Anesthesia Department Research Articles

Effect on Cuff Pressure of Various Endotracheal Tube Cuff Inflation Methods

Objective: To compare mean endotracheal tube cuff pressures generated using two endotracheal tube cuff inflation methods;just-Seal versus Stethoscope-Guided in patients undergoing elective surgery under general Anaesthesia.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.
 Methodology: A total of 100 patients undergoing elective surgery under general endotracheal tube anaesthesia between 18–60 years of age of either gender were included. Patients were equally allocated (n=50 each) to two Groups, A (Just Seal Group) and B (Stethoscope Guided Group). In the Group-A method, the air was injected until no air leak could be heard. The pressure was measured using a “Portex cuff pressure manometer”. In the Group-B method, a stethoscope bell was placed on the thyroid lamina, and harsh breath sounds were auscultated during ventilation. Cuff was inflated till the sounds changed to smooth sounds. The pressure was measured and then noted down. 
 Results: Among 100 patients, 39 % were males, and 61 % were females. The mean endotracheal cuff pressure in Group-A was 39.90±3.19 centimetres of water and 28.42±3.52 centimetres of water, with Group-B (p-value of 0.001).
 Conclusion: Post-intubation cuff pressure measured in patients undergoing elective surgery under general anaesthesia of the just seal group is higher than that in the stethoscope-guided group.
 Keywords: Cuff pressure, Stethoscope-guided, Tracheal intubation.

Comparison of the Efficacy of Intravenous Lignocaine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020.
 Methodology: Patients were randomly divided into two Groups by lottery method. Seventy-three were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous Dexmedetomidine-Group-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation.
 Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009).
 Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes.

Comparison of Frequency of Sore Throat and Cough after Prophylactic Lignocaine and Beclomethasone in Adults

Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019.
 Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endo-tracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted.
 Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in Beclomethasone-Group (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the Beclomethasone-Group (p=0.003).
 Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation.

PP097 [Extracorporeal Support » Renal replacement therapies]: TRAJECTORY OF KIDNEY RECOVERY IN PEDIATRIC PATIENTS REQUIRING CONTINUOUS KIDNEY REPLACEMENT THERAPY FOR ACUTE KIDNEY INJURY

Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan

PP525 [Lung » Modalities of respiratory support]: NON-INVASIVE NEURALLY-ADJUSTED VENTILATORY ASSIST IN CHILDREN AFTER CARDIAC SURGERY

Department of Pediatric Critical Care and Anesthesia, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia

Richard I. Cook, MD – 1953-2022

Article| November 2022 Richard I. Cook, MD – 1953-2022 Michael F. O'Connor, MD, FCCM, FASA Michael F. O'Connor, MD, FCCM, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor November 2022, Vol. 86, 40. https://doi.org/10.1097/01.ASM.0000897408.29363.76 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Michael F. O'Connor; Richard I. Cook, MD – 1953-2022. ASA Monitor 2022; 86:40 doi: https://doi.org/10.1097/01.ASM.0000897408.29363.76 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: accidents, care of intensive care unit patient, complex work environment, engineering, ohio, professors, safety, software We are saddened to share the news of the death of Richard I. Cook, MD, on August 31, 2022. He was arguably the best-known and most accomplished anesthesia-based expert on safety in the world. Richard graduated cum laude from Lawrence University in Appleton, Wisconsin, in 1975. He worked on supercomputer design and engineering applications at Control Data Corporation from 1975 to 1980. He graduated with his MD from the University of Cincinnati in 1986 and completed his anesthesiology residency in 1994. His gap years during that time were spent learning about accidents, safety, and complex systems with David Woods at the Ohio State University, the leading expert in the U.S. on these topics. From 1994 to 2012, Dr. Cook was a member of the Department of Anesthesia & Critical Care at the University of Chicago. While at the University of Chicago, Richard helped found the National Patient Safety Foundation at... You do not currently have access to this content.

