Anesthesia Department Research Articles

Overall anesthesia department quality of clinical supervision of trainees over a year evaluated using mixed effects models

BackgroundEarlier studies of supervision in anesthesiology focused on how to evaluate the quality of individual anesthesiologist's clinical supervision of trainees. What is unknown is how to evaluate clinical supervision collectively, as provided by the department's faculty anesthesiologists. This information can be a metric that departments report annually or use to evaluate the effect of programs on the quality of clinical supervision over time. MethodsThis retrospective cohort study used all 48,788 evaluations of the 115 faculty anesthesiologists using the De Oliveira Filho supervision scale completed by 202 residents and fellows over nine academic years at one department. ResultsThe distributions of mean scores among raters had marked negative skewness and were inconsistent with normal distributions. Consequently, accurate confidence intervals were impracticably wide, and their interpretation suggested lack of validity. In contrast, the logits of the proportions of scores equaling the maximum possible value, calculated for each rater, followed distributions sufficiently close to normal for statistically reliable use in random effects modeling. Parameters and confidence intervals were estimated using the intercept only random effects models, and then inverses computed to convert results from the logit scale to proportions. That approach is analogous to random effect meta-analysis of proportional incidence (or prevalence). Departments that chose to use semi-annual or annual surveys of trainees regarding supervision quality, and report those raw counts, will have far lower estimates of supervision quality versus when calculated accurately using daily evaluations of individual anesthesiologists. ConclusionsRandom effects meta-analysis of percentage incidences of maximum scores is a suitable statistical approach to analyze the daily supervision scores of individual anesthesiologists to evaluate the overall quality of clinical supervision provided to the trainees by the department over a year.

Comparison of 4.5% Versus 8% Sevoflurane for Inhalational Induction in Adults

Background: Inhalational induction is a frequently used anesthetic technique in pediatric patients. However, it is less frequently used in adult patients undergoing surgery. General anesthesia can be induced either by intravenous injection or inhalation of anesthetic drugs. There are no established guidelines about the usage of 4.5% vs 8% sevoflurane for inhalation induction in adults undergoing elective day care surgery. Aim: To compare mean time to loss of eyelash reflex using 4.5% vs 8% sevoflurane for inhalational induction in adult patients undergoing elective day care surgery. Methodology: This randomized controlled trial was conducted in the department of anesthesia, Mayo Hospital Lahoreover a period of six months from June 2018 to December 2018. A total of 60 patients were enrolled in the study. We included adult patients aged 18-60 years of either gender and ASA status I & II undergoing elective day care surgery. While, patients having history of adverse reaction to inhalational agents and those who were on chronic sedatives, antipsychotic treatment were excluded. Demographic data of age and gender were obtained along with their body weight, height and BMI. They were randomly divided into two study groups using lottery method. After routine pre-op check and attaching standard anesthesia monitoring, patients in group-A and group-B were given 4.5% sevoflurane & 8% sevoflurane respectively at a fresh gas flow of 8 L/min of oxygen and they were instructed to take deep breaths while inhaling gas with help of face mask. Results: The mean age in 4.5% sevoflurane group was 42.27±11.83 years while in 8% sevoflurane group it was 45.43±12.76 years. In 4.5% sevoflurane group there were 12(40%) male and 18(60%) female cases while in 8% sevoflurane group there were 11(36.67%) male and 19(63.33%) female cases. The mean time to loss of eyelash reflex in 4.5% sevoflurane group was 88.57±6.71 seconds and in 8% sevoflurane group the mean time to loss eyelashes reflex was 67.87±5.90 seconds. The mean time to loss eyelashes reflex was statistically less in 8% sevoflurane group, with p-value 0.001. Conclusion: We concluded that mean time to loss eyelashes reflex was considerably lesser with8% sevoflurane when compared with 4.5% sevoflurane for inhalational induction in adult patients for elective day care surgery. Keywords: Inhalational induction, sevoflurane, eyelash reflex, day care surgery.

