Tag: pubmed

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):236-242. doi: 10.4103/joacp.joacp_462_23. Epub 2025 Feb 22.

ABSTRACT

BACKGROUND AND AIMS: Desflurane helps in prompt awakening when discontinued. Since desflurane has a lesser blood: gas solubility than nitrous oxide, we hypothesized that use of air with desflurane would result in a rapid recovery compared to desflurane with nitrous oxide.

MATERIALS AND METHODS: After approval from the institutional ethical committee was obtained, this prospective, nonrandomized study (CTRI/2017/11/010558) was conducted. This study included 110 American Society of Anesthesiologists I-II patients aged 18-60 years, of either sex, undergoing general anesthesia using desflurane with air or nitrous oxide for elective surgery. The primary objective was to compare the time taken to achieve a modified Aldrete score of 9/10. The secondary objectives were to compare time to spontaneous respiration, time to extubation, time to verbal response, time to orientation, intraoperative opioid consumption, and incidence of explicit recall between groups. P <0.05 was considered significant.

RESULTS: The time required to achieve modified Aldrete score of 9/10 was higher in those who received nitrous oxide (899.09 ± 426.85 s) compared to those who received air (464.27 ± 190.28 s; P < 0.01). Time taken for spontaneous respiration, extubation, verbal response, and orientation was significantly higher with the use of desflurane with nitrous oxide compared to use of air. The intraoperative opioid requirement was statistically significant, but clinically not significant. Explicit recall was not seen in any of the patients.

CONCLUSION: Nitrous oxide delays the elimination of desflurane compared to air, thus delaying extubation and recovery and mitigating the beneficial effects of desflurane.

PMID:40248797 | PMC:PMC12002682 | DOI:10.4103/joacp.joacp_462_23

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):323-332. doi: 10.4103/joacp.joacp_26_24. Epub 2024 Aug 16.

ABSTRACT

BACKGROUND AND AIMS: Preclinical studies in rodents and primates have shown that anesthesia was neurotoxic to the developing brain after exposure in the neonatal period. Sevoflurane a commonly used inhalational anesthetic, especially in pediatric surgery, might cause behavioral impairment in the developing brain. Although favored for its rapid onset and minimal airway disturbance, sevoflurane has been implicated in neurotoxic effects such as anesthesia-induced developmental neurotoxicity in rodents, through various mechanisms. One of the mechanisms was disturbances in methylation metabolism which can be easily treated if it is proved. This study aims to evaluate the levels of S-adenosylmethionine [SAM] following sevoflurane anesthesia in neonates and to correlate the duration of sevoflurane exposure and S-adenosylmethionine levels.

MATERIAL AND METHODS: Sixty neonates were included in the study under general anesthesia. Pre- and postsevoflurane exposure arterial blood samples were collected in ethylenediamine tetraacetic acid vacutainers. Each sample was centrifuged at 1000 rpm for 10 min. Plasma was separated and stored at -80°C, then subjected to S-adenosylmethionine enzyme-linked immunoassay test for preand postsevoflurane exposure levels of SAM.

RESULTS: The difference between the pre- and post-SAM values is not statistically significant and also with increasing the duration of sevoflurane exposure there was no reduction in the SAM levels (r = 0.17), and the correlation was not significant (P = 0.18).

CONCLUSION: Single exposure to sevoflurane does not impact SAM levels in neonates undergoing general anesthesia.

PMID:40248795 | PMC:PMC12002701 | DOI:10.4103/joacp.joacp_26_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):250-256. doi: 10.4103/joacp.joacp_232_24. Epub 2025 Jan 29.

ABSTRACT

BACKGROUND AND AIMS: Postoperative pain is a major cause of discomfort after laparoscopic surgeries and thus necessitates prevention and treatment. This study aims to evaluate and compare two different doses of intraperitoneally nebulized (aerosol size: 0.4-4.5 micrometers) dexamethasone for the prevention of postoperative pain.