PP476 [Quality and Safety » Improvement huddles]: KEEPING IT STRAIGHT- THE PAEDIATRIC INTENSIVE CARE COMPLEX SCOLIOSIS STORY

1Paediatric Critical Care, Royal Hopital for Children and Young People, Edinburgh, U.K. 2Paediatric Anaesthetic Department, Royal Hopital for Children and Young People, Edinburgh, U.K.

COMPARISON OF ORAL MIDAZOLAM VERSUS ORAL TRICLOFOS FOR SEDATION OF CHILDREN POSTED FOR COMPUTED TOMOGRAPHY SCAN - A RANDOMIZED CONTROLLED, DOUBLE BLIND CLINICAL STUDY

Background: To maintain immobility of children for good quality computed tomography (CT) scans, sedation may be used. Present study was planned to compare the efficacy of oral triclofos and oral midazolam in children undergoing CT. Methodology: The prospective, comparative, randomized Indian study was conducted in Department of Anaesthesia at a J.J. Hospital and Grant Medical college. Study population was paediatric subjects between 2 years and 5 years (both inclusive) with ASA-I, exhibiting fearful or refractory behaviour at previous CT Scans. Oral triclofos 100 mg/kg was given to one group (100 patients) and oral midazolam 0.75 mg/kg in other group (100 patients) in preoperative room with facility of oxygen and multipolar monitor. Standardized scoring systems (Ramsay Sedation Scale, Aldrete Recovery Score) were used for evaluation. Vascular parameters, time of sedation onset and duration of recovery were also assessed. Results: Mean age and gender distribution were comparable between study groups (p>0.05). On comparing heart rate, systolic and diastolic BP between the Midazolam and Triclofos groups at all time-points, no significant difference was found (p>0.05). Mean sedation score and recovery score in the Midazolam group were found to be significantly higher compared to Triclofos group (p<0.05). Mean onset of sedation was found to be significantly quicker in the Midazolam group (p<0.05). In addition, the mean duration of sedation and duration of CT scans were significantly lower in the Midazolam group (p<0.05). Conclusion: Midazolam was found to have a better sedative profile compared to Triclofos in paediatric patients undergoing CT.

Comparative study of intubating LMA and I-gel for ease of insertion and as a conduit for endotracheal intubation

Background: A recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel and LMA was evaluated. Methods: This is a prospective study was conducted in the Department of Anesthesia at Sapthagiri Institute of Medical Sciences & Research Centre among 140 patients fulfilling the criteria. Fasting patients with ages 20-50 years undergoing elective procedures under general anesthesia with ASA physical status 1 and 2 and Mallampatti class I and II were included in the study. Whereas patients with ASA physical status 3 or 4, and having contraindications to insertion of LMA or i-gel™ such as; mouth opening less than 2 cm, increased risk of aspiration, anticipated difficult intubation and facemask ventilation, with Mallampatti class III to IV were excluded. Results: One of the groups was administered the I-gel (Group G) and the other group was given I-LMA (Group L). Two groups were statistically similar in terms of distribution of ASA physical status grading (p<0.05). Two groups were statistically similar in terms of mallampati score distribution. Distribution of duration of surgery was not statistically significant in both the groups (p>0.05). It was observed that insertion I-gel was easy in 50 out of 70 patients. Difficulin 56 out of 70 patients. Difficult to insertion took place in 14 patients. The comparison of ease of insertion between the two groups did not reveal any statistical significance (p>0.05). Conclusion: We concluded I-gel aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

Tuân thủ quy trình an toàn mổ lấy thai tại một bệnh viện năm 2020

Objectives: Describe the compliance with safe cesarean section procedures and influencing factors of the compliance in Thu Duc District Hospital, Ho Chi Minh City in 2020. Methodology: Cross-sectional study design, quantitative and qualitative data were collected. Direct observation of practicing safe surgical procedures during cesarean sections at the Department of Anesthesia and Resuscitation, Thu Duc District hospital was conducted. Interviews with hospital staff were conducted using semi-structured interview guides. The study was conducted from April to October 2020. The study sample size was 142 caesarean sections (C-sections). Results: The compliance rate of safe cesarean section procedure at each stage of surgery, was rather high: 95.8% at pre- . operative stage, 81.7% surgical stage, and postoperative stage was 92.2%. The compliance rate for safe cesarean section procedure was 81.7%. Some surgical safety actions are not performed in the emergency cases such as fetal distress. Recommendations: It is necessary to have specific guidance on the safety procedures for each level of emergency of C-section in the hospital. Keywords: surgical safety, cesarean section, procedure