Efficacy of Propofol and Fentanyl in Reducing Emergence Agitation in Pediatric Patients after Sevoflurane Anesthesia: A Prospective Comparative Study

Introduction: Emergence agitation is a common postoperative phenomenon in pediatric patients that can lead to adverse outcomes. Propofol and fentanyl have been used for its management, but their comparative efficacy remains unclear. This study aimed to compare the efficacy of propofol and fentanyl in reducing emergence agitation in pediatric patients after Sevoflurane anesthesia. Methods: This prospective observational study was conducted at the Pediatric Anesthesia Department of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh over a 6-month period. 160 pediatric patients between the ages of 2-8 who underwent elective surgery and experienced emergence agitation under Sevoflurane anesthesia were selected. Patients with certain medical conditions or allergies were excluded. The participants were randomly divided into two groups: one receiving propofol and one receiving fentanyl. Anesthesia was induced with 8% sevoflurane, and data was collected and analyzed to compare the efficacy of propofol and fentanyl in reducing emergence agitation in pediatric patients. Ethical approval and informed consent were obtained. Result: Both groups had similar mean age and weight, with the propofol group having a mean age of 3.6 (SD 2.8) years and a mean weight of 15.7 (SD 3.3) kg, while the fentanyl group had a mean age of 3.7 (SD 2.5) years and a mean weight of 15.9 (SD 3.6) kg. Most subjects were male, with 75% in the propofol group and 57.5% in the fentanyl group. The mean duration of anesthesia was similar, with the propofol group at 63.5 (SD 14.8) minutes and the fentanyl group at 61.6 (SD 11.9) minutes. The mean PAED score was lower in the propofol group (4.3, SD 3.2) compared to the fentanyl group (4.9, SD 3.5). Airway obstruction and laryngospasm were less frequent in the propofol group (2.5% and 1.25%, respectively) compared to the fentanyl group (6.25% each), and nausea/vomiting was lower in the propofol group (6.25%) compared to the fentanyl group (26.25%). ....

Obesity and Critical Illness-Associated Mortality: Paradox, Persistence and Progress.

Both authors: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. *See also p. 484. The authors have disclosed that they do not have any potential conflicts of interest.

Retraction: Methylation-induced downregulation and tumor suppressive role of microRNA-29b in gastric cancer through targeting LASP1.

// Hui Li 1 , Guoqing Liu 2 , Ke Pan 2 , Xiongying Miao 2 and Yong Xie 2 1 Department of Anesthesia, Second Xiangya Hospital, Central South University, Changsha, Hunan, China 2 Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China Correspondence to: Yong Xie, email: xiangyaxieyong@163.com Keywords: Received: RECEIVED_DATE     Accepted: ACCEPTED_DATE     Published: March 11, 2023 Copyright: © 2023 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Benefits of IV Clonidine in Premedication on Sympathetic Hyperactivity Related to Surgical Incision

Background: Clonidine stimulates the α2 receptors of the sympathetic nervous system which have a negative presynaptic feedback effect inducing a reduction in the secretion of adrenaline and noradrenaline. The main objective of our study was to evaluate the beneficial effects of clonidine on the hemodynamic response to surgical incision. Patients and Methods: This was a prospective, single-center, randomized, single-blind clinical trial that took place over a period of 4 months in the anesthesia department of the Essos hospital center in Yaoundé. All patients over the age of 18, ASA I or II, admitted for scheduled surgery were included in the study. The patients were randomly divided into two groups by drawing lots: group A (clonidine) and group B (non-clonidine). All patients in group A received clonidine IV (3μg/kg). Heart rate, systolic blood pressure, and diastolic blood pressure were observed at different times during the surgical procedure. Results: During the study period, 35 met the inclusion criteria: 20 patients for group A and 15 patients for group B. The average age was 34 years. The sex ratio was in favor of the male gender in both groups: 2.3 in group A and 2.7 in group B. ASA class 1 was the most represented (74.3%); visceral surgery most performed of all specialties in the two groups 55% (n=11) for group A and 53% (n=8) for group B. The systolic and diastolic arterial pressure curves are parallel in the two groups. There is a slight variation in PAS and PAD in group A "clonidine" compared to the baseline values. A tendency towards systolic arterial hypertension is observed in the “non-clonidine” control group. The heart rate remains stable in group A, while tachycardia is observed at the same time for the participants in group B. Conclusion: Clonidine is an alpha 2 adrenergic receptor agonist which makes it possible to limit the hypersecretion of catecholamines, potentially deleterious for the fragile patient, at the surgical incision.

