Retrospective Analysis of Clinical Characteristics and Outcomes of Pregnant Women with SARS-CoV-2 Infections Admitted to Intensive Care Units in India (Preg-CoV): A Multicenter Study.

Aim: The aim was to examine the outcomes of pregnant women admitted to intensive care unit with coronavirus disease-2019 (COVID-19) infection during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in India. The primary outcome of the study was maternal mortality at day 30. The secondary outcomes were the intensive care unit (ICU) and hospital length of stay, fetal mortality and preterm delivery. Materials and methods: This was a retrospective multicentric cohort study. Ethical clearance was obtained. All pregnant women of the 15-45-year age admitted to ICUs with SARS-CoV-2 infection during 1st March 2020 to 31st October, 2021 were included. Results: Data were collected from nine centers and for 211 obstetric patients admitted to the ICU with a confirmed diagnosis of COVID-19. They were divided in to two groups as per their SpO2 (saturation of peripheral oxygen) level at admission on room air, that is, normal SpO2 group (SpO2 > 90%) and low SpO2 group (SpO2 < 90%). The mean age was (30.06 ± 4.25) years and the gestational age was 36 ± 8 weeks. The maternal mortality rate was10.53%. The rate of fetal death and preterm delivery was 7.17 and 28.22%, respectively. The average ICU and hospital length of stay (LOS) were 6.35 ± 8.56 and 6.78 ± 6.04 days, respectively. The maternal mortality (6.21 vs 43.48%, p < 0.001), preterm delivery (26.55 vs 52.17%, p = 0.011) and fetal death (5.08 vs 26.09%, p = 0.003) were significantly higher in the low SpO2 group. Conclusion: The overall maternal mortality among critically ill pregnant women affected with COVID-19 infection was 10.53%. The rate of preterm birth and fetal death were 28.22 and 7.17%, respectively. These adverse maternal and fetal outcomes were significantly higher in those admitted with low SpO2 (<90%) at admission compared with those with normal SpO2. How to cite this article: Sinha S, Paul G, Shah BA, Karmata T, Paliwal N, Dobariya J, et al. Retrospective Analysis of Clinical Characteristics and Outcomes of Pregnant Women with SARS-CoV-2 Infections Admitted to Intensive Care Units in India (Preg-CoV): A Multicenter Study. Indian J Crit Care Med 2024;28(3):265-272.

Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey.

Introduction: Appropriate implementation of a ventilator bundle (VB) is the key step in the prevention of ventilator-associated pneumonia (VAP). However, knowledge and compliance of critical care staff for VB are inconsistent in developing countries. This cross-sectional survey was planned to evaluate critical care practitioners' knowledge of, adherence to, and barriers toward implementation of VB in the ICUs of a tertiary care institute. Methodology: All registered nurses and resident doctors who are direct care providers to patients of the ICU were included. Two sets of questionnaires were given to access knowledge and to identify potential barriers in the implementation of VB. To determine compliance with the VB, direct observation was done for three nonconsecutive days, and mean compliance per component of the bundle and overall compliance to VB was determined. Data were analyzed using descriptive and analytic statistics. Results: Of these 75 participants, 43 (57.33%) were resident doctors and 32 (42.67%) were staff nurses. The median knowledge score of resident doctors and staff nurses for VB was 7 (range 3-10) and 6 (range 2-9), respectively, with an overall score of 7 (range 2-10). Self-reported adherence to individual components of VB ranged from 75% to 95%, among these, adherence to oral care protocol, including use of chlorhexidine oral rinse, was most, and adherence to DVT prophylaxis was least. The most common potential barriers identified were fear of potential adverse effects and unawareness of guidelines. Conclusion: Considerable gap is observed between knowledge and implementation of VB among critical care practitioners. Despite knowledge, fear of adverse events and lack of proper training are key barriers in implementation of VB. How to cite this article: Paliwal N, Bihani P, Mohammed S, Rao S, Jaju R, Janweja S. Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey. Indian J Crit Care Med 2023;27(4):270-276.

Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature.

Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.

Comparing Perfusion Index and Visual Analogue Scores for Postoperative Pain Assessment Following Upper Limb Surgeries Under Supraclavicular Brachial Plexus Block: An Observational Study.

