Background and Aims: del Nido cardioplegia (DC), initially developed for paediatric cardiac surgery, is increasingly used in adult procedures due to its ability to provide prolonged myocardial protection with a single dose. However, its superiority over blood cardioplegia (BC) remains unclear. This study compared the effects of DC and BC on acid–base balance, potassium levels, and metabolic profiles in adults undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Methods: A retrospective observational study was conducted at a tertiary care centre over a period of 6 months. Forty-seven patients were divided into Group BC (received blood cardioplegia) and Group DC (received del Nido cardioplegia). Arterial blood gases were recorded at four intraoperative time points. The four time points were T1, baseline before CPB; T2, immediately after cardioplegia administration; T3, post-rewarming just before separation from CPB; and T4, before transfer to the intensive care unit. Statistical analyses were performed using independent t-tests and Chi-square tests, or their equivalent non-parametric alternatives when appropriate. Results: Group DC exhibited a significantly higher potential of hydrogen (pH) (7.49 vs 7.43, P = 0.003) and base excess (0.15 vs − 1.80 mmol/L, P = 0.014) at post-rewarming (T3). Potassium was lower in group DC at baseline (T1). Blood glucose was significantly higher in group BC at T3 (275 vs 207 mg/dL, P < 0.001) and T4 (258 vs 217 mg/dL, P = 0.033). Five patients in the DC group required blood transfusion during CPB. Conclusion: DC and BC showed largely comparable intraoperative metabolic and physiological profiles, with most observed differences remaining within acceptable physiological ranges and of limited clinical significance. DC may be a practical alternative to BC; however, larger prospective studies evaluating direct myocardial injury markers and postoperative outcomes are needed.
Background and Aims: Preoxygenation is crucial during rapid sequence induction, especially in peritonitis patients undergoing exploratory laparotomy who are prone to hypoxaemia. This study compares high-flow nasal oxygen (HFNO) versus facemask for preoxygenation efficacy, laryngoscopy duration, desaturation, arterial blood gases, and patient comfort. Methods: Sixty consenting, haemodynamically stable patients aged ≥15 years, scheduled for exploratory laparotomy, were randomised into two equal groups receiving preoxygenation using either HFNO at 50 L/min for 5 min or standard anatomical facemask (SMO) at 10 L/min. Arterial blood gas samples were obtained preoperatively, 5 min after preoxygenation, and 1 min following intubation. The primary outcome was partial pressure of arterial oxygen (PaO₂) after 5 min of preoxygenation. Secondary outcomes included partial pressure of arterial carbon dioxide (PaCO₂), peripheral oxygen saturation (SpO₂), laryngoscopy duration, desaturation incidence, patient comfort, and haemodynamic parameters. Statistical analysis was performed using independent t -test, Wilcoxon test, and Chi-square test. P <0.05 was considered statistically significant. Results: PaO 2 5 min after preoxygenation was higher in both groups, the mean (standard deviation) increase, greater in HFNO [376.86 (86.57)] than in SMO group [263.68 (77.39)]. This rise was higher even 1 min after intubation in HFNO group [312.89 (82.87)] versus SMO [215.61 (66.95)]. HFNO group also showed a less incidence of desaturation and a decrease in PaCO 2 [31.73 (5.46)] than in SMO group [35.72 (8.11)]. Conclusion: Preoxygenation for 5 min by HFNO is superior to facemask as there is an increase in PaO 2 , decreased PaCO 2 , less desaturation, and more comfort to patients undergoing exploratory laparotomy.
