Sulagna Bhattacharjee

Evaluation of i-gel(™) airway in children: a meta-analysis.

I‐gel™ is a relatively newer addition in the pediatric anesthesia practice. Its comparison with the other laryngeal mask airway repor‐ted a wide range of results. Randomized controlled trials where i‐gel™ has been compared with other laryngeal masks (laryngeal mask airway ProSeal™ and laryngeal mask airway Classic™) in children for airway management device during general anesthesia has been included in this meta‐analysis.

High-frequency ventilation does not provide mortality benefit in comparison with conventional lung-protective ventilation in acute respiratory distress syndrome: a meta-analysis of the randomized controlled trials.

Background:Despite implementation of lung-protective ventilation strategy, acute respiratory distress syndrome is associated with significant mortality, which necessitates the evaluation of ventilatory modes other than conventional lung-protective strategy. This meta-analysis of the randomized controlled trials has been undertaken to know whether high-frequency oscillatory ventilation (HFOV) provides any mortality benefit over conventional ventilation in adult patients with acute respiratory distress syndrome. Methods:Published randomized controlled trials comparing HFOV with conventional lung-protective ventilation in adult patients with acute respiratory distress syndrome were included in this meta-analysis. Results:A total 1,759 patient data from seven randomized controlled trials have been analyzed here. Primary outcome of the review is in-hospital/30-day mortality and secondary outcomes are duration of intensive care unit stay, duration of mechanical ventilation, requirement of additional treatment, and complications associated with the interventions. HFOV does not offer any in-hospital/30-day mortality benefit (386 of 886 in HFOV vs. 368 of 873 in conventional ventilation; risk ratio, 0.96; 95% CI, 0.77 to 1.19; P = 0.70) over conventional ventilation. It may also prolong the duration of mechanical ventilation (mean difference, 1.18 days; 95% CI, 0.00 to 2.35 days; P = 0.05). Duration of intensive care unit stay (mean difference, 1.24 days; 95% CI, −0.08 to 2.56 days; P = 0.06) and requirement of neuromuscular blocker is similar between two treatment arm. Incidence of refractory hypoxemia is significantly less (risk ratio, 0.60; 95% CI, 0.39 to 0.93; P = 0.02) with the use of HFOV. HFOV is not associated with increased incidence of barotrauma and refractory hypotension. Conclusion:HFOV should not be used routinely in all adult patients with acute respiratory distress syndrome as primary ventilation strategy in place of conventional lung-protective ventilation.

Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: A meta-analysis and systematic review ☆ ☆☆ ★

PURPOSE The role of high-flow nasal oxygen (HFNO) therapy in adult patients with acute hypoxemic respiratory failure is controversial. METHODS This meta-analysis of prospective randomized controlled trials (RCTs) has been designed to compare HFNO with noninvasive ventilation (NIV) and conventional oxygen therapy in such patients. RESULTS Initial database searching revealed 336 RCTs, of which 7 were included in this meta-analysis. Five RCTs compared HFNO with standard oxygen therapy, one compared HFNO with NIV, and one compared all three. HFNO did not decrease the requirement of higher respiratory support compared with control group. HFNO was associated with improved respiratory rate and dyspnea score, and better comfort in 3 RCTs, whereas other studies did not find any difference. CONCLUSION High-flow nasal oxygen does not offer any benefit over NIV or conventional oxygen therapy in terms of requirement of higher respiratory support.

Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial

Background and Aims: Transversus abdominis plane (TAP) block has been shown to provide postoperative pain relief following various abdominal and inguinal surgeries, but few studies have evaluated its analgesic efficacy for intraoperative analgesia. We evaluated the efficacy of TAP block in providing effective perioperative analgesia in total abdominal hysterectomy in a randomized double-blind controlled clinical trial. Materials and Methods: A total of 90 adult female patients American Society of Anesthesiologists physical status I or II were randomized to Group B (n = 45) receiving TAP block with 0.25% bupivacaine and Group N (n = 45) with normal saline followed by general anesthesia. Hemodynamic responses to surgical incision and intraoperative fentanyl consumption were noted. Visual analog scale (VAS) scores were assessed on the emergence, at 1, 2, 3, 4, 5, 6 and 24 h. Time to first rescue analgesic (when VAS ≥4 cm or on demand), duration of postoperative analgesia, incidence of postoperative nausea-vomiting were also noted. Results: Pulse rate (95.9 ± 11.2 bpm vs. 102.9 ± 8.8 bpm, P = 0.001) systolic and diastolic BP were significantly higher in Group N. Median intraoperative fentanyl requirement was significantly higher in Group N (81 mcg vs. 114 mcg, P = 0.000). VAS scores on emergence at rest (median VAS 3 mm vs 27 mm), with activity (median 8 mm vs. 35 mm) were significantly lower in Group B. Median duration of analgesia was significantly higher in Group B (290 min vs. 16 min, P = 0.000). No complication or opioid related side effect attributed to TAP block were noted in any patient. Conclusion: Preincisional TAP block decreases intraoperative fentanyl requirements, prevents hemodynamic responses to surgical stimuli and provides effective postoperative analgesia.