Comparison of Efficacy of Laryngeal Mask Versus I-Gel Airway Devices

Background: Adequate ventilation is the primary goal of general anesthesia. A variety of supra-glottic airway devices were introduced to simplify airway management and minimize complications.Objective: To compare the Laryngeal mask airway versus I-Gel in terms of insertion time, number of successful insertion attempts, and changes in hemodynamic parameters in patients getting general anesthesia.Material and Methods: This comparative study was performed at the Anesthesia department, Pir Abdul Qadir Shah Institute of Medical Sciences, Gambat from 1st July 2020 to 31st December 2020. Patients achieving the inclusion criteria were divided into two groups. In Group-A, the I-Gel device was used for airway maintenance; while in Group-B, the Laryngeal Mask Airway(LMA) was used. The mean insertion time, insertion attempts, and hemodynamic parameters were recorded and compared in both groups.Results: Total number of participants studied was 140; with 70 participants in each group. The mean age was 33.74+6.75 years in Group-A and 33.16+7.24 years in Group-B. Gender distribution showed 62.86 % (n=44) male in Group-A and 64.29% (n=45) in Group-B. A comparison of LMA versus I-Gel showed a mean insertion time of 22.81+3.09 seconds in Group-A and 31.53+2.46 seconds in Group-B (p<0.0001). The number of successful insertion attempts and the changes in the hemodynamic parameters was comparable in both groups (p>0.05).Conclusion: This study concluded that the I-Gel device has a significantly low insertion time compared to LMA in elective settings. So, its use can be handy in emergency settings.Keywords: I-Gel, LMA, General anesthesia, insertion time.

Malignant hyperthermia in Poland: A survey study.

Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden, uncontrolled skeletal muscle hypermetabolism in response to inhalation anesthetics and depolarizing relaxants. The estimated incidence of MH is between 1:10,000 and 1:250,000 anesthetic procedures. In Poland, due to lack of reporting, the incidence of MH is unknown. Dantrolene is imported as a life-saving drug (target import) and temporally authorized for sale. The aim of the study was to evaluate the prevalence of malignant hyperthermia in Poland and to assess the accessibility to dantrolene in Poland. A questionnaire was conducted among the chiefs of anesthesia and intensive care units in Poland. During the years 2014 to 2019, 10 episodes of MH have been reported in 238 surveyed polish anesthesia departments. The estimated prevalence is 1:350,000. Eight patients survived the MH crisis. Dantrolene is stocked in 48 (20%) anesthesiology departments. Among the surveyed hospitals, only in 38 (16%) it is possible to administer dantrolene within 5 minutes of suspecting a MH reaction. Less than half units (44%) have an algorithm for the management of MH episode in the operating theaters. The results of the study revealed, that the prevalence of MH in Poland is lower than the prevalence reported in other countries. Access to dantrolene in Poland is limited.