Background and Aims:Manipulation under anaesthesia (MUA) for frozen shoulder is usually done under intra-articular steroid injection along with local anaesthetic agents. The pericapsular nerve group (PENG) block is also found to be effective for MUA. This study aimed to compare the efficacy of the PENG block with that of intra-articular steroid injections in patients with frozen shoulder.Methods:This randomised controlled trial was conducted on 130 patients aged 18-75 years with stage 2 or stage 3 frozen shoulder scheduled for manipulation under anaesthesia. The participants were randomly assigned into two groups: Group S (intra-articular steroid injection) and Group P (PENG block). Group S received ultrasound-guided intra-articular injection of 40 mg triamcinolone with 2 mL of 2% lignocaine and 2 mL of 0.5% bupivacaine. Group P received ultrasound-guided PENG block using 10 mL of 0.5% bupivacaine and 10 mL of 2% lignocaine. Numerical pain rating scale (NPRS) scores for pain were recorded at 15 min; 30 min; and 1, 6, 12, and 24 hours. Range of Motion (ROM) and Shoulder Pain and Disability Index (SPADI) were also assessed. Data were analysed using Statistical Package for Social Sciences 19.0, and P < 0.05 was considered statistically significant.Results:NPRS pain scores were significantly lower in the PENG group across all time points (P < 0.001). At 15 minutes, the mean NRPS scores were 5.2 [95% confidence interval (CI) 4.8-5.6] in Group S and 4.1 (95% CI 3.5-4.7) in Group P. ROM and SPADI scores at 24 hours were significantly better in the PENG group. ROM improved across all planes in both groups; however, improvement was significantly greater in the PENG block group.Conclusion:PENG block is effective in providing pain relief and improving shoulder function following MUA in patients with frozen shoulder.
Background and Aims:As caesarean section (C-section) rates continue to rise, effective planning and management of postoperative pain become crucial. Poor control can delay early mobilisation and breastfeeding, and it also raises the risk of complications like thromboembolic events, postoperative ileus, and chronic pain development. This study aimed to compare the efficacy of postoperative analgesia between intrathecal morphine (ITM) and quadratus lumborum block (QLB) in the elective C-section. Methods:This prospective, double-blinded, randomised controlled trial included 60 women who underwent elective C-sections. The participants were randomly assigned to receive either ITM [0.1 ml (100 μg) of morphine] or bilateral QLB with 40 ml 0.375% ropivacaine. Both the ITM and QLB groups had received a subarachnoid block consisting of 2 ml of 0.5% hyperbaric bupivacaine with 0.1 ml of ITM or saline for a total of 2.1 ml. Postoperatively, pain score using the numerical rating scale (NRS), the need for rescue analgesia, and patient satisfaction score (0-10) were monitored for 48 h. Results:Out of the 60 parturients enroled, 59 were included in the final analysis (ITM n = 30, QLB n = 29). Postoperative pain scores assessed using the NRS were significantly lower in the ITM group than in the QLB group at 4, 8, 12, and 24 h after surgery (P = 0.042). The time to first request for rescue analgesia was longer in the ITM group than in the QLB group (19.8 ± 10.3 h vs 9.2 ± 4.3 h; P < 0.001). Patients in the ITM group also reported higher patient satisfaction scores. No clinically significant adverse effects were observed in either group during the study period. Conclusion:Group ITM was associated with lower postoperative pain scores, longer-lasting analgesia, reduced need for rescue analgesics, and higher patient satisfaction compared with QLB after elective C-section, with no clinically significant adverse effects.
Background and Aims:Airway management in cervical spine injury is challenging, and combining videolaryngoscopy with a flexible tracheoscope could enhance glottic visualisation, addressing the limitations when used alone. This prospective, open-label, randomised trial compared videolaryngoscopy-assisted flexible tracheoscopy (VLF) with videolaryngoscopy using a rigid stylet (VLS) for orotracheal intubation under simulated manual in-line stabilisation (MILS).Methods:A total of 158 American Society of Anesthesiologists physical status class I-III patients, aged 18-60 years, scheduled for elective surgery under general anaesthesia were enroled; 157 were analysed (VLF, n = 79; VLS, n = 78). Patients with an anticipated difficult airway, body mass index >30 kg/m2, or cervical spine pathology or requiring rapid sequence induction were excluded. After induction and application of MILS, an experienced anaesthesiologist performed orotracheal intubation. The primary outcome was time to successful intubation. Secondary outcomes were first-attempt success and complications (desaturation, mucosal trauma, post-operative sore throat).Results:The median (interquartile range) intubation time was significantly shorter with VLF [66 (57-78) s] compared to VLS [80 (70-95) s], with a median difference of 14 s (95% confidence interval: 8,18; P < 0.001). First-attempt success was 100% in Group VLF and 86% in Group VLS (P < 0.001). Three patients in the VLS group required removal of MILS due to intubation failure, whereas all VLF intubations were successful under stabilisation. The incidences of complications did not differ significantly between the groups.Conclusion:VLF provided faster and more reliable intubation than VLS during MILS, without increase in complications. This technique may be a valuable option for airway management when cervical spine movement must be minimised.
