Surgeon Satisfaction Scores Research Articles

A comparative study of two different doses of dexmedetomedine as an adjuvant to lignocaine in infiltration block for tympanoplasty: a triple-blinded, prospective, randomized controlled trial.

The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients' comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia. After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18- 65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student's t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chisquare/Fisher's exact test. A P value less than 0.05 was considered statistically significant. The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group. Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care.

Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial.

Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS. Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes. The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1-6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05). The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.

Enhancing ketamine anesthesia with midazolam and fentanyl for children's ear surgery: a prospective randomized study.

Myringotomy with tympanostomy tube insertion (MTI) is a superficial surgical procedure used to prevent hearing loss in children with serous otitis media. Intravenous anesthesia, often ketamine, is preferred for this procedure because of its ability to induce sedation without compromising airway reflexes. However, ketamine alone may be insufficient and potentially lead to spontaneous movement during surgery. This study evaluated the effectiveness of midazolam and fentanyl as adjuvants to ketamine in reducing spontaneous movement during MTI and enhancing the quality of recovery. This study involved two groups of 30 patients each: one group received intravenous ketamine (1.5 mg/kg) with an equal volume of normal saline (K group), while the other received a combination of midazolam, fentanyl, and ketamine (0.05 mg/kg, 1 μg/kg, and 1.5 mg/kg, respectively; MFK group). We assessed side effects, intraoperative patient movement, surgeon satisfaction, and emergence agitation scores. The MFK group exhibited significantly lower scores for patient movement (p<0.01) and emergence agitation (p<0.01) and markedly higher surgeon satisfaction scores (p<0.01) than the K group. Administering a midazolam-fentanyl-ketamine combination effectively reduced spontaneous movement during surgery and emergence agitation during recovery without prolonging discharge times in children undergoing MTI.

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Comparison of the Efficacy of Sterile Silicone Studs Versus Lidocaine for the Attenuation of the Hemodynamic Response to Skull Pin Insertion: A Randomized Controlled Trial

BackgroundSkull pin insertion causes hypertension and tachycardia that adversely affects cerebral hemodynamics. We compared the efficacy of sterile silicone studs (SS) and pin site infiltration with lidocaine in attenuation of the sympathetic response to skull pin insertion. MethodsOne hundred and twenty adult patients undergoing supratentorial craniotomy under general anesthesia were randomized to receive either medical-grade sterile SS (Group SS) or 2 ml of 2% plain lidocaine infiltration at each pin site (Group LO). The primary objective was the comparison of the hemodynamic (heart rate [HR] and mean arterial pressure [MAP]) response to skull pin insertion at baseline and 0, 1, 2, 3 and 5 minutes of skull pin insertion. The secondary objectives were to assess the requirement of rescue analgesia (fentanyl), complications like pin-site bleeding, and the surgeon satisfaction score. ResultsThe HR in Group LO was significantly greater at 0, 1, 2, 3 and 5 mins post pin insertion as compared to Group SS (P <0.05). The MAP was also significantly higher in Group LO at 0, 1, 2, and 3 mins post pin insertion (P = 0.001, 0.01, 0.034 and 0.042 respectively) as compared to Group SS. The number of patients requiring fentanyl [17/60 (28.3%) v/s 40/60 (66%), P=0.001] was lower in Group SS. The incidence of pin site bleeding was also lower in Group SS along with a greater surgeon satisfaction score. ConclusionSterile SS appears to be more effective than lidocaine infiltration in attenuating the hemodynamic response to skull pin insertion with minimal adverse effects. Further multi-centre studies are necessary to conclusively establish the safety and efficacy of sterile SS.

A Modified Subbrow Blepharoplasty for Correction of Severe Upper Eyelid Skin Laxity.

