Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial.

BACKGROUND: Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children. METHODS: We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed. RESULTS: Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001). CONCLUSION: Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.

Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial.

BACKGROUND: Quadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia. METHODS: Fifty-two patients with comparable demographic profiles were randomised into two groups, QLB-II (n = 26) and ESPB (n = 26). After the surgery, patients received either ultrasound-guided QLB-II or ESPB using 0.25% bupivacaine 0.3 mL/kg. Comparison of analgesic efficacy was in terms of fentanyl consumption (primary outcome), pain scores, incidence of complications in the 24-h postoperative period, and quality of recovery (QoR-15) on postoperative days one and two, and day of discharge. RESULTS: There was no significant difference in cumulative number of fentanyl doses (W = 349.000, P = 0.840), numerical rating score at rest (P = 0.648) or with movement (P = 0.520), QoR-15 scores on postoperative day one (P = 0.549), day two (P = 0.927) or day of discharge (P = 0.676). CONCLUSION: We concluded that patients who underwent QLB-II or ESPB reported similar analgesic efficacy, complications, and quality of recovery in the postoperative period.

Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial.

BACKGROUND: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. METHODS: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms. DISCUSSION: The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.

Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients. / Evaluación comparativa de dexmedetomidina y labetalol para atenuar las respuestas de estrés hemodinámico durante la colecistectomía laparoscópica en pacientes con hipertensión limítrofe.

OBJECTIVE: Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of haemodynamic stress response. METHODS: A total of 160 patients were considered for this prospective, randomized, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0µg·kg-1 i.v. dexmedetomidine or group L, to receive 0.3 mg·kg-1 i.v. labetalol in 100ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. RESULTS: After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 ± 13.866) as compared to group D (123.2 ± 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 ± 9.683 vs. 79.2± 14.153, P value .0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. CONCLUSION: In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal haemodynamics especially during periods of stress showing a relatively lower incidence of side effects.

G6PD deficiency in neonates: a prospective study.

One thousand consecutively born babies were screened for G6PD deficiency and observed for seven days for development of jaundice. Frequency of the deficiency was 3.9%, being 5% in males and 2.8% in females. Religion did not have any bearing on the frequency. Parental screening in cases of babies deficient in G6PD enzyme revealed deficiency of the enzyme in majority of the mothers. Hyperbilirubinemia developed in 48.7% of babies having G6PD deficiency : It is recommended that any neonate presenting with jaundice must be screened for G6PD deficiency not only to define the etiology of hyperbilirubinemia but also to prevent future hemolytic episodes.