BACKGROUND: Effective pain assessment is crucial to tailor the analgesic regimen post-operatively. Perfusion index (PI) has been reported to be a useful objective assessment tool for monitoring pain. This study aimed to explore the utility of PI in assessing postoperative pain in upper limb surgeries under supraclavicular block and its correlation with visual analogue scale (VAS) scores. METHODS: This prospective, observational study included 140 patients scheduled for elective upper limb surgeries. PI, VAS scores, heart rate (HR), mean arterial pressure (MAP) and physiological parameters were recorded at baseline and postoperatively. Inj. tramadol was administered when the VAS score exceeded ≥ 4 and the VAS score, PI, HR and MAP were recorded at 5, 10, 15 and 20 minutes after administration. Comparison of normally and non-normally distributed data was done using t-statistics and Mann-Whitney U-test respectively. Pearson correlation was used to establish a correlation between variables and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of PI to determine the onset of pain. RESULTS: There was a significant and moderate correlation between pre-analgesic and post-analgesic PI and VAS score (r = -0.425 and -0.448 respectively, p<0.001), while PI and MAP or PI and HR showed only a weak correlation. A cut-off value of 14.7 for PI showed 76.3% sensitivity and 100% specificity in predicting rescue analgesia requirements. CONCLUSION: The study supports the use of PI as an objective measure for postoperative pain assessment, with a notable correlation with VAS scores. The identified cut-off value for PI adds to its clinical utility in predicting the need for rescue analgesia.

Ultrasound-guided seldinger technique-assisted submental intubation for panfacial trauma-walking off the beaten path.

Introduction: After introduction of ultrasound, there is paradigm shift towards under vision performance of procedures in anaesthesia. Blind puncture and dissection of submental space may lead to vascular injury and injury to salivary glands. We describe the ultrasound guided Seldinger technique assisted submental intubation for panfacial trauma. Methodology: Modified ultrasound guided Seldinger technique for submental intubation in 10 patients, who were posted for open reduction and fixation of panfacial fractures. Total procedural time, peri-procedural complications such as bleeding, dislodgment of tube, desaturation and postoperative complications such as injury to sublingual glands/submandibular glands, hematoma, cheloid or hypertrophic scar formation or skin site infection were noted. Results: The mean time to perform submental intubation was 8.9 ± 0.94 minutes (range, 8-11 minutes). Only one patient had minor bleeding during procedure which was stopped after local application of pressure. All patients had a clean scar with no formation of cheloid or hypertrophic scar in the postoperative follow up. Conclusion: Ultrasound assisted submental intubation increases safety of the procedure in patients presenting with maxilla-facial trauma.

Comparison of Clinical Performance of C-MAC Video Laryngoscope Guided vs Blind Placement of I-Gel® in Paediatric Patients: A Randomized Controlled Open-Label Trial.

Objective: Placement of the supraglottic airway devices under direct vision has been shown to decrease the incidence of malposition in adults. This study was designed to compare the clinical performance of C-MAC guided and blind placement of i-gel® in paediatric patients. Methods: The present prospective, randomized controlled study was conducted on 102 paediatric patients scheduled to undergo elective infraumbilical surgeries under general anaesthesia. Patients were randomly divided into group "B" (blind) and group "C" (C-MAC) based on the technique used for placement of i-gel®. The primary objective of the study was to compare the incidence of malposition based on the fiberoptic bronchoscope (FOB) score of the glottic view. Oropharyngeal leak pressure (OPLP), hemodynamic parameters, and insertion characteristics (time taken to insert and the number of attempts) were secondary objectives. Categorical data were presented as ratio or percentage and continuous data were presented as mean ± standard deviation or median [95% confidence interval (CI)]. Results: The incidence of malposition (Brimacombe score 1 or 2) was significantly lower in group C compared to group B (7.8% vs 49% respectively) (P < 0.001); implying a relative risk reduction of 2.42 (95% CI 1.72 to 3.40) with C-MAC. On FOB assessment, the median (interquartile range) Brimacombe score was significantly better in group C [4 (4-4)] compared to group B [3 (2-3)] (P < 0.001). The OPLP was significantly higher in group C compared to group B. Other insertion characteristics were comparable in both the study groups. Conclusion: Compared to blind placement, C-MAC guided placement ensures proper alignment of i-gel® with periglottic structures and proper functioning of i-gel®.

