Indian Journal of Anaesthesia

JAIPUR AWARD ABSTRACTS: DAY CARE ANAESTHESIA
Year
: 2020  |  Volume : 64  |  Issue : 13  |  Page : 67--72

Jaipur Award Abstracts: Day Care Anaesthesia


 

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. Jaipur Award Abstracts: Day Care Anaesthesia.Indian J Anaesth 2020;64:67-72


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. Jaipur Award Abstracts: Day Care Anaesthesia. Indian J Anaesth [serial online] 2020 [cited 2020 Aug 5 ];64:67-72
Available from: http://www.ijaweb.org/text.asp?2020/64/13/67/277896


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 Abstract ID: ISAP257 Comparison between criteria based discharge and time based discharge from pacu in patients undergoing septoplasty surgery under general anaesthesia- a prospective observational study.



Radhika D

Kvg Medical College Sullia, Dakshina Kannada

Background & Aims: Discharge criteria based on physiological scoring system can be used in post anaesthesia care unit (PACU) to fast track patients after ambulatory surgery. In India, most institutions follow time -based discharge (TBD) method in PACU where patients get discharged after fixed interval of time by Anaesthesiologists order. Recent studies have shown that clinical criteria based discharge (CBD) method has reduced length of hospital stay. Though TBD can vary between institutions, CBD can help in standardizing the discharge criteria among institutions.

Methods: 30 patients of age 18-60 of American Society of Anaesthesiologist's physiological status I and II scheduled for Septoplasty surgery under general anaesthesia were studied. Modified Aldrete's score was assessed in PACU. Patients were shifted from PACU to the ward after a fixed time of 60 minutes. The mean CBD time was assessed when Modified Aldrete's score was >9 and was compared with TBD.

Results: Mean CBD time was 15.35±3min and was significantly lower than the TBD (60min). There was no significant difference between CBD in both genders. There were no respiratory or haemodynamic adverse events between CBD and TBD.

Conclusion: Patients can be discharged to ward from PACU based on Modified Aldrete's score early and safely instead of waiting for time based criteria, especially in minor surgeries. This study suggests CBD can help in speeding transit from PACU, thereby enhancing PACU efficiency and resource utilization.

REFERENCES:

Jain A, Muralidhar V, Aneja S, Sharma AK. A prospective observational study comparing criteria-based discharge method with traditional time-based discharge method for discharging patients from post-anaesthesia care unit undergoing ambulatory or outpatient minor surgeries under general anaesthesia. Indian J Anaesth. 2018;62(1):61–65. doi:10.4103/ija.IJA_549_17Armstrong, J., Forrest, H. & Crawford, M.W. A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients. Can J Anesth. 2015; 62, 1082–1088. doi:10.1007/s12630-015-0428-6

 Abstract ID: ISAP526: Chlorprocaine vs chlorprocaine and fentanyl for spinal anaesthesia in day care surgeries - a comparative randomised clinical study



Navyashree Ks, Prajwal V, Rangalakshmi S

Rajarajeswari Medical College and Research Hospital.

Background and Aims: An ideal anesthetic for spinal anesthesia (SA) in ambulatory surgeries would provide rapid onset, adequate potency, predictable duration, decreased neurotoxicity and systemic side effects. We studied the effect of adding intrathecal fentanyl to 2-Chlorprocaine(2-CP) and compared its duration, onset and recovery from plain 2-CP SA.

Methods: After IEC approval and patient consent, 40 patients of ASA I/II were randomly allocated into C and F groups. In sitting position, lumbar puncture was done and preservative free 1% 2-Chlorprocaine 4ml (40mg) + 0.5ml distilled water was injected in groupC, whereas in groupF, 1% 2-Chlorprocaine + 0.5ml (25mcg) Fentanyl was injected. Bilateral sensory block to pinprick was tested at 0,2,4,6,8, and 10 min after injection and every 10 minutes thereafter until complete block regression. Vitals, motor block, regression time, time to void, ultrasound guided pre and post-void bladder volumes, ambulation time, modified Aldrete scores were recorded.

Results: The duration of sensory blockade (Mean +/- SD in C and F groups = 83+/-10.49, 97+/-11.93 minutes) and void time (168+/-16.8, 191+/-15.1minutes) was extended with addition of intrathecal fentanyl (P<0.005). Motor block (assessed by Bromage scale) was comparable in both groups. All subjects were able to ambulate and void successfully in both groups and were shifted to PACU with an Aldrete score =/>9. Mean time to discharge was 283 +/- 34.77 minutes. No complications encountered.

