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BACKGROUND: This randomised controlled trial evaluated the effect of radiofrequency ablation (RFA) of genicular nerve on muscle strength in osteoarthritis knee patients with chronic pain. METHODOLOGY: Fifty-four patients with chronic knee osteoarthritis, experiencing significant pain (VNRS > 50) and moderate to severe disease (KL grade ≥ 2) were enrolled. Group 1 received RFA of genicular nerves of the affected knee while Group 2 received a sham procedure. The primary outcome was change in knee muscle strength evaluated using isokinetic peak torque(IPT) using IsoforceTM isokinetic dynamometer at 3 months. Secondary outcomes included changes in pain scores, function, perceived effect of the treatment and compliance to physiotherapy. RESULTS: At 3 months, significant difference was observed between IPT of flexor muscle at 60 and 180 degrees between the treatment and the Sham control (p-value = 0.01). No significant difference was observed in the extensor muscle strength. Within-group analysis revealed a significant increase in the IPT values for both extension and flexion at 60 and 180 degrees/sec evident across various time intervals. Group1 consistently reported lower VNRS scores at all time points. WOMAC scores of both groups were significantly different at all timepoints, with higher scores indicating reduced functionality in Group2. The GPE and compliance to physiotherapy were higher in Group1 patients at all times of follow up albeit decreasing trend in later periods. CONCLUSION: Application of RFA to genicular nerves in chronic OA knee patients resulted in better pain relief, improved functionality and increased muscle strength at extension and flexion at 3 months follow-up.
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BACKGROUND: Chronic low back pain is associated with both psychological and functional limitation. Yoga therapy has been shown to improve both the aspects. The present study was planned to evaluate integrated approach of yoga therapy with usaul care. AIMS: This controlled randomized trial was done to evaluate the clinical and molecular changes resulting from integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low back pain patients. MATERIAL AND METHODS: We enrolled 29 adult patients with non-specific chronic low back pain (CLBP). Patients were randomly divided into two groups. The control group received the usual care of treatment as per institutional protocol. The yoga group received IAYT as an adjunct to usual care. Primary outcomes were pain intensity assessed by verbal numerical rating scale (VNRS) and functional ability assessed by Modified Oswestry Disability Index (MODI). Secondary outcomes were pain catastrophizing, quality of life, fear of movement related to CLBP, type of pain, levels of ß-endorphin and TNF-α, and salivary CGRP. All parameters were measured at baseline, 1 and 3 months. RESULTS: A Significant decrease in VNRS score at 1 and 3 months was observed in both the groups with the yoga group showing a more significant reduction in pain over time than the control group (p = 0.036). MODI improved significantly only in the yoga group at 1 and 3 months. Intergroup comparison revealed significantly better MODI over time in the yoga group (p < 0.001). DN4, PDQ, PCS, HADS (anxiety), and Euro QOL had a statistically significant improvement at 1 and 3 months in the yoga group compared with the control group. The HADS (depression) had a statistically significant reduction scores in the yoga group at 3 months compared with the control group (p = 0.012). There was a significant reduction in TNF-α values in the yoga group compared with baseline (p = 0.004). CONCLUSION: IAYT therapy helped in addressing the psychological components of pain and improved quality of life patients with chronic low back pain compared with usual care.
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Dor Crônica , Dor Lombar , Transtornos Fóbicos , Yoga , Adulto , Humanos , Dor Lombar/terapia , Dor Lombar/psicologia , Qualidade de Vida , Projetos Piloto , Fator de Necrose Tumoral alfa , Resultado do Tratamento , Dor Crônica/terapiaRESUMO
BACKGROUND: Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS: In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS: We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION: An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER: Open Science Framework ( https://osf.io/tqmz2/ ).
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Pesquisa Biomédica , Dor Musculoesquelética , Telemedicina , Humanos , Masculino , Feminino , Consenso , Técnica Delphi , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/terapiaRESUMO
Opioids play a crucial role in pain management in spite of causing increased hospital morbidity and related costs. It may also cause significant risks such as postoperative nausea and vomiting (PONV), sedation, sleep disturbances, urinary retention and respiratory depression (commonly referred to as opioid related adverse effects) in postoperative patients. In order to evade these opioid related side effects and also improve pain management, multimodal analgesia i.e., combination of different analgesics, was introduced more than a decade ago. Both pharmacological and non-pharmacological techniques are available as opioid sparing analgesia. Research from around the world have proved pharmacological techniques ranging from acetaminophen, NSAIDs (non-steroidal anti-inflammatory drugs), N-methyl-D-aspartate receptor antagonists (NDMA), alpha-2 agonists, anticonvulsants such as gamma aminobutyric acid analogues, beta-blockers, capsaicin, lignocaine infusion to glucocorticoids to be effective. On the other hand, non-pharmacological methods include techniques such as cognitive behavioral therapy, transcutaneous electrical nerve stimulation (TENS), electroanalgesia, acupuncture and hypnosis. However, research regarding the effect of these non-pharmacological techniques on pain management is still needed.