Comparison of clinical performance of Ambu® AuraGain™ and BlockBuster® in anaesthetised preschool children-A randomised controlled trial.

Background and Aims: Supraglottic airway (SGA) devices are a boon to paediatric airway management. The clinical performances of the BlockBuster® laryngeal mask airway (LMA) and Ambu® AuraGain™ in preschool children were compared in this study. Methods: After ethical approval and trial registration, this randomised controlled study was conducted on 50 children, aged 1-4 years, randomised into two groups. Appropriate sized Ambu® AuraGain™ (group A) and LMA BlockBuster® (group B) were placed as per the manufacturer's recommendation under general anaesthesia. Appropriate size of the endotracheal tube was then chosen and inserted through the device. Primary objective of the study was to compare the oropharyngeal seal pressure (OSP), and secondary objectives were the first attempt intubation success rate, overall intubation success rate, SGA insertion time, intubation time, haemodynamic changes and postoperative pharyngolaryngeal complications. The Chi-square test was used to analyse the categorical variables, while the intragroup comparison of mean changes in outcomes was evaluated by the unpaired t-test. The level of significance was set at P < 0.05. Results: Demographic parameters were uniformly distributed in both the groups. The mean OSP in group A was 26.6 ± 0.95 cm H2O and in group B was 29.08 ± 0.75 cm H2O. Both the devices were successfully inserted in all the patients. The success rate of blind endotracheal intubation through the device in first attempt was 4% in group A and 80% in group B. Postoperative pharyngolaryngeal complications were relatively less in group B. Conclusion: LMA BlockBuster® provides higher OSP and provides a higher success rate of blind endotracheal intubation in paediatric patients.

Inventory Control Mechanism of the Pharmacy Store of a Recently Established National Institute in Eastern India: A Cross-Sectional, Investigative Analysis.

Background New establishments frequently face challenges. Pharmacy is integral to healthcare delivery institutes, and inventory management is crucial. The present study investigated the problems faced by the pharmacy of a newly established health institute and proposed relevant solutions to identify drugs needing stringent management control. Methods Responses were collected from seven pharmacists for questionnaires focusing on pharmacy problems and possible solutions. Always better control (ABC), vital essential desirable (VED), and ABC-VED matrix analysis were done on the drugs dispensed during the financial 2022-23. Results The predominant challenges identified were stockouts and shortages, expiry of medications, and supplier-related issues. The causes were mainly related to rural location, communication hurdles, and vendor management. Proposed solutions were integrating patients' electronic health records and bar code technology with the pharmacy's inventory management system, conducting pharmacy knowledge and skills upgradation sessions every six months, adopting ABC and VED analysis, and first-in first-out (FIFO), just-in-time (JIT). Total annual drug expenditure (ADE) for the drugs dispensed was 1,18,81,520 Indian Rupees. ABC analysis revealed 109 (22.8%), 115 (24.06%), and 254 (53.14%) of medicines as A, B, and C categories, respectively, accounting for 69.98, 20.00, and 10.07% of ADE. On ABC-VED matrix analysis, 125 (26.15%), 267 (55.86%), and 86 (17.99%) of drugs were found to be category I, II, and III items, respectively, accounting for 71.52, 23.84, and 4.64% of ADE. Conclusion Our study identified different pharmacy problems for a developing institute and suggested relevant measures. Categorization of drugs based on ABC and VED analysis will help to strengthen inventory control.

Comparison of oropharyngeal leak pressure of I-gelTM and BlockbusterTM laryngeal mask airway in anaesthetized pediatric patients.

BACKGROUND: Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. METHODS: A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. RESULTS: The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. CONCLUSIONS: The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

A Comparative Study to Evaluate Difficult Intubation Using Ratio of Patient Height to Thyromental Distance, Ratio of Neck Circumference to Thyromental Distance and Thyromental Height in Adult Patients in Tertiary Care Centre.

