Department Of Anesthesiology Research Articles

Comparison of Hyperbaric 0.5% Levobupivacaine and Hyperbaric 0.75% Ropivacaine for Intrathecal Use in Infraumbilical Surgeries: A Randomised Clinical Study

Introduction: Ropivacaine is a long-acting amide local anaesthetic agent and the pure S (-) enantiomer of propivacaine. It has been readily available as an isobaric solution for a long time. Recently, a hyperbaric solution has become available in the Indian market. Levobupivacaine is the pure S-enantiomer of bupivacaine, which is safer than racemic bupivacaine in regional anaesthesia. It has less affinity and strength of depressant effects on myocardial and Central Nervous System (CNS) vital centers in pharmacodynamic studies, along with a superior pharmacokinetic profile. Aim: To compare the sensory and motor blockade, time of twosegment regression, time for rescue analgesia, haemodynamic effects and sedative effects between hyperbaric 0.5% levobupivacaine and hyperbaric 0.75% ropivacaine. Materials and Methods: This prospective, double-blinded and randomised clinical study was conducted in the Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (a tertiary care institute), Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India, from September 2023 to July 2024, with a sample size of 40 patients. Patients with American Society of Anaesthesiologists (ASA) I/II status were randomly allocated into two equal groups of 20 each. Group-R received 0.75% hyperbaric ropivacaine 3.5 mL+0.1 mL normal saline (total 3.6 mL) and Group-L received 0.5% hyperbaric levobupivacaine 3.5 mL+0.1 mL normal saline (total 3.6 mL). Data were recorded using MS Excel and analysed using Statistical Package for Social Sciences (SPSS version 22.0) software. The Student’s t-test was used for data comparison regarding the onset and duration of sensory and motor blockade, time of two-segment regression, time for rescue analgesia, haemodynamic stability and sedative effects between the study groups. Results: The mean age for Group-R was 45.00±7.1 years and Group-L 51.95±8.03 years. onset of sensory blockade at the T10 level and the onset of motor blockade in Group-R were slower than in Group-L (p-value <0.05). The time to two-segment regression was significantly faster in Group-R than in Group-L (p-value <0.05). The duration of sensory and motor blockade, as well as the time for rescue analgesia, was significantly prolonged in Group-L compared to Group-R (p-value <0.05). The sedative effects, arterial oxygen saturation (SpO2 ) and respiratory rate were comparable in both groups. Intraoperatively, haemodynamics were more stable in Group-R compared to Group-L. Conclusion: The present study implies that in haemodynamically unstable patients, 0.75% hyperbaric ropivacaine can provide a less complicated neuraxial blockade. In contrast, levobupivacaine offers a superior effect in terms of the duration of blockade and analgesia. This makes levobupivacaine useful for longer-duration surgeries, while ropivacaine is more suitable for shorter-duration procedures.

Heidelberg Adult and Pediatric Airway Registry (HAPA-Registry)

Background: Advanced airway management is of fundamental importance in almost all areas of anesthesiology, emergency medicine, and critical care. Securing the airway is of the utmost importance, as this is a prerequisite for the oxygenation of the human organism. The clinical relevance of airway management is particularly evident in the fact that the primary cause of significant anesthesia-related complications can be attributed to this field. The need for the systematic recording of these procedures and their complications, as well as structured training in airway management and the evaluation of outcome parameters, is, therefore, evident. Methods: The HAPA-registry is a prospective and monocentric observational trial at the Department of Anesthesiology, Medical Faculty Heidelberg, University of Heidelberg, Germany. All patients requiring general anesthesia with consecutive advanced airway management during a surgical procedure were included. We, therefore, planned to include approximately 9000 patients in the first period. Following successful airway management, the anesthetist completed a case report form (CRF) in person. The intention was to record airway management cases on an annual basis for a period of several months, thus ensuring that the register remains up-to-date and that airway management procedures are continuously recorded. Discussion: The aim of this study was to establish an airway registry that enables the systematic recording and evaluation of different methods of airway management. The registry can be used to monitor and evaluate the implementation of current guidelines and recommendations for action, as well as the rates of success and complications.

