Academia Anesthesiologica International <p><strong class="pull-left">Academia Anesthesiologica International </strong>is a double-blinded peer-reviewed, open access, Bi-annual, online journal that publishes original research articles, review articles, case reports, brief communications and clinical studies in all areas/advances of anesthesia, pain and intensive care. <br><strong>Online ISSN: 2456-7388 | Print ISSN:&nbsp;2617-5479</strong></p> en-US (Dr. Rohit Varshney) Thu, 30 Jun 2022 10:20:20 +0000 OJS 60 Comparison of Restrictive Fluid Therapy versus Conventional Fluid Therapy on Renal Indices in Patients undergoing Major Abdominal and Gynaecological Surgeries: A Tertiary centre experience <p><strong>Background: </strong>Perioperative fluid administration during major abdominal and gynaecological surgeries is done to ensure optimal oxygen supply and tissue perfusion. Restricted fluid therapy produces concentrated urine to reduce availability of water. Osmotic gradient is created and maintained by kidneys which become increasingly concentrated from the cortex to the medulla. Restrictive fluid therapy in abdominal surgery patients is associated with faster return of bowel function, fewer complications and shorter hospital stay. <strong>Subjects and Methods: </strong>The study groups were divided as Conventional (‘traditional practice’) intravenous fluid group administered balanced salt solution as 10 mL/kg bolus followed by 8 mL/kg/hour as infusion until the end of surgery followed with maintenance infusion at 1.5 mL/kg/hour. The restrictive group fluid regimen administered intravenous fluid bolus limited to 5 mL/kg at induction and Balanced salt crystalloid at 5 mL/kg/hour as infusion was administered until the end of surgery, and bolus colloid/blood was used intraoperatively to replace blood loss (mL for mL); then a postoperative infusion rate of 0.8 mL/kg/hour until cessation of intravenous fluid therapy within 24 hours. <strong>Results: </strong>A significant increase in cystatin levels, a significant decline in serum potassium levels and in GFR (as per CKD-EPI formula based on combination of Cystatin C and Creatinine levels) was observed in both the groups. <strong>Conclusions: </strong>There was no significant difference between two groups for the primary renal function outcomes and electrolyte levels prior to surgery Post-operatively, mean serum urea, creatinine were comparable in both the groups in our study. Serum cystatin c levels were observed to be higher in restrictive group.</p> Abhishek Singh, Ajit Kumar, Ajay Kumar, Hem Chandra Bhatt Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparative Analysis of Efficacy and Haemodynamic Response between Intrathecal Hyperbaric 0.5% Bupivacaine with Isobaric 0.75% Ropivacaine Utilizing Fentanyl as Adjuvant in Subjects Undergoing Umbilical Surgeries <p><strong>Background: </strong>The present study aims the evaluation of hemodynamic reaction and efficiency of Intrathecal hyperbaric 0.5% Bupivacaine with isobaric 0.75% Ropivacaine utilizing Fentanyl in subjects who were planned for infra umbilical surgeries. <strong>Subjects and Methods:</strong> The patients planned with orthopaedic, urological, gyanecological and general surgeries that involve the lower abdominal area. All the patients were planned under spinal anesthesia. A total of 50 patients were included in the study. Patients were divided into two equal groups. All the patients were included in one of the 2 underneath declared groups as Bupivacaine group (Group B) n=25 and Ropivacaine group (Group R) n=25. Bromage scale was used to evaluate the revial of motor blockage and compactness. To check the loss of sensation the pin prick was utilized. <strong>Results: </strong>In group B that is Bupivacaine the sensory block was found to be elevated as compared to group R. the dissimilarity was establish to be statistical important. The motor block of 3 mins and hypotension was found to be more advanced and dense in group B as compared to group R patients. <strong>Conclusion: </strong>As compared to 0.5% bupivacaine; the 0.75% isobaric ropivacaine showed a comparable time of motor blockade. It shows more promising resul with dense motor block with the adjuvant utilization of Fentanyl in both the groups.