MATERIAL AND METHODS: In this double-blind, randomized control study, 135 patients undergoing laparoscopic surgeries were randomly assigned to three groups after obtaining ethical committee clearance and CTRI registration. Intraperitoneal nebulization was performed using the Aeroneb device, with group A receiving 16 mg dexamethasone, group B receiving 8 mg dexamethasone, and group C receiving 0.9% normal saline. The primary outcome was assessed by measuring visceral, somatic, and referred pain using a visual analog scale (VAS) at 6 hours postoperatively. Secondary outcomes included VAS at 1 and 24 hours, the hemodynamic response to pneumo-peritoneum, 24-hour anti-emetics, and opioid consumption.

RESULTS: VAS score at 6 hours was 0.9 ± 1.06 in group A, 1.7 ± 1.45 in group B, and 2.3 ± 1.87 in group C for referred pain; the values were statistically significant (P = 0.01). VAS score was 0.7 ± 0.76 in group A, 1.7 ± 1.82 in group B, and 2.2 ± 2.06 in group C for dull aching pain; the results were statistically significant at 24 hours (P = 0.001). None of the values at any time point were statistically significant (P < 0.05) for incisional pain. The rise in heart rate after 5 minutes of pneumoperitoneum was the least in group A compared to group C (P = 0.01). Group C had the highest consumption of anti-emetics and rescue analgesics (P = 0.001).

CONCLUSIONS: Intraperitoneal dexamethasone nebulization of 16 mg and 8 mg both are equi-effective in decreasing the severity of pain after laparoscopic surgeries compared to normal saline nebulization (P = 0.001).

PMID:40248791 | PMC:PMC12002692 | DOI:10.4103/joacp.joacp_232_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):286-291. doi: 10.4103/joacp.joacp_88_24. Epub 2025 Mar 24.

ABSTRACT

BACKGROUND AND AIMS: Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aimed to develop and validate a multivariable, prognostic model for postoperative hypotension in patients receiving epidural analgesia.

MATERIAL AND METHODS: We retrieved retrospective cohort data of adults undergoing abdominal or thoracic surgery at five hospitals between 2014 and 2023 who received epidural analgesia for at least 24 hours after surgery. A systematic literature search helped define a priori candidate exposures. The primary outcome was postoperative hypotension during the first 72 hours after surgery. Multiple logistic regression was performed to evaluate a multivariable model. Exposures identified as statistically significant were used for logistic regression, linear discriminant analysis, and decision-tree model of random forest. Classification error was used to compare models, and variable importance was used for random forest analysis.

RESULTS: In total, 829 participants were included. The incidence of postoperative hypotension was 38.8%. Multivariable analysis identified the following independent prognostic factors: male sex, white race, body mass index, intraoperative hypotension, use of arterial line, bupivacaine concentration of 0.125% (vs. lower concentrations), and anesthesia duration. The error misclassification rate was 67% for multiple logistic regression, 27% for linear discriminant analysis, and 33.4% for random forest model.

CONCLUSION: Using retrospective cohort data, a prognostic model of hypotension produced the best performance results using linear discriminant analysis, with an error misclassification rate of 27%. Further studies are required to perform model optimization for future clinical use.

PMID:40248788 | PMC:PMC12002708 | DOI:10.4103/joacp.joacp_88_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):219-225. doi: 10.4103/joacp.joacp_258_23. Epub 2025 Mar 22.

ABSTRACT

BACKGROUND AND AIMS: Postoperative pain is one of the most common problems after thoracic surgery. In this study, we aimed to investigate the analgesic effects of two different doses of intrathecal morphine (ITM) based on ideal body weight in patients who underwent video-assisted thoracoscopic surgery (VATS).

MATERIAL AND METHODS: Forty-six patients scheduled for elective lung resection were included in this study. Patients were allocated to receive 10 μg/kg (Group I) and 7 μg/kg (Group II) ITM according to the ideal body weight for postoperative analgesia. Intraoperative and postoperative hemodynamic variables, postoperative morphine consumption, pain scores (at rest and effort), side effects, and additional analgesic requirements were recorded.

RESULTS: Postoperative pain scores did not differ in the first 12 h between the groups, but were significantly lower in Group I compared with Group II at 18 and 24 hours (P = 0.024 and P = 0.017 at rest, and P = 0.025 and P = 0.002 at effort, respectively). Postoperative morphine consumption was statistically significantly lower in Group I at all time periods (P < 0.05). The incidence of side effects was similar for both groups (P > 0.05).

