Anesthesia Department Research Articles

Evaluation of Preventive Effect of Zinc Lozenge on Sore Throat after Placement of ProSeal Laryngeal Mask Airway: A Randomised Controlled Study

Introduction: Postoperative Sore Throat (POST) is a known complication after general anaesthesia with an endotracheal tube (14.4% to 50%) and less so with Supraglottic Airway (SGA) devices (5.8% to 34%). Various modalities and drugs can decrease POST. Zinc possesses anti-inflammatory and antioxidant properties and is utilised in oral mucositis and xerostomia. Aim: To evaluate the effect of preoperative administration of a zinc lozenge on POST after the removal of the Proseal Laryngeal Mask Airway (PLMA). Materials and Methods: In this randomised, double-blinded controlled study was conducted at the Department of Anaesthesia at Pt. BD Sharma PGIMS, Rohtak, Haryana, India, over a period of five months from August 2020 to December 2020. 100 patients aged 18-60 years of either sex belonging to American Association of Anesthesiologists (ASA) I and II undergoing elective surgery under general anaesthesia with PLMA placement were randomly allocated into two groups to receive a 40 mg zinc lozenge (Group-I) or placebo (Group-II) and were asked to chew it 30 minutes preoperatively. Patients with upper respiratory tract infections, at risk of aspiration, or with anticipated difficult intubation were excluded from the study. The incidence and severity of POST were assessed on a 4-point scale (0-3) at 30 minutes, 2, 4, and 24 hours postoperatively. The primary outcome of the study was the incidence of POST at four hours postoperatively, and the secondary outcome was the severity of POST at 30 minutes, two hours, and 24 hours postoperatively. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software programme. The Chi-square test and unpaired t-test were used for statistical analysis. Results: The mean age in Group-I was 38.6±12.32 years and in Group-II was 37.90±14.84 years (p-value 0.79). Data regarding the distribution of patients according to sex were comparable with a p-value of 0.31. There was a significantly lower incidence of POST in Group-I (zinc group) than in Group-II (placebo group) at four hours with a p-value of 0.004. Conclusion: The present study has shown that the preoperative administration of a 40 mg zinc lozenge effectively reduces the incidence and severity of POST in the postoperative period, peaking at four hours after general anaesthesia. Zinc lozenges are easy, convenient, non invasive, and successfully prevent POST.

Study to compare the incidence of post-dural puncture headache in obstetric patients using cutting and pencil-point spinal needle in spinal anesthesia

Background: Spinal anesthesia is one of the most commonly used regional anesthesia techniques. Post-dural puncture headache (PDPH) is a well-known iatrogenic consequence of spinal anesthetic and diagnostic lumbar puncture, primarily caused by loss of cerebral spinal fluid. To reduce complications, spinal needles have undergone modifications. The two most important modifiable risk variables for PDPH were needle shape and size. In young expecting mothers, post-cesarean sections are associated with an increased incidence of PDPH. Aims and Objectives: The aims and objectives of the study are to compare the incidence of PDPH in obstetric patients using cutting and pencil-point spinal needles following spinal anesthesia. Materials and Methods: This 1-year double-blind study was carried out in the Department of Anaesthesia from August 2021 to July 2022. The study comprised obstetric patients who were scheduled for elective-segment cesarean section. The subarachnoid block needle was divided into Groups A and B at random: Group A 25-gauge Whitacre spinal needle with a pencil point, whereas Group B 25-gauge Quincke spinal needle with a cutting bevel. Records were kept on age, height, weight, and gestational age. A follow-up was conducted up until the discharge date. The incidence and severity of PDPH after spinal anesthesia were examined in both groups. The results were analyzed with SPSS 20.0, and the Fischer exact and Chi-square tests were used to look for statistical significance. Results: The current study included 120 patients in total, 60 patients in each of Groups A and B. When a pencil point Whitacre was used, the incidence of PDPH was 2 (3.3%), however, when a cutting Quincke needle was used, the incidence was 7 (10.8%). With a P < 0.05, the relationship between the two was considered statistically significant. The pain severity was mild in both patients of Group A. Of the seven patients in Group B, four had mild pain, two had moderate pain, and one had severe pain. Conclusion: The pencil-point 25-G Whitacre spinal needle has a lower incidence of PDPH than the traditional 25-G Quincke needle and was suggested for patients at risk of PDPH. In light of this, the current study suggested using pencil-point spinal needles for lumbar punctures and spinal anesthesia in obstetric patients.

Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal isobaric levobupivacaine in lower segment caesarean section

Background/Aim: Caesarean section is one the most common surgeries encountered in the operating room worldwide in the younger demo-graphic ages from 18-39 years of age. The objective of this study was to compare the efficacy of dexmedetomidine versus fentanyl as adjuvants to intrathecal levobupivacaine in the lower segment caesarean section. Methods: This quasi-experimental study was carried out at the Anaesthesia Department, Combined Military Hospital, Rawalpindi, Punjab, Pa-kistan from July 2021 to July 2023. A total of 240 patients were studied. They were divided into the dexmedetomidine group (n = 120) and fentanyl group (n = 120) group. Patients in both groups received 2.5 mL of 0.5 % of isobaric levobupivacaine with the dexmedetomidine group receiving 5 mcg of the drug and the fentanyl group 25 mcg of fentanyl to a total volume of 3 mL. Primary variables measured were: time to complete sensory and motor block, total duration of the block, time to first rescue analgesia after block regression in the post anaesthesia care unit (PACU) and mean PACU stay. Secondary variables observed were hypotension, nausea, vomiting and shivering. Results: The time on onset for a sensory block in the dexmedetomidine group was delayed compared to the fentanyl group (4.35 ± 0.14 min and 3.39 ± 0.11 min, respectively), (p < 0.0001). The duration of the block was longer for the dexmedetomidine group with a mean time of 327.26 ± 12.60 min versus 243.3 ± 22.75 min (p < 0.0001). When comparing the motor blockade, the time of onset to successfully reach Bromage score 3 was similarly delayed in the dexmedetomidine group with a mean time of onset of 3.33 ± 0.12 min versus 2.36 ± 0.09 min (p < 0.0001). A similar trend was seen in the duration of the block with a mean time of 262.17 ± 13.31 min versus 203.34 ± 1.47 min (p < 0.0001). Conclusion: Dexmedetomidine offered advantages over fentanyl as an adjunct to levobupivacaine spinal anaesthesia with a longer block duration and less adverse effects profile. It is recommended to use dexmedetomi-dine due to its better safety profile, longer duration and better hemodynamic stability. Fentanyl should be reserved when the early onset of the block is required in emergency cases.

A Single-Centre Experience of an Anesthesia-Led Pediatric Peripherally Inserted Central Catheter Service at a Specialized Cancer Institute

Introduction: To report our experience of establishing a pediatric peripherally inserted central catheter (PICC) line procedure led by the anesthesia department of a tertiary care cancer center. Materials / Patients and Methods: A retrospective review was conducted over a period of 28 months. Variables such as demographic data, indications, the number of days the line remained in situ, and the frequency of adverse events were considered. Results A total of 112 patients between the ages of one and fourteen years who had PICC lines inserted were included. All procedures were done under general anesthesia by two separate anesthesia teams with established protocols. Insertion was guided by ultrasonography through the basilic (n = 84, 75%), median cubital (n = 12, 10.7%), femoral (n=1, 0.9%), or cephalic (n=15, 13.39%) veins in the non-dominant arm. The insertion success rate was 97.3% while the unsuccessful in 2.7%. The 4Fr (French number) PICC line was used in 95 (84.82%) patients and 5F in 17 (15.17%) patients. The PICC line was used for an average of 85.47 days (ranging from 0 to 350 days). Chemotherapy (n = 89, 78.47%), difficult Intravenous (IV) access (n=15, 13.39%), and palliative care (n=8 7.14%) patients require long-term venous access. 38 (33.92%) patients had completed treatment with PICC line while 4 (3.57%) patients lost follow-up. Conclusion: PICC - lines are an essential element of cancer treatment in children. Anesthesia-led PICC line service is a reliable option. They maintain operating room, PICC line sterility during insertion, and complications comparable to follow the recommended precautions.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p < 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

Comparison of Dexmedetomidine with Tramadol for Treatment of Shivering Post Spinal Anaesthesia