Periorbital aging is characterized by dermatochalasis, lateral hooding and malformation of multiple eyelid creases. Rejuvenation of periorbital region is of great concern in aging Asians, especially for the females. However, the conventional subbrow blepharoplasty was indicated for mild or moderate skin laxity. For severe laxity, double-eyelid incision is necessarily to be involved. This study aims to improve the severe upper eyelid dermatochalasis through an extended subbrow single-incision approach with desirable outcomes. Patients underwent this surgical method from October 2020 to April 2022 were retrospectively reviewed. The redundant skin and orbicularisoculimuscle were excised through a spindle-like subbrow incision delicately designed in the sitting position. Surgical outcomes were evaluated by heights of designed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC) at different follow-ups. The overall satisfaction score of cosmetic outcomes was assessed by an independent surgeon and patients themselves based on the evaluation of: subbrow scar, eyelid symmetry, lateral hooding lifting, visual block improvement and brow shape. A total of 75 cases were reviewed, including 3 men and 72 women. The preoperative HPPC, HPMC, and HPLC were 4.27 ± 0.40, 4.72 ± 0.45 and 3.41 ± 0.35 mm. The values were postoperatively improved to 7.01 ± 0.46, 6.57 ± 0.34 and 5.69 ± 0.26 mm, respectively, presenting significantly different (p<0.05). The mean surgeon satisfaction scores were 3.6 ± 0.6 (range, 2.0-4.0), and patient satisfaction scores were 3.5 ± 0.6 (range, 2.0-4.0). No hypertrophic scar, sunken upper eyelids or other complications was found. The modified subbrow blepharoplasty method is an effective and safe alternative for correcting severe upper eyelid skin laxity, which can achieve both good cosmetic outcomes and functional improvement. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A comparative study between the effect of intravenous versus intranasal dripping of dexmedetomidine on intraoperative blood loss during functional endoscopic nasal sinus surgery

ABSTRACT Background Functional endoscopic sinus surgery (FESS) is considered one of the most common ENT procedures. The main obstacle is impaired vision owing to excessive bleeding. Many drugs have been used to control such issues. Dexmedetomidine has a great affinity to α2-adrenergic receptors. This research evaluated the hypotensive effect of intravenous against the intranasal dexmedetomidine in FESS. Materials and methods Patients randomized into 2 equal groups:Dexmedetomidine intravenous group (IV group) (n = 35): IV dexmedetomidine 1 μg/kg in 100 ml of normal saline (0.9%) was infused 15 min before starting anesthesia, followed by 0.5 μg/kg/h. At the same time, intranasal saline was given as a placebo.Dexmedetomidine intranasal group (IN group) (n = 35):IN dexmedetomidine (2 μg/kg) was given 15 min before induction, 1 ml in each nostril. At the same time, the patient received 100 ml of saline (0.9%)15 min before anesthesia, followed by IV saline as a placebo. The primary outcome was Boezaart’s grading scale. Other outcomes were the recorded hemodynamics, surgical satisfaction, sedation score, and adverse events. Results The calculated blood loss and Boezaart’s scale were lower in the IV group (p value < 0.001). Also, the IV group’s mean arterial blood pressure (MAP) and heart rate were significantly lower. The total intraoperative fentanyl dose was lower in the IV group. Surgeon satisfaction and sedation scores were significantly higher in the IV group. Conclusions Intravenous dexmedetomidine provides a better surgical field, more surgeon satisfaction, and lower blood loss for FESS.

Multimodal blood loss prevention bundle for endoscopic resection of juvenile nasopharyngeal angiofibroma: A case series.

Surgery for excision of juvenile nasopharyngeal angiofibroma (JNA) carries the possibility of massive life-threatening haemorrhage. Anaesthetic management aims to maintain haemodynamic stability and reduce blood loss. This case series describes the application of the bundled approach as a multimodal blood loss prevention bundle (MBLPB). Twenty patients underwent 23 surgeries with MBLPB. The blood loss and the number of units of blood transfused were recorded. The surgeon satisfaction score was assessed. The median [interquartile range (IQR)] estimated blood loss was 1300 (650-2350) ml. Patients with tumours in stages I and II had a median (IQR) blood loss of 550 (270-750) ml compared to patients with higher grades of tumours (stages III, IV) with a median (IQR) blood loss of 2100 (1300-2500) ml. Median (IQR) units of packed red cells transfused was 1 (0-3). The surgeon's satisfaction score was high when MBLPB was applied for JNA. However, it does not appear to reduce blood loss markedly.

Comparison of Opioid-Based Versus Opioid-Sparing Anesthesia in Patients Undergoing Glioma Surgery.

