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Byline: Priyanka. Mudavath, Indira. Gurajala, Prasad. Kaluvala, Padmaja. Durga Background and Aims: Most studies have found that lumbar epidural catheterisation is technically easier with a paramedian than median approach. There [...]

Byline: Shibani. Padhy, Indira. Gurajala, Padmaja. Durga, Akhya. Kar, Manjeera. Doppalapudi, P. Pranay Background and Aims: Predicting complications after major oncosurgery is particularly daunting in the elderly subcategory of patients [...]

Byline: Madhusudan. Upadya, Padmaja. Durga, Sumesh. Rao, Madhuri. Kurdi Researchers often claim primacy in their study being first in their country's populace, pointing to ethnic importance. Race and ethnicity play [...]

Background and Aims: Chronic post thoracotomy pain (CPTP) is a nagging complication and can affect quality of life (QOL). Studies conducted across globe have found a wide variability in the risk factors predisposing to chronic pain following thoracotomy. As no study on CPTP is available from India, we aim to detect the prevalence of CPTP, assess the predisposing factors implicated in its causation and study the impact of CPTP on QOL. Methods: After obtaining clearance from Institutional ethics committee, medical records of patients who underwent open posterolateral thoracotomy between January 2012 and December 2015 were reviewed. Data on perioperative variables, address, and contact number were collected from the patient records. All patients were mailed the Telugu translation of medical outcome study short form -36(MOS-SF-36) QOL questionnaire and were contacted telephonically to enquire about presence of CPTP and QOL. A univariate analysis was done to assess factors associated with CPTP and a multivariate logistic regression analysis was done subsequently to identify independent risk factors of CPTP. QOL indices were compared between those patients who suffered from CPTP and those who did not. Results: The prevalence of pain in our study was 40.86% (85/208). The factors implicated in the causation of CPTP were diabetes mellitus, preoperative pain, rib resection, and duration of chest tube drainage with odds ratio of 9.8, 2.6, 6.7, and 1.03, respectively. The health-related QOL showed poor scores in all domains in patients suffering from CPTP. Conclusion: The prevalence of CPTP was high. It significantly impacts health-related QOL.

Byline: Shibani. Padhy, Abhiruchi. Patki, Akhya. Kar, Padmaja. Durga, L. Sireesha Background and Aims: Adductor canal block (ACB), though an effective procedure for postoperative analgesia in total knee arthroplasty (TKA), [...]

Background and Aims: The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery. Material and Methods: In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite. Results: There was a statistically significant decrease in both pain threshold (P < 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery (P = 0.048). The magnitude of change in pain scalars was greater in females (P < 0.001), those with a high anxiety score, and a history of severe painful experience in the past. Conclusion: Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research. [ABSTRACT FROM AUTHOR]

Byline: Ankur. Khandelwal, Kiran. Jangra, Manisha. Katikar, Padmaja. Durga, G. Maheswara Rao Anaesthesiology is an ever-changing science and amongst its sub-specialities, the field of neuroanaesthesia is making rapid strides. The [...]

Introduction: The empiric use of antibiotics in Coronavirus Disease-2019 (COVID-19) infection is not routinely recommended unless a secondary bacterial infection is suspected or confirmed. However, there have been reports of widespread antibiotic use in COVID-19 patients, despite a low rate of secondary bacterial co-infection. Therefore, this study aims to understand the factors influencing the empirical prescription of antibacterial drugs in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients in Indian settings, as the available data is sparse and conflicting. Aim: To determine the factors associated with antibacterial prescription in patients with proven COVID-19 infection at a tertiary care hospital. Materials and Methods: An antibacterial surveillance study was conducted at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study duration was two months, from September 2020 to October 2020. The study included COVID-19 patients admitted to critical and non-critical COVID-19 Care Units. Patient data, including demographics, general and systemic examination details, biochemistry, pathological and microbiological reports, and treatment details, were collected using a specially designed form. Patients who were prescribed antibacterial drugs (other than repurposed antibacterial drugs for COVID-19 treatment) were considered as cases, while the rest were classified as controls. The Hazard Ratio (HR) for factors associated with antibacterial prescription was estimated using Cox regression analysis with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 200 patients, of whom 45 (22.5%) received antibacterial drugs and were classified as cases, while the remaining 155 (77.5%) received antibacterial drugs and were classified as controls. The median age of cases and controls was 59 and 46 years, respectively. Cox regression analysis showed that procalcitonin >1 ng/mL (HR: 1.074, 95% Confidence Interval [CI]: 1.009-1.142, p-value=0.02) and admission to the critical care unit were independent predictors of antibacterial prescription. Additionally, high-dose steroid use (>120 mg/day of Methylprednisolone [MPS]) was associated with a 20% higher risk of antibacterial prescription, although the values were statistically non-significant (HR: 1.203, 95% CI: 0.503-2.879, p=0.678). Conclusion: Admission to critical care units and procalcitonin levels >1 ng/mL were identified as independent predictors of antibacterial prescription in COVID-19 patients. Compliance with hospital-based standard treatment guidelines promotes the rational use of antibacterial drugs. [ABSTRACT FROM AUTHOR]

