Anesthesia Department Research Articles

Comparison of Intravenous Ondansetrone versus Stimulation of P6 Acupuncture Point in Prevention of Intraoperative Nausea and Vomiting during Caesarean Section

Objective: To draw a comparison between acupuncture point stimulation with prototype drug ondansetron to establish its efficacy. Study Design: Quasi-Experimental study. Place and Duration of Study: Anesthesia department, Combined Military Hospital, Quetta Pakistan, from Aug 2022 to Jan 2023. Methodology: Hospitals ethical committee given its permission with IERB number# ERC/88/2023. 50 patients were included in the study, with 25 in each study group as OS (Ondansetrone), who received intravenous ondansetron and OP (Acupuncture) group who received stimulation of P6 acupunture point. The gravid ladies with reproductive age group (18 to 40 years) were included. The patients were monitored for any nausea/retching and vomiting as primary outcome. Results: The frequency of nausea and vomiting was analogous in both study groups. 10(20%) patients who received ondansetron developed nausea and vomiting while 23(46%) patients did not have any episode of nausea, vomiting or retching. Similarly, 38(76%) group OP patients who were underwent transcutaneous stimulation of Nei-Kuan point didn’t show any signs of nausea and vomiting. 12(24%) patients in group OP developed nausea and vomiting which was comparable to group OS statistics with p value of 0.405. This shows that there was no significant difference between two study group. Conclusion: Stimulation of P6 acupunture point was analogous to ondansetron for prevention of intra-operative nausea and vomiting.

Awareness Regarding Biomedical Waste Among Postgraduate Residents

Background: Biomedical waste poses significant health and environmental risks if improperly managed, particularly in low-resource settings where awareness among healthcare professionals remains inadequate. Existing literature indicates persistent knowledge gaps among medical staff, yet contemporary evidence from Pakistani tertiary hospitals is limited. Objective: This study aimed to assess the level of awareness and knowledge regarding biomedical waste management among postgraduate residents at a tertiary care hospital, focusing on departmental differences, attitudes toward educational initiatives, and the prevalence of good biomedical waste practices. Methods: A descriptive cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, in April 2024. The study included 92 postgraduate residents from the Departments of Surgery, Anesthesia, and Gynecology, with proportional representation across training years; residents not formally enrolled or declining consent were excluded. Data were collected via a pre-tested, validated 14-item online questionnaire, measuring knowledge, attitudes, and departmental distribution. Ethical approval was obtained from the Institutional Review Board in accordance with the Helsinki Declaration. Descriptive and comparative analyses were performed using SPSS version 27.0. Results: Among 92 respondents (mean age 28 years), departmental distribution was Anesthesia (56.5%), Gynecology (27.0%), and Surgery (16.3%). Good knowledge of biomedical waste management was observed in 43.0% of Gynecology, 32.0% of Surgery, and 25.0% of Anesthesia residents. Seventy-two percent of participants supported regular surveys and educational programs. No missing data were reported; inferential statistics were limited by data structure. Conclusion: The study highlights suboptimal awareness and significant interdepartmental variation in biomedical waste management knowledge among postgraduate residents. Targeted training and continuous professional development are essential to bridge the knowledge gap and enhance clinical safety. Improving awareness in this area is crucial for safeguarding healthcare workers, optimizing waste management, and aligning with global best practices.

Barriers and Enablers to Using a Mobile App-Based Clinical Decision Support System in Managing Perioperative Adverse Events Among Anesthesia Providers: Cross-Sectional Survey in China.