Anaesthesia teams´ perception of mental wellbeing, the psychosocial work environment and patient safety culture

AbstractBackgroundMental health issues among healthcare professionals (HCPs) are rising, impacting individual wellbeing, healthcare systems, and patient safety. This exploratory study aimed to analyse the association between anaesthesia teams' perception of their mental wellbeing, psychosocial work environment, and patient safety culture in a university hospital's anaesthesiology department. Second, to identify types of stressors and strategies to overcome them. Third, to explore differences in perception by profession, gender, and years of experience. Finally, to evaluate the psychometric properties of the questionnaire.MethodsA questionnaire covering mental wellbeing, teamwork, psychosocial work environment, and patient safety culture was sent to all HCPs in the department in May 2021 via e‐mail. The questionnaire consisted of 35 questions, 4 demographic questions, and 2 open text fields.Results293 HCPs responded (73% response rate); 60% agreed their work is emotionally challenging, and 30% experienced weekly emotional strain. Significant differences were seen between professions in terms of stressors. Clinical situations contributed most to doctors' emotional strain, while nurses scored higher on making compromises and being busy. A strong relationship was seen between weekly/daily emotional strain and making compromises in standards, clinical situations, and busyness.ConclusionIn conclusion, all HCPs experienced emotional strain, with different causes and coping strategies across professions. Support was primarily found among colleagues and networks. Interestingly, low emotional strain correlated positively with coping, teamwork, psychological safety, and patient safety culture, suggesting an interrelation between these dimensions and HCPs' mental health. These findings may inform future conceptualisations of mental health, psychological safety, and safety culture.

Identifying biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials.

Cardiogenic shock (CS) is a heterogeneous clinical syndrome, making it challenging to predict patient trajectory and response to treatment. This study aims to identify biological/molecular CS subphenotypes, evaluate their association with outcome, and explore their impact on heterogeneity of treatment effect (ShockCO-OP, NCT06376318). We used unsupervised clustering to integrate plasma biomarker data from two prospective cohorts of CS patients: CardShock (N=205 [2010-2012, NCT01374867]) and the French and European Outcome reGistry in Intensive Care Units (FROG-ICU) (N=228 [2011-2013, NCT01367093]) to determine the optimal number of classes. Thereafter, a simplified classifier (Euclidean distances) was used to assign the identified CS subphenotypes in three completed randomized controlled trials (RCTs) (OptimaCC, N=57 [2011-2016, NCT01367743]; DOREMI, N=192 [2017-2020, NCT03207165]; and CULPRIT-SHOCK, N=434 [2013-2017, NCT01927549]) and explore heterogeneity of treatment effect with respect to 28-day mortality (primary outcome). Four biomarker-driven CS subphenotypes ('adaptive', 'non-inflammatory', 'cardiopathic', and 'inflammatory') were identified separately in the two cohorts. Patients in the inflammatory and cardiopathic subphenotypes had the highest 28-day mortality (p (log-rank test)=0.0099 and 0.0055 in the CardShock and FROG-ICU cohorts, respectively). Subphenotype membership significantly improved risk stratification when added to traditional risk factors including the Society for Cardiovascular Angiography and Interventions (SCAI) shock stages (increase in Harrell's C-index by 4% (p=0.033) and 6% (p=0.0068) respectively in the CardShock and the FROG-ICU cohorts). The simplified classifier identified CS subphenotypes with similar biological/molecular and outcome characteristics in the three independent RCTs. No significant interaction was observed between treatment effect and subphenotypes. Subphenotypes with the highest concentration of biomarkers of endothelial dysfunction and inflammation (inflammatory) or myocardial injury/fibrosis (cardiopathic) were associated with mortality independently from the SCAI shock stages. Dr Sabri Soussi was awarded the Canadian Institutes of Health Research (CIHR) Doctoral Foreign Study Award (DFSA) and the Merit Awards Program (Department of Anesthesiology and Pain Medicine, University of Toronto, Canada) for the current study.

Propofol Priming for Enhancing Induction Safety in Hypertensive Patients: A Prospective Double-blind Randomised Controlled Trial