Objective: To compare the efficacy of Dexmedetomidine with Tramadol for shivering post-spinal anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: A total of 158 patients who underwent gynaecological, orthopaedic and general surgical procedures under spinal anaesthesia using 0.5% hyperbaric Bupivacaine 12-15 mg were included in the study. Out of these 158 patients, 64% (102 patients) developed shivering after spinal anaesthesia. These 102 patients were divided into two equal groups, i.e., Group-D (n=51), who received 0.5 μg/kg Dexmedetomidine and Group-T (n=51), who received 0.5 mg/kg tramadol. The response in the next 15 mins was evaluated objectively as “effective” or “non-effective” by the treating Anesthesiologist. Results: Dexmedetomidine and Tramadol were effective in treating shivering following spinal anaesthesia. Our study showed that Dexmedetomidine was more effective than Tramadol in treating shivering, with an effectiveness of 88.2 % shivering relief in Group-D and an effectiveness of 51 % shivering relief in Group-T. The effectiveness was significant in both groups, with statistical significance in Group-D compared to Group-T (p<0.05). Conclusion: Shivering relief was more responsive in patients who received Dexmedetomidine than Tramadol after spinal anaesthesia.

Comparative Efficacy of Fentanyl Vs Dexmedetomidine Intrathecally as an Adjuvent to Isobaric Levo-Bupivacaine in Infra-Umbilical Surgery: A Prospective Randomized Study

Background: Fentanyl is a potent, highly lipophilic, synthetic opioid analgesic used as an adjuvant in spinal anaesthesia. Dexmedetomidine is also a potent, lipophilic, selective α2-adrenergic agonist. Compared to Dexmedetomidine, it has an earlier onset of block, better intraoperative analgesia with increased side effects(such as, nausea, vomiting or respiratory depression). Aim: To compare Fentanyl(25 ug) versus Dexmedetomidine(10 ug) as an adjuvant with 0.5% isobaric Levo-Bupivacaine in infra-umbilical surgeries. Material & Methods: A prospective, randomized, controlled study. Department of Anaesthesia, K. D. Medical College, Hospital and Research Centre in Mathura. Patients between 20-60 years of either sex, ASA Grade I – II, scheduled for elective infra-umbilical procedures with no co-morbid conditions. Simple random method(sealed envelope). Results: The sensory block duration is 7.71±0.31 hrs in D group and 3.78±0.83 hrs in group F with p value <0.05. The mean time taken for attaining motor blockade is 2.06 ± 1.17 mins in D group, 2.45 ± 1.39mins in F group. but statistically not significant between group D and in F group (p=0.2). The motor block duration is 7.33 ± 0.28hrs in group D and 3.39 ± 0.91 hrs in F group which suggestive of statistically highly significant (p=0.001). Conclusion: In infra-umbilical surgery, levo-Bupivacaine with adjuvant dexmedetomidine (10 ug) intrathecally has a longer duration of sensory and motor block with preserved hemodynamic stability and lesser adverse effects in comparison to adjuvant fentanyl(25 ug). However, onset of sensory block is earlier with fentanyl.

Comparison of the Mean Post-Operative Pain Score with Ultrasound Guided Transversus Abdominis Plane (TAP) Block and Wound Infiltration with Local an Aesthetic Agent in Abdominal Surgeries

Objectives: To compare the mean post-operative pain score with ultrasound-guided transversus abdominis plane block and wound infiltration with local anaesthetic agents in abdominal surgeries. Study design: Comparative prospective study Place and Duration of Study: Department of Anaesthesia, Intensive Care and Pain Management, Combined Military Hospital, Bahawalpur Pakistan, from Oct 2018 to Apr 2019. Methodology: Sixty patients undergoing abdominal surgery aged 18-60 years were included. The patients in Group-A received transverses abdominis plane block with 20 ml of 0.25% Bupivacaine bilaterally, while those in Group-B received 20 ml of 0.25% Bupivacaine as local wound infiltration. Each patient was followed till 6 hours post-operatively. Results: Out of 60 patients, 35(58.33%) were male, and 25(41.67%) were females. In our study, the Visual analogue score was 1.63±0.85 in Group-A (ultrasound-guided TAP block) compared with 4.47±1.07 in patients with Group-B (wound infiltration with a local anaesthetic agent) with a p-value of 0.001, which was statistically significant. Conclusion: The study concluded that the mean pain score in patients with ultrasound-guided Transversus abdominis plane block is less compared to wound infiltration with local anaesthetic agents in abdominal surgeries.

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Pain Management after Total Abdominal Hysterectomy

Background: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.Methods: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.Results: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min & 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p< 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p< 0.001).Conclusion: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.