</p> Anilkumar S Patel, Ambaram Virchanddas Patel Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparative Analysis between Intravenous Ondansetron and Granisetron in Attenuation of Hypotension during Spinal Anaesthesia in Patients Undergoing Caesarean Section <p><strong>Background: </strong>The aim was to evaluate the Ondansetron and Granisetron to avert hypotension and bradycardia induced by spinal anesthesia within subjects that required to undergo cesarean sections. <strong>Subjects and Methods: </strong>One Hundred and five patients were incorporated in the research. Subjects were separated into 3 groups group A (n=35) consist subjects that acknowledged intravenous 4 mg Ondansetron that was diluted in normal saline, Group B consist subjects that got intravenous 1 mg Granisetron that was diluted in normal saline and group C (n=35) got 10 ml intravenous normal saline 5 minutes earlier to subarachnoid Block. <strong>Results: </strong>All groups were statistically analogous to baseline systolic blood pressure (SBP). It was considerably fewer in Granisetron group as contrast to Ondansetron group 5 minutes. Diastolic blood pressure was statistically analogous amid all groups at baseline. The mean blood pressure was statistically similar amid the 3 groups at baseline. <strong>Conclusion: </strong>Intravenous Ondansetron 4 mg administrations earlier to spinal anaesthesia reduce the events of hypotension, bradycardia and vasopressor necessity in LSCS Subjects. Granisetron had no consequence on haemodynamic factors. There were considerably fewer occurrences of postoperative Nausea and Vomiting in Ondansatron and Granisetron group.</p> Uma R. B Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparision of Ropivacaine with Lignocaine Adrenaline versus Bupivacaine with Lignocaine Adrenaline in USG Guided Axillary Approach of Brachial Plexus Block <p><strong>Background: </strong>In the present study we have done evaluation of ropivacaine and bupivacaine in upper limb surgeries under axillary block with onset and period of blocks and hemodynamic changes. <strong>Subjects and Methods: </strong>The research was at all subjects of orthopedic department undergo upper limb surgery through the phase. A total 64 Subjects were elected and allocated into 2 groups arbitrarily (32 in each group). Group B received 20 ml of 0.5% bupivacaine with 10 ml of 2% Lignocaine adrenaline, while Group R received 20 ml of 0.5% Ropivacaine with 10 ml of 2% Lignocaine adrenaline by axillary route. Intraoperatively, all the vital parameter was monitored. Postoperative analgesia was evaluated visual analogue scale (VAS). <strong>Results: </strong>No significant dissimilarity concerning age, weight and gender allocation among 2 groups. Sensory onset block of Group R is 7.06 ± 0.08 min whereas in Group B it was 7.15 ± 0.88 min. The period of sensory block in Group R is 587.75±13. 37 min, while that in Group B is 589.75 ± 13.12 min, motor block phase in Group R was 596.5 ± 13.91 min while in Group B it is 598. 84 ± 13.56 min. <strong>Conclusion: </strong>Sensory and motor onset block in ropivacaine and bupivacaine group were almost comparable and no clinical and statistical dissimilarity in the 2 groups.</p> Jayendrakumar C. Makwana, Madhavi S Mavani, Hardik Brahmbhatt, Shah Dipeshkumar Pankajkumar, Mansi Bimal Shah, Khyati Barot Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Common Postoperative Complications Following General Anesthesia in Oral and Maxillofacial Surgery: A Cross-sectional Study <p><strong>Background: </strong>The rationales of current research assessed postoperative complications in subjects undergo maxillofacial surgery underneath general anesthesia plus decide the shelter of general anesthesia with co morbidities. <strong>Subjects and Methods: </strong>Current research includes 250 subjects who were operated underneath general anesthesia. Different parameters such as age, gender, laboratory and radiographic parameters, preoperative intraoperative, and postoperative were documented. Post-operative problems were evidenced and separated: 1. Complications unswervingly connected to surgical process 2. Complications connected to general anesthesia. <strong>Results: </strong>There were 140 males and 110 were females. About 79% of subjects demonstrate sore throat, nausea in 68%, vomiting in 43%, headache in 31%, hypertension in 19%, hypotension in 30%, myalgias in 22%, bleeding in 3%, sleep trouble with connected behavioral troubles in 33% plus wound infection in 12%.