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BACKGROUND AND AIMS: Literature documents EC50 (End-tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2% and most of these studies suggest maintaining the required end-tidal sevoflurane concentration for 10-25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min. MATERIAL AND METHODS: In this randomized trial, children aged 2_8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8% sevoflurane and 100% oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end-tidal sevoflurane concentration at 2% for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was "movement" and successful if "no movement" occurred. End-tidal concentration was increased/decreased (step-size 0.2%) using Dixon and Massey up and down method in the next patient depending upon the previous patient's response. RESULTS: EC50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100% oxygen was 1.1% (0.9-1.2) at 2.5 min and 1.6% (1.5-1.7) at 5.0 min. Derived EC95 (95% CI) at 2.5 min was 1.8% (1.5-9.2) and at 5.0 min was 1.8% (1.4-8.8) respectively. CONCLUSION: We suggest maintaining end-tidal sevoflurane of 1.6% for 2.5 min and 1.8% for 5 min for successful CLMA insertion.
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BACKGROUND: Intravenous cannulation at lighter planes of anaesthesia can lead to adverse respiratory and haemodynamic events. So far, there is no consensus on optimum end tidal sevoflurane concentration required for intravenous cannulation in children. We aimed to evaluate the optimum end tidal concentration at which an intravenous cannulation can be successfully attempted without movements in paediatric patients after inhalational induction of general anaesthesia. MATERIAL AND METHODS: In this clinical trial, paediatric subjects of either sex aged 1-3 years, weighing 7-15 kg having American Society of Anaesthesiologists physical status I/II of undergoing elective cataract surgery were included. After inhalational induction of general anaesthesia with 8% sevoflurane and 100% oxygen, end tidal sevoflurane concentration was maintained at 2% for 4 minutes for the first child. This was followed by intravenous cannulation attempted by an experienced anesthesiologist. The intravenous cannulation was considered to be unsuccessful if there was "movement" and successful if there was "no movement" in response to the stimuli of cannulation. End-tidal concentration was increased/decreased (step-size 0.2% for sevoflurane) using Dixon and Massey up and down method in the next patient depending upon previous patient's response. RESULTS: The sevoflurane EC50 for successful intravenous cannulation is 1.32% ± 1.0%. Pearson correlation (r) between weight of the child and response to intravenous cannulation was found to be 0.40 with P value of 0.008. CONCLUSION: Intravenous cannulation can be accomplished without movements at end tidal sevoflurane of 1.3% in children aged 1-3 years in 50% of children.
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Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Cateterismo Periférico/métodos , Sevoflurano/administração & dosagem , Anestesia Geral/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacocinética , Peso Corporal , Extração de Catarata , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Movimento , Estudos Prospectivos , Sevoflurano/efeitos adversos , Sevoflurano/farmacocinéticaRESUMO
Postamputation limb pain or phantom limb pain (PLP) develops due to the complex interplay of peripheral and central sensitization. The pain mechanisms are different during the initial phase following amputation as compared with the chronic PLP. The literature describes extensively about the management of established PLP, which may not be applicable as a preventive strategy for PLP. The novelty of the current narrative review is that it focuses on the preventive strategies of PLP. The institution of preoperative epidural catheter prior to amputation and its continuation in the immediate postoperative period reduced perioperative opioid consumption (Level II). Optimized preoperative epidural or intravenous patient-controlled analgesia starting 48 hours and continuing for 48 hours postoperatively decreased PLP at 6 months (Level II). Preventive role of epidural LA with ketamine (Level II) reduced persistent pain at 1 year and LA with calcitonin decreased PLP at 12 months (Level II). Peripheral nerve catheters have opioid sparing effect in the immediate postoperative period in postamputation patients (Level I), but evidence is low for the prevention of PLP (Level III). Gabapentin did not reduce the incidence or intensity of postamputation pain (Level II). The review in related context mentions evidence regarding therapeutic role of gabapentanoids, peripheral nerve catheters, and psychological therapy in established PLP. In future, randomized controlled trials with long-term follow-up of patients receiving epidural analgesia, perioperative peripheral nerve catheters, oral gabapentanoids, IV ketamine, or mechanism-based modality for prevention of PLP as primary outcome are required.