Comparison Between Caudal and Combined Caudal with Spinal Anesthesia in Paediatric Bilateral Inguinal Hernia Surgery

Objective: To compare the analgesic efficacy and adverse effect profile of using caudal anaesthesia versus caudal combined with spinal anaesthesia for paediatric patients undergoing bilateral inguinal hernia surgery. Study Design: Prospective longitudinal study. Place and Duration of Study: Anaesthesia Department of Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Eighty paediatric patients between ages 5-10 years requiring bilateral inguinal hernia repair were included in the study. The Caudal Group received 0.25% Bupivacaine per the Armitage regime at a 1 ml/kg volume to reach an effective sensory level of T10. The Combined Group received spinal anaesthesia at a dose of 0.3 mg/kg for >15 kg patients and 0.4 mg/kg for 5-15 kg patients in the L4-L5 epidural space for an effective spinal level of T10. Once the spinal was administered, the same caudal dose as per the caudal Group's Armitage regime. Results: The total duration of block and subsequent reversal to the S1 level was 326.2±12.6 minutes in the Caudal Group versus 441.22±31.8 minutes in the Combined Group (p<0.001). The mean time for the first dose of analgesia for pain was required after 5.27±0.24 hours in the caudal versus 7.03±0.20 hours in the Combined Group. Conclusion: We conclude that the combined caudal spinal approach offers better and superior pain control, resulting in less IV analgesic requirement and less hospital stay, offering a good alternative to general anaesthesia in paediatric surgeries.

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications in the Post-anesthesia Care Unit: A Prospective Observational Study.

Background Neuromuscular blocking agents (NMBAs) are employed during general anesthesia induction for endotracheal intubation and to facilitate specific surgeries requiring muscle relaxation. However, residual neuromuscular blockade (RNMB) can lead to respiratory complications in post-anesthesia care units (PACUs). This study investigates RNMB incidence in PACUs and its association with postoperative airway and respiratory issues. Methods A prospective observational study on patients undergoing general anesthesia with NMBAs was conducted at the Department of Anesthesia, Salmaniya Medical Complex, Bahrain, over six months (April to September 2023). Train-of-four (TOF) ratios were calculated using an acceleromyograph upon PACU arrival. Data on demographics, perioperative variables, and postoperative complications were recorded. Results Among 82 patients, 30 (36.6%) had RNMB upon PACU arrival. RNMB incidence declined: 17.1% at 10 minutes, 6.1% at 20 minutes, and 2.4% at 30 minutes, resolving by 40 minutes. Demographics and procedure duration showed no correlation with RNMB. Postoperative respiratory complications affected 23.2% of patients, notably higher in those with RNMB (p = 0.001). Among patients with TOF <90% at PACU arrival, 46.7% experienced complications compared to 9.6% with TOF ≥90% (p<0.001). Participants without RNMB had a significantly higher weight (p = 0.046). Airway support was required for 30% of patients, all with TOF <90% (p<0.001). Conclusion This study emphasizes the importance of assessing and monitoring neuromuscular function to detect and prevent RNMB in PACUs. RNMB presence correlated with an increased susceptibility to postoperative respiratory complications. Regular quantitative neuromuscular monitoring is advisable in clinical practice to proactively mitigate RNMB incidence and its complications.

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

ObjectivesAnaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of the...

Implementation and evaluation of an event reporting system in an academic anaesthesia department

BackgroundReporting adverse clinical events is essential to a culture of safety in healthcare. However, self-reporting such events is generally not widely prevalent in a typical academic anaesthesia department.MethodsWe set out...

Oral cannabidiol (CBD) as add-on to paracetamol for painful chronic osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial.