Perioperative adverse events (PAEs) pose a substantial global health burden, contributing to elevated morbidity, mortality, and health care expenditures. The adoption of clinical decision support systems (CDSS), particularly mobile-based solutions, offers a promising avenue to address these challenges. However, successful implementation hinges on understanding anesthesia providers' knowledge, attitudes, and willingness to embrace such technologies. This study aimed to evaluate the knowledge, attitudes, and willingness of Chinese anesthesia professionals to adopt a mobile CDSS for PAE management, and to identify key factors influencing its implementation. A nationwide cross-sectional survey was conducted among anesthesia providers in China from September 5 to December 31, 2023. Participants included anesthesiologists and nurse anesthetists, who play pivotal roles in perioperative care. A 51-item questionnaire, structured around the Knowledge-Attitude-Practice (KAP) framework, was distributed via WeChat through professional anesthesia associations. The questionnaire covered four domains: (1) demographic characteristics, (2) knowledge assessment, (3) attitude evaluation, and (4) practice willingness. Multivariable regression analyses identified predictors of KAP outcomes, with sensitivity analyses focusing on nurse anesthetists. The study included 2440 anesthesia professionals (2226 anesthesiologists and 214 nurse anesthetists). Overall, 87.3% (2130/2440) expressed willingness to adopt the CDSS, with 87.5% (1947/2226) of anesthesiologists and 85.5% (183/214) of nurse anesthetists showing readiness. However, only 39.2% (956/2440) were satisfied with existing incident management systems. Key findings indicated that higher knowledge scores were associated with female gender (coefficient=0.19, P=.003), advanced education, and lack of previous informatics experience (coefficient=0.29, P<.001). Nurse anesthetists scored lower than anesthesiologists (coefficient=-0.76, P<.001). Negative attitudes were more prevalent among older practitioners (coefficient=-0.13, P<.001), females (coefficient=-0.66, P<.001), nurse anesthetists (coefficient=-1.12, P=.003), and those without prior PAE exposure (coefficient=-0.97, P<.001). Higher willingness was observed among practitioners in Southwest China (coefficient=0.10, P=.048), those with positive attitudes (coefficient=0.06, P<.001), and those dissatisfied (coefficient=0.32, P<.001) or neutral (coefficient=0.11, P=.02) towards existing systems. Infrequent departmental incident discussions would reduce practice willingness (coefficient=-0.08, P=.01). This national study highlights a strong readiness among Chinese anesthesia professionals to adopt mobile CDSS for PAE management. However, critical barriers, including role-specific knowledge disparities and ineffective organizational communication, must be addressed to ensure successful implementation. Collaborative efforts among local authorities, health care facilities, anesthesia departments, and technology developers are essential to design and implement tailored strategies. Key recommendations include interdisciplinary training programs to enhance nurse anesthetists' competencies, institution-level incentives to promote incident reporting, and user-centered CDSS designs that prioritize seamless integration into clinical workflows. These measures are vital for improving perioperative incident reporting systems and ultimately advancing the safety and outcomes of surgical patients.

Comparison of Intrathecal Bupivacaine with Additives Buprenorphine Versus Bupivacaine with Dexmedetamidine for Postoperative Analgesia in Lower Limb Surgeries

Objective: This study compared intrathecal bupivacaine with additive buprenorphine versus bupivacaine with dexmedetomidine in lower limb surgery Study Design: Randomized Controlled Trial study. Place and Duration of Study: This study was conducted at the Department of Anesthesia, DHQ Teaching Hospital Gujranwala from for 12 months from 30-09-2021 to 29-092022. Methods: After taking informed consent and demographic detail 60 patients were1enrolled. Patients were divided randomly into 021groups.1Group 1, patients were given 60μg of buprenorphine with 2cc (15mg) of 0.75 % heavy bupivacaine. Group 2, patients were given 5μg of dexmedetomidine with 2cc (15mg) of 0.75 % heavy bupivacaine. The duration between start of spinal anaesthesia till the first dose of rescue analgesia recorded as duration of analgesia. Results: From buprenorphine group the mean duration of analgesia of the patients was 234.67±131minutes whereas in group dexmedetomidine the mean duration of1analgesia of the patients was 275.17±29.77 minutes (p value=&lt;0.001). From buprenorphine, VAS score was 3.87±0.63 while with dexmedetomidine group VAS score was 3.90±0.66 (p =0.842). From buprenorphine group the mean rescue analgesia was 4.40±0.56 mg while from dexmedetomidine group the mean rescue analgesia was 4.33±0.55 mg (p-value=0.644). Conclusion: These findings suggest that while dexmedetomidine may provide prolonged analgesia, both adjuvants effectively manage postoperative pain, offering viable options for spinal anesthesia in lower limb procedures.

Effectiveness and Safety of Nebulized Colistin in Ventilator Associated Pneumonia

