for intubation was less and less external laryngeal manipulation maneuvers were performed to achieve successful intubation. The ease of endotracheal intubation was superior for the King Vision videolaryngoscope. The King Vision videolaryngoscope with proper tranining, could be a safe and portable alternative in patients with cervical spine immobilization.