Introduction: Propofol is popular for inducing general anaesthesia, but it has drawbacks such as hypotension and bradycardia in a dose-dependent manner, especially in hypertensive patients. Reducing the total dose of Propofol using the priming principle has proven to be effective; however, it has not been studied in high-risk hypertensive patients. Therefore, the current study was planned. Aim: To evaluate the effects of priming on Propofol induction in controlled hypertensive patients, with objectives to assess haemodynamic parameters, total dose, and sideeffects. Materials and Methods: This prospective, comparative, double-blind randomised controlled trail was performed at the Department of Anaesthesiology, Pt. Bhagwat Dayal Sharma (B.D.) Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India, from April 2023 to April 2024. A total of 60 patients scheduled for elective surgery under general anaesthesia with controlled hypertension were randomly assigned to either Group 1 (study group, n=30), where Propofol priming was used, or Group 2 (control group, n=30). Demographics, total Propofol dose, haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP)}, and adverse events were evaluated using International Bussiness Machine (IBM) Statistical Package of Social Sciences (SPSS) version 25.0. The Kolmogorov-Smirnov test was used for normalisation, and the Mann’s-Whitney U test, Independent t-test, and Chi-square test were used for data analysis. Results: In Group 1 (study), the mean age was 49.36±9.42 years, while in Group 2 (control), it was 49.36±9.19 years (p=0.91). A lesser dose of Propofol was needed in the study group (Group 1) (90.07±19.73 mg) compared to the control group (Group 2) (120.00±21.81 mg) (p=0.001). Haemodynamic alterations were more pronounced in the controls compared to the study group. After induction, a significant fall in MAP was observed in the controls compared to the study group (67.63±5.86 mmHg vs. 90.63±4.33 mmHg) (p=0.001). Adverse effects, such as pain at the injection site, were reported in one patient (n=1) in Group 2. Conclusion: The priming principle significantly reduces the total Propofol dose and leads to more stable haemodynamics during general anaesthesia induction in controlled hypertensive patients. Priming with Propofol is advised for patients with hypertension when inducing general anaesthesia.

Reducing unnecessary preoperative testing through a comprehensive EMR based digital algorithm.

We hypothesised that the implementation of an electronic medical record (EMR) embedded perioperative clinical decision support (CDS) application, Anesthesia Testing Guidelines (ATG), would result in at least a 10% reduction of unnecessary perioperative testing in patients undergoing elective surgeries. The development and implementation of ATG occurred in several phases: 1) team development, 2) development of an embedded EMR application, 3) creation of ATG training and education toolkit, and 4) implementation involving promoting ATG through training and education, addressing challenges, and monitoring compliance. The proportions of patients with any overutilisation across 19 perioperative tests were compared between the baseline cohort and the ATG implementation cohort. The overutilisation of perioperative tests was observed in 77.6% of the baseline cohort (n=59,799) and 68.1% in the ATG cohort (n=132,131), with a significant 12.2% reduction over two years of implementation (p<0.0001). The two tests with the greatest amount of associated cost were reduced by 46% for chest X-rays and 39% for complete metabolic panels. The health system was able to reduce overall costs by 22% from baseline. Interrupted time series analysis estimated an immediate 7.5% decrease in monthly overutilisation when ATG initially launched, and it continued to decrease by 0.24% per month. Our findings suggest CDS ATG is a successful tactic to reduce unnecessary preoperative testing while maintaining quality of care and improving cost avoidance. This type of CDS implementation approach transforms organisational behaviour and medical practices to follow defined guidelines, thereby improving the value of care. CDS ATG was supported by UPMC Department of Anesthesiology and Perioperative Medicine and UPMC Department of Finance.

Comparison of the Insertion Conditions and Haemodynamic Changes during I-Gel Insertion using Propofol, Ketamine-Propofol (Ketofol) and Thiopentone Intravenous Induction Agents: An Interventional Study