Background: Colistin is one of the few remaining effective antimicrobial agents against multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria, and is currently regarded as one of the last therapeutic options. After giving aerosol delivery, colistin concentrations were significantly higher in the pulmonary epithelial lining fluid compared to plasma. This study investigates the effectiveness and safety of nebulized colistin as monotherapy (without concomitant IV administration of colistin) in the treatment of ventilator-associated pneumonia. Objective: Evaluation of the effectiveness and safety of nebulized colistin in ventilator-associated pneumonia. Methods: This prospective randomized clinical trial was conducted in the ICU of the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital. The study included patients on mechanical ventilation with ventilator-associated pneumonia sensitive to colistin organisms (Acinetobacter, Pseudomonas, Klebsiella) without prior renal impairment. Then, the patients were divided into two equal groups by computer-generated randomization by a research randomizer. Group A received intravenous colistin, and group B received nebulized colistin as a monotherapy. The analysis was carried out using descriptive and inferential statistics with the help of SPSS. Result: This prospective randomized clinical trial was conducted to see the effectiveness and safety of nebulized colistin compared to intravenous colistin. The clinical cure rate was higher in group B than in group A (65.7% in nebulized group B, 51.5% in intravenous group A), although it was not statistically significant (p=0.743). The microbiological eradication rate was also higher in nebulization group B (94.3%) compared to intravenous group A (85.7%), although it was not statistically significant (p=0.075). Nephrotoxicity is the major adverse event at 25.7% among intravenous group A compared to 5.7% in nebulized group B (p=0.001). Colistin nebulization therapy is usually well tolerated, with only a few side effects being reported. These include coughing, bronchospasm, and throat irritation, which are frequently brought on by the osmolality and preservatives in solutions. We found bronchospasm in nebulized colistin in 1 patient (1.96%). An almost equal proportion of mortality was present in both groups: 28.5% in intravenous group A and 25.7% in nebulization group B (p=0.453). Mean duration of mechanical ventilation in intravenous group A and nebulized group B were 8.19 ± 5.59 and 7.96±3.63 days, respectively (p=0.802). The mean ICU duration of the patients in intravenous group A and nebulized group B were 10.08±6.44 and 9.45±3.76 days, respectively (p=0.55). The mean CPIS (Clinical Pulmonary Infection Score) score reduction of the patients exposed to nebulized and intravenous colistin were 3.8±1.04 and 4 ± 1.17, respectively, which is not statistically significant (p= 0.372). The mean TLC (Total Leukocyte Count) normalization duration of patients in intravenous group A and nebulized group B were 7.43±2.836 and 6.51±2.87 days, respectively (p=0.14). Conclusion: Both nebulized and intravenous colistin are equally effective for treating colistin-sensitive ventilator-associated pneumonia, though intravenous colistin is more nephrotoxic. Bangladesh Crit Care J March 2025; 13 (1): 11-17

Comparison of ultrasound guided intraarticular shoulder injection and suprascapular nerve block versus ultrasound guided intraarticular shoulder injection in pain management of frozen shoulder patients.

Objective: To compare ultrasound guided intraarticular shoulder injection and suprascapular nerve block versus ultrasound guided intraarticular shoulder injection in pain management of frozen shoulder patients. Study Design: Quasi Experimental study. Setting: Department of Anesthesia and Pain Medicine, Shaikh Zayed Hospital, Lahore. Period: Sep 2023 to Feb 2024. Methods: Patients aged 18 years and above presenting with symptoms consistent with frozen shoulder, confirmed through clinical evaluation and imaging studies. Patients with history of shoulder surgery, concomitant shoulder pathology were excluded. Participants were allocated to two groups: Group A received ultrasound-guided intraarticular shoulder injections, while Group B underwent a combination of ultrasound-guided intraarticular shoulder injections and suprascapular nerve blocks. The primary outcome measure was pain intensity assessed using the Visual Analog Scale (VAS) at baseline and follow-up intervals (2nd day, 1st week, 2nd week, and 4th week post-intervention). Secondary outcome measures included passive and active range of motion (ROM) of the shoulder joint assessed using a goniometer at corresponding time points. Collected data were processed and analyzed using IBM SPSS, version 27.0. Results: Mean age of patients in Group A was 50.04 ± 12.45 years and that of Group B was 50.60 ± 11.64 years with majority of them being females in both groups. Mean duration of the condition was 3.65 ± 1.08 months and 3.36 ± 1.31 months in Group A and B, respectively. At the time of enrollment into the study, the mean VAS score in Group-A was 7.20 ± 1.12 and in Group-B was 7.12 ± 0.93 without any statistical difference (p=0.784). On the 2nd day, Group A exhibited a significantly lower mean VAS score compared to Group B (p = 0.004). Statistically significant improvement in active as well as passive ROM was recorded following intervention in both the groups. This improvement was observed in all directions of motion. At first follow-up (2nd day) following intervention the improvement in passive and active abduction, flexion and extension were comparable in the two groups (p&gt;0.05). Conclusion: In conclusion, our study highlights the significant advantage of Group A over Group B in achieving greater passive range of motion post-surgery, particularly evident in abduction, flexion, extension, internal rotation, and external rotation. These findings emphasize the potential benefits of tailored rehabilitation protocols in optimizing functional outcomes following shoulder surgery.

Changing minds, saving lives: how training psychological safety transforms healthcare.