Comparison of Manual Mode With Automatic Gas Control Mode for Sevoflurane Consumption in Maquet Flow-I Anesthesia Machine

Background: Inhalational anesthetic agents used for general anesthesia can have adverse effects on operation theater staff and environment. The innovative automated gas controller reduces inhalational anesthesia agent consumption. Aim: To compare sevoflurane consumption in manual mode versus automatic gas control (AGCTM) mode on Maquet Flow-i anesthesia machine in adult laparoscopic surgeries. Methods: This study was a randomized control trail conducted at Department of anesthesia, Security Forces Hospital Riyadh, Saudi Arabia and Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan from December 2019 till December 2020. Sixty patients were randomly divided into two Groups A (Automatic Gas Control, AGCTM) and Group B (Manual Mode). Sevoflurane consumption and sevoflurane consumption rate was calculated in both groups. Data was analyzed using SPSS V.20. Results: Two groups were comparable in term of age, gender, and comorbidities. The mean sevoflurane consumption rate in group A was 23.92+4.6 as compared to 40.23+4.4 in group B (P=0.001). Similarly sevoflurane consumption rate is also statistically significant. (0.28 + 0.04 ml/min vs 0.47 + 0.02 ml/min, p=0.001) Conclusion: Sevoflurane consumption and sevoflurane consumption rate is lower in AGCTM mode as compared to manual mode of Maquet Flow-I anesthesia machine. Keywords: Sevoflurane, Maquet Flow-i, Automatic Gas Controller (AGCTM), Laparoscopic Surgeries

Self-Stigmatization of Healthcare Workers in Intensive Care, Acute, and Emergency Medicine.

This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.

Association Between the Community Prevalence of COVID-19 and Daily Unscheduled Absences of Anesthesiologists, Nurse Anesthetists, and Residents in an Academic Anesthesia Department.

Introduction An "unscheduled absence" refers to an occurrence when an employee does not appear for work and the absence was not approved in advance by an authorized supervisor. Daily unscheduled absences need to be forecasted when doing staff scheduling to maintain an acceptable risk of beingunable torun all anesthetizing locations and operating rooms planned. The number of extra personnel to be scheduled needs to be atleast twice aslarge as the mean number absent. In an earlier historical cohort study, we found that our department's modeled risks of being unavailable unexpectedly differed among types of anesthesia practitioners (e.g., anesthesiologists and nurse anesthetists) and among weekdays (i.e., Mondays, Fridays, and workdays adjacent toholidays versus other weekdays). In the current study, with two extra years of data, we examined the effect of the coronavirus COVID-19 pandemic onthe frequency of unscheduled absences. Methods There were 50 four-week periods studied atalarge teaching hospital inthe United States, from August 30, 2018to June29, 2022. The sample size of 120,687 person-assignment days (i.e., a person assigned to work on a given day) included 322 anesthesia practitioners (86 anesthesiologists, 88 certified registered nurse anesthetists, 99 resident and fellow physicians, and 49 student nurse anesthetists). The community prevalence ofCOVID‑19 was estimated using the percentage positive among asymptomatic patients tested before surgery and other interventional procedures at the hospital. Results Each 1% increase in the prevalence of COVID-19 among asymptomatic patients was associated with a 1.131 increase in the odds ofunscheduled absence (P < 0.0001, 99% confidence interval 1.086 to1.178). Using an alternativemodel with prevalence categories, unscheduled absences were substantively more common when the COVID-19 prevalence exceeded 2.50%, P [Formula: see text]0.0002. For example, there was a 1% unscheduled absence rate among anesthesiologists working Mondays and Fridays early in the pandemic when the prevalence of COVID-19 among asymptomatic patients was 1.3%. At a 1% unscheduled absence rate, 67 would be the minimum scheduled tomaintain a <5.0% risk for being unable to run all 65 anesthetizing locations. Incontrast, there was a 3% unscheduled absence rate among nurse anesthetists working Mondays and Fridays during the Omicron variant surge when the prevalence was 4.5%. At a 3% unscheduled absence rate, 70would be the minimum scheduled tomaintain the same risk of not being able to run 65 rooms. Conclusions Increases in the prevalence of COVID-19 asymptomatic tests were associated with more unscheduled absences, with no detected threshold. This quantitative understanding ofthe impact ofcommunicable diseases on the workforce potentially has broad generalizability toother fields and infectious diseases.