Background In the neurosurgical population, opioids may cause respiratory depression, leading to hypercapnia, increased cerebral blood flow (CBF), and ultimately increased intracranial pressure (ICP), which can mask early signs of intracranial complications and delayed emergence. This study was designed to compare perioperative hemodynamic stability, analgesia, and recovery parameters in opioid-based (fentanyl) general anesthesia versus opioid-sparing (dexmedetomidine) general anesthesia in patients undergoing glioma surgeries. Methodology This prospective observational comparative study compared 52 patients in two groups. Twenty-six (50%) patients in group F received Inj. fentanyl IV (intravenous; bolus 2 mcg/kg 10 minutes before induction and then infusion 1 mcg/kg/hour till 30 minutes before skin closure), whereas 26(50%) patients in group D received Inj. dexmedetomidine IV (0.5 mcg/kg infusion 10 minutes before induction and then maintenance with a 0.5 mcg/kg/hour infusion till 30 minutes before skin closure). Perioperative heart rate (HR), mean arterial pressure (MAP), Numerical Rating Scale for Pain (NRS) assessment and postoperative emergence time, modified Aldrete score,patient satisfaction, and surgeon satisfaction score were estimated and compared in both groups. Results The mean HR was less in group D compared to group F at following time points - 10 minutes after infusion (P= 0.006), laryngoscopy and intubation (P= 0.003), pinning of the skull (P< 0.001), one hour after dura opening (P= 0.007), two hours after dura opening (P = 0.006), five minutes after extubation (P< 0.001), and 30 minutes after extubation (P= 0.011). MAP was lower in group D compared to group F at the following time intervals: 10 minutes after infusion (P= 0.008), five minutes after extubation (P= 0.007), 30 minutes after extubation (P< 0.001), and one hour after extubation (P= 0.023). A significant decrease in emergence time in group D compared to group F (P< 0.001) was noted. NRS was lower in group D at eight hours (P= 0.005) and 12 hours (P< 0.001) post-extubation. Conclusions Dexmedetomidine can be used as an alternative to fentanyl in terms of perioperative hemodynamic stability, perioperative analgesia, smooth early recovery from anesthesia, patient satisfaction, and surgeon satisfaction.

Ultrasound-guided Pectoral Nerve Block in Combination with Interpleural Block for Surgical Anesthesia during Breast Cancer Surgery: A Prospective Feasibility Study

Abstract Background: The aim of this study was to evaluate the feasibility of ultrasound-guided pectoral nerve block combined with interpleural block for surgical anesthesia during the modified radical mastectomy (MRM). Methods: Thirty-six female patients scheduled to undergo MRM were included in this study. After taking all aseptic precautions, an ultrasound-guided pectoral nerve block and interpleural block were performed with 20 ml of 0.25% bupivacaine for each block. We started all patients on dexmedetomidine infusion to achieve conscious sedation and used injection ketamine as rescue analgesia. We recorded hemodynamic parameters throughout the surgery and visual analog scale scores of pain at baseline and after providing rescue analgesia. Postoperatively, we assessed surgeon and patient satisfaction scores. Results: MRM was completed in 31 (86%) out of the 36 recruited patients. Among these 31 patients, 5 (16%) did not require a rescue dose of ketamine, 14 (45%) required one rescue dose, and 12 (39%) patients required two rescue doses of ketamine. Postoperatively, the median patient and surgeon satisfaction scores were 85 (75–90) and 85 (80–90), respectively. The mean dose of dexmedetomidine was 175 (±27) μg, and the mean dose of ketamine was 32.8 (±6) mg. No serious adverse events were reported. Conclusion: MRM can be feasibly performed under ultrasound-guided pectoral nerve block and interpleural block, along with conscious sedation, without any significant adverse events.

Comparison of Epidural, Combined Spinal Epidural, and Dural Puncture Epidural Techniques for Labor Analgesia