Introduction: The I-gel was designed to mitigate adverse reactions by providing the advantages of a secure airway without the complications associated with visualisation and tracheal intubation, specifically reducing the risk of barotrauma and vocal cord damage. Insertion requires a good induction agent and adequate depth of anaesthesia to achieve proper jaw relaxation and to prevent effects such as coughing, gagging, laryngospasm and any movements. Induction agents like propofol, ketamine and thiopentone have facilitated Laryngeal Mask Airway (LMA) insertion with ease. Aim: To compare insertion conditions and haemodynamic changes during I-gel insertion using propofol, ketamine-propofol (ketofol) and thiopentone as intravenous induction agents. Materials and Methods: An interventional study was conducted at a tertiary care hospital, Anaesthesiology Department of Dhiraj General Hospital in Piparia, Vadodara, Gujarat, India from August 1, 2023, to July 31, 2024. within one year after receiving ethical clearance from the institutional ethical committee. A total of 36 patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged 18-60 years, were randomly divided into three groups. The induction agents administered before I-gel insertion for general anaesthesia in groups 1, 2 and 3 were propofol (2 mg/kg), ketofol (1 mg/kg ketamine and 1 mg/kg propofol) and thiopentone (4 mg/kg), respectively. Intubating conditions such as jaw mobility, number of attempts, ease of insertion, duration of insertion and haemodynamic response during I-gel insertion were recorded. The Kruskal-Wallis test and Chi-square test were used for quantitative and qualitative parameters, respectively. A p-value of ≤0.05 was considered statistically significant. Results: The mean age of Group-1, Group-2 and Group-3 was 34.67±5.97 years, 33.25±8.70 years and 36±8.48 years, respectively. Complete jaw relaxation and mouth opening were better in the ketofol group than in the propofol group (p-value: 0.003) and were significantly lower in the thiopentone group. Induction time was faster in the ketofol group than in the other groups. Patients in the ketofol and propofol groups exhibited better intubating conditions and preserved haemodynamics following I-gel insertion compared to those in the thiopentone group. Conclusion: Compared to propofol and thiopentone, ketofol demonstrated a faster onset of action and ensured better insertion conditions and greater haemodynamic stability, making it a preferred choice for I-gel insertion.

Christmas article: Maximum bladder capacity at an anesthesiology department’s Christmas party

Christmas parties, a longstanding Danish tradition, became festive occasions in the 1960s. This study examines if healthcare professionals, especially doctors and nurses, have larger bladder capacities than the general population, as they often delay restroom breaks. At the North Zealand University Hospital Department of Anesthesiology's 2023 Christmas party, participants delayed urination until a strong urge occurred. Bladder volumes were measured using a Biocon-700 ultrasound bladder scanner. The primary endpoint was maximum bladder capacity, which was analysed as a continuous variable and compared with population data from the literature. Data included gender, profession, and scanning time. Statistical analyses were done using t-tests and multiple linear regression analysis. Of the 60 bladder scans, the average bladder capacity was 644 ml (SD: ± 248 ml). No significant difference was found between healthcare professionals and the general population (p = 0.55). However, excluding measurements within functional capacity (less-than 400 ml), healthcare professionals showed significantly larger maximal bladder capacities. Men and doctors had larger capacities than women and nurses. Although the primary analysis showed no significant difference, the secondary analysis suggests that healthcare professionals may have larger bladder capacities. Potential limitations include measurement uncertainties and a lack of data on comorbidities. Further research is needed to confirm these findings.

A COMPARATIVE STUDY OF CLINICAL EFFECT OF HYPERBARIC BUPIVACAINE WITH FENTANYL VS HYPERBARIC LEVOBUPIVACAINE WITH FENTANYL FOR SPINAL ANAESTHESIA IN ADULT PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES

Objective: The aim of the present study was to compare the safety and efficacy of 2.5 ml of 0.5 % hyperbaric bupivacaine with 25 mcg of fentanyl and 2.5 ml of 0.5 hyperbaric levobupivacaine with 25 mcg fentanyl when given intrathecally in adult patients undergoing elective lower limb surgeries. Methods: Our study was carried out in the Department of Anaesthesiology &amp; Intensive Care, Rajindra hospital attached to Government Medical College Patiala from Jan 2023 to Jan 2024. The study was conducted on 100 patients and randomly divided into two groups with 50 patients in each group. Results: There was no significant difference in the age, sex and weight distribution of the patients between the groups. The baseline data in both the groups was not statistically significant. In group I, Incidence of hypotension was 44% while it was 8% in group II and Incidence of bradycardia in group I was 48% while it was 8% in group II. Thus the difference between incidence of hypotension and bradycardia was found statisticallly significant as p value is &lt;0.05. In group I, Mean time to onset of sensory block was 2.72±0.08 minutes while it was 2.76±0.08 minutes in group II which was statistically nonsignificant as p value was &gt;0.05. In group I, Mean Duration of sensory block was 247.90±24.12 minutes while it was 311.18±15.57 minutes in group II which was statistically highly significant as p value was &lt;0.001. In group I, Mean time to onset of motor block was 1.60±1.18 minutes while it was 2.27±0.064 minutes in group II which was statistically highly significant as p value is &lt;0.001. In group I , Mean duration of motor block was 144.32±18.48 minutes while it was 112.04±12.15 minutes in group II which was statistically highly significant as p value was &lt;0.001.The mean bromage scale at different intervals in group I and group II intraoperatively showed statistically significant results. Conclusion: We concluded that in Lower limb surgeries, combination of levobupivacaine and fentanyl decreases the incidence of adverse effects such as hypotension and bradycardia, provides a better hemodynamic stability and offers shorter block time thus minimizing the risk and providing early mobility. Therefore, the combination of levobupivacaine with fentanyl could be preferred combination for lower limb surgeries.