164 OLDER PATIENTS AT THE PREOPERATIVE ASSESSMENT CLINIC: CHANGING THE FOCUS FROM FIT FOR SURGERY TO OPTIMISATION FOR SURGERY

Abstract Background The Pre-operative Assessment Clinic (PAC) is run by the Anaesthetic Department and assesses older patients undergoing elective orthopaedic surgery. The aim of this study was to examine how PAC currently assesses older patients and how effective it is in assessing for likelihood of postoperative complications and requirement for rehabilitation. Methods A single-centre, retrospective study that received approval from the local ethics committee. Data were collected on all patients post elective orthopaedic surgery admitted to the on-site specialist rehabilitation unit for older persons, between 1st May 2020 and 31st December 2021. Data were collected from hospital Information Technology platform, Bluespiers. Results Seventy-six patients (58 female; median age: 80 years) were included. Median time from PAC to surgery was 95 days. Functional assessment was completed in 63.16% of cases, formal cognitive assessment was done in 13% of cases. Number of falls in the preceding year was recorded in 31% of patients. Baseline mobility was recorded in 93% of cases. Whilst smoking and alcohol history was recorded in 96% of cases, number of units was not calculated. 45% (n=34) of patients were correctly identified as likely to require post-operative inpatient rehabilitation. PAC did not record sarcopaenia, polypharmacy or delirium risk factors. From our dataset, at least 13% had sarcopaenia, 80% had polypharmacy and 23% required opiate medications. Post-operatively, 16% of patients developed a delirium and 12% had an acute kidney injury. Conclusion In its current format, PAC fails to optimally risk stratify frail, older patients. Attention concentrates on fitness for surgery rather than optimisation of patients. Failure to record frailty, sarcopenia, cognitive impairment and risk factors for delirium is leading to missed opportunities in terms of delirium prevention, and peri-operative optimisation of older patients as well as discharge planning before surgery. Collaboration with specialist geriatric services at PAC should improve patient outcomes.

A Survey of Current Practices and Adherence to Coronavirus Disease Airway Management Guidelines Among Frontline Healthcare Professionals in a Resource-Limited Country.

The coronavirus disease 2019 (COVID-19) has brought anaesthesiologists, intensive care and emergency physicians to the forefront due to their airway management skills. The aim of survey was to determine current practice trends in COVID-19 airway management among frontline healthcare professionals of Pakistan and their adherence to standard principles proposed by most consensus guidelines. An online questionnaire was designed based on consensus guidelines from international societies. We contacted consultants and trainees nationwide working in anaesthesia, intensive care, and emergency departments through emails, phone calls, and social media platforms. A total of 285 individuals participated in this cross-sectional descriptive study. Intubations were largely performed by anaesthetists followed by emergency physicians. Deteriorating respiratory failure (89%) was the most frequent indication. Availability of trained staff, use of intubation checklist, limited staff presence during intubation, and use of appropriate personal protective equipment were positive findings. One-third reported that their workplace did not have negative pressure rooms for aerosol-generating procedures, and 63.3% responders do not perform airway assessment before intubation. The device of choice for the first attempt at laryngoscopy was Macintosh laryngoscope (51.6%) followed by videolaryngoscopes with disposable blades (24.2%). Availability of rescue devices in case of unanticipated difficult airway is variable; laryngeal mask airway (70.1%), bougie (82.2%), and stylet (68.7%) were present at majority places. Frequency of airway-related adverse events including hypoxemia (69.8%) and failed first attempt intubation (35.2%) was significant. This survey found satisfactory knowledge, comparable practices, and offers some important insights about airway management in COVID-19 patients by healthcare professionals of Pakistan.