Pre-Anesthetic Consultation at the University Clinics of Kinshasa: Patient Profile, Type of Surgery, Anesthetic Protocol

<i>Introduction</i>: PAC is an element of anesthetic safety that makes it possible to collect information about the patient (history, physical examination), to assess the operative risk, to choose the technique of anesthesia and perioperative care best suited to the clinical condition of the patient. General objective was to describe the practice of PAC at the University Clinics of Kinshasa. <i>Methods</i>: This is a cross-sectional descriptive study carried out in Kinshasa from 1 January to 31 December 2021 (12 months), at the Department of Anesthesia and Resuscitation (ARD) of the University Clinics of Kinshasa. It involved all patients who had been consulted as part of a scheduled surgery, i.e. 443 patients. <i>Results</i>: The average age was 36.6 years with extremes of 7 days and 91 years. The female sex was predominant with 55.3%. Hypertension was the most found medical history in 13.5%. Gyneco-obstetric surgery (22.3%), otolaryngological surgery (13.8%) and neurosurgery (10.2%) were the most common of the surgical types. ASA I and ASA II patients were the most common (85.3%). General anesthesia accounted for 59% with Sevoflurane offered in 91% of general anesthesia. Spinal anesthesia accounted for 35.7%. <i>Conclusion</i>: The PAC is regularly performed in our environment in case of scheduled surgery and concerns all available surgical specialties.

Raised Serum Uric Acid as a Predictor of Perinatal Outcome in Parturient with Pregnancy Induced Hypertension

Objective: To evaluate the association of increased uric acid in pregnancy-induced hypertension with adverse perinatal outcomes.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Departments of Anesthesia, Gynecology &amp; Obstetrics, Combined Military Hospital, Okara Pakistan, from Mar to Sep 2018.&#x0D; Methodology: After approval of the Hospital Ethical Committee, 106 patients with pregnancy-induced hypertension were included in our study (n=53 in each group). Group-A had patient with raised uric acid, whereas Group-B had normal uric acid. Perinatal outcomes were monitored prospectively.&#x0D; Results: There was no difference in demographic profile of the two study groups. Raised uric acid was shown to be associated with a higher cesarean mode of delivery (p=0.014); preterm delivery (0.001); intrauterine growth retardation (0.038); and low APGAR at 5mintues (0.008). Raised uric had a sensitivity greater than 65% and specificity greater than 50% for perinatal outcomes.&#x0D; Conclusion: Raised uric acid is associated with adverse perinatal outcomes in neonates.

Childbirth in Bhutan: A study on the use of neuraxial analgesia for labor pain

AbstractBackgroundThe practice of neuraxial labor analgesia (NLA) as a mode of pain relief was introduced in Bhutan in 2016 despite it being in practice for more than five decades. There is a lack of data on NLA in Bhutan. Therefore, this study describes the use of NLA and its outcome over 4 years in Bhutan.MethodsA retrospective descriptive study was conducted from 1 January 2018 to 31 December 2021. The data were obtained from the Anesthesia Department, medical records, admission forms, and birth‐registers. A total of 524 women were included. Data were recorded using 2021 Microsoft Excel version 16.57 (22011101) and analyzed using Epi Info 7.2.5.0. Categorical data were summarized using frequencies and percentages. Continuous data were summarized using mean and standard deviation.ResultsThe incidence of NLA usage was 3.5% (524/15,119). Most women were between 21 and 30 years (67.2%). Modes of delivery following NLA were spontaneous vaginal delivery, cesarean section, and assisted vaginal delivery 63.4%, 18.4%, and 18.3%, respectively. Non‐reassuring fetal status (37.5%) and failed progression of labor (36.5%) were the leading indications of cesarean section. The primary reason for assisted vaginal delivery was poor maternal effort (55.2%). Neonates of the mother who received neuraxial analgesia had neonatal jaundice in 8%, neonatal intensive care unit admission in 0.76%, and Apgar score less than 7 in 5.1% and 0.2% at 1 and 5‐min, respectively, after birth.ConclusionAlthough NLA is safe for both mothers and babies, its use is low in Bhutan. The probable reason for the low incidence could be a shortage of anesthesiologists, cultural beliefs, and lack of awareness. The Ministry of Health and the Department of Anesthesia should work together to improve the service.