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BACKGROUND: Children undergoing computerized tomography (CT) frequently require sedation to allay their anxiety, and prevent motion artifacts and stress of intravenous (IV) cannulation. AIMS: The aim of this trial was to compare the effectiveness of oral midazolam and intranasal dexmedetomidine as sole premedicants in children for carrying out both IV cannulation as well as CT scanning, without the need for additional IV sedatives. METHODS: Fifty-nine children, aged 1-6 years, scheduled to undergo CT imaging under sedation were randomized to receive either 0.5 mg·kg-1 oral midazolam (group M) or 2.5 mcg·kg-1 intranasal dexmedetomidine (group D). After 20-30 min, intravenous cannulation was performed and response to its placement was graded using the Groningen Distress Rating Scale (GDRS). After cannulation, children were transferred on the CT table, and assessed using the Ramsay sedation score (RSS). CT imaging was performed without any further sedative if the RSS was ≥4. If there was movement or decrease in sedation depth (RSS ≤ 3), ketamine 1 mg·kg-1 IV was given as an initial dose, followed by subsequent doses of 0.5 mg·kg-1 IV if required. RESULTS: A Significantly higher proportion of children in group D (67%) achieved RSS ≥ 4 as compared to group M (24%) (P-0.002). The risk ratio (95% CI) was 2.76 (1.38-5.52). Significantly lower GDRS scores were noted in group D (1(1-2)) as compared to group M (2(1-2)) at the time of venipuncture (P = 0.04). CONCLUSION: In the doses and time intervals used in our study, intranasal dexmedetomidine (2.5 µg·kg-1 ) was found to be superior to oral midazolam (0.5 mg·kg-1 ) for producing satisfactory sedation for CT imaging.
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Ansiedade/prevenção & controle , Dexmedetomidina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Pré-Medicação/métodos , Tomografia Computadorizada por Raios X/psicologia , Administração Intranasal , Administração Oral , Criança , Pré-Escolar , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Lactente , Masculino , Midazolam/administração & dosagem , Resultado do TratamentoRESUMO
OBJECTIVE: The contribution of neuropathic pain (NeP) in chronic pain conditions is increasingly emphasized with the development of multiple questionnaire-based measurement scales. The painDETECT questionnaire (PDQ) is a frequently used self-reported outcome measure to assess NeP in patients with chronic pain conditions in research and regular clinical practice. The aim of the study was to translate and cross-culturally adapt the PDQ into Hindi (Hi-PDQ) for use in India and to investigate its psychometric properties. METHODS: PainDETECT questionnaire translation into the Hindi language was carried out according to standard guidelines. Patients suffering from chronic pain attending a pain clinic were recruited. Patients completed the Hi-PDQ at baseline and were retested was conducted after 3 days Exploratory factor analysis (EFA) was carried out to assess the factor structure of the Hi-PDQ. Measurement properties, including floor and ceiling effects, discriminative validity, and psychometric properties, were also assessed. RESULTS: A total of 160 patients with chronic pain were recruited, including 80 in each NeP and non-NeP group. The retest was completed in 82 patients. Mean Hi-PDQ scores were significantly higher in the NeP group compared with the non-NeP group (20.7 [SD 5.9] vs. 9.9 [SD 5.9]; P < 0.01). EFA revealed a 2-factor structure explaining 56.9% variance. The Hi-PDQ was found to have adequate internal consistency (Cronbach's alpha = 0.83), test-retest reliability (intraclass correlation coefficient = 0.94), and excellent discriminant validity (area under the curve = 0.88), with an optimal cutoff value of > 18 (sensitivity and specificity of 82.5% and 91.2%, respectively). CONCLUSION: The PDQ was successfully translated into the Hindi language. The Hi-PDQ showed good discriminative validity and psychometric properties. The Hi-PDQ is a reliable instrument to assess NeP in chronic pain conditions.