<strong>Conclusion: </strong>Majority of post-operative impediments was minor and convenient, though several complications are most important and these can be slanted to fundamental systemic condition. General anesthesia is a secure method of guarantee wellbeing and reassure through surgery but still, there can be complications that have to be documented.</p> Radha Saodekar, Rajashree Gondhalekar, Jayshree Kalamkar Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Effect of Preemptive Intravenous Paracetamol on Post-Operative Analgesic Requirement in Subjects Undergoing Laparoscopic Cholecystectomy Under General Anaesthesia with Placebo Controlled Trial <p><strong>Background: </strong>Present study was done to assess the outcome of preemptive intravenous paracetamol on post-operative analgesic necessity in subjects undergo laparoscopic cholecystectomy undergoing General Anaesthesia (GA) through placebo controlled trial. <strong>Subjects and Methods:</strong> Current research performed in the Department of Anesthesiology, at Tertiary care institute of India for the period of 1 year. 150 subjects undergo laparoscopic cholecystectomy underneath GA by period of fewer than or equivalent to 90 mins were incorporated in research. Subjects were arbitrarily allocated into 3 groups: Group I: Got IV paracetamol 1 g (100 ml) 30 min earlier to beginning, with Hundred ml of IV normal saline earlier to closure of skin. Group II: got hundred ml IV normal saline 30 min prior to introduction, and IV paracetamol 1 g previous to closure of skin. Group III: Getting hundred ml IV normal saline 30 min prior to introduction, and previous to shutting of skin. All groups Comprise of 50 subjects each. <strong>Results: </strong>Mean VAS scores were considerably superior in group II (2.84±0.85) at 2 hours as contrast to Group I (2.46±0.30). Mean pain score was considerably superior in Group III at 15 minutes and 2 hours compare evaluate to Group I. &nbsp;<strong>Conclusion: </strong>Preemptive organization of 1gram of IV paracetamol in subjects undergo laparoscopic cholecystectomy offer superior eminence analgesia with reduced pain scores through the postoperative era, improved subject approval and reduced post-operative Fentanyl use.</p> Ambaram Virchanddas Patel, Anilkumar S Patel Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 A Comparative Evaluation of MgSo4 and Dexamethasone as an Adjuvant to Local Anaestheticin Brachial Plexus Block (USG Guided) for Upper Limb Surgery <p><strong>Background: </strong>The aim of this research was to evaluate the addition of MgSO4 beside dexamethasone to bupivacaine in the prolongation of ultrasound-guided supraclavicular brachial plexus block for uppet limb surgeries. <strong>Subjects and Methods: </strong>A total of 60 patients, ASA I and II grades, undergoing upper limb surgeries were registered in this research. The Ultrasound guided Supraclavicular brachial plexus block was performed with 0.5% bupivacaine 20 ml plus either 2 ml dexamethasone 8 mg (group D) or 2 ml of 10% MgSO4 (group M). The data collected were: the onset of sensory and motor block, the duration of sensory and motor block and the analgesic duration. <strong>Results: </strong>The onset of sensory and motor block, the duration of sensory and motor block and the time to first analgesic demand was significantly longer (P&lt;0.05) in Group D. Intra-operative hemodynamics was analogous and no substantial side effect was observed in the research. <strong>Conclusion: </strong>Present research exhibits that the addition of Dexamethasone to Bupivacaine when compared to addition of MgSO4 to Bupivacain in supraclavicular brachial plexus block provides improved sensory and motor block duration and prolonged duration of analgesia with no side effects, therefore could be a additional balanced mixture.