Psychological safety is a crucial component in highly functioning healthcare teams, enabling every member to speak up, take innovative risks and admit mistakes without fear of personal attack or repercussions. Leaders play a significant role in fostering this positive environment that boosts effective communication, enhances teamwork and decision-making and promotes incident reporting. Developing these non-technical skills, along with updated medical knowledge and procedural skills, is a key factor in providing better and safer patient care.Creating and sustaining psychological safety in the workplace requires a cultural and mindset shift that impacts how team members interact with each other. The anaesthesia teams from seven VinMec Healthcare System (VMHS) hospitals across Vietnam faced several critical challenges, including cultural embeddedness, geographical dispersion and a hierarchical structure where deference prevailed.Nonetheless, VMHS leadership established a goal to transform the Anaesthesia and Pain Management Department into one of the safest in Southeast Asia. A multifaceted team comprised of top management, training experts and simulation specialists was essential in driving the initiative forward.The intervention highlights the importance of leadership engagement, structured curriculum design and feedback loops to ensure continuous improvement in staff competency and collaboration. Over 18 months, 112 anaesthesia doctors and nurses completed a series of online learning modules and on-site simulation training sessions. Preliminary outcomes indicate significant progress in non-technical skills such as communication, teamwork and cognitive aid utilisation among participants. There has also been a noticeable reduction in patient safety incident scores across hospitals.This article presents a replicable model for addressing the cultural, practical and logistical challenges of integrating psychological safety into a large healthcare system by introducing an innovative, mixed-method training programme. It provides insights for healthcare leaders seeking to achieve sustainable improvements in patient safety and quality of care.

Comparison of Pre-emptive Tramadol versus Diclofenac in Postoperative Pain Management after Laparoscopic Cholecystectomy

Effective Pre-emptive analgesia is essential to improve pain control and reduce opioid consumption. Non-opioid analgesics such as diclofenac and tramadol are commonly used, but their comparative efficacy remains an area of interest. Objective: To compare mean postoperative pain intensity and time to 1st analgesic requirement between diclofenac and tramadol groups as Pre-emptive analgesics among patients undergoing laparoscopic cholecystectomy. Methods: This quasi-experimental study was conducted at Department of Anaesthesia, Mayo Hospital, Lahore, over period of six months. Quasi experimental study. 50 patients scheduled for elective laparoscopic cholecystectomy were included and randomized into two groups using lottery technique. Group D (diclofenac sodium 100mg), and Group T (oral tramadol 100mg), respective drug was given two hours before surgery. Postoperatively, NRS score were assessed at 8th hour, and time to first analgesic request was recorded. Data were analyzed using SPSS version 26.0, p-value ≤ 0.05 considered statistically significant. Results: Postoperatively, mean NRS score at 8th hour was significantly lower in Group T (3.56 ± 1.32) compared to Group D (4.52 ± 1.22) (p=0.01). Mean time to first analgesic request was significantly longer in Group T (104.04 ± 12.02 minutes) than in Group D (91.64 ± 8.51 minutes) (p&lt;0.001). Conclusions: Preoperative administration of oral tramadol provides superior postoperative analgesia compared to diclofenac sodium, as evidenced by lower pain scores at the 8th postoperative hour and longer time to first analgesic request. Tramadol may be more effective option for pain control in patients undergoing elective laparoscopic cholecystectomy.

Effectiveness of Atraumatic Needle to Avoid Post-Dural Puncture Headache

Objective: To determine occurrence of headache after a dural puncture using an atraumatic needle. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 336 patients were divided into two groups of 168 patients each, after obtaining institutional approval and informed consent from patients. Female patients, of reproductive age group, who were scheduled to receive subarachnoid block before c-section, were included in the study. We compared the usage of a traumatic needle (25 gauge) compared to atraumatic (25 gauge) in causing post-lumbar puncture (LP) headache. Results: Post-LP headache occurred in 7.1% of the patients assigned to the atraumatic needle and 32% of the patients assigned to the traumatic needle, which was found to be significant (p=0.001). Conclusion: We found that usage of atraumatic needles led to a reduction in the occurrence of headaches during lumbar puncture.

Dexmedetomidine as an Adjunct to Anti-Hypertensive Medication in Hemodynamic Management of Post-Operative Young Patients with Pre-Eclampsia