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Neuralgia/diagnóstico , Medição da Dor/métodos , Inquéritos e Questionários , Adulto , Dor Crônica/diagnóstico , Comparação Transcultural , Análise Fatorial , Feminino , Humanos , Índia , Idioma , Masculino , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , TraduçõesRESUMO
OBJECTIVES : This study translates the Pain Catastrophizing Scale (PCS) into Hindi and examines the psychometric properties of the translated version (Hindi PCS [Hi-PCS]) in patients with chronic low back pain (CLBP). METHODS : Forward and backward translations were performed from English to Hindi according to standard methodology. A final version was evaluated by a committee of clinical experts and Hi-PCS was then pilot-tested in 10 patients with CLBP. Cross-cultural validation of the resulting adapted Hi-PCS was done by administering Hi-PCS at baseline to 100 patients with CLBP (≥ 12 weeks pain) who were able to read and write in Hindi, and re-administering Hi-PCS after 3 days. Construct validity was assessed using factor analysis. Psychometric properties including internal consistency; test-retest reliability; and convergent validity with pain severity, functional disability, and health-related quality of life (HRQoL) were also assessed. RESULTS : Principal component analysis observed a three-factor structure, which explained 58% of the variance. Confirmatory factor analysis elicited the best fit as judged by the model fit indices. Hi-PCS as a whole was deemed to be internally consistent (Cronbach's α = 0.76). Intraclass correlation coefficient for the Hi-PCS is 0.923 (95% CI: 0.875-0.953). Hi-PCS was moderately correlated with pain intensity (r = 0.651) and functional disability (r = 0.352), and negatively correlated with QoL (r = -0.380). CONCLUSIONS : PCS translation and cross-cultural adaptation to Hindi demonstrated good factor structure along adequate psychometric properties and could be recommended for use in CLBP research in India.
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Catastrofização/diagnóstico , Dor Crônica/diagnóstico , Dor Lombar/diagnóstico , Multilinguismo , Medição da Dor/normas , Tradução , Adulto , Catastrofização/etnologia , Dor Crônica/etnologia , Comparação Transcultural , Feminino , Humanos , Índia/etnologia , Dor Lombar/etnologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
BACKGROUND: A previous study by our group demonstrated an increase in oropharyngeal leak pressures and a deterioration of ventilation in maximum neck flexion with the I-Gel™ . To ascertain the optimal degree of neck flexion which increases OPLP without compromising ventilation we conducted a prospective self-controlled trial with the I-Gel™ in different degrees of neck flexion in anesthetized paralyzed children. METHODOLOGY: The I-gel™ was inserted in 60 children undergoing inhalation induction with muscle paralysis for routine general anesthesia. Recordings of peak inspiratory pressures (PIP) at flexion of 15°, 30°, and 45° were taken as the primary outcome. Expired tidal volume, ventilation scoring, fiberoptic gradings, and OPLP in different degrees of flexion were recorded as secondary outcomes. RESULTS: There was a significant increase in mean PIP in cm H2 O at flexion 30° [13.3 (95% CI 12.8-13.8) cm H2 O, P < 0.001] and 45° flexion (16.5 [15.9-17.1] cm H2 O, P < 0.001) compared to neutral. A decrease in the expired tidal volume was seen at flexion of 30° (7.6 [7.3-7.8] cm H2 O, P = 0.00) and 45° (7.6 [7.3-7.8] cm H2 O, P = 0.00). There was deterioration of ventilation score, mean [range] at 30° flexion 2[0-3], and 45° flexion 1[0-3] compared to the neutral 3[2-3]. There was a significant increase in OPLP with an increase in degree of flexion. CONCLUSION: We conclude that 15° neck flexion can safely be applied without compromising ventilation with the I-Gel™ in anesthetized paralyzed children. However, Flexion of 30° or more warrants caution or the use of alternative devices like an endotracheal tube due to increase in PIP and worsening of ventilation score.
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Anestesia Geral , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Posicionamento do Paciente/métodos , Anestesia por Inalação , Criança , Pré-Escolar , Feminino , Humanos , Intubação Intratraqueal/métodos , Masculino , Pescoço , Orofaringe , Pressão , Estudos ProspectivosRESUMO
BACKGROUND: Studies that have compared and quantified the oropharyngeal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of head-neck position changes on the functioning of I-gel(™) in pediatric population still remain unevaluated. AIM: This study aimed to quantify the influence of different head and neck positions namely neutral, maximum flexion, and maximum extension on OPLP, ventilation scoring, and fiberoptic grading using I-gel(™) in anesthetized, paralyzed children. METHODS: I-gel(™) was inserted in 30 paralyzed, anesthetized children scheduled for elective urological and orthopedic procedures. Anesthesia was induced with sevoflurane in oxygen. Atracurium was administered intravenously to facilitate neuromuscular relaxation. Recordings of OPLP in neutral, maximum flexion, and maximum extension were taken as primary outcome. Fiberoptic grading, insertion of ryle's tube and ventilation scoring were also measured in different head and neck positions as secondary outcomes. RESULTS: The OPLP was significantly higher in flexion (27.6 ± 3.3 cm H2 O, P = 0.000) and lower in extension (19.6 ± 3.2 cm H2 O, P = 0.006) in comparison to the neutral position (23.2 ± 3.2 cm H2 O). There was a worsening of the fiberoptic view in flexion compared to neutral position (0/5/19/6 vs 5/21/4/0). The ventilation score was poorer (1 [0-3], P < 0.05) and peak inspiratory pressures higher in flexion (15.2 ± 1.4 cm H2 O, P = 0.000) compared to the neutral position (10.4 ± 1.6 cm H2 O). CONCLUSION: Caution is warranted in pediatric patients while ventilating with I-gel(™) in extreme flexion of head and neck owing to poor ventilation despite increase in OPLP.