Background: Lumbar epidural analgesia is a safe, effective, and beneficial technique for both the parturient and the fetus. Dural puncture epidural has been claimed to be better than combined spinal epidural and epidural techniques by many. We undertook this study to compare the three techniques regarding duration, quality of analgesia, and side effects. Debate regarding the best neuraxial technique for labor analgesia continues. Materials and Methods: The parturients of ASA grade I and II of age group 20–35 years were randomly divided into three groups of 20 each. Group E (epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in the epidural space. Group CSE (combined spinal epidural group) received 2.5 mg of intrathecal isobaric levobupivacaine with 25 µg fentanyl and epidural top up of 15 ml of 0.125% levobupivacaine with 30 µg fentanyl. Group DPE (dural puncture epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 µg fentanyl in epidural space; intrathecal medication was withheld. Epidural top-up doses were given as per Visual Analog Scale (VAS). Analgesic efficacy, extent of sensory and motor block, maternal and fetal outcome, duration of analgesia, and maternal satisfaction score were compared among three groups and analyzed statistically. Results: The onset and symmetry of sensory blockade and VAS score were better in CSE group. DPE group had better sacral coverage and less asymmetric blockade. Groups CSE and DPE had superior maternal and surgeon satisfaction scores in comparison to group E. Both groups E and DPE provided analgesia with minimal motor blockade and ambulation.

Role of erector spinae plane block in transjugular intrahepatic portosystemic shunt procedure: A randomized controlled trial

ABSTRACT Background Anesthesia for transjugular intrahepatic portosystemic shunt (TIPS) for lowering raised portal pressure is clinically challenging. As patients, candidates for TIPS are medically complex due to chronic liver disease, adding to remote area anesthesia’s complexities. Multimodal analgesia, including erector spinae plane block (ESPB), can improve anesthesia quality with patient satisfaction. Methods Fifty-six patients scheduled for TIPS, aged 18–60 years and with Child classification A or B, were randomly allocated into two groups. The ESPB group experienced ESPB (n = 24), while the control group was introduced with sedation spontaneously breathing (n = 24). Primarily, we investigated the records of the hemodynamic profile and analgesia nociceptive index (ANI). As a secondary aim, we recorded the opioid consumption, complication incidence, and patient and interventional radiologist satisfaction scores. Results Heart rate was significantly lower in the ESPB group at the beginning of the procedure, liver puncture, and balloon dilatation events, while there were no significant differences in mean blood pressure. Analgesia assessment by ANI was significantly higher in the ESPB group indicating adequate analgesia. Opioid consumption was significantly lower in the ESPB group than in the control group. Statistical analysis for patient satisfaction showed better results in the ESPB group, while the surgeon satisfaction score showed no significant statistical differences. Conclusion ESPB could be recommended as an alternative to analgesia in TIPS and its vulnerable patients to improve safety by reducing sedation-related morbidity and complications with improving the patient’s degree of satisfaction.

Comparison of lung ultrasound technique versus clinical method to evaluate the accuracy of size and placement of left endobronchial double lumen tube in patients undergoing elective thoracic surgery: a prospective observational study.

Anthropometric measurements like height and gender have been frequently found to be inaccurate in prediction of size of double lumen tube (DLT). A tracheal ultrasonography (TUS) is a technique that can be used to predict the size of DLT and its correct placement for lung isolation. We aim to check the accuracy of ultrasound over clinical methods. This prospective study included 68 patients undergoing elective thoracic surgery requiring one-lung ventilation (OLV) with DLT. The groups were assessed for the size of DLT by either anthropometric measurement using height and gender (Group C) or ultrasound method (Group U). Further, the accuracy of placement of DLT was assessed through, either lung auscultation in group C or various ultrasonographic and ventilatory parameters such as lung isolation in the first attempt (lung sliding and lung pulse sign), oxygenation status and peak airway pressure, in group U. Surgeon satisfaction score was also compared in both the groups. The accuracy of predicted DLT size between Group C and Group U was statistically significant (p=0.044). In Group C, 56% of patients showed a mismatch between the predicted DLT size and the actual size required, while in Group U, the mismatch was only 32.4%. The accuracy of DLT placement through group C was 41% as compared to 79% in Group U. Surgeon satisfaction score was also significantly higher in Group U as compared to Group C (p=0.0028). Thus, our study suggests that tracheal and chest ultrasonography for DLT size selection and placement for lung isolation is superior to clinical methods.

A Prospective Observational Study Analyzing the Analgesic Efficacy of Caudal Block and Nerve Stimulator-Guided Pudendal Nerve Block in Children Undergoing Hypospadias Repair.