Role of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Intensive Care Unit

Background: Acute respiratory distress syndrome (ARDS) necessitates rapid recognition for early intervention and favourable outcomes. The Berlin Definition may not be always helpful for ARDS diagnosis in critically ill patients, because of the inability to acquire adequate information from bedside chest X-rays. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS, but the effectiveness of lung ultrasound in ARDS diagnosis remains uncertain. Objective: To explore the efficacy of lung ultrasound (LUS) for the diagnosis of ARDS in ICU. Methods: This observational, cross-sectional study was conducted in the ICU, DMCH at the Department of Anaesthesia, Analgesia, Palliative, and Intensive Care Medicine from March 2017 to June 2019. Lung ultrasound was performed on acute hypoxic respiratory failure patients requiring mechanical ventilation. chest X-ray, arterial blood gas analysis, and echocardiography were done to fulfill the Berlin Definition. ARDS was diagnosed by the ‘CXR-based Berlin Definition’ and ‘LUS-based Berlin Definition’. Results: A total of 141 patients were assessed. Their median age was 35 years. Primary diagnoses were sepsis, pulmonary oedema, pneumonia, and trauma. A total of 62 (43.97%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 69 (48.93%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ‘LUS-based Berlin Definition’ were 90.3%, 83.5%, 81.2%, 91.7%, and 86.5% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis of ARDS in the intensive care unit. Bangladesh Crit Care J September 2022; 10(2): 104-109

Effectiveness Of Intrathecal Dexmedetomidine In Combination With Hyperbaric Bupivacaine For Lower Abdominal Surgeries And Its Postoperative Analgesic Characteristic.

Intra-thecal anaesthesia is the commonly preferred, block for surgeries of lower abdomen, perineal and lower limb. It is easy to administer and very economical but needs skills. Intrathecal use of local anaesthetics possesses a short duration of action and needs early use of rescue analgesia postoperatively. Objective was to assess the efficacy of Dexmedetomidine in adjuvant with bupivacaine for neuraxial anaesthesia and postoperative analgesic characteristics. It was a prospective comparative study, conducted at Anaesthesia Department, Liaquat National Hospital, Karachi from January to July 2020. Overall 100 patients conveniently recruited who underwent lower abdominal procedures were allocated into two groups by randomization, i.e., 50 in each group and were labelled as Group N and Group D10. Group N consist of 0.5% bupivacaine 10 mg (2 ml) + diluted with 0.5ml normal saline dilution and group D10 consist of 10 μg Dexmedetomidine + 0.5% bupivacaine 10 mg (2 ml) with 0.5 ml normal saline dilution, total 2.5 ml dose in each group. The duration of block and regression was evaluated. . The study showed significant differences in sensory and motor block to reach T10 and Bromage 3 respectively. Patients who were assigned in Group D reported short onset of sensory to reach T10 (5.4±1.17) and motor to reach Bromage 3 (10.4±1.03) as compared to Group N (9.9±2.12 and 17±22) respectively. Participants of Group D required rescue analgesia in less amount throughout intervals as compare to group N. The usage of 10ug Dexmedetomidine adjuvant with 0.5% bupivacaine significantly reduced the onset on sensory T10 and motor Bromage 3 and also prolong duration of sensory and motor regression, moreover minimal adverse effects and less use of rescue analgesic drugs were observed.

Catechol-O-Methyltransferase (COMT) Enzyme Level In Preoperative Anxiety Patients