Objective: To compare hemodynamic stability and patient outcomes when using dexmedetomidine as an adjunct to anti-hypertensive medication in post-operative young patients with pre-eclampsia Study Design: Quasi-experimental study Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Bannu, Pakistan from 15 Jan - 15 Dec 2023. Methodology: A total of 180 patients were recruited for this quasi-experimental study. Patients were divided into Group-D (n=80) to receive Dexmedetomidine along with standard anti-hypertensive therapy, which included intravenous Labetalol, and Group-S (n=80) to receive standard anti-hypertensive therapy with intravenous Labetalol alone. Primary variables studied were hemodynamic profile in all patients, including heart rate and blood pressure checked at 1,3,6,12,18, and 24 hours. Secondary variables studied were sedation levels, mean total dose of analgesia required for post-operative pain in 24 hours, and the incidence of adverse effects including bradycardia, hypotension, nausea/vomiting and headache. Results: Mean arterial pressure (MAP) after 01 hour of therapy between Group-D and Group-S was 98.64±1.63 mmHg versus 100.55±4.75 mmHg (p=0.001), after 03 hours of therapy was 85.56±1.27 mmHg versus 89.13±2.29 mmHg (p&lt;0.001), after 06 hours of therapy was 77.56±1.36 versus 89.35±2.90 mmHg (p&lt;0.001), after 12 hours of therapy was 74.33±1.38 mmHg versus 82.94±4.26 mmHg (p&lt;0.001), after 18 hours of therapy was 70.46±0.82 mmHg versus 78.61±0.60 mmHg (p&lt;0.001) and after 24 hours of therapy was 67.99±1.08 mmHg versus 78.64±0.57 mmHg (p &lt;0.001). Conclusion: Addition of Dexmedetomidine to standard anti-hypertensive therapy results in a better hemodynamic profile, better patient comfort, less requirement for analgesia with a tolerable adverse effects profile.

Efficacy of Erector Spinae Block Versus Transversus Abdominis Plane Block in Post Operative Pain Control After Laparoscopic Cholecystectom

Objective: To compare post-operative analgesic efficacy of ultrasound guided erector spinae block versus transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan, from May to Oct 2022. Methodology: Our patients were divided into erector spinae block Group (Group ESP) (n=20) and transversus abdominis plane block Group (Group TAP) (n=20). After the surgery, before extubating, a consultant anesthetist with at least 5 years of regional block experience, performed the blocks in selected patients under ultrasound guidance following standard techniques and protocols. Results: Duration of surgery between both Groups was comparable, with a mean time of 128.5±5.1 minutes in the ESP versus 127.3±5.7 minutes in the TAP Group (p=0.13). However, time to first rescue analgesia was significantly increased in ESP Group at 238.5±5.1 minutes versus 174.1±6.0 minutes in TAP Group (p=0.0001). Consequently, total analgesia requirement was also significantly decreased in ESP Group with 4.6±0.5 mg in 24 hours versus 8.2±0.9 mg in 24 hours in TAP Group (p=0.0001). Mean HDU stay was also decreased significantly between ESP and TAP Group, being 27.8± 2.3 hours versus 44.25±5.5 hours (p=0.0001). Conclusion: ESP block provides superior analgesia, good adverse effect profile, early mobilization and decreased hospital stay when compared to TAP block for laparoscopic cholecystectomy.

The Effectiveness of Citro Soda Solution for Relief of Epigastric Discomfort and Dyspepsia in the Intraoperative Period During Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial

Objectives: This study aimed to evaluate the effectiveness of Citro Soda solution in relieving intraoperative dyspepsia among patients undergoing elective cesarean sections (LSCS) under spinal anesthesia. Study Settings: The study was conducted in the Department of Anesthesia at Holy Family Hospital over a six-month period following approval from the institutional ethics committee. Duration of Study: Six months from 16 July 2024 to 15 January 2025. Methodology: This randomized controlled trial (RCT) included 60 patients, randomly assigned to receive either Citro Soda (n=30) or placebo (n=30) one hour prior to spinal anesthesia. Inclusion criteria comprised women aged 18–55 years undergoing elective cesarean section with subjective dyspepsia in their third trimester. Patients with chronic gastritis, gastrointestinal disease, or major comorbidities were excluded. The primary outcome was subjective relief of dyspeptic symptoms, assessed intraoperatively. Surgical duration and pain relief scores were also compared between the two groups. Results: The mean surgical duration was 62.24 minutes (±16.88) in the Citro Soda group and 60.13 minutes (±16.27) in the placebo group (p = 0.623). The mean pain relief score was 1.20 (±0.41) in the Citro Soda group compared to 1.37 (±0.49) in the placebo group (p = 0.157). Conclusion: Citro Soda did not significantly reduce intraoperative dyspepsia during cesarean section under spinal anesthesia. While it remains an effective gastric acid neutralizer, it does not appear to provide meaningful symptomatic relief.

Catalyzing peritoneal dialysis growth in Brunei: The crucial role of governmental support.