Hypospadias repair is a common pediatric surgery. While caudal block (CB) is the most widely used procedure for analgesia, pudendal nerve block (PNB) can be utilized as an alternative. We evaluated the postoperative analgesic efficacy of CB and PNB in children undergoing hypospadias repair. In this prospective observational study, we evaluated 101 patients who received standard general anesthesia along with CB or PNB. Postoperative pain score (Face, Legs, Activity, Cry, and Consolability {FLACC} score) along with the total number of analgesicdoses and the total amount of analgesic drugs consumed within 24 hours were noted. Time to first rescue analgesia, post-block penile length and midshaft circumference, surgeon satisfaction score, and postoperative complications were also evaluated. Out of 101 patients observed, 50 received CB, and 51 received PNB. At 24-hour interval, the median FLACC score in CB was 6, while in the PNB, it was 4 (p<0.001). None of the patients who were given PNB received more than three doses (p<0.001), and the average consumption of analgesic drugs within 24 hours was significantly higher in CB (38.4±4.28) compared to PNB (21.7±6.33) (p<0.0001). The median time to first rescue analgesia in CB was four hours, while in patients receiving PNB, it was eight hours(p<0.001). The increase in penile volume was significantly higher with CB as compared to PNB (p<0.001). Surgeon satisfaction score was found to be better with PNB (p<0.002). Patients who received PNB had significantly reduced pain scores and analgesic consumption in the first 24 hours post surgery.

Comparison of spermatic cord ligation and the vas plexus ligation in canine orchiectomy: A prospective clinical study.

Orchiectomy with a vas deferens to pampiniform plexus ligation (VPL) is a novel method, and it is unclear how its short-term outcomes compare with the results of a conventional method, spermatic cord ligation (SCL). To compare the short-term outcomes of SCL and VPL on inflammation, surgery time, bleeding, pain and surgeon satisfaction during canine open orchiectomy. Thirty male crossbred dogs undergoing open orchiectomy were enrolled the study. Dogs were randomly allocated to one of the SCL or VPL groups, with 15 patients in each. In the SCL group, the spermatic cord was ligated using absorbable sutures. The vas deferens, and pampiniform plexus self-tying were performed in the VPL group. Surgery time, bleeding and surgeon satisfaction scores were recorded. Inflammation at the surgical site was assessed using infrared thermal camera over three days, and pain associated with inflammation was scored on the third day. On Day 3, the average temperature in the SCL group was significantly higher than that of the VPL group, with a mean difference of 4.63°C (95% CI: 2.34-6.93, p<0.001). Moreover, the surgery time in the VPL group was significantly longer compared to the SCL group, with a mean difference of 1.7min (95% CI: 0.28-3.11, p=0.021). The bleeding score was also significantly higher in the VPL group (p=0.012). On the other hand, surgeon satisfaction and pain scores were not significantly different between groups. Both SCL and VPL methods are safe and effective for orchiectomy in dogs. VPL is comparable in efficacy and safety and has the additional benefit of less inflammation.

EFFICACY AND SAFETY OF CONVENTIONAL EPIDURAL VERSUS COMBINED SPINAL EPIDURAL IN PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE AND RANDOMIZED CLINICAL STUDY

Objectives: The aim of the study was to compare the efficacy and safety of conventional epidural (ED) versus combined spinal epidural (CSE) in percutaneous nephrolithotomy (PCNL) with addition of opiods and dexmedetomidine. Methods: This prospective, randomized, and double-blinded clinical study was conducted in the in patients undergoing PCNL. Group CSE had received CSE anesthesia and Group ED given conventional epidural anesthesia. Time to first rescue analgesic and total dose of rescue analgesic along with hemodynamic parameters were compared up to 24 h. Patient, surgeon satisfaction score, and post-operative complications were also compared. Results: Time from onset of sensory block to first requirement of analgesia was prolonged in group CSE (218.4±18.30 min) as compared to Group ED (210±17.88 min). (p&lt;0.001) Mean time for first rescue analgesia postoperatively was highly significant in group CSE (2.42±0.49) as compared to Group ED (2.08±0.28). (p&lt;0.0001) Total dose of levobupivacaine required was high in Group ED (49.66±7.02) as compared to Group CSE (45.66±3.12). (p&lt;0.001) In Group ED, surgeon score was good in 20 (44.44%) patients and which was highly significant. In Group CSE, surgeon score was excellent in 41 (91.1%) patients and which was highly significant. (p&lt;0.001) Post-operative complications in both the group were comparable (p&gt;0.05). Conclusion: This study concluded that though both the anesthesia techniques are safe and efficient with each having its own benefits. CSE had proven superiority over the epidural technique.