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Anestesia por Inalação/métodos , Cabeça , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Pescoço , Posicionamento do Paciente/métodos , Criança , Pré-Escolar , Feminino , Tecnologia de Fibra Óptica , Humanos , Lactente , Masculino , Procedimentos Ortopédicos , Paralisia , Respiração Artificial , Resultado do Tratamento , Procedimentos Cirúrgicos UrológicosRESUMO
INTRODUCTION: This study was conducted to determine the effect of oral midazolam (OM) or intranasal dexmedetomidine (IND) on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. We hypothesize that premedication with either agent might reduce the sevoflurane EC50 for laryngeal mask airway placement in children to a similar extent. METHODS: Fifty-two American Society of Anesthesiologists (ASA) I children (aged 1-6 years) scheduled for general anesthesia with laryngeal mask airway were randomized to one of the three groups: group M received 0.5 mg · kg(-1) OM with honey and intranasal saline, group D received 2 µg · kg(-1) IND along with oral honey, and group P received oral honey and intranasal saline at least 30 min prior to induction of anesthesia. Anesthesia was induced with incremental sevoflurane up to 8% in 100% O2 . A predetermined target endtidal sevoflurane (ETsevo ) concentration (2% in the first child of all three groups) was sustained for 10 min before the attempt of laryngeal mask airway insertion by adjusting dial concentration. No intravenous anesthetic or neuromuscular blockade was used. ETsevo was increased/decreased (step size 0.2%) using Dixon's and Massey's up and down method in next patient depending upon previous patient's response. Placement of the laryngeal mask airway without movement, coughing, biting, or bucking was considered as successful. EC50 of sevoflurane was calculated as the average of the crossover midpoints in each group, which was further confirmed by probit analysis. RESULTS: The EC50 of sevoflurane for laryngeal mask airway placement after OM (1.66 ± 0.31) and IND (1.57 ± 0.14) premedications was significantly lower than the placebo group (2.00 ± 0.17, P < 0.0001). The EC95 (95% CI) derived from probit regression analysis was 2.34% (2.22-2.51%) with OM, 1.88% (1.77-2.04%) with IND, and 2.39% (2.25-2.35%) with placebo group. CONCLUSIONS: Oral midazolam and IND premedications significantly reduce the sevoflurane EC50 for laryngeal mask airway insertion in children by 17% and 21%, respectively.
