Indian Journal of Anaesthesia

: 2020  |  Volume : 64  |  Issue : 13  |  Page : 22--28

KOPS Award Abstracts: Paediatric Anaesthesia


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 Abstract ID: ISAP079: Early postoperative oral fluid intake in pediatric surgery under general anaesthesia: a controlled randomized clinical study

Nutan, Vinod Kumar Verma, Swati

Indira Gandhi Institute of Medical Sciences, Patna, Bihar

Background and aims: It is difficult to differentiate between the multifactorial cause of postoperative distress among children undergoing surgery under general anaesthesia such as thirst, hunger, pain, postoperative vomiting and emergence delirium. This may lead to inappropriate treatment including administration of opioids. Aim of this study was to evaluate influence of early postoperative oral fluid intake on the use of opioid analgesics and incidence of postoperative vomiting after paediatric surgery under general anaesthesia.

Methods: After ethical committee approval and clinical trial registration (CTRI/2018/01/011505); 200 patients aged 1-6 years, belonging to ASA classes I and II scheduled for extraperitoneal infraumblical surgeries under general anaesthesia were randomly allocated into liberal group (LG) and control group (CG). In LG 10% Dextrose water (10ml/kg) was offered first if Face Legs Activity Cry Consolability (FLACC) score was ≥4 in PACU. In CG children were given morphine 0.05mg/kg postoperatively if FLACC score was ≥4 and drinking was allowed after return to the ward. Paracetamol 15mg/kg i.v. was given 8-hourly in both groups. In both groups morphine was repeated after 1hr and thereafter every 4 hours if FLACC score was ≥4 as per institutional opioid protocol.

Results- Data from 187 patients were analysed. Demographic characters, type and duration of surgery were comparable. Incidence of POV in LG and CG was 10.87 and 23.16% respectively with p-value 0.007. Opioid was needed in 13.04% and 35.79% of the patient in LG and CG with p-value 0.005. PACU stay was 65.38 min and 76.95 min in LG and CG respectively with p-value 0.002 (all differences were statistically significant). There was no complication in any of the group.

Conclusion- Early postoperative oral fluid intake was associated with a reduction in opioid use and POV incidence.


Radke OC, Biedler A, Kolodzie K, Cakmakkaya OS, Silomon M, Apfel CC. The effect of postoperative fasting on vomiting in children and their assessment of pain. Paediatr Anaesth 2009; 19: 494–9Kearney R, Mack C, Entwistle L. Withholding oral fluids from children undergoing day surgery reduces vomiting. Paediatr Anaesth 1998; 8: 331–6

 Abstract ID: ISAP133: Ultrasound assessment of gastric contents and volume in paediatric surgical patients: A clinical audit

Pooja, Tejesh C.A, Prathima P.T

M.S. Ramaiah Medical College, Bangalore

Background & Aims: Perioperative pulmonary aspiration of gastric contents is a rare event in clinical practice of paediatric anaesthesia. Volume of the gastric content is one of the predisposing factors for pulmonary aspiration. The aim of the present clinical audit was to detect “at-risk stomach” by ultrasound visualisation of solid gastric contents and/or by quantification of gastric volume > 1.25mL/kg in children scheduled for elective surgery

Methods: Children aged 1 to 18 years scheduled for elective surgery were subjected for preoperative gastric ultrasound examination in supine and right lateral decubitus positions after obtaining parental consent. Gastric contents were qualitatively graded and the gastric volume was quantified by validated formula as described by Perlas et al.

Results: We analysed 51 children scheduled for elective surgery during the one month period of audit. In five children antrum could not be visualised due to excessive air and hence 46 children were included for data analysis. None of children had solid gastric contents. The mean calculated gastric volume was16.6±13.8 mL and the mean gastric volume/kg was 0.68±0.36 mL/kg. Three children had gastric volume > 1.25mL/kg signifying “at-risk stomach”. Three children had grade 2 stomach as assessed qualitatively.

Conclusion: Ultrasound assessment of gastric contents and residual volume is a good preoperative tool in paediatric population to detect children at risk of pulmonary aspiration of gastric contents.