OUR EXPERIENCE OF REGIONAL ANESTHESIA FOR PERCUTAEOUS NEPHROLITHOTOMY SURGERIES IN 213 CASES

Percutaneous nephrolithotomy (PCNL) is mainly done for renal and upper ureteral stone removal1. Anesthesia techniques are general or regional anesthesia. Many studies have shown perioperative events related to anaesthesia 2. Regional anesthesia is preferred mainly to avoid general anesthesia related complications, and postoperative morbidity and to enhance practice of fasttracking. So we studied intraoperative instability, postoperative complications and patient and surgeon satisfaction in patients who received regional anaesthesia. After ethical committee approval, regional Method: anaesthesia were given for all 213 patients between 18-65 yrs who underwent PCNL surgeries. Perioperative hemodynamics like blood pressure, heart rate , postoperative complications in terms of shivering, vomiting, blood loss, pain and patients's and urosurgeon's satisfaction score was assessed. Out of 213, 28 patients were Result: received combined spinal epidural anaesthesia. Spinal anaesthesia was given to remaining 185 patients. In Intraoperative events, bradycardia (1), hypotension ( 31), bleeding at surgical site(2), and 1 case with hemothorax. Pain score was tolerable in 183 (85.9%) and intolerable in 30 (14%) patients. Hospital stay was total 3 days in 79% cases, more than 3 days in 21% cases. Surgeon's Satisfaction score was 2 in 23.9%, 3 in 75% for surgeons. Patient s satisfaction score was 2 in 24% and 3 in 75 %. In this mi Conclusion: nimally invasive urosurgeries, regional anaesthesia is an altenative anaesthesia choice for PCNL because of better hemodynamic stability, lesser complications and better satisfaction by surgeons and patients. Counselling, optimization of the patients by anaesthesiologists ,urosurgeons are needed for rapid recovery of such cases

EFFICACY OF INTRAVENOUS DEXMEDETOMIDINE VERSUS MAGNESIUM SULPHATE FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY: A RANDOMIZED DOUBLEBLIND STUDY.

Background &amp; Aim: Controlled hypotension is an anaesthestic technique in which there is deliberate reduction of systemic blood pressure during general anaesthesia. The aim of our study was to compare the efcacy of intravenous dexmedetomidine and magnesium sulphate for controlled hypotension in functional endoscopic sinus surgery. A randomized, Method: prospective, and double-blind study was carried out, which included 92 patients of either sex of ASA grade I &amp; II who underwent elective FESS. Patients were randomly assigned to two groups: Group D, patients received dexmedetomidine 1 µg/kg infused over 10 minutes before induction of anesthesia, followed by continuous infusion of 0.4-0.8μg/kg/hr. Group M, Patients received intravenous MgSO4 40 mg/kg infused over 10 minutes before induction of anesthesia, followed by continuous infusion of 10 to 15 mg/Kg/hr. Results: There was no signicant difference in MAP and HR between both the groups. Average category scale was lower (p&lt;0.001) and surgeon's satisfaction score was higher (p&lt;0.001) in group D when its compared group M. Blood loss was less in group D than group M. Incidence of Bradycardia &amp; Hypotension in group D was 15.22% &amp; 36.96% while in group M was 2.17% &amp; 13.04%. The difference in incidence of Bradycardia &amp; Hypotension in both the groups was statistically signicant. Both dexmedetomidine and MgSO4 provide satisfac Conclusion: tory controlled hypotension in FESS. However, dexmedetomidine is found to be more effective in terms of good surgical eld, less blood loss, better surgeon satisfaction score.

Evaluation of magnesium sulfate as an adjuvant in sub-Tenon anesthesia for cataract surgery: A prospective, randomized controlled trial.