Background and Aims: Intravenous induction agents like propofol and etomidate change the airway mechanics and thus influence mask ventilation. These changes have an impact on the administration of muscle relaxant in a difficult mask ventilation scenario. The difference in dynamics of airway after administration of two different intravenous agents has been assessed in this study. Material and Methods: After formal registry in clinical trials, patients undergoing general anesthesia were recruited and randomized into group P and E. Patients were induced with either of the intravenous agents, and mask ventilation was performed with a ventilator. After 60 s, rocuronium was administered and ventilation continued. Measurements of tidal volume, peak airway pressure, and compliance were taken from the anesthesia ventilator at different time points – induction, relaxant, and intubation. Results: There was no statistically significant difference between the two groups with respect to demographics, airway parameters, and airway mechanics, as measured by tidal volume, peak airway pressure, and lung compliance. There was an improvement in the tidal volume and compliance following induction with propofol, with a P value of 0.007 and 0.032, respectively, obtained in within-group comparison. Conclusion: Propofol and etomidate were comparable in airway mechanics, but compliance and tidal volumes improved with propofol, which facilitated face mask ventilation. [ABSTRACT FROM AUTHOR]

The coronavirus disease COVID-19 caused by SARS-CoV-2 was a worldwide public health emergency which affected millions of people including frontline healthcare workers too. We evaluated the clinical features and biochemical investigations in COVID-19 affected healthcare workers (HCW) admitted to NIMS Intensive care unit (ICU) including survivors and non-survivors to identify risk factors for mortality. We did a retrospective study of 78 HCW with RTPCR confirmed COVID-19 infection admitted in ICU between July and November, 2020. Subjects were grouped into survivors and non-survivors. Clinical features and biochemical investigations were compared. Survival analysis was performed to analyze the risk factors of mortality. Out of the 78 patients admitted to ICU, the majority were males (64%). Non-survivor patients were older with a median age of 64 years. There were significantly higher proportion of females (59%) in non-survivors. COVID-19 non-survivors had significantly more incidence of cardiovascular disease and also higher blood levels of AST, CPK, CRP, D-dimer, IL-6, LDH, urea, NTproBNP and procalcitonin. Hazard's ratios showed that the mortality risk was significantly higher and survival was significantly lower in patients more than 60 years in age, females and those having IL-6 >40.06 pg/mL, LDH >461U/L, NTproBNP >1188 pg/mL, procalcitonin >0.5 pg/mL, urea >67 mg/dL, creatinine >1.3 mg/dL, D-dimer >573 ng/mL, ferritin >1488 ng/mL, andCPK >191U/L. Our study identified that the mortality risk was significantly higher and survival was significantly lower in patients older age group, females and those having higher IL-6, LDH, NTproBNP, procalcitonin, urea, creatinine, D-dimer, ferritin and CPK. Determination of specific clinical and biochemical features as above would help in better understanding of the pathophysiology, prognosis and appropriate intervention for potential outcomes. [ABSTRACT FROM AUTHOR]

Byline: Indira. Gurajala, Padmaja. Durga Perioperative myocardial infarction (PMI) is an important indicator of outcome after noncardiac surgery. Identifying patients at risk of PMI helps in risk stratification and modification. [...]

Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG), valve surgery and combined procedures (CABG with valve surgery). The model calibration was performed using Hosmer-Lemeshow goodness of fit test and receiver operating characteristics (ROC) analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients), 7.1% (34 patients) for CABG, 4.3% (16 patients) for valve surgery and 16.2% (6 patients) for combined procedures. The Hosmer-Lemeshow statistic was

Background: The presence of autonomic neuropathy can potentially blunt the reflex sympathetic response of vasoconstriction to prone positioning, thus possibly influencing changes in pulse pressure variation and its ability to predict fluid responsiveness. A hypothesis that in the presence of co-existing autonomic dysfunction, a fluid challenge in mechanically ventilated patients undergoing surgery in the prone position would fail to produce significant changes in pulse pressure variation was formed and tested. Methods: An initial preoperative screening for autonomic dysfunction was performed on 60 ASA grade 1 and 2 adult, consenting volunteers who were electively posted for surgery in the prone position using a battery of 5 bedside clinical tests (0-2 tests positive). A fluid challenge of 6% hydroxyl-ethyl starch, 6ml/kg over 10 minutes, was given to patients in both the groups, 15 minutes after surgical incision. Pulse Pressure Variation was monitored after induction, 5 minutes after induction, 5 minute after prone positioning, on initiation of fluid bolus and 15 minutes after starting the bolus. The observer was blinded to the findings of the preoperative screening. Results: A significant decrease in PPV was seen 15 minutes after starting the bolus (17.72±3.78 vs. 9.80±1.65 and 17.36±2.05 vs. 8.32±1.67) in both the groups, which was comparable between the two groups. Conclusion: It was determined, in the end, that autonomic dysfunction does not affect the predictive power of PPV for fluid responsiveness in anaesthetized prone individuals. [ABSTRACT FROM AUTHOR]