Painful knee osteoarthritis (KOA) is common, pharmacological treatment, however, is often hampered by limited tolerability. Cannabidiol, which preclinically showed anti-inflammatory, analgesic activity, could supplement established analgesics, but robust clinical trials are lacking. The aim of our study was to investigate the effects of oral high-dose CBD administered over 8 weeks on pain, function and patient global assessment as an add-on to continued paracetamol in chronic symptomatic KOA. Prospective, randomized, placebo-controlled, double-blind, parallel-group study. Single center, Outpatient Clinic, Department of Special Anaesthesia and Pain Therapy at Medical University of Vienna, Austria. Eligibility criteria included: age: 18-98 years; painful KOA; score ≥5 on the pain subscale of the Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Index; KOA confirmed by imaging. Participants were on continued dosage of paracetamol 3g/d and randomly assigned by web-based software 1:1 to oral cannabidiol 600mg/d (n=43) or placebo (n=43). Study period: 8 weeks. Primary outcome: Change in WOMAC pain subscale scores (0=no pain, 10=worst possible pain) from baseline to week 8 of treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04607603. Trial is completed. The trial was conducted from October 1, 2020 to March 29, 2022. 159 patients screened, 86 randomized. Among 86 participants (mean age, 62.8 [SD 20.3] years; 60 females [69.8%]), 58 (67.4%) completed the trial. Mean baseline WOMAC pain subscale was 6.0±1.1. Analysis: Intention-to-treat principal. Mean reduction in WOMAC pain subscale was 2.5 (95% CI: 1.8-3.3) in the cannabidiol group and 2.4 (95% CI: 1.7-3.2) in the placebo group with no significant group difference (p=0.80). Adverse events were significantly more frequent with cannabidiol (cannabidiol: 135 [56%]; placebo: 105 [44%]) (p=0.008). Rise above baseline of liver aminotransferases and gamma-glutamyltransferase was significantly more common in the cannabidiol (n=15) than the placebo group (n=5) (p=0.02). In KOA patients, oral high-dose add-on cannabidiol had no additional analgesic effect compared to adding placebo to continued paracetamol. Our results do not support the use of cannabidiol as an analgesic supplement in KOA. Trigal Pharma GmbH.

A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions

: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I &amp; II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.

Knowledge and Attitudes of Anesthesia Staff on Pain in the Hospitals of Niamey

Aim of the study: To assess the knowledge and attitudes of anesthesia staff on the management of pain in the hospitals of Niamey. Patients an method: This was a multicenter descriptive cross-sectional study carried out in five hospitals in Niamey (Republic of Niger) from July 3rd to December 3rd, 2021. Were been included in the study, all the anesthesia staff who agreed to answer the questionnaire. The variables studied were: age, gender, seniority, sector of activity and qualification, definition of pain, different types of pain, the impact of pain on the body, tools used for assessment of pain, difference between acute and chronic pain, knowledge about analgesics, the practical attitudes of pain management. The data were intered and processed with Epi info 7.2 software and the Microsoft Office 2019 pack. Results: Our study concerned 106 agents from the anesthesia and resuscitation department of the hospitals that served as our study framework. There is a female predominance of 55.42% with a sex ratio of 0.80. The 45-54 age group was the most represented with 40.07% of cases. The average age of respondents was 44.95 ± 8.9 years. Anesthesia nurses were the most represented with 90.36%. The operating theatre unit was the most represented sector of activity with 85.54%. All the respondents knew the definition of pain. The different types of pains were known by 45.78% of respondents. The most used pain scales were visual analog scale (VAS) and verbal descriptor scale (VDS) respectively in 53.01 % and 12.05 % of cases. Tramadol and paracetamol were the mostly used analgesics respectively in 98.80 % and 97.59%. Intravenous morphine titration was known to 67.47% of the respondents. Only 18.07% of the respondents benefited from a training on the management of pain. Conclusion: The knowledge and attitudes of anesthetists on pain deserve to be updated through theorical and practical training to improve the management of pain in our hospitals.

Frequency of intraoperative hypotension after the induction of anesthesia in hypertensive patients with preoperative angiotensin converting enzyme inhibitors

Objective: is to evaluate the intraoperative hypotension after anesthesia induction in controlled hypertensive patients who have been taking ACE inhibitors preoperatively.&#x0D; Methodology: Prospective study conducted at department of anesthesia and ICU Jinnah Postgraduate Medical Institute, Karachi, Pakistan from 1st march 2021 to 28th February 2022. Before the surgery, the patient's mean arterial pressure and blood pressure (systolic, diastolic) were recorded in the preoperative holding area. During the surgery, the primary anesthesia team maintained an intraoperative monitoring chart. After the surgery, patient was shifted to recovery room, patient was monitored for blood pressure, for at least 10 minutes after the shifting from operation theater.&#x0D; Results: There were 73.1% males and 26.9% females, 57.7% patients had hypotension. The mean age, BMI and duration of anesthesia of the patients was 54.07±6.85 years, 26.52±4.45 kg/m2 and 82.19±3.16 minutes, respectively. There were 74.7% patients had hypotension and on antihypertensive drugs other than ACE inhibitor and hypotension was occurred in 74.5% of patients who are using ACE inhibitors as antihypertensive drugs (p&gt;0.050).&#x0D; Conclusion: Higher incidence of intraoperative hypotension in patients with controlled hypertension who are taking ACE (Angiotensin-Converting Enzyme) inhibitors. So, controlled hypertension with ACE inhibitors is a significant risk factor for intraoperative hypotension.&#x0D; Keywords: Intraoperative hypotension, ACE inhibiotrs, Hypertensive, Anesthesia, Antihypertensive