A Study to Compare the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam Combination in Patients Undergoing Elective Infraumbilical Surgery

Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Several adjuvants have been tried along with local anesthetic for prolonging the duration of analgesia. In this study, we have observed the effect of midazolam as an adjuvant in patients undergoing infraumbilical surgery. In this prospective, randomized, double blinded, and parallel group and open label study of 90 adult patients aged 18–60 years, of American Society of Anaesthesiologists (ASA) status I and II, scheduled for elective infraumbilical surgery, were randomly allocated in two groups. Each patient in group “B” received hyperbaric bupivacaine 12.5 mg along with 0.4 mL of normal saline in the subarachnoid block, and patients of group “BM” received 12.5 mg hyperbaric bupivacaine along with preservative free midazolam 0.4 mL (2 mg). We found that use of midazolam as adjuvant with the local anesthetic in spinal anaesthesia significantly increases the duration of analgesia (median 320 min versus 220 min) and motor block (median 255 min versus 195 min) but decreases the incidence of postoperative nausea-vomiting (PONV).

Comparison of Ondansetron and Dexamethasone for Prophylaxis of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries: A Meta-Analysis of Randomized Controlled Trials.

Background. Postoperative nausea and vomiting (PONV) is a significant complication after laparoscopic surgeries. Ondansetron and dexamethasone are most commonly used drugs for PONV prophylaxis. Comparisons of these two drugs have not been systematically reviewed till date. Methods. PubMed, PubMed Central, and CENTRAL databases were searched with the following words: “dexamethasone,” “ondansetron,” “laparoscopy,” and “PONV” to identify randomized trials that compared ondansetron and dexamethasone for PONV prophylaxis after laparoscopic surgeries. Results. Data of 592 patients from 7 RCTs have been included in this meta-analysis. Incidence of postoperative nausea at 4–6 h is significantly lower when dexamethasone was used instead of ondansetron (p = 0.04; OR 0.49, 95% CI 0.24–0.98, M-H fixed). Incidence of nausea is similar at 24 hours (p = 0.08, OR 0.71, 95% CI 0.48, 1.05; M-H fixed); vomiting is also similar at 4–6 h (p = 0.43, OR 1.27, 95% CI 0.70–2.27; M-H fixed) and also at 24 h (p = 0.46, OR 0.92, 95% CI 0.73, 1.16; M-H fixed). Conclusion. Dexamethasone is superior to ondansetron in preventing postoperative nausea after 4–6 h of laparoscopic surgeries. However, both the drugs are of equal efficacy in preventing postoperative vomiting up to 24 h after surgery. However, results should be interpreted with caution due to clinical heterogeneity in the included studies.

Comparison of LMA Supreme™ with i-gel™ and LMA ProSeal™ in children for airway management during general anaesthesia: A meta-analysis of randomized controlled trials

STUDY OBJECTIVE A few randomized trials have compared LMA Supreme™ with LMA ProSeal™ and i-gel™ in children but their conclusions varied widely. This systematic review and meta analysis has compared the former device with the latter two devices. DESIGN Meta-analysis and systematic review using the Mantel-Haenszel method and pooled mean difference using inverse variance method. SETTING Meta-analysis of published prospective randomized controlled trials. PATIENTS Paediatric patients undergoing surgery under general anaesthesia. INTERVENTION LMA Supreme™ with LMA ProSeal™ or i-gel™ as airway management device. RESULTS Electronic database searching revealed four randomized trials where LMA Supreme™ has been compared with LMA ProSeal™ and three trials where a comparison was made between LMA Supreme™ and i-gel™ in paediatric population. LMA Supreme™ provided similar oropharyngeal leak pressure when compared to LMA ProSeal™ [mean difference (95% CI) 1.57 (-1.33, 4.47)cm H2O; p=0.29] and i-gel™ [mean difference (95% CI) 1.18 (-2.11, 4.47)cm H2O; p=0.48]. First insertion success rate is also similar when LMA Supreme™ is compared to LMA ProSeal™ [RR (95% CI) 1.03 (0.97, 1.1); p=0.74] and i-gel™ [RR (95% CI) 0.99 (0.95, 1.03); p=0.51]. Device insertion is significantly faster with LMA Supreme™ than i-gel™ [mean difference (95% CI) 1.87 (0.93, 2.81) s; p<0.0001]. CONCLUSION We suggest that LMA Supreme™ may be an alternative to LMA ProSeal™ and i-gel™ in children for airway management during general anaesthesia.