Conclusion: 2-CP is an ideal agent for SA and addition of intrathecal fentanyl significantly prolonged sensory blockade making it an attractive choice for SA in the outpatient setting.

REFERENCES:

Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, Montgomery J, Russon K, Potparic O, Stocker M. Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia. 2019 Jun;74(6):778-92.Vath JS, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added fentanyl. Anesthesia & Analgesia. 2004;98(1):89-94.

 Abstract ID: ISAP016: Comparative study between TIVA vs inhalational mode of anaesthesia in patients undergoing modified radical mastectomy



Nitesh Goel, Rupam Jha, Manoj Bhardwaj, Rajiv Chawla.

Department of Anaesthesia, Rajiv Gandhi Cancer Institute & Research Centre

Background and Aim: The need of ecofriendly1 anaesthesia which can offer good recovery profile and greater hemodynamic stability demands the use of total intravenous anesthesia (TIVA). We have compared feasibility of TIVA with inhalational mode of anaesthesia in patients undergoing Modified Radical Mastectomy.

Methodology: After ethical clearance and registration, 100 adult patients of American Society of Anaesthesiologists Grade I - III were randomly allocated into two groups (50 each) using chit in box method. Group I was maintained with 1-4% sevoflurane with 50% nitrous oxide in oxygen, and Group T was maintained with Inj. Dexmedetomidine @1mcg/kg over 10 min followed by 0.7 mcg/kg/hr along with propofol @ 25-100 mcg/kg/min with 50% air in oxygen to maintain a bispectral index (BIS) value of 40-60. Analgesia was maintained with inj. fentanyl 2mcg/kg and morphine 0.1mg/kg. Heart rate (HR), mean blood pressure (MBP), BIS were recorded intraoperatively. Modified Aldrete score (MAS), intraoperative awareness and consumption of individual agent was recorded at the end of surgery. For comparison of scale variables between TIVA and Inhalational groups, independent sample 't' test for significance difference between two sample means have been followed. Mean and SD have been computed using descriptive statistics procedure.

Results: HR, MBP and MAS score were comparable in two groups (p>0.05). In TIVA group opioid consumption was significantly lower (morphine: 3.69 vs 4.85mg, p<0.05). None of our patients had any episode of intraoperative recall. Cost per patient was 40% in TIVA group (Rs. 740/1678)

Conclusion: TIVA provides stable intraoperative hemodynamics, good recovery at a low cost in ecofriendly manner as compared to inhalational anaesthesia.

REFERENCES:

Matt campbell, J. M. Tom pierce, atmospheric science, anaesthesia, and the environment, continuing education in anaesthesia critical care & pain, volume 15, issue 4, august 2015, pages 173–179.V Buchh, B Saleem, F Reshi, A Hashia. S Gurcoo, A Shora, S Qazi. A comparison of total intravenous anaesthesia (TIVA) to conventional general anaesthesia for day care surgery. The internet journal of anesthesiology. 2008 volume 22 number 1

 Abstract ID: ISAP352: Evaluation of the ability of perfusion index in detection of ulnar nerve sparing during ultrasound guided supraclavicular block



S Kammukutti, R Amutha Rani, J Bridgit Merlin, A Anne Feno.

Department of Anaesthesiology, Tirunelveli Medical college Hospital, Tirunelveli, Tamilnadu

Background and Aims: USG guided supraclavicular nerve block is a popular anaesthetic approach for upper limb surgeries. A successful supraclavicular block is associated with vasodilatation. The perfusion index (level of vascular dilatation) is a good objective predictor for successful uptake of block. To evaluate the ability of perfusion index (PI) as an objective predictor of successful supraclavicular block and in detection of ulnar nerve sparing. Also to estimate the appropriate timing for optimal PI ratio (PIR)

Methods: The study was performed on 40 ASA I&II patients scheduled for elective upper limb orthopaedic procedures under USG guided supraclavicular nerve block. The PI was recorded at baseline, every min for 10 min and every 5 min for 30 min in blocked index and little fingers and unblocked index finger. Block success was assessed by sensory and motor function tests at 20 minutes. PIR was calculated as PI after 10 min divided by PI at baseline.

Results: In 37 cases of effective block , PI (index finger) were 8.34+ 2, 8.4 + 2.2 and 8.5+2.14 at 10, 20, 30 min respectively ,with significant increase in 10 minutes .PI –(1.4-2.2)&(0.8-4.4) in unblocked & 3 failed blocks respectively.PI & PIR were statistically significant (p<0.001). PI and PI ratio in blocked limb were higher in index finger at all-time points when compared with little finger - ulnar nerve

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Conclusion: Perfusion index is a useful objective measure of successful supraclavicular nerve block. Appropriate time for optimal PIR is at 10 minutes.