Brunei Darussalam, a small Southeast Asian nation, faces a unique healthcare challenge with one of the world's highest incidence and prevalence of kidney replacement therapy. This report highlights the remarkable success of Brunei in increasing the utilization of peritoneal dialysis (PD) to address this challenge. As of August 2023, Brunei's PD penetrance rate stands at 16%, a significant leap from 9.7% just three years ago. This is comparable to many other high-income countries. The key to this success lies in a series of governmental support strategies that fostered rapid PD growth. These strategies include the establishment of a dedicated task force, securing dedicated operating theater slots, collaboration with surgery and anesthesia departments, nephrologist training, a dedicated surgeon for complex cases, outsourcing to private hospitals, prioritizing nursing staff, structured patient training programs, patient advocacy and established clinical protocols. These collaborative efforts, along with a patient-centric approach, have not only reduced PD catheter insertion waiting times but also empowered patients to voice their preferences in shared decisions. Brunei's journey serves as an inspiring example for other nations seeking to proliferate their PD services.

Tapentadol Versus Tramadol for Preemptive Analgesia in Elective Surgery Under General Anesthesia: A Randomized Controlled Trial

Background: Effective control of postoperative pain is a critical component of perioperative care. Tramadol is commonly used for preemptive analgesia but is associated with variable efficacy and notable side effects. Tapentadol, a newer analgesic with a dual mechanism of action, may offer improved analgesia with fewer side effects. However, comparative data between tapentadol and tramadol in the context of elective surgeries under general anesthesia are limited. Objective: To assess the difference in mean postoperative pain intensity, as quantified by the visual analog scale (VAS), between patients administered tapentadol 75 mg and those administered tramadol 100 mg for preemptive analgesia during elective surgical procedures under general anesthesia. Methods: A randomized controlled trial (RCT) was conducted at the Department of Anesthesia, Jinnah Hospital, Lahore, over six months (September 2, 2023 – March 2, 2024). A total of 60 patients (aged 18–60 years) scheduled for elective surgery under general anesthesia were randomized to receive either tramadol or tapentadol. Patients in Group A (tramadol) received 100 mg of tramadol orally 30 minutes before surgery, while those in Group B (tapentadol) received 75 mg of tapentadol orally 30 minutes before surgery. Standard general anesthesia was administered to all patients. The primary outcome was postoperative pain, assessed using the visual analog scale (VAS) at three hours postoperatively. Secondary outcomes included postoperative nausea and vomiting (PONV) episodes recorded during the three-hour observation period. Patients with known allergies to opioids, chronic pain conditions, or a history of substance abuse were excluded. Randomization was performed using a lottery method. Data were analyzed using appropriate statistical tests. Results: The mean age of patients was 44.30 ± 4.57 years in the tramadol group and 42.46 ± 5.07 years in the tapentadol group (p = 0.147), while the mean BMI was 28.13 ± 12.33 kg/m² and 25.79 ± 3.80 kg/m², respectively (p = 0.192), with no statistically significant difference between the groups. The mean postoperative pain score was significantly lower in the tapentadol group (1.96 ± 0.18) compared to the tramadol group (3.16 ± 0.37) (p &lt; 0.001). Gender distribution showed that in the tramadol group, 65.4% (n = 17) were male and 38.2% (n = 13) were female, while in the tapentadol group, 34.6% (n = 9) were male and 61.8% (n = 21) were female (p = 0.067), indicating a tendency toward a higher female population in the tapentadol group. Regarding postoperative nausea and vomiting (PONV), although not statistically significant, there was a trend toward fewer episodes in the tapentadol group; however, a quantitative measurement of this metric was absent from the abstract. Conclusion: This study concludes that tapentadol 75 mg is a more effective preemptive analgesic than tramadol 100 mg in reducing postoperative pain scores in patients undergoing elective surgery under general anesthesia. Further research is warranted to investigate the optimal dosing and long-term effects of tapentadol in this setting and to perform a more rigorous assessment of PONV between the two drugs.

Enhancing Research Visibility: Analyzing Anesthesia Faculty at AIIMS, New Delhi, on Google Scholar

Research visibility is crucial in enhancing a researcher's academic recognition, accessibility, and impact. This study examines the research productivity and scholarly influence of faculty members in the Anesthesia Department at AIIMS, New Delhi, using Google Scholar metrics, including total publications, citation count, h-index, and i10-index. Among the 48 faculty members, only 27 have a Google Scholar profile, and just 12 have integrated a verified email ID, indicating limited adoption of the platform for academic visibility. The analysis of scholarly output reveals that Associate Professor Dr Anju Gupta has the highest number of publications (532). At the same time, Additional Professor Dr Souvik Maitra leads in citations (5,969), h-index (33), and i10-index (66), reflecting a strong research influence. Mid-career faculty members, particularly additional and associate professors, demonstrate higher engagement in research, while senior professors appear to focus more on mentorship and administrative responsibilities. The study also highlights gender representation in research, with female faculty members making substantial contributions. The findings emphasize the need for increased institutional support and awareness regarding the benefits of Google Scholar to enhance research visibility, foster collaboration, and strengthen the department's academic impact.