Therapeutic hypothermia after cardiac arrest is not associated with favorable neurological outcome: a meta-analysis

BACKGROUND Cardiac arrest is associated with very high mortality and causes neurological dysfunction in the survivors. Therapeutic hypothermia is one of the recommended modality in the postarrest management. However, recent findings question its benefit in postarrest management. This meta-analysis has been conceptualized to quantify clinical benefit of therapeutic hypothermia in post-cardiac arrest patients. METHODS Prospective, randomized, and quasi-randomized controlled trials comparing the efficacy of therapeutic hypothermia in post-cardiac arrest adult population with a post-cardiac arrest management protocol that does not include therapeutic hypothermia were included in this meta-analysis. Two authors independently searched PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration for potentially eligible trials. RESULTS Data of 1399 patients from 6 controlled trials have been included in this systematic review and meta-analysis. Therapeutic hypothermia does not provide any benefit in favorable neurological outcome (P=.06; odds ratio, 1.80; 95% confidence interval [CI], 0.97-3.35; n=1384), in survival at hospital discharge (P=.58; odds ratio, 1.16; 95% CI, 0.69-1.96; n=1399), and in long-term survival (P=.36; odds ratio, 1.32; 95% CI, 0.73-2.39; n=1292). Therapeutic hypothermia also increases incidence of pneumonia (P=.02; odds ratio, 1.30; 95% CI, 1.04-1.64; n=1204; number needed to harm, 15). CONCLUSION Therapeutic hypothermia in the post-cardiac arrest management protocol does not provide any benefit in favorable neurological outcome, survival to hospital discharge, and long term survival. Incidence of pneumonia may be increased with the use of therapeutic hypothermia.

Gabapentina e pregabalina no período perioperatório em cirurgia cardíaca: uma revisão sistemática e metanálise

OBJECTIVES Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery. METHODS Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review. RESULTS Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications. CONCLUSION Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.

Reexpansion pulmonary edema after hepatic hydatid cyst excision

Reexpansion pulmonary edema (RPE) is a rare but wellknown complication after thoracocentesis [1]. It usually follows reexpansion of the collapsed lung from pneumothorax or pleural effusion [2]. RPE may be very severe at times and may require extracorporeal membrane oxygenation support for management [3]. We are reporting a case of unilateral pulmonary edema in an elderly who had a huge hydatid cyst of liver causing collapse of predominantly lower lobe of the right lung. A 72-year-old gentleman with a history of hydatid cyst of liver was scheduled for a laparotomy and excision of hydatid cyst. He did not have any medical comorbidity, and his clinical examination revealed a 9-cm× 10-cm soft palpablemass in the right subcostal region. He also complained of occasional breathlessness particularly during exertion. A chest x-ray revealed an elevated right hemidiaphragm (Fig. 1). All other clinical examinations and laboratory examinationswerewithin normal limit. He was scheduled to undergo a laparotomy for hydatid cyst excision under general anesthesia. A standard general anesthesia with endotracheal intubation was followed; intraoperative blood loss was around 250 mL, and he received around 1.25 L crystalloid during surgery, which lasted for around 1 hour. During surgery, his hemodynamic and respiratory parameters were within normal limit. At the end of surgery, when we noticed spontaneous respiratory activity, residual neuromuscular blockade was reversed with neostigmine and glycopyrrolate. Just after when the patient started breathing, we noticed pink frothy secretion in the endotracheal tube with increased oxygen requirement. On auscultation, basal crepitation was noted in the right lung. Wemade a presumptive diagnosis of RPE, and the patient was shifted to intensive care unit for overnight mechanical ventilation. A chest x-ray found diffuse opacities suggestive of pulmonary edema limited to right hemi thorax only (Fig. 2). The patient responded to diuretics and morphine, and he was weaned off from mechanical ventilation and extubated next day. Most of the available case reports are after drainage of pneumothorax or pleural effusion. To the best of our knowledge, RPE after relieve of abdominal mass effect has not been