REFERENCES

Predicting successful supraclavicular brachial plexus block using pulse-oximeter perfusion index A.Abdelnasser, B.Abdelhamid, A.Elsonbaty, A .Hasanin,A.Rady,BJA:British Journal of Anaesthesia,Volume 119,Issue 2,August 2017,Pages 276-280Perfusion index in detection of ulnar nerve sparing during supraclavicular nerve block Bassant M .Abdelhamid,Cairo University ClinicalTrials.gov Identifier:NCT03880201

 Abstract ID: ISAP453: A comparative study of Visual analogue scale for anxiety (VAS-A) and Hamilton anxiety rating scale (Ham-A) for assessment of preoperative anxiety in patients posted for elective surgeries



Chethana C S, Asha N.

Bangalore Medical College and Research Institute, Bangalore.

Background and aims: Preoperative anxiety is an unpleasant state of tension or uneasiness that leads to sympatheticoadrenal activity which can interfere with intraoperative events and post-operative recovery. Objective assessment and special questionnaires are too complicated for everyday use hence the use of simple and easy to administer vas-a might allow detection of patients with high anxiety. To compare the outcome of vas-a scale to that of ham-a scale in patients posted for elective surgeries in preoperative period.

Methods:In preoperative period to a total of 98 patients vas-a was administered first and the results were concealed from clinician administering ham-a inorder to double blind the study. Outcome of both the scoring systems were compared and statistical tests were applied.

Results:

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Kappa agreement between vas-a score and ham-a score was 0.536 (moderate agreement)

In the study there was significant positive correlation between vas-a score and ham-a score with pearson corelation of 0.702

Conclusion: vas-a is an efficient tool for measuring preoperative anxiety. A score of 50mm and above can be a reliable indicator of anxiety.

REFERENCES:

Facco E, Stellini E, Bacci C, Manani G, Pavan C, Cavallin F, Zanette G. Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiol. 2013 Dec;79(12):1389-95Bansal T, Joon A. Preoperative anxiety-an important but neglected issue: A narrative review. Indian Anaesth Forum 2016;17:37-42

 Abstract ID: ISAP599: Psychomotor recovery of dexmedetomidine compared with propofol after sedation during spinal anaesthesia



Vishnu.P, S. P Chittora, Tinson Varghese Thomas

Jhalawar Medical College, Jhalawar

Background and Aims:Psychomotor recovery is an essential part of daycare surgery. Propofol and dexmedetomidine are commonly used for daycare procedures.This study is designed to evaluate psychomotor recovery of dexmedetomidine compared with propofol after sedation during spinal anaesthesia

Methods: 66 patients were included .Group D received dexmedetomidine 0.5mcg/kg(loading dose),followed by 0.2-1 mcg/kg/hr. Group P received propofol infusion of 25-100 mcg/kg/min.Psychomotor recovery was assessed by finger-tapping ,manual dexterity ,visual spatial memory capacity and pen and paper tests.Psychomotor tests were done every 30 minutes for 2 hours followed by every hour upto 4 hours after surgery . Students t test was used to find the significance of psychomotor recovery between two groups .P<0.05 was considered as significant.

Results: The motor recovery using finger tapping test was faster in group D than Group P.(73.94+ 42.13 vs 101.21+ 37.98 minutes,P value =0.007).Motor recovery using pegboard test was faster in group P than group D(82.12+40.37 vs 99.39+43.08 minutes ,P value 0.098).Visual spatial capacity memory test and pen and paper test were unaffected.

Conclusion: Patients who received dexmedetomidine showed earlier recovery with finger tapping test

REFERENCES:

Pawar S, Malde A. Psychomotor, cognitive and ambulatory recovery after propofol anaesthesia. IJA. 2009;23:1Arain SR, Ebert TJ. Efficacy,side effects and recovery characteristics of dexmedetomidine versus propofol during intraoperative sedation. Anaesth Analog 2002;95:461-6.

 Abstract ID: ISAP684 : Opioid Free Anaesthesia Improves Postoperative Quality of Recovery after surgery for elective lumbar spine surgeries - A prospective, randomized, comparative study.



P. Gayatri, B. Sowbhagya Lakshmi, B. Vishnu Mahesh Babu, B.Snehalatha.

Department of Anaesthesiology, RMC, Kakinada.