</p> Kinjal B. Patel, Dhruvini H. Patel, Rupal B. Shah, Kunj R. Panagar Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparison Between two Different Doses of Ketamine as Pre-Emptive Analgesic in Patients of Laparoscopic Cholecystectomy for Postoperative Analgesia <p><strong>Background: </strong>Pre-emptive analgesic can be used as to decrease early pain post-surgery and also prevent the formation of long-term pain by subsiding the CNS sensory pathway. Ketamine is an n-methyl-d-aspartate (NMDA) receptor antagonist, desired for its effectiveness to intercept intraoperative as well as postoperative pain as a pre-emptive analgesic. Ketamine blocks the NMDA receptors and obliterate the peripheral painful stimulation and theory shows it prevents CNS stimulation. Following lap cholecystectomy pain comes from various components like peritoneal stretching, diaphragmatic irritation and insufflation. So, the study was planned to assess pre-emptive analgesic efficacy of ketamine for patients posted for lap cholecystectomy. <strong>Subjects and Methods:</strong> Randomly patients were allocated in 3 groups of thirty patients with ASA grade I and II of either sex, age group between 18 to 55 years admitted for laparoscopic cholecystectomy. After preoxygenation patient induced and intubated with proper size endotracheal tube. Post intubation the study drug was diluted upto10ml with saline and administered i.v by an anaesthesiologist 10 minutes before skin incision. Group A patients received Inj.Ketamine 0.5mg/kg i.v, Group B patients received Inj.Ketamine 1.0mg/kg i.v, Group C patients received Normal Saline i.v. This study was carried out to compare and evaluate the efficacy of different doses of ketamine (0.5 and 1.0 mg/kg IV) for pre-emptive analgesia in patients of laparoscopic cholecystectomy with reference to Intraoperative hemodynamic changes, VAS score, time for first top-up analgesic, total number of doses of analgesic used within first 12 hours, postoperative hemodynamic changes, adverse effects. <strong>Results: </strong>The demographic profile and the period of sedation/operation was found to be comparable in groups. Pulse rate and systolic Bp was slightly high in ketamine Group (1.0mg/kg) as compared to ketamine Group (0.5mg/kg) and Group C in first 20 mins which was statistically significant. After 20 minutes pulse rate and systolic Bp higher in saline Group compared to ketamine Groups which was statistically significant. The mean VAS score on deep breathing, at rest and on movement was significantly higher in saline group as compared to ketamine groups postoperatively. The average time for initial rescue analgesic was significantly higher in ketamine groups (1mg/kg &amp; 0.5mg/kg) on average 3 hours as compared to saline group less than hour. Adverse effects related to ketamine was found to be higher with 1.0mg/kg as compared to 0.5mg/kg and saline. <strong>Conclusion: </strong>Hence, ketamine has a conclusive role as a pre-emptive analgesic in minimizing postoperative pain. It also decreases requirement of analgesic in patients undergoing laparoscopic cholecystectomy. Lower dose of ketamine with 0.5mg/kg having fewer side effects and with less vital parameter changes is an ideal dose as pre-emptive analgesia.</p> Nikita P. Divecha, Dhaval Kumar C Patel Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 A Study of Capnography Monitoring During Monitored Anaesthesia Care (MAC) <p><strong>Background: </strong>MAC alone or with local anaesthesia accounts for a relatively high percentage of anaesthesia services now a days. Capnography is a non-invasive monitoring device that closely approximates the arterial carbon dioxide (CO2) levels and thus the ventilatory status of the patients. Objectives were to detect adverse respiratory events by observing the trend in respiratory rate (RR), EtCO2 value, SpO2 value and found association between them. <strong>Subjects and Methods:</strong> Total 60 patients of age 14-65 years of either