CONCLUSIONS: The use of 10 μg/kg ITM according to the ideal body weight provides more effective analgesia without increasing the side effects compared to 7 μg/kg ITM after VATS.

PMID:40248787 | PMC:PMC12002694 | DOI:10.4103/joacp.joacp_258_23

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):265-269. doi: 10.4103/joacp.joacp_28_24. Epub 2024 Aug 16.

ABSTRACT

BACKGROUND AND AIMS: The use of intra-articular injection has been widely accepted as a therapy for pain due to osteoarthritis of the knee. We aimed to compare the efficacy of intra-articular injection of platelet-rich plasma (PRP) with a combination of bupivacaine and corticosteroid in osteoarthritis of the knee.

MATERIAL AND METHODS: Fifty patients (aged more than 50 years) with pain pattern consistent with osteoarthritis of the knee who did not respond to conservative treatment were included in the study. They were randomly divided into two groups of 25 each: group I (n = 25) patients were administered fluoroscope-guided intra-articular knee injection of bupivacaine and steroid, and group II (n = 25) patients were administered intra-articular knee injection of PRP. In group I, patients were administered 9 ml of drug solution comprising 8 ml of 0.5% bupivacaine and 1 ml of triamcinolone (40 mg). In group II, patients were administered 6 ml of PRP. Pain, patient satisfaction, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed at different time intervals before and after the procedure for up to 12 months.

RESULTS: Pain score and WOMAC were both clinically and statistically better at 2 weeks and 1 month after injection in group I (P < 0.05). But results were better clinically in group II compared to group I at 2, 3, 6, and 12 months after the procedure. More than 50% of patients in both groups had excellent satisfaction.

CONCLUSIONS: Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically higher with PRP for longer duration.

PMID:40248785 | PMC:PMC12002684 | DOI:10.4103/joacp.joacp_28_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):280-285. doi: 10.4103/joacp.joacp_40_24. Epub 2024 Dec 16.

ABSTRACT

BACKGROUND AND AIMS: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6-18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients’ self-reported belief about the efficacy of treatment, and side effects or complications, if any.

MATERIAL AND METHODS: Forty patients attending the Pain Management Centre of either sex in the age group of 20-70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0-10), patients’ self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any.

RESULTS: The majority of the patients in our study were in the age group of 40-50 years, and 80% of the patients were females and weighed 60-70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period (P < 0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period (P < 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection.

CONCLUSIONS: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients’ self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.

PMID:40248784 | PMC:PMC12002680 | DOI:10.4103/joacp.joacp_40_24

Mov Ecol. 2025 Apr 17;13(1):27. doi: 10.1186/s40462-025-00549-2.

ABSTRACT

Understanding species-habitat associations is fundamental to ecological sciences and for species conservation. Consequently, various statistical approaches have been designed to infer species-habitat associations. Due to their conceptual and mathematical differences, these methods can yield contrasting results. In this paper, we describe and compare commonly used statistical models that relate animal movement data to environmental data. Specifically, we examined selection functions which include resource selection function (RSF) and step-selection function (SSF), as well as hidden Markov models (HMMs) and related methods such as state-space models. We demonstrate differences in assumptions while highlighting advantages and limitations of each method. Additionally, we provide guidance on selecting the most appropriate statistical method based on the scale of the data and intended inference. To illustrate the varying ecological insights derived from each statistical model, we apply them to the movement track of a single ringed seal (Pusa hispida) in a case study. Through our case study, we demonstrate that each model yields varying ecological insights. For example, while the selection coefficient values from RSFs appear to show a stronger positive relationship with prey diversity than those of the SSFs, when we accounted for the autocorrelation in the data none of these relationships with prey diversity were statistically significant. Furthermore, the HMM reveals variable associations with prey diversity across different behaviors, for example, a positive relationship between prey diversity and a slow-movement behaviour. Notably, the three models identified different “important” areas. This case study highlights the critical significance of selecting the appropriate model as an essential step in the process of identifying species-habitat relationships and specific areas of importance. Our comprehensive review provides the foundational information required for making informed decisions when choosing the most suitable statistical methods to address specific questions, such as identifying expansive corridors or protected zones, understanding movement patterns, or studying behaviours. In addition, this study informs researchers with the necessary tools to apply these methods effectively.