Background and Aims: Enhanced recovery after surgery (ERAS) and multimodal analgesia are established care models that minimize perioperative opioid consumption and promote positive outcomes after spine surgery. Opioid-free anaesthesia (OFA) is an emerging technique that can achieve similar goals. The purpose of this study was to compare the patient recovery using the QOR-40 at 24hr postoperatively and perioperative opioid requirement in lumbar spine surgeries between opioid-free anaesthesia (OFA) and opioid containing anaesthesia (OCA).

Methods: After obtaining approval from institutional ethics committee and informed consent, sixty patients were included in the study, were randomized into two equal groups:

OFA group received Dexmedetomidine (50 mcg), Ketamine (50 mg), and Lignocaine (500 mg) diluted to 50ml, infusion at the rate of 7 ml/hr preceded by bolus of 7ml.

OCA group received Fentanyl (1mcg/kg) bolus followed by 0.5 μ/kg/hr.

Primary outcome was Quality of recovery(QOR) - 40 at 24hrs postoperatively, and the secondary outcomes were postoperative numerical rating scale (NRS ) for pain, time to first rescue analgesia, number of rescue analgesics, and the incidence of postoperative nausea and vomiting, length of hospital stay.

Results: A statistically significant (p<0.05) difference in total QOR - 40 score at 24hrs postoperative was observed between the groups (QOR-40 of 180.0 [162.0–190.0] in the OFA group and168.0 [154.0–183.0] in the OCA group; P = 0.032). OFA group had significantly more time to first rescue analgesia, lower NRS pain scores, less number of rescue analgesics and Ondansetron use.

Conclusion: Opioid-Free anaesthesia in lumbar spine surgeries minimizes the perioperative opioid exposure without adversely affecting pain control or recovery with stable hemodynamics.

REFERENCES:

Hakim KY, Wahba WZ. Opioid-free total intravenous anesthesia improves postoperative quality of recovery after ambulatory gynecologic laparoscopy. Anesth Essays Res 2019;13:199-203.Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al: Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol 65:191–199, 2015.

 Abstract ID: ISAP014: Bispectral index guided harmonisation of anaesthesia induction and tracheal intubation procedures: A randomized controlled study



Moloy Rajkhowa, Amitabh Dutta, Chand Sahai

Sir Ganga Ram Hospital, New Delhi.

Background & Aims: Anaesthesia induction and direct laryngoscopy-intubation (DLI) are essential interventions of anaesthesia delivery that have different haemodynamic implications. Bisepectral index (BIS), has been increasingly utilized for monitoring depth-of-anaesthesia during the intraoperative period, however it has never been used for both induction of anaesthesia and DLI procedures.This study investigated whether BIS guided control of depth of anaesthesia has the potential to achieve haemodynamic harmonisation during 'induction of anaesthesia' and 'DLI'.

Methods: Study included 180-adult patients scheduled to receive GA(90-patients per group). Standard monitoring along with BIS was applied. Two intravenous fentanyl boluses (1-μg/kg each) were successively administered at '0' and '3' minute time-points. Anaesthesia was induced at 6-min with 1.5 mg/kg propofol followed by assessment of either Loss of Verbal Contact (LOVC) (Group-1) or a BIS score of ≤ 50 (Group-2)as an end-point to induction. A re-assessment of BIS at 120-seconds was done. Additional bolus of 0.5mg/kg of propofol was administered if BIS>50 in Group 2,no additional bolus was administered in Group 1.

Results: Both the groups were comparable for demographic variable including (age, body weight, height, BMI and gender)There was significant difference between the two groups in terms of the primary objective (NIBP differential between post-induction and post-intubation systolic blood pressure). [Group-1; n=85; 20.98±25.59],[Group-2 n=86; 12.84±24.50] (P<0.05).

Conclusion: The use of BIS and ensuring adequate anaesthesia depth at the time of DLI has the potential to offset sympathetic stimulation and achieve haemodynamic optimisation.