Background: The induction dose of propofol is reduced with concomitant use of opioids as a result of a possible synergistic action. Aim and Objectives: The present study compared the effect of fentanyl and two doses of butorphanol pre-treatment on the induction dose of propofol, with specific emphasis on entropy. Methods: Three groups of 40 patients each, of the American Society of Anaesthesiologistsphysical status I and II, were randomized to receive fentanyl 2 μg/kg (Group F), butorphanol 20 μg/kg (Group B 20) or 40 μg/kg (Group B 40) as pre-treatment. Five minutes later, the degree of sedation was assessed by the observer′s assessment of alertness scale (OAA/S). Induction of anesthesia was done with propofol (30 mg/10 s) till the loss of response to verbal commands. Thereafter, rocuronium 1 mg/kg was administered and endotracheal intubation was performed 2 min later. OAA/S, propofol induction dose, heart rate, blood pressure, oxygen saturation and entropy (response and state) were compared in the three groups. Statistical Analysis: Data was analyzed using ANOVA test with posthoc significance, Kruskal-Wallis test, Chi-square test and Fischer exact test. A P

Background and objectives: To perform comparative investigation of intra-operative Fentanyl dose administered between the study group and the control group of the population selected for study. To distinguish the intra-operative dose requirement of Fentanyl administered between the study group and the control group. Evaluation of the degree of post operative pain in the study and the control group. Estimation of the rescue analgesic required in Post Operative Care Unit in the study group and the control group. To report the peri operative adverse events in the study and the control group. To approximate the time required for extubation in the study group and the control group. Methods: A Prospective comparative randomized study was conducted after obtaining Institutional Ethical Committee approval with no EC/NIMS/2736/2021 and Informed Consent of the patients was conducted in Department of Anaesthesia at Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India from December 2020 - November 2021 which included females of 18-60 years age undergoing mastectomy Surgery under General Anaesthesia. Results:The study statistically evaluated impression of intra operative fentanyl dose guided by hemodynamic and SPI parameters. Correlation of different fentanyl doses to the parameters like age, BMI, cardiological health, Spectral entropy, intraoperative and post operative events and symptoms, mean extubation time was estimated during mastectomy. Conclusion: The study derives inference from mastectomy performed under general anaesthesia that SPI guided group will distinguish by better hemodynamic stability which will probably result into lower intraoperative fentanyl requirement. Also, apositive postoperative analgesic property andlesser chance of postoperative nausea and vomiting reported when compared with study conducted using conventional hemodynamic guidance. [ABSTRACT FROM AUTHOR]

Difficulty in airway management is a major cause of morbidity and mortality in anesthetic practice. The ability to identify patients at risk of difficult tracheal intubation is important especially in patients with apparently normal airways. The importance of preoperative prediction of a difficult airway is obvious, as 85% of all mistakes regarding airway management result in permanent cerebral damage and up to 30% of all anaesthetic deaths can be attributed to the management of difficult airways. In patients with limited cervical extension, the intubation will turn out to be even more difficult as we cannot make the neck extension in these scenarios, visualization of glottis will be very difficult and it will ultimately result in complications. Thorough preoperative assessment is essential to identify the patients at risk of difficult intubation so that proper management can be planned beforehand. As there is no preoperative assessment criteria or tool to predict the difficulty in these limited cervical extension patients, the purpose of the present study was to evaluate the accuracy of the Neck circumference to Inter incisor gap ratio in predicting the difficulty of laryngoscopy in limited cervical extension patients. [ABSTRACT FROM AUTHOR]

Background and Aims: The manipulation of urinary tract, the mandatory requirement of ureteral stenting, and bladder catheterization in patients undergoing percutaneous nephrolithotomy (PCNL) produces significant pain and dysuria postoperatively. The present study compared the efficacy of pregabalin with placebo in attenuation of these symptoms in patients undergoing PCNL. Material and Methods: This randomized controlled study was conducted in 110 patients of either sex, aged 18–65 years undergoing elective PCNL requiring nephrostomy tube under general anesthesia. Group G (n: 53) received pregabalin 150 mg and Group P received placebo (n: 49) orally 1 h before the anesthetic induction. All the patients received standard anesthetic protocol. Pain at the site of nephrostomy, instrumentation-induced dysuria (IID), anxiety, and sedation scores were recorded at 0 min, 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h postoperatively. Hemodynamics, total requirement of rescue analgesia, and incidence of any adverse effects were also noted. Results: Patients were demographically comparable between the two groups. There is no difference in nephrostomy site pain between the groups at different points of measurements. IID was less with pregabalin at 0 min, 15 min, 30 min, 1 h, and 2 h after extubation (P value < 0.05, 43% in Group G vs. 68% in group P). Severe urgency was seen in 4%, moderate in 31%, and mild in 33% of patients in placebo group. No patient in pregabalin had severe grade of instrumentation-induced dysuria score (P < 0.05). Patients in Group P required more rescue analgesic (P: 0.009). Anxiety scores, sedation scores, and hemodynamic parameters were comparable. Conclusion: A single dose of 150 mg pregabalin as oral premedication given 1 h before surgery reduced the incidence and intensity of IID compared to placebo in patients undergoing PCNL without significant adverse effects. [ABSTRACT FROM AUTHOR]