OBJECTIVE: Patients' airway assessment is one of the foremost responsibility of every anaesthesiologist. Several preoperative predictive methods have been studied by various authors to find the best difficult airway predictor. We conducted this study to compare three methods to predict difficulty of laryngoscopic endotracheal intubation viz Ratio of patient Height to Thyro-Mental Distance (RHTMD), Ratio of Neck Circumference to Thyro-Mental Distance (RNCTMD) and Thyro-Mental Height (TMHT) in adult patients. METHODS: This prospective observational study was conducted on 330 adult patients, ASA staus I and II, aged 18-60 years of either sex, weighing 50-80 kg scheduled for elective surgeries under general anaesthesia. Patient's height, weight, Body Mass Index (BMI) was recorded and thyromental distance, neck circumference, TMHT were measured preoperatively. Laryngoscopic view was graded according to Cormack- Lehane (CL) Grade. Predictive indices and optimal cut-off values were calculated using ROC curve analysis. RESULTS: Difficulty in laryngoscopic endotracheal intubation was encountered in 12.42% patients. The sensitivity, specificity, positive predictive value, negative predictive value and Area Under Curve (AUC) for TMHT were 100%, 95.2%, 75.54%, 100%, 0.982; for RHTMD were 75.6%, 72.7%, 28.18%, 95.45%, 0.758 and for RNCTMD were 82.9%, 65.4%, 25.37%, 96.42%, 0.779 respectively. There was no statistically significant difference to predict difficulty of laryngoscopic intubation between any of them (P < .05). CONCLUSIONS: Among these 3 parameters, TMHT was found to be the best preoperative method to predict difficult laryngoscopic endotracheal intubation with highest predictive indices and AUC. The RNCTMD was found to be more sensitive and useful method than RHTMD to predict difficulty of laryngoscopic endotracheal intubation.

"The show must go on": Aftermath of Covid-19 on anesthesiology residency programs.

COVID-19 has caused tectonic changes in the personal and professional lives of anesthesiologists and, among several aspects, anesthesiology residency and sub-specialty training has also undergone an unforeseen overhaul. We read the articles published on the impact of COVID-19 on training of anesthesiologists and set out to extract and narrate all the significant observations. At the outset, we begin by explaining how this pandemic posed a threat to the safety of the residents and mitigating measures like PPE and barriers that have now become 'the new normal'. Sub-specialties like critical care, cardiac anesthesia, pain and palliative care have also faced difficulty in imparting training due to an initial dearth in elective surgery case load but have adapted innovative measures to overcome that. Initially, conducting thesis and research became difficult due to problems in achieving the desires sample size needed to get significant results, but this pandemic has emerged as a dynamic laboratory where topics like 'psychological impact of COVID-19' and 'development of artificial intelligence models in COVID -19 ICUs' came into the fore. Pattern of examination has also become virtual and webinars showed how knowledge, with the right medium, has the potential of global outreach. As the pandemic took a toll on the mental health of the residents, attention was paid to this previously neglected aspect and ensuring their emotional well-being became a priority to avoid the issue of burn-out. We comment on how what initially was considered a scary problem, actually paved way for growth. It brought attention to safety, innovation, new tools for training, finding solutions within constraints, continuing developing our residents into future leaders who were also trained for mitigating disasters. Changes like online education, research on socio-economic impact, priority to mental health and artificial intelligence are here to stay and by imbibing it, we ensure that 'the show must go on'.

Real-time ultrasound-guided epidural catheter placement in infants: a case series.

Although epidural catheter insertion under ultrasound (US) guidance in the pediatric age group has been reported in the literature, it is yet to be adopted widely in clinical practice. The incomplete fusion of bones in pediatric patients provides an acoustic window for the US. The epidural space in children is at shallow depth, hence a high-frequency probe, which provides better resolution can be used. We present a case series in which real-time US-guided epidural catheter placement was performed in 10 infants in lower thoracic and upper lumbar interspaces. We reiterate that the use of real-time US during epidural catheter placement in patients increases the success rate of epidural catheter placement while decreasing procedural complications.

Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial.

BACKGROUND: Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. METHODS: Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study's primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. RESULTS: The median Ramsay sedation scale at 30 min was 3 (1-4) in group D and 3 (1-3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). CONCLUSIONS: Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

Comparison of the efficacy of Macintosh laryngoscope-guided insertion of I-gel™ with the conventional blind insertion technique - A randomised study.