REFERENCES:

Messieha ZS, Guirguis S, Hanna S. Bispectral index monitoring (BIS) as a guide for intubation without neuromuscular blockade in office-based pediatric general anesthesia: a retrospective evaluation. Anesth Prog. 2011;58(1):3–7. doi:10.2344/0003-3006-58.1.3M.-A. Lallemand, C. Lentschener, J.-X. Mazoit, P. Bonnichon, I. Manceau, Y. Ozier, Bispectral index changes following etomidate induction of general anaesthesia and orotracheal intubation. BJA 2003; 91(3):341–346. https://doi.org/10.1093/bja/aeg175

 Abstract ID: ISAP416: A comparative study of vital capacity induction with sevoflurane to intravenous induction with propofol for insertion of laryngeal mask airway in adults



V. Archana, S.G.K Murthy, A.S. Kameshwarrao

Konaseema Institute of Medical Sciences and RF, Amalapuram

Background & Aims: The laryngeal mask airway is a popular supraglottic airway device, with intravenous propofol being the agent of choice for its insertion. Sevoflurane is a volatile anaesthetic agent, which combines rapid, smooth inhalational induction of anaesthesia with rapid recovery, making it ideal for day care anaesthesia. Aim was to compare conditions for LMA insertion following induction with intravenous propofol and vital capacity induction with sevoflurane and number of attempts for insertion of Laryngeal Mask Airway.

Methods: We have conducted randomized double blinded clinical trial where 100 adult patients were allocated randomly into two groups of 50 each; group P (Propofol group) and group S (Sevoflurane group). Patients in group P were induced with 2.5 mg/kg intravenous Propofol and lidocaine 0.3 mg/kg, and in group S, after priming the Bain's circuit with Sevoflurane 8% in 50% N2O and O2 (flow rate – 8 litre/minute) for 30 secs, patients were asked to take vital capacity breaths via the face mask connected to primed circuit. One minute after the loss of eyelash reflex, which was considered as the end-point of induction, the LMA insertion was attempted. Scoring system was used to grade the conditions for the LMA insertion.

Results

The mean time required for induction with propofol is 50.9 secs and with sevoflurane is 73.8 secs,The mean time required for LMA insertion with propofol is 75.2 secs and in sevoflurane group is 74.96 secs.Haemodynamic parameters were more stable in sevoflurane group.

Conclusion

Haemodynamic parameters were more stable in sevoflurane group.

REFERENCES:

Dongare DH, Kale JV, Naphade RW. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol in adult patients. Anesth Essays Res. 2014;8(3):319–323. doi:10.4103/0259-1162.143122Vinaya U, Amol S, Himanshu D, Karuna T. Comparison of inhalational vital capacity induction with sevoflurane to intravenous induction with propofol for insertion of laryngeal mask airway in adults: A randomized study. Anesth Essays Res. 2018;12(1):73–79.

 Abstract ID: ISAP718: Comparative study of perioperative blood glucose levels in various anaesthetic techniques (general, spinal and epidural) in non-diabetics and diabetics (controlled)



Heena Naaz, Vijaya Rekha, Aejaz Ul Haq

Deccan college of medical sciences, Hyderabad

Background and Aims: Surgery produces a stress response resulting in various biochemical and hormonal changes. The most widely known metabolic disturbance is elevated blood sugar. Perioperative morbidity and mortality are affected by the inadequate glycemic control. There are variations in hyperglycaemic response with various anaesthetic agents and techniques. Among the factors affecting genesis of hyperglycemia Diabetes stands as a strong pillar. The aim of the study is to evaluate degree of rise of blood sugar levels as a measure of stress during anaesthesia and surgery, under various anaesthetic techniques between non-diabetics and diabetics (controlled).

Methods: The study was conducted at Deccan college of medical sciences, Hyderabad in ninety adult patients (30 to 55 years age), undergoing various elective surgeries of 60 to 90 minutes duration under three anesthetic techniques (General Anaesthesia (GA), Epidural (EA), and spinal Aneasthesia (SA)). 45 of these patients were not diabetic and 45 are controlled diabetics. Rise of blood sugar was compared among three techniques in each group and among similar techniques between both groups. For estimating blood glucose levels, preoperative,4 intraoperative and 2 postoperative venous blood samples were collected.

Results: In diabetics and non-diabetics, the blood sugar fluctuation is less with regional techniques and furthermore, less under SA.

RISE IN BLOOD SUGAR LEVEL (% INCREASED ) AT VARIOUS TIME INTERVALS – IN NON-DIABETICS AND DIABETICS

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Conclusion: As the stress response to surgery is comparatively less in SA, glycemic control is better in SA. In diabetics, because of the metabolic disturbance and glucose intolerance, response to surgical stress is exaggerated. We recommend SA over epidural and general anaesthesia whenever possible in reducing surgical stress response.

REFERENCES

Berghe GVD, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in crically ill patients. N Engl J Med 2001;345(19):1359 67.Lazar HL, Philippides G, Fitzgerald C, Lancaster D, Shemin RJ, Apstein C. Glucose-insulin-potassium soluons enhance recovery aer urgent coronary artery bypass graing. J ThoracCardiovascSurg 1997;113(2):354-62.