Quality of sleep among trainee doctors at the Charles Nicolle Hospital during the 2nd wave of COVID19

IntroductionSleep quality depends on several factors such as smoking, physical activity, diet, and certain pathologies such as obstructive sleep apnoea syndrome. Indeed, following a COVID-19 infection, several trainee doctors complained about a deterioration of their sleep quality.ObjectivesTo evaluate the quality of sleep of medical trainees working at Charles Nicolle Hospital who were infected by SARS-COV2.MethodsWe conducted a descriptive cross-sectional study, among medical trainees at Charles Nicolle Hospital, infected by COVID-19 during the period from July 2020 to November 2020. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Trainees were contacted during the period August 2022 to September 2022.ResultsFifty-three trainee doctors have joined our study. Forty-five of them had a significant sleep disturbance with a Pittsburgh Sleep Quality Index (PSQI) greater than five. The average age was 29.4±3.07 years old with a female majority (75%). No psychiatric history was found. The most affected category of trainees were residents (74%), particularly those working in the general surgery department (18%) and the anaesthesia and intensive care department (9%). Among those trainees, 80% had night shifts with an average of six shifts per month. Sleep latency was high in 20% of cases. A sleep duration of less than five hours per night was found in 18% of the cases. Six participants reported using sleeping pill three to four times a week.ConclusionsOur study revealed a significant sleep disturbance among trainee doctors. This could be due to the SARS-COV2 infection but can also be explained by the night shifts burden and the great mental load at work during this pandemic period.Disclosure of InterestNone Declared

Effectiveness of Popliteal Nerve Block in below Knee Surgeries

Aim: To observe the effectiveness of sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia in local population Study design: Descriptive cross-sectional study Place and duration of study: Department of Anesthesia, The Indus Hospital, Karachi from 11th March 2013 to 15th March 2014. Methodology: One hundred and fourteen patients with elective operations like wound debridement of foot, amputation of toes were included. After 15 minutes of giving the block, and at the time of incision, the patient was asked about his/her pain level by showing the pain scale. If the patient points at level 0, the surgery was proceed and the block was termed as effective. Results: Most of the patients were between 51-70 years of age and mean age was 58.83±9.21 years. There were 73(64.04%) males and 41(35.96%) females. Seventy four (64.91%) were in ASA-III, 32(28.07%) were in ASAIV and 8(7.02%) were in ASAV. The pain was not reported in 103(90.35%) patients while 11(9.6%) had pain in which 4 patients had mild pain, 5 moderate and 2 had severe pain. Block was effective in 103(90.35%) cases and ineffective in 11(9.65%) cases. Conclusion: Sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia be taken as an anaesthesia method for surgeries below the knee as well as for the control of the post-operative pain specifically in patients where spinal anaesthesia is not favorable Keywords: Below knee surgery, Sciatic nerve block, Popliteal nerve block

Effect of Intravenous Lignocaine vs Placebo on Hemodynamic Responses during Direct Laryngoscopy

Aim: To determine the effect of placebo vs intravenous lignocaine pre-intubation on hemodynamic responses during direct laryngoscopy. Study design: Randomized control trial Place and duration of study: Department of Anaesthesia, Indus Hospital, Karachi from 1st March 2017 to 31st August 2017. Methodology: One hundred and twenty patients were included and divided into two groups. In one group, lignocaine arm (1.5mg/kg I/V lignocaine) was given while placebo arm was given (6ml normal saline pre-intubation) in group two. In both groups after arrival at the operation theatre, base-line parameters like the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure was measured non-and later hemodynamic assessment was done before giving lignocaine, prior and post intubation and after 3,5 and 10 minutes of intubation. Results: Fifty six (46.15%) were male while 64 (53.85%) were females. No patients were found to have asthma, COPD, ischemic heart disease, TB, CHF, Cushing syndrome, phenochromcytoma, and drug allergy. No significant association was found between the two groups when comparing the gender, BMI, comorbids, ASA grade and Mallampati grade. The systolic blood pressure at 3,5 and 10 minutes was significant in the two groups, while diastolic was not significantly associated. The pulse rate at3 and 10 minutes was found to have a significant association while at 5 minutes was insignificant. MAP showed no significant association between the two groups. Conclusion: Hemodynamic stability is only affected in terms of systolic blood pressure, while other parameters are not significantly affected. Keywords: Lignocaine, Hymodynamic changes, Laryngoscopy