COMPARISON OF ARTERIAL PRESSURE AND VASOPRESSOR (PHENYLEPHRINE) AMONG PATIENTS UNDERGOING TURP WITH SPINAL ANESTHESIA VERSUS SADDLE BLOCK

Transurethral Resection of Prostate (TURP) is a common procedure for treating Benign Prostatic Hyperplasia (BPH) in elderly males. Spinal Anesthesia is conventionally used during the procedure; however, some studies have preferred saddle block regarding the average time of induction requirement for vasopressors. This study compared the mean change in mean arterial pressure and the mean vasopressor requirement (phenylephrine) among patients undergoing TURP with spinal anesthesia versus Saddle block. This randomized controlled trial was conducted at the Anesthesia Department, Jinnah Hospital Lahore, for Six months on 120 cases (group 1: 60, group 2: 60) of male patients aged 40-80 years undergoing TURP surgery. Patients in Group A received 2 ml of 0.75% bupivacaine and were placed supine with one pillow, while Group B received 2 ml of hyperbaric 0.75% in the same manner as Group A but remained in the sitting position for 10 minutes and then made supine with one pillow under the head. Demographic and clinical data was entered and analyzed using SPSS. Mean, Standard Deviation, Frequency, and percentages were calculated for quantitative and qualitative data, respectively, and an independent sample t-test was used for mean differences, keeping p-value&lt;0.05 as significant. The mean age in the Spinal anesthesia group was 61.23 ± 12.06 years, while the mean age in the Saddle block group was 59.55 ± 11.57 years. In the Spinal and Saddle block, the mean arterial pressure before the procedure was 102.60 ± 5.33 and 95.52 ± 4.52, respectively. The mean change in MAP in the spinal group was 20.02 ± 5.76, and in the Saddle block group was 10.95 ± 5.93. The mean vasopressor requirement in Spinal anesthesia was 102.18 ± 19.17, and in Saddle block was 30.67 ± 26.46, respectively. All measures showed significantly lower mean change in Saddle block groups, p-value &lt; 0.05 for all. This study's findings concluded that the mean change in mean arterial pressure and Vasopressor (phenylephrine) requirement among patients undergoing TURP Saddle block was favorable. So, TURP can be safely performed under saddle block without hypotension and less vasopressor requirement.

Organisation of UK hospitals and anaesthetic departments in the treatment of peri‐operative cardiac arrest: an analysis from the 7th National Audit Project (NAP7) local co‐ordinator baseline survey

SummaryWe report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri‐operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on‐site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri‐operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal.

Comparing anesthesia modes in major burns: Total intravenous anesthesia versus general anesthesia - A cross-sectional study in a Central Indian government hospital

Background: Burn injuries remain a significant public health concern, causing complex trauma. Early excision and skin grafting are standard in burn management to reduce infection and scarring. The choice of anesthesia is critical for optimal pain control and hemodynamic stability. Aims and Objectives: This study aims to compare total intravenous anesthesia (TIVA) and general anesthesia (GA) in patients of major burns. Materials and Methods: The study was conducted in the Department of Anaesthesia, M.G.M. Medical College and M.Y. Hospital, Indore, over a period of 12 months. One hundred and twenty patients with 10–12% total burn area were included and randomized into two groups of 60 patients each. Group T patients received TIVA and Group G patients received GA. Results: Both the groups were comparable with respect to age, gender, and baseline vitals. The mean heart rate, systolic and diastolic blood pressure, and mean MAP were significantly higher in Group G at 0, 30, and 60 min. In Group T, all patients achieved an Aldrete score of 9 or more within 10 min. Pain was more prevalent in Group G patients, and the comparison was found to be statistically significant. The mean time to first rescue analgesia in Group T was later than Group G, and the difference was found to be statistically significant. Conclusion: From the results, we may conclude that TIVA provides superior hemodynamic stability, shorter post-anesthesia unit recovery time, and improved analgesia compared to GA. However, there are lacunae in the literature, hence we recommend that larger studies comparing these two anesthesia modes be conducted before generalizing the present findings to the general population.