Analyzing Patterns in Anesthesiology Residents' Exam Performance Using Data Mining Techniques

Background: Residency is a critical period in the development of medical professionals. It provides hands-on training and exposure to various medical specialties, enabling residents to improve their skills and achieve expertise in their chosen field. Objectives: This study aimed to extract frequent patterns in annual and board examination performance among anesthesiology residents by analyzing results from the department's weekly exams. Methods: This cross-sectional study was conducted in the Department of Anesthesiology, Critical Care, and Pain Medicine (DACCPM) from September 2022 to June 2023. Weekly intra-group exams were administered at the university's electronic exam center for residents in their first to fourth years (CA-1 to CA-4), with a total of 61 participants. Learner grades were categorized as excellent (A), good (B), average (C), poor (D), and inferior (E). The Apriori algorithm was employed to extract frequently repeated patterns in these exams and compare them with results from the final national examination. Results: A total of 24 exams were conducted, with all 61 residents participating. The most frequent patterns, identified with a minimum support of 0.41, revealed that residents generally achieved average scores in exam 7 and very poor scores in exams 1 and 5. The study found a statistically significant relationship between residents’ scores in in-training examinations (ITEs) and their national examination performance. Conclusions: Analyzing residents’ exam performance using frequent pattern recognition can help identify their strengths and weaknesses. Faculty members can utilize these insights to better plan curricula and enhance the quality of education.

Comparison of ease of endotracheal intubation with fixed height pillow versus pillow height attained by alignment of external auditory meatus to sternal notch

Background: Endotracheal intubation is considered to be the “Gold Standard” for airway management during the administration of general anesthesia and in critical care setting because of its advantages, which allows delivery of anesthetic gases and oxygen through positive pressure ventilation without inflation of stomach, permits access to tracheobronchial tree for pulmonary hence minimizing the risk of gastric content aspiration, and improves surgical access to head and neck. The major determinants of easy tracheal intubation are optimal laryngoscopy and a good visualization of the glottis. Aims and Objectives: The aims and objectives of the study are to seek the optimal pillow height that gives the best direct laryngoscopic view and can be recommended as the starting head position before direct laryngoscopy in adults. Materials and Methods: The present study was conducted in a prospective randomized comparative manner in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak after obtaining approval from the institutional ethical committee (approval number: No. BREC/Th/20/Anaesth.../034). Patients included were scheduled for elective surgery under general anesthesia requiring endotracheal intubation. The inclusion criteria were patients aged 18–50 years of either sex of ASA I and II. Results: A total of 50 subjects, 25 in each group, were included in the final analysis. Following observations and results were drawn from the present prospective and randomized study using appropriate statistical tests. The various observations were out of 50 patients in the study population, and the mean age in years of patients in Group 1 was 38.48±11.77 years and 39.36±11.64 years in Group 2. Conclusion: To conclude, alignment of external auditory meatus to sternal notch offers better conditions for endotracheal intubation than conventionally used sniffing position when assessed in terms of Cormack–Lehane grading and time taken for laryngoscopy and intubation.

The Role of Edmonton Frailty Scale in Determining the Postoperative Complications in Elderly: A Prospective Observational Study.

To explore the effect of Edmonton Frailty Index on the determination of postoperative complication and mortality rates in patients over 65 years of age. An observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkiye, from January to July 2021. Patients aged >65 years undergoing surgery were inducted. Frailty was defined as a multisystemic condition in which physical, physiological, and cognitive abilities are reduced. Demographic data, ASA, and Edmonton Frailty Test Score (EFS) were noted preoperatively. Subsequently, these patients were followed perioperatively and evaluated by Clavien-Dindo test (CDT) during the first month postoperatively. There was no statistically significant difference between genders, except EFS, which was higher in females than in males. EFS increased as age increased with a statistically significant positive correlation. The patients with the highest EFS underwent neurosurgical operations. There was a statistically significant and positive correlation between the length of hospital stay and EFS. EFS values increased as the ASA score increased and the positive correlation was statistically significant. The mild frality group had the highest CDT scores and were statistically significant. Frailty assessed by EFS has a statistically significant correlation with ASA and the CDT scores of the patients. EFS value was associated with length of hospital stay, unlike the ASA score. Both EFS and ASA were correlated with the CDT. Preoperative evaluation, especially in geriatric patients, is very important in determining postoperative complications, mortality, and length of hospital stay. Edmonton frailty index, Clavien-Dindo scoring, American society of anaesthesiologists.