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Objective: To evaluate the diagnostic accuracy of auscultation in the detection of inappropriate positioning of endotracheal tube, in patients undergoing elective surgeries, by taking fiberoptic bronchoscopy as gold standard. Study design: cross sectional study Place and duration: Department of anesthesia, Nishtar Hospital, Multan Methodology: A total of 205 patients admitted in general surgery ward were included in the study. The pre-operative assessment was done one day before surgery. The level of difficulty of intubation was assessed during pre-operative assessment. SPSS version 23 was used for data analysis. Tests of significance chi square and t-test were applied. P-value &lt; 0.05 was taken as statistically significant. Results: Therefore, the estimated sensitivity was 72.03%. The estimated specificity was 65.6%. Positive predictive value was 73.9% and negative predictive value was 63.3%. Two hundred and five patients were included in this study of both genders. Gender distribution revealed as n=144 (70.2%) males and n=61 (29.8%) females. The mean age of the patients was 38.92±10.61years. ASA status I and II observed as n=121 (59.0%) and n=84 (41.0%), respectively. Mallampati grading I and II observed as n=127 (62.0%) and n=78 (38.0%), respectively. Laryngoscopy grading I and II observed as n=135 (65.9%) and n=70 (34.1%), respectively. Practical Implication: The main objective of this study was to evaluate the relative diagnostic accuracy of auscultation during GA. Therefore, we evaluated each technique's sensitivity, specificity, (PPV), (NPV) and overall accuracy in detecting incorrect endotracheal tube positioning. Conclusion: The five point auscultation technique is a reliable method of confirmation of endotracheal intubation, as verified by flexible fiberoptic bronchoscope. Keywords: Auscultation, Fiberoptic bronchoscopy, General analgesia, Diagnostic accuracy, sensitivity.

Incidents and Accidents during Anesthesia in Scheduled and Emergency Surgery at the Gabriel Toure Hospital

Introduction: The aim of this study was to evaluate the incidents and accidents during anesthesia in surgery at the Gabriel TOURE hospital. Methodology: This was a descriptive prospective study of anesthetic incidents and accidents that took place in the anesthesia department of the Gabriel TOURE hospital on the operating sites of programs and surgical and gyneco-obstetric emergencies ranging from the 1st January to March 31, 2021. Our study focused on all patients who underwent emergency and scheduled anesthesia during the period. Included were all patients with at least one accident or incident, All patients who did not present accidents and incidents or who refused to participate in the study were not included. The data was collected on the survey sheets and analyzed using the EPI INFO 7 software. Data entry was made using Windows XP software. Results: Over a period of 03 months, we collected 741 patients operated on in the operating theaters of the Gabriel TOURE hospital, of which 100 patients presented accidents/incidents in scheduled and emergency surgery, i.e. a rate of 13.49%. Urgent surgery represents 15.23% of incidents or accidents. Conclusion: We were able to take stock of several elements related to our practice of anesthesia. One of the essential interests of this work was the comparison of a population of subjects having "been victims of an anesthesia accident to the whole population anesthetized in the same structures, by the same practitioners, over the same period of study”.

Effect of Pregabalin on Succinylcholine Induced Fasciculation, Myalgia and Hyperkalemia in Spine Surgery