 Abstract ID: ISAP142: Eutectic mixture of prilocaine and lignocaine (2.5%) vs 5% lignocaine vs placebo for pain relief in newborns undergoing venipuncture, a hospital based, double blind randomised case control study

Shreyas BM, Karunakar. K. Adappa

A. J. Institute of Medical Science, Mangaluru

Background & Aims: Venipuncture is one of the most common cause of iatrogenic pain in neonates which is equally stressful to the parents as well as to the personnel performing the procedure. Despite an abundance of data that demonstrate the efficacy of local anesthetics for reducing venipuncture pain in neonates their use in day to day practice is not used widely used. Our objective was to evaluate the efficacy of EMLA cream and 5% Lignocaine cream versus placebo for pain relief in newborns undergoing venipunture

Methods: Our study was a hospital based, double blind randomised, case control study. 240 eligible newborns were randomised into EMLA, 5%Lignocaine and placebo groups after randomization. The respective creams were applied 1 hour before the procedure and pain scores were assessed using NIPS scoring during venepunture. Data was analysed using SPSS ver. 20.0 statistical package. Student's unpaired t-test and paired t tests was used to compare continuous data, and to compare pain scores one way ANOVA was used to compare categorical data. A P-value <0.05 was considered statistically significant.

Results: Paired t-tests revealed significant lower NIPS scores in EMLA and 5% Lignocaine group than the placebo group (p value = 0.001).

Conclusion: From our study it can be concluded that both EMLA and 5% Lignocaine are equally efficacious and cost effective in reducing the pain of venepuncture in neonates.


Lillieborg S, Otterbom I, Ahlen K, Long C. Topical anaesthesia in neonates, infants and children, BJA. 2004;92:450-45.

 Abstract ID: ISAP216: Comparison of nebulized dexmedetomidine versus combination of ketamine and midazolam for premedication in preschool children undergoing elective surgery-a prospective randomized double blinded study.

Harini, Anilkumar Ganeshnavar, Archana Endigeri, S. Hulakund

S.N.Medical College, Bagalkot

Background and aims: The aim of my study was to compare the efficacy of nebulized dexmedetomidine and combination of midazolam and ketamine to reduce the preoperative anxiety.


Methods: After obtaining institutional ethical clearance. Informed consent has been taken from guardian. The sample size calculated was 60 with 30 in each group A (dexmed 2 microgram/kg) and group B (midazolam 0.1 mg/kg+ ketamine 1 mg/kg). Children aged 3-7 yrs ASA I-II,posted for any elective surgery undergoing general anaesthesia were included in surgery. In the preop room children were given nebulization with dexmedetomidine in group A patients and combination of midazolam +ketamine in group B patients. The primary objective was degree of sedation .Secondary objectives were patient acceptance of medication, parental separation anxiety scale, mask acceptance scale and post op Emergence agiation, FLACC scale and complications.

Results: The Degree of sedation was better in Group B patients ( 3.4±1.24) than in group A (2.41±1.18) with P value(0.002), mask acceptance was better in group B patients (1.9±0.9) than in Group A(2.8±0.97) with P value 0.001, patient acceptance of medication ,parental separation anxiety scale emergence agitation and Demographic variables, complications were comparable in both the groups .

Conclusion:In our study we found that combination of nebulized midazolam and ketamine was better alternative premedication to attenuate preoperative anxiety in pre-school children.


Abdel-Ghaffar HS, Kamal SM, El Sherif FA, Mohamed SA. Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy. BJA 2018:1-8.Jain K, Ghai B, Saxena AK, Saini D, Khandelwal N. Efficacy of two oral premedicants: Midazolam or a low dose combination of midazolam-ketamine for reducing stress during intravenous cannulation in children undergoing CT imaging. Paediatr Anaesth 2010;20:330-7

 Abstract ID: ISAP 302: Comparision of analgesic effect of thoracic epidural and ultrasound guided erector spinae block in pediatric thoracic surgeries: A case series.

Nandyala Vineela Reddy, Sandhya Ghodke, Rinita Paul.

Rainbow Children's Hospital, Marathahalli, Bangalore

Back ground and aims: Regional Anaesthesia has become an area of interest in pediatrics because of effective pain relief, patient satisfaction and comfort. Thoracic epidurals were routinely used for thoracic procedures, but fascial plane blocks are gaining importance.

To compare the efficacy and postoperative analgesic effects of thoracic epidural and Ultrasound guided Erector spinae block in pediatric thoracic surgeries.

Methods :This was a prospective study conducted in Rainbow Children's Hospital, Bangalore. Eight patients undergoing elective thoracic surgeries (Video Assisted Thoracoscopic Surgeries) were divided into two groups, Group A ,who received 0.125% bupivacaine using single shot thoracic epidural at T7-T8 in a dose of 0.5 ml/kg using loss of resistance to saline technique and group B who received 0.125% 0.5ml/kg bupivacaine at T7-T8 using Ultra Sound Guided Erector spinae block. Post procedure Visual Analog Scale was used to assess pain for first 24 hrs. Pain assessment was done 6th hrly. Time of first requirement of analgesics was noted. Injection Paracetamol intravenous15mg/kg was given as rescue analgesia to VAS score >4.






