Preoperative Fasting of Eight Hours Provide Better Gastric Emptying: Ultrasound Assessment of Gastric Volume.

BACKGROUND: Preoperative fasting is a common practice to decrease perioperative aspiration risk. The American Society of Anesthesiologists (ASA) recommends preoperative fasting of 8 hours after a full meal. ASA preoperative fasting recommendation is based on the Western diet. A typical Western diet has a higher fat content than Asian standard solid meals. This study aimed to analyze intragastric volume with ultrasound after 6-hour and 8-hour fasting after an Asian traditional solid meal. METHODS: This cohort study recruited 37 subjects from January to February 2019. Subjects were patients scheduled for elective non-digestive surgery and planned for preoperative fasting of 8 hours. Before preoperative fasting, all subjects consumed standard Asian meals. We performed an ultrasound of the gastric antrum during the relaxation phase after two contractions. After a good image was acquired, the cross-sectional area and gastric volume (GV) were calculated. GV was grouped based on a border value of 1.5 mL/kg. RESULTS: GV 6 hours after solid intake was 30.93 (1.60-205.25) mL, and GV 8 hours after solid intake was 16.34 (0.73-62.49) mL (P = 0.002). After 6 hours, 5.4% of the subjects had a GV above 1.5 mL/ kg, while after fasting for 8 hours, the GV of all subjects was below 1.5 mL/kg. Age was correlated moderately and negatively with the GV of 6 hours and 8 hours fasting (P < 0.001, correlation coefficient = -0.610, and P < 0.001, correlation coefficient = -0.580). CONCLUSION: Intragastric volume 8 hours after a standard Asian meal intake was lower than 6 hours after a traditional Asian meal.

Improvement in medical students' knowledge on chronic pain assessment through integrative learning approaches: a randomized controlled trial.

Introduction: This study aimed to compare the knowledge and skills of medical students in chronic pain assessment after being trained using the PQRST (P, provoke and palliate; Q, quality; R, region and radiation; S, severity; T, time) and ACT-UP (A, activity; C, coping; T, think; U, upset; P, people) mnemonics with those using only the PQRST mnemonic. Methods: A double-blind, randomized controlled trial was conducted at the Faculty of Medicine, Universitas Indonesia, including forty students who participated in a simulation-based chronic pain assessment workshop. Pre- and post-test scores were used to assess participants' knowledge. Two independent raters assessed the students' skills. Results: No significant differences in knowledge or skills were observed between the groups; however, a significant improvement in the post-test scores (85.71 [71.43-95.24]) compared to the pre-test scores (61.90 [25.87-90.48]) was observed. The students reported high satisfaction with the workshop. Conclusions: Training with the PQRST and ACT-UP mnemonics is not better than training with the PQRST mnemonic alone in improving students' knowledge and skills in chronic pain assessment. Nevertheless, this pain education workshop was beneficial for student learning. Learning of patient-oriented chronic pain assessment should be provided in a repetitive and integrative fashion using different approaches, such as lectures, demonstrations, simulations, and interactions with patients experiencing chronic pain. To conclude, mnemonics are helpful but not a primary learning tool.

Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial.

Background and Aims: Video laryngoscopy highly improves the success rate for endotracheal intubation. However, commercially available video laryngoscopes such as McGrath MAC® can be costly. An economical video laryngoscope was assembled by attaching a fibreoptic videoscope into a Macintosh laryngoscope. This randomised study aimed to compare the intubation time of this self-assembled modified Macintosh video laryngoscope (SAM-VL) and McGrath MAC® (McGrath). Methods: This study enroled 62 adults scheduled for elective surgery under general anaesthesia with endotracheal intubation. The primary outcome was total intubation time. Secondary outcomes were the time for glottic visualisation (time A), time for tube insertion after glottic visualisation (time B), first-attempt intubation success rate, degree of glottic visualisation, and need for backward, upward, rightward pressure (BURP) assistance, complications, and user satisfaction. The tests used were: Kolmogorov-Smirnov and the Mann-Whitney test to analyse the data's distribution and the primary outcome, respectively. Results: The median total intubation time in the SAM-VL group versus the McGrath was 63 s (27-114s) versus 74 s (40-133s), respectively (P = 0.032). Intubation time B was significantly faster, while the score of glottic visualisation and BURP assistance was significantly higher in the SAM-VL group. The differences in the rate of successful first attempts and complications were not statistically significant. SAM-VL users rated the ease of blade insertion and manoeuvrability, degree of glottic visualisation, and overall rating as very high. Conclusion: Endotracheal intubation using self-assembled modified video laryngoscope is faster and allows better glottis visualisation than McGrath MAC®.