A randomized control trial was done between January and December of 2018, in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine of Dhaka Medical College Hospital, Bangladesh, to evaluate the preventive effect of pregabalin on succinylcholine induced adverse effects, i.e., fasciculation, myalgia and hyperkaliemia in spine surgery. Sixty patients of elective spine surgery under general anaesthesia were selected and divided into two groups. Pregabalin 150 mg was given to one group and matching placebo was given to another group orally with sips of water one hour before surgery. Succinylcholine 1.5 mg/kg was given after induction agent. Muscle fasciculation was observed just after succinylcholine administration. Serum potassium was measured 5 minutes before induction and 5 minutes after succinylcholine administration. After completion of surgery reversal was given. Time of first analgesic demand was recorded. Injection Morphine 0.15 mg/kg intramuscular was given when patient complained about pain. Myalgia (muscle pain not associated with surgery) was observed 24 hours after anaesthesia and total morphine consumption was recorded. Use of pregabalin 150 mg one hour before surgery reduced the severity of fasciculation and the incidence and severity of postoperative myalgia. It also reduced the rise of serum potassium concentration after succinylcholine administration though the rise was within normal limit. Pregabalin also reduced the total opioid consumption after surgery.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 73-80

Comparison Between Pethidine and Nalbuphine Hydrochloride Combating Epigastric Pain During Mopping of Intraperitoneal Blood in Lower Uterine Caesarean Section Operation

A randomized prospective single blind trial was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between July 2021 and February 2022, to compare the effects of intravenous pethidine and nalbuphine hydrochloride combating epigastric pain and discomfort during mopping of intraperitoneal blood in lower uterine caesarean section (LUCS) operation. A total of 120 women participated in the study. They were randomly divided into two groups: group A (n=60) received intravenous diluted (with normal saline) 20-25 mg of pethidine, while group B (n=60) received intravenous diluted 10-20 mg of nalbuphine hydrochloride. There were no differences observed in mean age, weight, height, and duration of operation between two groups (P&gt;0.05). However, participants of group B reported less or no epigastric pain and discomfort during mopping of intraperitoneal blood than that of group A (P&lt;0.05), i.e., episode and intensity of pain measured by using visual analogue scales indicated that nalbuphine hydrochloride has a longer duration of action than pethidine. Our study revealed that intravenous diluted nalbuphine hydrochloride works better than pethidine to minimize epigastric pain and discomfort during mopping of intraperitoneal blood in lower uterine caesarean section (LUCS) operation. &#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 81-86

Anesthesiologists and Voter Advocacy: A Novel Avenue for Civic Outreach.

From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina. Accepted for publication May 31, 2022. Funding: Funding for Operation Vote SC was provided by the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to Andrew D. Fisher, MD, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29464. Address e-mail to [email protected].

A Multidisciplinary Approach to Improvements in Perioperative Antibiotic Prophylaxis at a Military Treatment Facility.

Surgical site infections complicate 2%-5% of surgeries. According to the Centers for Disease Control and Prevention, half of all surgical site infections are preventable. Adherence to published recommendations regarding perioperative antibiotic administration decreases the incidence of surgical site infections. Members of the Department of Anesthesia noticed casual observations of inaccurate prescribing of antibiotics at our institution, Brooke Army Medical Center, and approached the Antimicrobial Stewardship Program to collaborate on this issue. A team of anesthesiologists, clinical pharmacists, and infectious disease specialists collaborated with the Department of Surgery to improve this effort as part of a multiyear project from 2018 to 2021. We first assessed adherence to recommended perioperative antibiotic use to establish a baseline and next, noticing gaps, created a project with the goal to improve compliance to >90% across surveyed measures. Our key interventions included educational initiatives, creation of facility-specific guidelines, peer benchmarking, updating order sets, interdisciplinary collaboration, creation of intraoperative reminders and visual aids, and tailored presentations to selected services. Of 292 charts (2.3% of cases from January to October 2018) reviewed pre-intervention, compliance rates were 84% for antibiotic choice, 92% for dose, 65% for redosing, and 71% for postoperative administration. Of doses, 100% were timed correctly, and thus, this variable was not targeted. Post-intervention, our review of 387 charts (10% of cases from May to November 2020) showed no change in correct antibiotic choice (84%) and statistical improvement to 96% for correct dose, 95% for correct redosing, and 85% for correct postoperative administration (P < .05 for all). Our multidisciplinary approach of collaboration with multiple departments, creating guidelines and providing feedback, improved compliance with perioperative antibiotic administration recommendations.