In group A VAS scores were higher compared to group B. The time of first requirement of analgesics was earlier in group A compared to group B. The duration of analgesia with single shot epidural lasted for about 4 to 6 hrs post op whereas that with Ultrasound guided Erector spinae block lasted for 8 or 10 hrs post operatively.


Ultra Sound Guided erector spinae block provides better post operative analgesia compared to thoracic epidural in pediatric Video assisted thoracoscopic surgeries.


Adhikary SD,Pruett A, Forero M, Thiruvenkata Rajan V. ESP block as an alternative to epidural analgesia for post opearive analgesia following video assisted thoracoscopic surgery. Indian J Anaesth.2018 Jan;62(1):75-78.Munoz F, Cubilos J, Bonilla AJ, Chin KJ. Erector spinae block for post operative analgesia in pediatric oncological thoracic surgery. Can J Anaesth 2017 Aug;64(8):880-882.

 Abstract ID: ISAP389: Comparison of ease of intubation with airtraq optical laryngoscope versus miller laryngoscope in neonates– a randomised interventional study

Narayan Kamath, Neelam Dogra, Anupama Gupta

SMS Medical College, Jaipur

Background and aims: The AirTraq optical laryngoscope has been extensively evaluated in adults; it improves the ease of intubation and is associated with less movement of the cervical spine. Studies on pediatric patients specially neonates are necessary due to the differences in airway in comparison with adults. Thus we aimed at comparing the ease of intubation with AirTraq v/s Miller laryngoscope in neonates as primary objective and hemodynamic changes and airway trauma as secondary objectives.

Methods: 64 neonates of ASA class I-II, posted for routine surgery requiring tracheal intubation were randomly divided into 2 groups; AirTraq (n = 32) or Miller (n = 32). Intubation time, number of attempts, percentage of glottic opening (POGO) score, VAS for intubation were recorded. Hemodynamic variables noted at baseline, immediately after intubation (T0), 1, 3, and 5 min after intubation (T1,T2,T3). Airway trauma (if any) during intubation was also noted.

Results: The use of AirTraq in comparison with Miller laryngoscope was associated with shorter intubation time [(15.56±3.35s) v/s(18.25±4.44s), respectively, P=0.008], better POGO score [95(90-100) v/s 75(52.5-87.5)], better VAS for intubation (P=0.004). The number of first and second attempts at intubation were (30&2) and (29&3) for AirTraq and Miller group respectively. Airway trauma was observed in 1 patient in Miller group.


Conclusion: AirTraq decreases intubation time, provides better POGO score and ease of intubation, less hemodynamic changes during intubation as compared to Miller laryngoscope.


White MC, Marsh CJ, Beringer RM, Nolan JA, Choi AY, Medlock KE, Mason DG. A randomised, controlled trial comparing the Airtraq™ optical laryngoscope with conventional laryngoscopy in infants and children. Anaesthesia. 2012 Mar 1;67(3):226-31.Das B, Samanta A, Mitra S, Jamil SN. Comparative evaluation of Airtraq™ optical Laryngoscope and Miller's blade in paediatric patients undergoing elective surgery requiring tracheal intubation: A randomized, controlled trial. Indian journal of anaesthesia. 2017 Apr;61(4):326.

 Abstract ID: ISAP652: Ultrasound evaluation to predict difficult airway in children below 2 years: An observational trial

Shubhkarman Kahlon, Divya Jain, Neerja Bhardwaj, Komal Gandhi, Anudeep Jafra

Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background and aims: In adults, parameters like tongue thickness, anterior soft tissue thickness, hyomental distance ratio have been used to predict difficult airway. However, the usefulness of ultrasonography to predict difficult airway in infants and children remains unevaluated. The aim of this study was to evaluate the feasibility of sonography as a tool to measure the hyomental distance ratio and tongue thickness to oral cavity ratio in children less than 2 years of age to predict difficult laryngoscopy.