Comparison of the Effects of Target-Controlled Infusion of Propofol and Sevoflurane as Maintenance of Anesthesia on Hemodynamic Profile in Kidney Transplantation.

BACKGROUND: Target-controlled infusion (TCI) propofol and sevoflurane are common agents for general anesthesia, including for kidney transplantation procedure. This study compared the effect of TCI propofol and sevoflurane on intraoperative hemodynamic profile in kidney transplant patients. METHODS: A single-blinded prospective study was performed in 46 kidney transplant recipients who were randomized into receiving TCI propofol or sevoflurane as anesthetics maintenance. Hemodynamic parameters such as mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) were measured at baseline before induction, postintubation, first surgical incision, every 15 minutes after the first incision, reperfusion, and 15 minutes after reperfusion. Data were analyzed using unpaired t-test, paired t-test, and general linear model. RESULTS: Intraoperative MAP, CI, SVI, and SVRI changes were similar in both groups (p = 0.480, 0.216, 0.086, and 0.054). In comparison to the baseline value, TCI propofol and sevoflurane groups showed significant reductions of MAP at postintubation (p=0.010; p < 0.001) and during the first surgical incision (p=0.009; p < 0.001); significant reduction of CI at postintubation (p=0.003; p < 0.001) and during the first surgical incision (p < 0.001; p < 0.001); significant reduction of SVI at postintubation (p=0.013; p=0.008), during the first surgical incision (p=0.008; p=0.003), and 15 minutes after reperfusion (p=0.010; p=0.005); and significant increasing of SVRI during the first surgical incision (p=0.007; p=0.005). The TCI propofol group showed significantly lower SVRI compared to the sevoflurane group postintubation (p=0.029) and during the first surgical incision (p=0.026). CONCLUSION: Intraoperative hemodynamic profile was similar between the TCI propofol and sevoflurane group during kidney transplant surgery. The TCI propofol group had higher CI and SVI but showed significantly lower SVRI as compared to the sevoflurane group. The incidence of postanesthesia agitation, postoperative outcome, and complication were not significantly different between the two groups.

Comparison between Vapocoolant Spray and Eutectic Mixture of Local Anesthetics Cream in Reducing Pain during Spinal Injections.

BACKGROUND: Eutectic mixture of local anesthetics (EMLA) cream is often used for local anesthesia during spinal injections. However, this agent has delayed onset of action while vapocoolant spray serves more advantages. The vapocoolant spray containing ethyl chloride has fast onset and is safe, low cost, and widely available. This study aimed at comparing the effectiveness of vapocoolant spray and EMLA cream in reducing pain for spinal injections. METHODS: This was an experimental study on 94 subjects with 47 subjects treated with EMLA cream and 47 subjects treated with vapocoolant spray. The effectiveness of anesthesia was assessed by using Numeric Pain Rating Scale (NPRS) and patient movement during the surgery. RESULTS: This study found that the pain scale was NPRS 0 (0-3) for the EMLA group and NPRS 0 (0-4) for the vapocoolant spray group. There was no significant difference between two groups for pain scale according to the Mann-Whitney U test. For patient movement, the movement was reported only in one (2.1%) patient in the EMLA group and one (2.1%) patient in the vapocoolant spray group. Based on Fisher's test, there was no significant difference between the two groups for patient movement. CONCLUSIONS: Both EMLA cream and vapocoolant spray were equally effective in reducing pain during spinal injection. There was no difference in degree of pain reduction and patient movement between the EMLA cream group and the vapocoolant spray group during spinal injection.