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Dexmedetomidina/farmacologia , Máscaras Laríngeas , Éteres Metílicos/farmacocinética , Midazolam/farmacologia , Medicação Pré-Anestésica/métodos , Administração Intranasal , Administração Oral , Anestésicos Inalatórios/farmacocinética , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Criança , Pré-Escolar , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Lactente , Masculino , Midazolam/administração & dosagem , SevofluranoRESUMO
BACKGROUND: The optimal end-tidal sevoflurane and desflurane concentration for successful ProSeal laryngeal mask airway (PLMA) removal in unpremedicated anaesthetised adults has not been determined. OBJECTIVES: We determined end-tidal sevoflurane and desflurane concentration in 50% of anaesthetised adults (EC50: concentration at which there is 50% chance of patients showing 'no movement' response) for smooth PLMA removal. DESIGN: Randomised controlled double blind study. SETTING: Operating theatre of a government tertiary care institute. The study period was December 2011 to January 2013. PATIENTS: Thirty nine unpremedicated American Society of Anesthesiologists (ASA) physical status I and II women with cervical carcinoma (aged 30 to 60 years) scheduled for implantation of intracavity caesium under general anaesthesia with PLMA as an airway device were included in the study. INTERVENTIONS: The participants were randomised to one of the two groups receiving either desflurane or sevoflurane for anaesthesia maintenance. Anaesthesia induction was performed with intravenous propofol. Predetermined end-tidal sevoflurane concentration (initiating at 2%) or desflurane (initiating at 4%) was sustained for 10âmin before PLMA removal was attempted. End-tidal concentrations were increased/decreased (step-size 0.2% for sevoflurane and 0.5% for desflurane) using Dixon and Massey up and down method in the next patient depending upon previous patient's response. Patient responses to PLMA removal were classified as 'movement' or 'no movement'. MAIN OUTCOME MEASURES: EC50 was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. RESULTS: EC50 (95% confidence interval) of sevoflurane and desflurane for PLMA removal were 1.58% (0.669 to 2.060) and 2.79% (2.733 to 2.841), respectively. CONCLUSION: Predicted EC50 and EC95 of sevoflurane and desflurane for smooth removal for the PLMA were 1.58 (0.669 to 2.060), 2.27 (1.859 to 21.16), 2.79 (2.733.2.841) and 3.27% (3.173 to 3.395), respectively. TRIAL REGISTRATION: Registered with Clinical Trial Registry of India (URL: http://www.ctri.in), Registry ref no: CTRI/2012/12/004285.
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Anestésicos Inalatórios/administração & dosagem , Isoflurano/análogos & derivados , Éteres Metílicos/administração & dosagem , Neoplasias do Colo do Útero/cirurgia , Adulto , Anestesia Geral/métodos , Anestésicos Intravenosos/administração & dosagem , Desflurano , Remoção de Dispositivo , Método Duplo-Cego , Feminino , Humanos , Isoflurano/administração & dosagem , Máscaras Laríngeas , Pessoa de Meia-Idade , Propofol/administração & dosagem , Análise de Regressão , SevofluranoRESUMO
BACKGROUND AND AIMS: Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding. MATERIALS AND METHODS: Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidal surgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval. RESULTS: Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A. CONCLUSION: Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions.
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Background and Aim: Sevoflurane, a preferred anaesthetic for children, exhibits a dose-dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end-tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction. Methods: Two paediatric groups (1-12 months and 12-36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as 'no movement', and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient's responses. Results: The study included 75 children. The effective concentration of sevoflurane causing 'no movement' during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1-12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12-36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing 'no movement' during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1-12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12-36 months group. Conclusion: In paediatric patients, a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in 1-12 months age group compared to 0.5% required in 12-36 months age group, achieving success in 50% of the study population.
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Essential care workers like police personnel, social workers, and office and administrative staff of health institutions are also at increased risk of coronavirus disease 2019 (COVID-19) exposure along with healthcare workers. The present study aims to estimate the distress, anxiety, depression, and sleep impact of COVID-19 pandemic on essential workers through an online survey. This cross-sectional study (included 369 participants) was conducted in Chandigarh through an online survey using three psychological scales: Peritraumatic Distress Inventory (PDI), Insomnia Severity Index, and Depression Anxiety Stress Scale. Three-hundred-sixty-nine frontline warriors from hospital and community settings were included in the study. The respondents include police personnel (274; 73.66%), office staff (24; 6.45%), social workers (53; 14.24%), and media staff (21; 5.65%). Maximum distress was reported by media/transport officials on duty (85.7%). The majority of them scored high (>14), and slightly less than one-fourth (23.8%) scored significantly abnormal (>23) on PDI. About 42.9% reported moderate insomnia, 52.4% exhibited severe anxiety, and 33.3% of media/transport participants reported severe depression. Psychological morbidity is high in media/transport and social workers working in the community during the COVID-19 pandemic.
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BACKGROUND: The Lancet Low Back Pain (LBP) Series highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs and (2) how that care is delivered. DESIGN: An online mixed-methods study. METHODS: A Consortium for LBP in LMICs (n = 65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with 5 years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using inductive and deductive coding and developed a thematic framework. RESULTS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women, 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and people with lived experience (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The thematic framework comprised 8 themes: (1) self-management is ubiquitous, (2) medicines are the cornerstone, (3) traditional therapies have a place, (4) society plays an important role, (5) imaging use is very common, (6) reliance on passive approaches, (7) social determinants influence LBP care pathway, and (8) health systems are ill-prepared to address LBP burden. CONCLUSION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. J Orthop Sports Phys Ther 2024;54(8):560-572. Epub 11 April 2024. doi:10.2519/jospt.2024.12406.