Oral Endotracheal Intubation with Restricted Glottis View using C-MAC D Blade®: A Randomised Controlled Trial

Introduction: The perspective of airway management has undergone a considerable transformation since the advent of Video Laryngoscopes (VL). VL has rapidly been accepted as an intubation tool in a variety of clinical scenarios. This heralds a wide array of VL models with their own strengths and weaknesses. The C-MAC D blade® is one such VL with an angulated blade that provides an excellent glottis view, but negotiating the Endotracheal Tube (ETT) past the glottis opening and into the trachea might be difficult. No study till date was done on the C-MAC D blade® with different glottis views for intubation. Aim: To compare the Total Time of Intubation (TTI) with restricted glottis view and full glottis view with C-MAC D blade® as the primary aim, along with the first attempt intubation rate and complications during intubation. Materials and Methods: The present prospective single-centre randomised controlled trial was conducted in the Department of Anaesthesiology, Shree Krishna Hospital, PSMC, Karamsad, Gujarat, India, from September 2021 to August 2022. A total of 42 patients were randomly divided into two groups: group-F (n=21), which had a full glottis view, and group-R (n=21), which had a restricted glottis view. Randomised glottis views were achieved with the C-MAC D blade® VL during oral endotracheal intubation in both groups. Video recordings of the intubations were made, and TTI, first attempt success rate and complications during intubation were noted. Statistical analysis was done with an independent sample t-test to compare the two groups of continuous variables using STATA version 14.2. Results: The mean age in group-F was 45.86±10.83 years and in group-R was 47.76±9.14 years. The male-to-female ratio in group-F was 10:11 and in group-R was 9:12. Overall, the firstattempt successful intubation rate with the C-MAC D blade® in both groups was 90.48%. However, it was higher in group-R (95.24%) compared to group-F (85.71%). TTI was less in group-R compared to group-F (36.19±11.11 vs 45±15.89 seconds, p-value=0.0438). Group-R had lower incidence of postoperative sore throat (14.29% vs 57.14%, p-value=0.004) compared to group-F. Conclusion: Total time of intubation was less with a restricted glottis view compared to a full glottis view with C-MAC D blade® VL. Additionally, the restricted view had a higher first attempt intubation rate. Postoperative sore throat was significantly lower in the restricted view, with a lesser incidence of oropharyngeal trauma compared to the full glottis view.

Paediatric Pain Assessment and Perioperative Pain Management: A Survey of Practice in Teaching Hospitals in the Two Provinces of Pakistan.

To map the practice of paediatric perioperative pain assessment and management among consultant anaesthetists working in teaching institutions in the two provinces of Pakistan. A cross-sectional survey. Place and Duration of the Study: Department of Anaesthesiology, Teaching institutions of Sindh and Khyber Pakhtunkhwa (KPK), Pakistan, from January to October 2022. A questionnaire was designed to determine the participants' practices about perioperative pain assessment and management. It consisted of 26 questions that included participants' demographic data and questions about their paediatric practice. A total of 152 responses were received (response rate 76%). Most participants (n = 84, 55.3%) had a two-year diploma in anaesthesiology, while 38.2% had a four-year diploma. Additionally, 66.4% worked at public sector hospitals and 28.3% at private hospitals. Only 66% of respondents used paediatric pain scales for pain assessment in the recovery rooms. Most participants, 72.2%, had no Paediatric Pain Management Guidelines available at their institution. Only 5% had access to 5 analgaesic medications, while 32% had access to only 2 medications for intraoperative pain management. The practice of anaesthesiologists in these two provinces of Pakistan is highly varied since there is a lack of national guidelines. Paediatric anaesthesia, Acute pain, Pain management, Pain measurement, Paediatric pain assessment, Anaesthesia and analgaesia, Survey and questionnaires.