sex posted for elective procedures carried out under MAC were included in this study. The study investigator (who did not participate in the patient care) was present throughout each procedure and recorded all the data. The sedation provider was blinded to the capnography data throughout the procedure. At any time during the procedure if SpO2 dropped to ≤ 90% or RR ≤8 breaths/min or EtCO2 ≥45 mm Hg, it was considered as respiratory depression and absence of EtCO2 waveform for ≥15 seconds was considered as apnoea. During the study whenever EtCO2 value was ≥60 mm Hg or respiratory rate dropped to ≤6 breaths/min, the study investigator had informed to the sedation provider for timely intervention. <strong>Results: </strong>Main anaesthetic agent used in the study was Inj. Propofol with average dose 1.7 mg/kg and Inj. ketamine 1mg/kg which is safe dose for sedation. Out of 60 patients of the study, total 27 patients (45%) fulfilled either of the pre-defined RD criteria along with apnoea episodes in study. Out of these 27 patients, apnoea (absence of EtCO2 waveform) episodes were detected only by the capnography in 6 (10%) patients. There was total 8 episodes of apnoea in this study, 4 were of &lt; 15 seconds duration and 4 episodes were of ≥ 15 seconds duration in whom the sedation provider was informed by the study investigator for the safety of patients. When we correlated all the 3 parameters, SpO2 detected RD in 22 patients within 20 minutes of starting procedures. Whereas RR and EtCO2 detected RD in 5 and 7 patients respectively either alone or with other parameters. Out of those 27 patients total 25 required interventions. While in rest 33 patients without respiratory events (RE), 11 patients required intervention. When we compared interventions in patients with RE and without RE, p value was &lt;0.001, hence, RE patients required more interventions compared to non-RE patients. <strong>Conclusion: </strong>Though, the value of capnography in monitoring ventilation in patient undergoing procedure under sedation is well appreciated, we could identify few cases of respiratory depression by sole capnography as compared to pulse oximetry. Also, the anaesthesiologists providing sedation were vigilant and able to provide timely intervention in study. Thus, capnography cannot replace clinical observation methods and pulse oximetry in identifying respiratory events. But its value cannot be neglected also, as capnography serves as a warning monitoring tool by instantly drawing anaesthesiologist’s attention.</p> Mitali K Ahir, Hemangini Patel Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparative Study of Hyperbaric Ropivcaine and Hyperbaric Bupivacaine for Spinal Anaesthesia <p><strong>Background: </strong>Ropivacaine is a newly introduced amide local anaesthetic. Hyperbaric Ropivacaine solutions are known to produce reliable spinal anaesthesia, having good motor sensory dissociation. Ropivacaine is 40 % less potent than Bupivacaine and less cardiotoxic. AIM: To evaluate and compare the clinical efficacy of 0.5% Hyperbaric solution of Ropivacaine versus Bupivacaine in terms of characteristic of spinal blockade, hemodynamic stability, intraoperative and postoperative side effects and recovery profile. <strong>Subjects and Methods:</strong> The study enrolled 100 patients of either sex, ASA grade I and II randomly allocated into two groups Group B (Bupivacaine) and Group R (Ropivacaine). Group B received 3 ml of 0.5 % Hyperbaric Bupivacaine and Group R received 3 ml of 0.5 % Hyperbaric Ropivacaine. Onset and duration of sensory blockade assessed by pin prick method. Onset and duration of motor blockade assessed by modified Bromage scale. Various parameters of subarachnoid blockade, hemodynamic variables, recovery, quality of anaesthesia, recovery and side effects were assessed. <strong>Results: </strong>Hyperbaric Ropivacaine group had late onset of sensory, motor blockade and lesser degree of motor blockade, shorter total duration of motor and sensory blockade with early regression. It had good hemodynamic profile. Patients in this group passed urine sooner. Patients had early mobilization in Ropivacaine group. <strong>Conclusion: </strong>Ropivacaine provided a reliable spinal anaesthesia with early recovery profile and lesser side effects compared to Bupivacaine and hence Ropivacaine may be a better option for day care setting.