Background: Incidence of perioperative anxiety is very high, many preoperative patient experience anxiety . Thiamine acts as an essential nutrition funtionate as cofactor enzyme in most of mitochondria in brain. Brain is very susceptible to thiamine deficiency because its dependency on mitochondrial ATP production. Decreased ATP production result in inhibition of COMT activity. Low COMT levels indicated tendency for anxiety. The aim of this study is to determine the effect of thiamine in increasing COMT enzyme levels in patient with preoperative anxiety&#x0D; Methods : A true experiment with pretest-posttest control group and double-blind design conducted at the Department of Anesthesia and Intensive Care of University of North Sumatra in August 2019. The 60 patients were analyzed which were planned for and done an elective surgery under general anesthesia. Preoperative anxiety was measured with Amsterdam Preoperative Anxiety and Information Scale (APAIS) and COMT enzyme level measured by ELISA assays. &#x0D; Results : The results showed that from 64 patients had incidence of preoperative anxiety in this study was 48.3%. We found that there is significant differences in COMT enzyme levels in thiamine group compared to control (p value = 0.001). In addition, it was seen that in thiamine group had an increased COMT levels from 0.96 ng/dL to 1.78 ng/dL, while in control group there also slight increasing from 0.44 ng/dL to 0.78 ng/dL. This show that increase in COMT levels is greater in thiamine group than control group. &#x0D; Conclusion : Thiamine can cause increasing COMT enzyme levels in patients scheduled for elective surgery with preoperative anxiety under general anesthesia

ANALGESIC EFFICACY OF BILATERAL SUPERFICIAL CERVICAL PLEXUS BLOCK ADMINISTERED BEFORE THYROID SURGERY UNDER GENERAL ANAESTHESIA – A CASE SERIES

Background: Thyroid surgery is moderately painful, but is increasingly being considered as a day- care procedure also Thyroid surgery is associated with increased incidence of Post operative Nausea and Vomiting. Bilateral supercial cervical plexus block (BSCPB) provides an adjuvant technique in view of adequate post operative pain relief and increase the time for rst requirement of rescue analgesia. Place And Duration Of Study: Department of Anaesthesia , Government Nagapattinam Medical College and Hospital, Nagapattinam- 611001 ( August 2021 to June 2022). 35 patients with euthyroid status undergoing total thyroidectomy were gi Methods: ven Bilateral supercial cervical plexus block with 10 ml of 0.25% Bupivacaine 5ml each side after induction of General Anaesthesia. Primary outcome was time of requirement of rst rescue analgesic in the postoperative period. Secondary outcomes were visual analogue scale (VAS) scores at 0, 4, and 8 hrs and incidence of postoperative nausea and vomiting (PONV ). Bilateral Supercial Cervical ple Results: xus Block given after induction General anaesthesia and Before skin incision effectively reduced the post operative pain in patients undergoing total thyroidectomy.

Determining the Effect of Intrathecal Dexmedetomidine on Postoperative Pain Relief after Cesarean Section

Objective: To analyze efficacy of intrathecal Dexmedetomidine as adjunct to hyperbaric Bupivacaine in terms of postoperative analgesia after caesarean section. Study Design &amp; Setting: This randomized controlled trial was conducted at Department of Anesthesia, Rawal Institute of Health Sciences, Islamabad from20th, October 2018 to 20thApril 2019 after taking Ethical board approval from the Institute. (letter no RIHS-REC/030/18, dated, 18th October 2018). Methodology: Total n=120 patients having ASA status I, II undergoing elective cesarean section were randomly divided into 2groups (60 each) by lottery method. Group-A, was given hyperbaricBupivacaine (0.5%) 12mg alone and group-B, was given hyperbaricBupivacaine (0.5%) 12mg along with injection Dexmedetomidine 4ug in intrathecal space respectively. Patients were followed in postoperative period for onset of pain and requirement for rescue analgesia in first 6 hours. Results: There was statistically significant difference in mean onset of postoperative pain among both the groups-A and B (178.18 ± 12.51 versus 364.07± 35.58min respectively with p value 0.000), as well as, postoperative analgesic requirement, in first 6 hours, 39 (65.0 %) versus 31 (51.7 %) with p-value 0.000 respectively. However, on stratification, considering effect modifiers, like age (20-30 years and 30-40 year and previous history of cesarean section), there was statistically significant difference in mean onset of pain in both groups, but no significant difference was found regarding rescue analgesic requirement in both groups. Conclusion: Intrathecal Dexmedetomidine along with hyperbaric Bupivacaine was better than hyperbaric Bupivacaine alone in controlling postoperative pain in caesarean section.