To evaluate the efficacy, safety, and satisfaction for the use of adjuvant; magnesium sulfate (MgSO4) in sub-Tenon anesthesia for cataract surgery. This single centered randomized, double blind trial was held in 2021 after approval of ethical committee at the Eye Hospital, Riyadh, Saudi Arabia. Cataract patients to be operated using local anesthesia were randomly assigned to two groups; Group magnesium sulfate (MS) received 50 mg/0.5 ml of magnesium sulfate and Group normal saline (NS) received 0.5 ml of normal saline added to the standard mixture, respectively. Absence of eyelid dropping and akinesia of the globe at different time after anesthesia were considered as ineffective anesthesia. The age and sex-adjusted generalized estimating equation (GEE) analysis was carried out. Complications, patient's and surgeon's satisfaction were also compared. Each group had 100 cataract patients. Effectiveness of block was not significantly different in two groups (adjusted odds ratio, 0.90; 95% confidence interval [CI], 0.62, 1.31; P = 0.594). The likelihood of "no eye-opening" significantly increased with time (adjusted odds ratio, 1.26; 95% CI, 1.18-1.34; P < 0.001). Subconjunctival bleeding was significantly higher in the MS versus NS Group (36 of 98 [36.7%] vs. 11 of 102 [10.8%], P < 0.001). Chemosis was not significantly different between the groups (P = 0.95). Patient's satisfaction score was very good (9/10) but slightly higher in NS group than MS (P = 0.001) while surgeon's satisfaction score was similar in both groups (P = 0.149). Although safe, adding 50 mg of magnesium sulfate did not improve the effect of sub-Tenon anesthesia for cataract surgery. Risk of subconjunctival bleeding was higher in cataract patients operated using MgSO4 compared to those managed with the conventional sub-Tenon anesthetic.

Comparison of Different Carbon Dioxide Insufflation Rates on Hemodynamic Changes in Laparoscopic Surgeries: A Randomized Controlled Trial.

Introduction The injury and detrimental effects of carbon dioxide (CO2) insufflation during laparoscopic surgeries may be due to the higher flow rates used during insufflation. The aim of our study was to study the effects of different CO2 insufflation flow rates on hemodynamic parameters in laparoscopic surgeries. The secondary objectives were to compare the patient and surgeon satisfaction scores, postoperative shoulder scores, and surgical site pain scores. Methods This prospective, randomized, double-blinded trial was commenced after institutional ethical committee approval and The Clinical TrialsRegistry- India (CTRI) registration (CTRI 2021/10/037595). Ninety patients scheduled for laparoscopic cholecystectomy were randomly divided into three groups based on CO2 insufflation flow rate by computer-generated random numbers and the sealed envelope method: Group-A: 5 L/min; Group-B: 10 L/min; and Group-C: 15 L/min. General anesthesia was standardized in all three groups. Mean arterial pressure (MAP) and heart rate were recorded at different timelines, which included the arrival in the operating room (T0), just before the induction of anesthesia (T1), at the beginning of pneumoperitoneum (T2), 10 minutes (T3), 20 minutes (T4), 30 minutes (T5), and 60 minutes (T6) after the pneumoperitoneum, at the end of the operation (T7), five minutes (T8), and 15 minutes (T9) after arriving at the recovery room. The patient and surgeon satisfaction scores were assessed on a 5-point Likert scale. The visual analog score (VAS) was used to assess the surgical site pain and shoulder pain every four hours for 24 hours. The continuous data were assessed by one-way analysis of variance (ANOVA), and the categorical data were assessed by the Chi-square test. The sample size was estimated based on a pilot study and using the G Power 3.1.9.2 Program (Universitat Kiel, Germany) calculator. Results There was an increase in the mean arterial pressure (MAP) between the groups 60 min after pneumoperitoneum creation with higher flow rates. The baseline MAP was 85.76± 10.11 in group A, 86.03± 9.79 in group B, and 88.13± 8.46 in group C. At 60 min from the creation of the pneumoperitoneum, the MAP increased significantly from 99.17 ± 9.35 in group A, 102.43 ± 8.24 in group B, to 106.83 ± 8.31 in group C. This was statistically significant with a p-value of 0.004. There was a statistically significant difference in heart rate between the groups 10 minutes after pneumoperitoneum creation. No complications were reported in any of the groups. The postoperative shoulder pain was more severe when higher flows were used at 20 and 24 hours. The surgical site pain was also significantly more for up to 12 hours following surgery with higher flows. Conclusion We conclude that low-flow CO2 insufflation during laparoscopic surgeries is associated with fewer hemodynamic changes, better patient satisfaction scores, and lower postoperative pain scores.