Comparison of Intrathecal Morphine versus Ultrasound-Guided Regional Analgaesia Techniques for Post-Caesarean Recovery Quality.

To investigate the impact of ultrasound-guided regional analgaesia techniques on postoperative recovery and compare them with those of intratecal morphine (ITM) in obstetric patients undergoing elective caesarean delivery (CD). Observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Konya City Hospital, Konya, Turkiye, from January to December 2022. The study involved six groups of 30 patients each, categorised by postoperative analgaesia: ITM, posterior transversus abdominis plane block (TAPB), lateral TAPB, transversalis fascia plane block, posterior quadratus lumborum block, and erector spinae plane block. Recovery was assessed using the Obstetric Quality of Recovery Score-10 (ObsQoR-10) at 24 hours, whereas satisfaction was measured with a Likert scale. Time to the first analgaesia, total opioid consumption, nausea, and the need for antiemetics were compared. ObsQoR-10, satisfaction, and numerical rating scale scores were consistent across groups (p >0.05). The lateral TAPB group required more opioids and had earlier analgaesic requests (p = 0.009 and p = 0.05, respectively). ITM was more likely to cause nausea and pruritus compared to regional analgaesia techniques (p = 0.062 and p <0.001). Ultrasound-guided regional analgaesia techniques provided similar postoperative recovery and patient satisfaction levels as ITM. Moreover, regional analgaesia techniques, except lateral TAPB, may offer similar alternatives to ITM within multimodal analgaesia strategies for CD. Caesarean delivery, Multimodal analgaesia, Patient-reported outcome, Regional analgaesia techniques, Quality of recovery.

Psychological safety in the perioperative environment: a cost-consequence analysis

IntroductionPsychologically unsafe healthcare environments can lead to high levels of staff turnover, and unwanted financial burden. In this study, we investigate the hypothesis that lower levels of psychological safety are...

Сравнение методик пункционно-дилатационной трахеостомии Фрова и Григгс у пациентов с избыточной массой тела и ожирением: рандомизированное контролируемое исследование

INTRODUCTION: Tracheostomy is one of the most frequently performed operations in intensive care patients. This is due to the fact that in the population of intensive care patients, puncture tracheostomy has a number of advantages compared to surgical tracheostomy (ST). This determines the urgency of finding ways to reduce the risk of perioperative complications during puncture tracheostomy in intensive care patients, especially in overweight and obese patients. OBJECTIVE: To study the advantages and limitations of puncture dilation tracheostomy (PDT) performed using the Frova method under ultrasound control in intensive care patients with overweight and obesity, in comparison with the Griggs PDT method under fibrobronchoscopic (FBS) control. MATERIALS AND METHODS: The presented prospective study was conducted in the departments of anesthesiology and intensive care of the A.I. Burnasyan Federal Medical Biophysical Center FMBA from 2017 to 2021, which included 92 overweight and obese patients whose body mass index (BMI) was more than 25 kg/m2 and required tracheostomy. Two groups were identified: group (n = 48) — Frova tracheostomy under ultrasound control, group (n = 44) — Griggs tracheostomy under FBS control. RESUITS: Performing PDT using the Frova technique under ultrasound control is feasible and safe in intensive care patients with overweight and obesity, whereas with grade 3 obesity with a BMI of more than 41 kg/m2 and/or with a thickness of pretracheal soft tissues of more than 40 mm, PDT using the Frova technique should be abandoned and should be considered as absolute contraindications for performing PDT using the Frova method under ultrasound control. CONCLUSIONS: PDT using the Frova method under ultrasound control, when compared with the Griggs method with FBS control, can significantly reduce the incidence of intraoperative desaturation, arterial hypotension, intraoperative severe hemorrhagic complications, postoperative soft tissue infection around a tracheostomy wound.