</p> Vidyalakshmi, Balbir Singh Sekhon, Mandeep Kaur, Rakesh Sadhu, Namita Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 Comparison of Dexamethasone versus Dexmedetomidine as an Adjuvant to Local Anesthetic Drug in USG Guided Axillary Brachial Plexus Block <p><strong>Background: </strong>The aim of the present research was to evaluate the safety and effectiveness of adding 8 mg dexamethasone and 50 mcg dexmedetomidine in 20 ml 0.5% bupivacaine in USG guided axillary brachial plexus block in adult subjects. <strong>Subjects and Methods: </strong>A randomized clinical research was performed in 60 subjects aged between 18 to 70 years of either gender having ASA grade I or II undergoing various scheduled upper limb surgeries. USG guided brachial plexus block was given. subjects in group A received 20ml bupivacaine 0.5% and dexamethasone 2ml (8 mg) while those in group B received 20ml bupivacaine 0.5% and dexmedetomidine 0.5ml (50mcg) +1.5 ml NS. Parameters observed were; onset of motor and sensory blockade; duration of motor and sensory blockade; Times of 1st rescue analgesia, cardiorespiratory effects and adverse effects. Post operatively subjects were evaluated by utilizing a 10-point Visual Analogue Scale (VAS). <strong>Results: </strong>There was no significant dissimilarity among the onset of&nbsp;&nbsp;&nbsp;&nbsp; motor and sensory blockade between the two groups. The length of motor block was significantly more in Group A. The duration of sensory block was significantly longer in Group A. The time for first analgesic prerequisite in Group A was 19.18± 0.87 hrs and in Group B was 13.03± 0.80 hrs. No complications were noted in either of the subjects among all the two groups. <strong>Conclusion: </strong>Adding of dexamethasone and dexmedetomidine as an adjuvant to bupivacaine for axillary brachial plexus block considerably extends the duration of sensory and motor block and duration of postoperative analgesia. Duration of motor block, sensory block and post operative analgesia is significantly extends in dexamethasone group compared to dexmedetomidine.</p> Dhruvini H. Patel, Kinjal B. Patel, Rupal B. Shah, Krishna S. Trivedi Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000 A Randomized Control Study to Compare Postoperative Analgesic Efficacy between USG Guided Erector Spinae Plane Block versus Transverse Abdominis Plane (Tap) Block in Elective Lower Segment Caesarean Section at a Tertiary Care Centre <p><strong>Background: </strong>Aim of present research was to evaluate analgesic effectiveness of ultrasound guided (USG) bilateral ESP block with that of bilateral anterior TAP block in LSCS surgery. <strong>Subjects and Methods:</strong> Sixty women were planned for elective caesarean deliveries under intrathecal anaesthesia were included in the trial. The women were arbitrarily owed in identical numbers to an ESP group or a TAP group in detach opaque envelopes. Postoperative pain was calculated by the visual analogue scale (VAS) pain score at rest at 0, 4, 8, 12, 24 hours. <strong>Results: </strong>Significant dissimilarity in median duration of analgesia among the ESP group and the TAP group. The median total tramadol use in the primary 24 hours was significantly superior in the TAP group than in the ESP group. VAS pain scores at rest for repeated measures were 0.3 units lesser on average in the ESP group than in the TAP group during the primary 24 postoperative hours and 0.5 units lower in the ESP group in the first 8 postoperative hours. <strong>Conclusion: </strong>The ESP block has a extended duration of analgesia, hold-up the time to primary necessity for analgesia, and decrease tramadol utilization compared with the TAP block and can be utilized in multimodal analgesia and opioid free schedules following caesarean section.</p> Alka Shah, Chandra Chandrasekharan, Chiranshi Shah Copyright (c) 2022 Author Thu, 30 Jun 2022 00:00:00 +0000