Comparison of Haemodynamic Stability among Different Anaesthesia Techniques in Patients Undergoing Modified Radical Mastoidectomy: A Randomised Controlled Trial

Introduction: Traditionally, Modified Radical Mastoidectomy (MRM) is conducted under General Anaesthesia (GA) or Local Anaesthesia (LA) with sedation; however, the latter technique can cause patient discomfort and complications due to airway obstruction. The use of a supraglottic device not only secures the airway but also eliminates laryngoscopy-related risks. Aim: To compare the efficacy and safety of three different anaesthesia techniques: GA with endotracheal intubation, Laryngeal Mask Airway (LMA) and sedation with a Hudson mask. Materials and Methods: A single-blind, randomised control trial was conducted in the Department of Anaesthesia, GSVM Medical College (tertiary care centre), Kanpur, Uttar Pradesh, India, from October 2016 to September 2017. Ninety patients were randomly divided into three groups of 30 each: group A (GA with endotracheal intubation), group B (LMA with spontaneous respiration) and group C (sedation with Hudson mask). Haemodynamic parameters, intraoperative bleeding and surgeon satisfaction scores, were recorded and analysed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and using appropriate tests of significance. Results: The mean±Standard Deviation (SD) age in group A, group B and group C was 46.93±11.17 years, 46.85±11.25 years and 46.18±12.69 years, respectively. No statistical difference was found in the demographic profile among the groups. Both group A and group B showed a significant increase in Heart Rate (HR) at zero, one and three minutes compared to group C, which had consistently higher HR from five minutes onward throughout the surgery (p-value &lt;0.001). Group C also displayed significantly higher Mean Arterial Pressure (MAP) starting from five minutes and throughout the procedure compared to the other groups (p-value &lt;0.05). A significant drop in mean±SD Saturation of Peripheral Oxygen (SpO2 ) levels was observed in group C (94.46%±1.47%) at one minute compared to the other groups (p-value &lt;0.001). Group C had significantly higher mean±SD intraoperative bleeding (39.66±9.37 mL) compared to group A (17.33±4.49 mL) and group B (18.16±4.04 mL) (p-value &lt;0.001). In groups A and B, the mean±SD surgeon satisfaction scores (6.46±0.50 and 6.48±0.50, respectively) were significantly higher compared to group C (4.66±0.84) (p-value &lt;0.001). Conclusion: General anaesthesia with endotracheal intubation and LMA provide superior haemodynamic stability, reduced intraoperative bleeding and higher surgeon satisfaction compared to sedation with a Hudson mask in MRM. Additionally, the use of LMA omits the need for laryngoscopy, which limits the initial haemodynamic fluctuations at the time of device insertion.

The in-vitro performance of a modern portable respirator in different lung models and as an alternative intensive care respirator: A simulation based cohort study.

Transporting ventilated patients safely and without loss of efficacy is a challenge. Portable ventilators are generally used to transport critically ill patients, but their performance is often limited. This study aimed to compare the in-vitro performance of a modern portable respirator with a modern intensive care respirator for different lung settings. An in-vitro testing of a portable and an intensive care respirator. Anaesthesia Department at the University Children's Hospital Zurich. The portable respirator Hamilton T1 was compared with the established intensive care respirator bellavista1000 (BV) while applying different settings with the ASL 5000 (ASL) device. The ASL can simulate neonatal, paediatric, and adult lung settings with normal or impaired lung function. Accuracy of delivered tidal volumes, proximal and distal airway pressures and mechanical lung properties were assessed. Bland-Altman analyses showed higher accuracy for applied tidal volumes delivered by the portable respirator, 12.6% [95% confidence interval (CI) -8.9 to 34.2], compared with the intensive care respirator, 15.9% (95% CI -18.5 to 50.3). In neonatal and infant lung models particularly, the accuracy of delivered tidal volumes by the portable respirator, 13.2% (95% CI -8.9 to 35.3) was superior to those delivered by the intensive care respirator, 20.9% (95%CI -15.9 to 57.7). Lung compliance estimation was performed more accurately by the intensive care respirator, whereas the portable respirator measured airway resistance more accurately. However, both respirators showed only moderate overall accuracy when assessing lung mechanics. The tested portable respirator proved to be a useful device for invasive ventilation of critically ill patients. The overall performance is non-inferior to a conventional intensive care respirator.

SAFE anaesthesia for patients at risk of pulmonary aspiration: A nationwide survey.