Anesthesia in Obese Patients and Complications

Background: Almost all ages and socioeconomic categories are affected by the complex illness known as obesity, which has major social and psychological ramifications. Global obesity rates have reached epidemic proportions and obesity plays a significant role in the burden of chronic illnesses and disabilities worldwide. The aim of the study was to assess the Anesthesia in obese patient and its Complications in a tertiary care hospital. Materials and mathods: This cross-sectional observational study was carried out in the Department of Anesthesiology, Bangabandhu Memorial Hospital (BBMH) from July 2020 to June 2022.Total sample size was 200. Adult in-patients who had undergone non-cardiac surgery and were older than 18 with a BMI greater than 30 kg/m2 met the inclusion criteria. Pregnancy, ambulatory surgery and missing or insufficient data on the desired outcomes were the exclusion criteria. Results: Mean age ±SD was 32 ± 0.9 years. About 55% of the patients were female and 45% were male. Regarding ASA classification 53.5% had 2, 45.5% had 3 and 1.0% had 4 score. Regarding coexisting disease 42.5% had hypertension, 14% had dyslipidemia, 18% had DM type-2 and 7.5% had obstructive sleep apnea. Here, type of anesthesia was 55% general anesthesia, 6% normal mask ventilation, 25% regional anesthesia, 4% total intravenous anesthesia and 10% LMA (Laryngeal Mask Airway). Regarding complication 4.5% was Reintubation, 5.5 %Pneumonia, 7.5% Upper airway obstruction, 0.5% Delay emergence respectively. 2.5% Urinary retention, 5% Oliguria, 2% Wound infection. 0.5% myocardial infarction and 0.5% Cardiac arrest occurred and no death occur inpatient respectively. Conclusion: Obesity has long been seen from a surgical standpoint as a risk factor for unfavorable post-surgical outcomes. Patients who are morbidly obese may experience respiratory adverse effects following surgery as a result of physiological disruption. The undesirable effects range depending on the surgical population. IAHS Medical Journal Vol 7(1), June 2024; 97-101

Abstract Su806: Enhancing Cardiac Arrest Registries and Research – A Framework for Handling Defibrillator Data

Background: Cardiac arrest is the most time-sensitive medical condition, and survival probability is highly dependent on early, high-quality cardiopulmonary resuscitation (CPR) measures. Resuscitation registries are established tools for continuous quality improvement and serve as a source for research. Yet they lack comprehensive information on the quality of CPR measures themselves—such as the depth, rate, and release of chest compressions—and are limited in the temporal resolution of these measures. However, data on both are contained in the recordings of defibrillators. Aims: To develop a framework for healthcare providers to gain immediate case-specific feedback, reduce documentation efforts and make fine-grained information accessible for research. Approach: An open-source Python module named CPRDAT (Kern et al. Zenodo, https://doi.org/10.5281/zenodo.10057964) was designed. This module is capable of importing and extracting data from various defibrillators as well as data recorded by VitalRecorder ( VitalDB , Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea) into a uniform data object. Methods were implemented to automatically process, analyze, and aggregate these time-series of physiological signals, with particular attention to CPR. To reduce manual annotation workload, classification algorithms were developed. Plotting routines were developed to display the signals interactively in web applications, allowing healthcare providers to interact with the data through zooming, scaling, shifting, concatenating, merging and labelling. Results: The module was implemented into the German Resuscitation Registry, offering users a manufacturer-agnostic, data-driven, case-specific debriefing tool. Extracted information on CPR measures is stored in the registry. The framework, able to manage multiple time-series data sources, was further implemented in other settings, such as the analysis of laboratory data of a CPR swine model. Conclusions: The new module dramatically enhances the accessibility of physiologic time-series recordings. More fine-grained data will provide deeper insights into processes and CPR physiology. Finally, the open-source Python module abolishes barriers in research.

Practical experience in developing and implementing standard operating procedures for preventing patient falls in the hospital in the activities of medical staff

Today, the quality of nursing care directly depends on the level of training and competence of the staff, new forms of care, practical experience and skills in working with modern technologies. Target. To study the experience of improving innovations in the work of nurses-anesthesiologists of the anesthesiology and resuscitation department in connection with high-tech open-heart surgeries, in particular, during the implantation of mechanical left ventricular bypasses and orthotopic heart transplantation. Results. Nurses-anesthesiologists play a key role in providing high-quality care to patients in a cardiac surgery hospital. Innovations help the nurse improve monotonous and routine tasks, speed up and facilitate patient care, ensure safety during manipulations, increase the speed and quality of the treatment and diagnostic process, reduce staff labor costs, save the nurse’s time. Much attention in the center is paid to training, continuous professional development of highly qualified personnel. Conclusion. Improvements in the work of mid-level medical personnel, in particular, nurse anesthetists, are a key area for improving the quality and safety of medical care in a cardiac surgery hospital. Further development of competencies, training, implementation of new technologies and strengthening of teamwork will optimize the work of the entire treatment process.