PMID:40247418 | DOI:10.1186/s40462-025-00549-2

Ital J Pediatr. 2025 Apr 17;51(1):126. doi: 10.1186/s13052-025-01965-1.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effects of community-acquired pneumonia (CAP) on cardiac function in children and compare the effectiveness of tissue Doppler imaging (TDI) and two-dimensional speckle tracking echocardiography (2D-STE) with conventional echocardiography in the early detection of biventricular cardiac dysfunction in children with CAP.

METHODS: The study included 50 hospitalized children diagnosed with CAP and 50 matched healthy controls. All patients underwent cardiac evaluation including conventional echocardiography, TDI, and 2D-STE.

RESULTS: Fifty children with CAP with a mean age of 5.02 ± 2.46 years participated in the study. Thirty-two were male (64.0%). LV systolic function (S) and RV diastolic function (E’/A’) were significantly lower in the diseased group compared to the control group (p < 0.001). The myocardial performance index (MPI) of both ventricles was significantly higher in the diseased group compared to the control group (p < 0.001). In patients with CAP, the mean value of two-dimensional longitudinal strain (2D LS) was significantly lower than that of the control group (p < 0.001). No statistically significant differences in echocardiographic parameters were observed when comparing complicated and non-complicated CAP subgroups.

CONCLUSION: TDI and 2D-STE demonstrated the ability to detect early biventricular dysfunction in pediatric patients diagnosed with CAP.

PMID:40247416 | DOI:10.1186/s13052-025-01965-1

Mov Ecol. 2025 Apr 17;13(1):28. doi: 10.1186/s40462-025-00557-2.

ABSTRACT

BACKGROUND: Current research on livestock movement ecology focuses on quantifying the factors that trigger alterations in movement behavior and understanding hidden mechanisms. Modern tracking technologies and robust statistical analysis models deliver new opportunities for investigating how individual animals cope with the joint effect of biotic and abiotic factors at different time scales.

METHODS: We applied multivariate Hidden Markov Models (HMMs) to characterize the fine-scale movement behavior (30-second intervals) of GPS-tracked domestic Zhongwei goats (Capra aegagrus hircus) for 124 days and analyzed the combined influence of biotic and abiotic factors and specific time of day on their seasonal movement behavioral transition in a predator-free, semi-arid mountain grassland in China.

RESULTS: We classified the behaviors of goats into two states: foraging (low step length, varied turning angle) and travelling (long step lengths, small turning angles). The terrain slopes had the most impact on their movement behavioral transition in the full year, spring, autumn, and winter. However, in the summer with hotter temperatures, the specific time of day explains their movement behavior most. Forage resources indicated by the Normalized Difference Vegetation Index (NDVI), and terrain ruggedness measured by the Vector Ruggedness Measure (VRM), had less impact on their behavior transitions compared to terrain slope and specific time of day. Elevation and solar radiation could not explain their movement behavior in different seasons, nor could NDVI in winter or VRM in spring and autumn. Across different seasons, the probability of foraging behavior increased with the later times of day, steeper terrain slopes, and higher NDVI, while it decreased with increasing VRM. The impact of NDVI on the probability of foraging behavior was largest during the early onset of vegetation growth in spring, and lowest in winter coinciding with a lower availability of food resources. The movement speed was lower, and the daily foraging percentage was higher in spring and winter due to lower food resources and shorter daylight hours. In contrast, movement speed was higher, and the daily foraging percentage was lower in summer and autumn with more food resources and longer daylight hours. The percentage of time allocated to foraging increases hourly from 9:00 am to 8:00 pm across various seasons.

CONCLUSIONS: HMMs were found to be useful for disentangling the movement behavior of goats. Our approach provides new insights into the seasonal and daily behavioral strategies of goats. Results demonstrate that in the mountain region, terrain slopes and specific times of the day more effectively trigger domestic goat behavioral transition from one state to the next compared with biotic factors, represented herein by NDVI, across different seasons. The early onset of vegetation growth and a shorter period of available high-quality forage in spring, significantly influenced goat behavioral transitions. Overall, these results are important for designing appropriate grazing management strategies that satisfy the ecological and socioeconomic demands of semi-arid grassland ecosystems.

PMID:40247393 | DOI:10.1186/s40462-025-00557-2