Methods: After ethical committee clearance and CTRI registration (CTRI/2019/05/019014) Airway assessment using Conventional parameters and airway sonography was performed in 90 children below the age of 2 years preoperatively. Conventional parameters included weight, height, BMI, neck circumference, thyromental distance. The sonographic parameters like hyomental distance was measured while the head was placed inthe neutral position and then in a hyperextended position, and the hyomental distance ratio (HMDR) was calculated. The tongue thickness and oral cavity thickness was measured and ratio calculated (TT/OCT). Standard general anaesthesia was given. The laryngoscopic view was graded using Cormack Lehane (CL) grading. The ability of hyomental distance ratio in predicting difficult laryngoscopy was assessed as primary outcome and tongue thickness to oral cavity ratio as secondary outcome. Statistical analysis included sensitivity, specificity, positive predictive value and negative predictive value with 95% CI. Logistic regression analysis was done to identify factors predicting difficult laryngoscopy and intubation.

Results: 6 out 90(7.5%) patients had difficult laryngoscopy. The mean (SD) HMDR in children with easy laryngoscopy was 1.15 (0.11) and in difficult laryngoscopy was 1.03 (0.01). The mean (SD) TT/OCT in children with easy laryngoscopy was 0.75 (0.10) and in easy laryngoscopy was 0.65 (0.11). The results of Logistic regression analysis identified HMDR, Neck circumference as factors for difficult airway.


Conclusions: Airway sonography can form a useful tool for predicting difficult airway in children less than 2 years. Preoperative assessment of the hyomental distance ratio may predict difficult laryngoscopy resulting in difficult intubation.


Heinrich S, Birkholz T, Ihmsen H, Irouschek A, Ackermann A, Schimdt J. Incidence and predictors of difficult laryngoscopy in 11.219 pediatric anesthesia procedures. Pediatr Anesth 2012; 22: 729-36.Andruszkiewicz P, Wojtczak J, Sobczyk D, Stach O, Kowalik I. Effectiveness and validity of sonographic upper airway evaluation to predict difficult laryngoscopy. J Ultrasound Med 2016; 35: e27–e36.

 Abstract ID: ISAP720: Comparison of caudal block and usg guided transversus abdominis plane block for analgesic efficacy in paediatric patients in lower abdominal surgeries- a randomised double blinded study

Srishti Talukdar, Faiza Ahmed Talukdar

Department of Anaesthesiology and Critical Care, Gauhati Medical College & Hospital, Guwahati

Background and Aims: Caudal block is a commonly used regional technique for analgesia in paediatric lower abdominal surgeries. However, it is also associated with potentially serious complications like -intravenous injection leading to seizure or cardiac arrest, dural puncture, haematoma, sepsis etc. TAP block is a regional block of the anterior abdominal wall covering T10-L1 sensory distribution providing safer and effective post operative analgesia. Although the efficacy of TAP has been well established in various studies in adults there are limited studies conducted in children. This study aimed to compare the analgesic efficacy of caudal block with TAP block in paediatric lower abdominal surgeries.

Methods- After Hospital Ethics Committee approval, 70 patients of age 1-10 years, belonging to ASA I and II category, scheduled for elective unilateral lower abdominal surgery were enrolled for the study. They were divided into- Group A receiving caudal block with 1ml/kg 0.3% ropivacaine and Group B receiving USG guided TAP block with 0.5ml/kg 0.3% ropivacaine. Pain was assessed using FLACC score hourly till 6 hours and then 6 hourly till 24 hours postoperatively. Duration of analgesia, cumulative ketorolac requirement, haemodynamics (heart rate, blood pressure) and any side effects were also recorded.

Results- Pain score of caudal group was significantly lower than TAP group during initial 5 hours (p < 0.05 till 5 hours) post operatively. Conversely, pain score of TAP group was significantly lower at 12th hour (1.41±0.74 vs 2.11±1.11; p=0.003) and 18th hour (0.97±0.71 vs 1.39±0.68; p=0.015). No significant difference was found in the duration of analgesia between the two groups (p=0.64). The cumulative dose of ketorolac requirement was significantly lower in TAP group (10.58 ± 4.64mg vs 17.06 ± 6.00mg, p=0.004). Haemodynamics were comparable between the two groups. Nausea and vomiting was seen in 2 and 3 patients in caudal group and TAP group, respectively. Urinary retention was reported in 3 patients of caudal group and none in TAP group.

Conclusion-TAP block provided superior analgesia compared to caudal block in the late postoperative hours as shown by lower pain scores and lesser cumulative dose of rescue analgesia requirement.


Bryskin RB, Londergan B, Wheatley R, Heng R, Lewis M, Barraza M et al. Transversus Abdominis Plane Block Versus Caudal Epidural for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial. Anesth Analg. 2015;121(2):471-8. doi: 10.1213/ANE.0000000000000779. Sethi N, Pant D, Dutta A, Koul A, Sood J, Chugh PT. Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery. J Clin Anesth. 2016;33:322-9. doi: 10.1016/j.jclinane.2016.03.067. Epub 2016 May 19.