Background and Aims: This study was designed to compare the efficacy of Macintosh laryngoscope-guided insertion of I-gel™ with the conventional blind insertion technique. Methods: A total of 156 adult patients scheduled to undergo elective surgery under general anaesthesia were included. All participants were randomly divided into two groups; I-gel™ was inserted with conventional blind and Macintosh laryngoscopic-guided technique in group A and B respectively. The primary objective of the study was to determine the incidence of optimal positioning in both the groups based on fibreoptic bronchoscope score of the glottic view. Oropharyngeal leak pressure, haemodynamic parameters and insertion characteristics were also compared. Categorical data were presented as ratio or percentage, continuous data were presented as mean ± standard deviation or median (95% confidence interval). The strength of association between insertion technique and the anatomical fit of the device was calculated by relative risk ratio. Results: Fibreoptic scores were significantly better in laryngoscope-guided insertion group when compared to the blind insertion group (P < 0.0001). The incidence of malposition was 3.85% in the laryngoscopic insertion group and 39.4% in the blind insertion (P < 0.0001). Oropharyngeal leak pressure was higher in laryngoscope-guided insertion group than in blind insertion group (26.89 ± 3.37 cm H2O versus 24.42 ± 3.00 cm H2O; P < 0.0001). Other insertion characteristics except time taken to insert the device were comparable in both groups. Conclusion: When compared to the standard blind insertion technique, laryngoscope-guided insertion of I-gel™ results in better alignment with the laryngeal inlet providing a proper anatomical fit and better airway seal pressure.

Comparison of analgesic efficacy of intrathecal 1% 2-chloroprocaine with or without fentanyl in elective caesarean section: A prospective, double-blind, randomised study.

BACKGROUND AND AIMS: Preservative free 1% 2-chlorprocaine is a short acting local anaesthetic agent suitable for day care surgical procedures. Potentiation of analgesic action of intrathecal local anaesthetics by the addition of opioids is well known. In this study, we investigated the effect of intrathecal fentanyl as an adjuvant to 1% 2-chloroprocaine (2-CP) in parturients undergoing elective lower segment caesarean section (LSCS). METHODS: This prospective randomised comparative study was performed on 150 healthy, term parturients planned for elective low risk LSCS, divided into two equal groups. The group CS received 1% preservative-free 2-CP 3 ml (30 mg) + 0.5 ml normal saline and group CF received 1% preservative-free 2-CP 3 ml (30 mg) + 0.5 ml fentanyl (25 µg) with a total volume of 3.5 ml intrathecally in both groups. The duration of sensory blockade, duration of motor blockade, maximum height of sensory block, haemodynamic parameters, quality of block, neonatal outcome, patient satisfaction and any side effects were recorded. RESULTS: There were no significant differences in demographic characteristics, haemodynamic parameters, onset of sensory block, onset of motor block and duration of motor block between the groups. The duration of sensory block and duration of analgesia was statistically prolonged in group CF than group CS (P value < 0.0001). There was no statistical difference in the Apgar score of newborns in both groups. The adverse effects (hypotension, bradycardia, nausea/vomiting, shivering and transient neurological symptoms) were comparable in both the groups. CONCLUSION: The addition of fentanyl to 1% 2-chloroprocaine intrathecally prolonged the duration of sensory block and postoperative analgesia in patients undergoing LSCS.

Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial.

BACKGROUND: Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery. METHODS: A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h. RESULTS: The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; P < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; P < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L. CONCLUSIONS: The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.

Reversal agents: do we need to administer with neuromuscular monitoring - an observational study.

BACKGROUND AND AIMS: In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal. METHODS: The patients posted for surgery of <2 h duration were included in the study. The cohort of patients was formed on the basis of those who were exposed to objective neuromuscular monitoring of recovery (train-of-four [TOF] ratio of 0.9 or more; exposed group) and the patients who were not exposed to objective neuromuscular monitoring (non-exposed group) acting as a control. Using objective neuromuscular monitoring, the time required for recovery from muscle relaxation when neostigmine was not given for reversal was noted and it was then compared with that of the control group. RESULTS: A total of 190 patients were enrolled over a period of 3 years. With the use of TOF ratio of 0.9 for extubation, patients safely recovered from neuromuscular blockade, without using neostigmine, with no difference in the mean recovery time (14.48 ± 1.138 min) as compared to the control group (12.14 ± 1.067 min, P = 0.139). There was no incidence of reintubation in post-operative period. CONCLUSION: With objective neuromuscular monitoring, we can ensure complete recovery from the neuromuscular blockade while avoiding the use of anticholinesterases.