Background and Aims:Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality. Although 100 μg intravenous carbetocin is commonly administered for uterotonic prophylaxis at caesarean delivery, the optimal dose remains uncertain. The primary objective was to evaluate the dose-response relationship of intravenous carbetocin in achieving adequate uterine tone during elective caesarean delivery. Methods:In this randomised, parallel-group, dose-response trial, 100 parturients scheduled for elective caesarean delivery were assigned into five groups to receive intravenous carbetocin at doses of 100 μg, 80 μg, 60 μg, 40 μg, or 20 μg (n = 20 per group) immediately after foetal delivery. The primary outcome was satisfactory uterine tone at 2, 5, and 10 minutes. Secondary outcomes included blood loss, requirement for additional uterotonics, PPH incidence, blood transfusion, haemodynamic variables, and adverse events. Trend analysis assessed dose-response relationships. Results:Baseline demographic and obstetric characteristics were comparable among groups. Uterine contraction increased progressively from 75% to 85% at 2 minutes to 90-95% at 5 minutes and 95-100% at 10 minutes, with no significant intergroup differences (P = 0.960, 0.921, and 0.724, respectively). Mean blood loss and requirement for additional uterotonics were similar across groups. The incidence of PPH, need for blood transfusion, haemodynamic variables, and adverse events were comparable. No significant dose-response relationship was observed. Conclusion:In low-risk, non-obese women undergoing elective caesarean delivery under spinal anaesthesia, intravenous carbetocin doses ranging from 20 μg to 100 μg resulted in similar uterotonic response and blood-loss outcomes, with no statistically significant differences between the different dose groups.
Background and Aims: Residency selection in anaesthesiology traditionally relies on curriculum vitae review, work-based assessments, and behavioural interviews which may not adequately capture non-academic attributes. Emerging evidence suggests team-based assessments may offer a more dynamic evaluation of such qualities. This study explores the feasibility and acceptability of an escape room in Anaesthesiology residency selection and evaluates its potential to provide additional insights into candidate ranking. Methods: In this pilot study, 26 candidates completed a team-based escape room activity assessing situational awareness, task management, and communication. Evaluations were conducted via customised rubric based on Accreditation Council of Graduate Medical Education (ACGME) domains, alongside traditional interviews. Escape room, interviews, and department survey scores were correlated with the final rank order list (ROL) using Spearman's coefficient. Candidate and panel feedback were collected post activity. Results: The candidates rated the escape room as part of the selection process positively. The panel feedback was generally supportive, though some suggested improving consistency and ease of evaluation. Interview (r = 0.603, P = 0.001) and survey scores (r = 0.921, P < 0.001) correlated strongly with the ROL, while escape room scores demonstrated a weak correlation (r = 0.244, P = 0.229). The lack of correlation likely reflects the low weight assigned to the escape room, consistent with its role as a complementary assessment, without implying direct impact on final ranking. Weak correlations with interview (r = 0.197, P = 0.334) and survey scores (r = 0.172, P = 0.400) suggest it may capture complementary attributes not assessed by traditional methods. Conclusion: Escape rooms offer a novel approach to assessing non-academic attributes in residency selection, though further refinement is needed for consistent application.