 Abstract ID: ISAP827: To compare effect of sterofundin v/s ringer's lactate on intraoperative acid base and electrolyte status in children undergoing major surgery: A randomized, double blind, study

Anie Joseph, Neelam Dogra, Pratibha Rathore, Isha Bijarnia

Department of Anaesthesia, SMS Medical College and Attached Hospitals, Jaipur

Background and Aims: Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis in children[1]. Sterofundin is associated with better preservation of acid base and electrolytes in adults [2]. As there is paucity of literature in children, we conducted this study to compare the effect of sterofundin v/s ringer's lactate with the primary objective of change in plasma pH. Secondary objectives were to compare the change in Serum electrolytes (Cl-, Na+, K+,Ca2+), renal function and occurrence of hypoglycaemia.

Methods: After ethics clearance and parental consent 40 children aged between 1 month to 12 years scheduled for major surgery (duration 60-120mins) were randomized to receive Sterofundin or Ringer's Lactate both added with 1% glucose intraoperatively in each group. Children with preoperative electrolyte abnormalities, hemodynamic instability, and severe renal or hepatic dysfunction were excluded. Acid Base status, electrolytes and blood glucose levels were recorded at soon after induction and at end of surgery.

Results: Demographic variables were comparable. On intragroup comparison [Table 1] Statistically significant difference was observed in ringer lactate group in the mean difference in pH 0.03±0.05(p=0.0253, 95% CI 0.00-0.06) and in sterofundin group in the mean difference in S chloride 2.64±5.74(p=0.0115,95%CI -5.12-(-)0.69). On intergroup group [Table 2] comparison there was no statistically significant difference between the groups in the effect on pH, S.lactate, Base Excess or electrolytes. Hypo or hyperglycaemia did not occur in any case{Table 1}{Table 2}

CONCLUSION: Sterofundin has a better profile than ringer lactate in maintaining plasma pH and is comparable in maintaining Serum electrolytes, base excess and S lactate. STEROFUNDIN can be used safely in infants and children as it did not affect renal function and maintained glucose homeostasis.


Sümpelmann R, Becke K,Zander R,Witt L. Perioperative fluid management in children:can we sum it all up now? Curr Opin Anaesthesiol. 2019 Jun;32(3):384-391Anne Kiran Kumar,A Chaitanya Pratyusha, J Kavitha, Gopinath Ramachandran Comparative study of effect of intraoperative administration of ringer's lactae, steroundin, plasmalyte-A and kabilyte on ionic and acid base status. Medpulse International journal of Anaesthesiology 2017;4(3):59-67.

 Abstract ID: ISAP765: “Efficacy of ketamine soaked pharyngeal pack for prevention of sore throat following oro-nasal surgeries in paediatrics.”

Shilpa Nijalingappa Bingi, Sandhya K

Bangalore Medical College and Research Institute, Bangalore.

Background and aims: Post operative sore throat occurs in 21-65% of patients undergoing General anaesthesia . It is rated as 8th most common adverse effect post operatively .Many methods have been used to mitigate post operative sore throat apart from drug soaked pharyngeal packs.

Ketamine soaked pharyngeal pack at1mg/kg has probable advantage of prolonged with mucosa, thereby producing sustained drug release at the site of action and preventing post operative sore throat.

Methods: This is a prospective randomized control study in 70 ASA1 or ASA2 patients undergoing oro-nasal surgeries. Group K (n=35) received Ketamine soaked pharyngeal pack (1mg/Kg) and group N (n=35) received normal saline soaked pharyngeal pack intra operatively. We compared post-operative sore throat, dysphagia, observational pain scores and hemodynamic variables in both the groups

Results: Post-operative sore throat, dysphagia and observational pain score were comparatively less in group K compared to group N (p=<0.05). Hemodynamic profile were comparable in both groups with no side effects .

Conclusion: Ketamine soaked pharyngeal pack at the dose of 1mg/kg, reduced the incidence of post-operative sore throat and dysphagia with minimal side-effects compared to normal saline soaked pharyngeal pack in paediatrics. It also reduced the requirement of post operative analgesia.



Canbay O, CelebiN, Uzun S, Şahin A, Celiker V, Aypar U. Topical ketamine and morphine for post tonsillectomy pain. European journal of anaesthesiology.2008 Apr;25(4):287-92.Basha S, McCoy E, Ullah R, Kinsella JB.The efficacy of pharyngeal packing during routine nasal surgery–a prospective randomised controlled study.Anaesthesia.2006;61(12):1161-5.