Clinical practice in patients at risk of pulmonary aspiration varies widely. However, data on actual management, decision-driving factors and controversial issues remain elusive. We aimed to comprehensively review the management of patients at risk of pulmonary aspiration and identify controversies among anaesthesia professionals. National interprofessional survey. All anaesthesia departments in Switzerland. The survey was distributed electronically to all members of the Swiss Society of Anaesthesiology and Perioperative Medicine, members of the Swiss Interest Group for Anaesthesia Nursing and all department heads in Switzerland. None. Consensus and controversies in clinical practice and management of patients at risk of pulmonary aspiration. A total of 684 respondents were included in the final analysis (59 department heads, 366 consultants, 99 registrars, 160 nurse anaesthetists). The response rate from physicians was 47%. Consensus (>80% agreement or disagreement) was reached on 9/12 (75%) questions regarding preparation for rapid sequence induction (RSI), 6/13 (46%) regarding RSI practice and 3/8 (38%) regarding management of aspiration incidents. Major controversies included high-flow pre-oxygenation (55% agreement), the validity of modified RSI in adults (52% agreement), the primary use of video-laryngoscope (76% agreement) and management of apparent regurgitation. Subjective factors such as clinical presentation were considered more important than objective factors such as medical history, comorbidities or gastric ultrasound. Across a wide range of experience and professional groups, we found a strong consensus on the indication and performance of 'traditional' RSI. However, clinical decision-making still relies heavily on subjective impressions, while newer risk stratification and management techniques remain controversial.

Adherence to Practice Guidelines for Postoperative Epidural Analgesia.

To evaluate the adherence to practice guidelines for epidural insertion along with the medicines used for postoperative analgesia and the incidence of complications. Clinical audit. Place and Duration of the Study: Doctors Hospital and Medical Centre, Lahore, Pakistan, from January 2021 to December 2023. Non-probability consecutive sampling technique was used to collect the data. After the approval to conduct this audit was obtained from the Ethical Committee of the hospital, data were collected from Surgical Epidural Registers of the anaesthesia department. All calculations were done manually and then put in Microsoft Word Document. A total of 308 surgical epidurals were inserted over the period of three years. Procedures constituted 125 (40.6%) orthopaedic procedures, 41 (13.31%) thoracic surgery procedures, 36 (11.7%) general surgery procedures, 25 (8.11%) hepatobiliary procedures, 14 (4.54%) urology procedures, and 12 (3.89%) gynaecological procedures. Level of insertion was as per the recommended guidelines in 200 (64.9%) patients out of 308. Bupivacaine was the most commonly used medicine, with 0.1% concentration generally preferred in the authors' setup. Among the adjuvants, fentanyl, dexmedetomidine, and tramadol were used. Overall complication rate was 40 (12.98%), with motor blockade being the most common, followed by nausea/vomiting, hypotension, dural tap, and blood tap. This audit will help in rectifying the loopholes in the surgical epidural analgesia services provided by the authors' study centre, but also other epidural analgesia service providers to make changes in their practices for better outcomes in future. Epidural analgesia, Dural tap, Blood tap, Motor blockade, Bupivacaine.

Comparison of Lignocaine with Ondansetron for Attenuation of Propofol-Induced Pain in Adult Patients Undergoing Laparoscopic Cholecystectomy

Intravenous administration of propofol causes pain that impacts anesthesia procedures. Objective: To compare the efficacy of intravenous Lignocaine and Ondansetron in reducing propofol-induced pain, hemodynamic stability and assess the occurrence of associated adverse effects during induction using a pain scale. Methods: It was a Quasi-Experimental study and conducted for six months from Sep 2024 to Jan 2025 at the Anesthesia department at Islam Medical College, Sialkot. To measure pain effects at laparoscopic cholecystectomy among adult patients. The patients were received 0.5mg/kg Lignocaine through the vein or 8mg Ondansetron before they received propofol treatment. Medical staff evaluated patients' pain levels on a standard scale while recording their vital signs. Data were analysed by SPSS 21.0. The categorical data was analysed through chi-square and evaluated continuous values with an independent t-test at a significance level of 0.05. Results: Lignocaine brought better pain relief from propofol than Ondansetron at a statistical significance of p &lt; 0.001. People in the Lignocaine group reported 15% of bad pain while 32% of patients in the Ondansetron group felt the same pain level. Ondansetron caused short-lived drops in blood pressure and heart rate but the application of Lignocaine generated mild skin issues. Conclusions: The study proved Lignocaine worked better than Ondansetron at stopping propofol pain effects. Despite its merits Ondansetron still serves as a good treatment option and medical staff should monitor heart-related side effects. Additional medical trials must test the effectiveness of using both drugs together as a pain treatment option.