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Author(s): Comparative study of the effect of inhalational anaesthetic agents: sevoflurane, isoflurane and desflurane on the blood glucose levels in non-diabetic patients under general anaesthesia: a randomised controlled trial Chandini [...]

Author(s): Comparison of preoperative gastric volumes after ingestion of carbohydrate-containing clear fluid versus plain water in adults undergoing elective laparoscopic surgery: A randomised controlled study Akshitha Swamy, Rajnish Kumar AIIMS, [...]

Comparative study of the effect of inhalational anaesthetic agents: sevoflurane, isoflurane and desflurane on the blood glucose levels in non-diabetic patients under general anaesthesia: a randomised controlled trial Chandini K, [...]

Comparison of preoperative gastric volumes after ingestion of carbohydrate-containing clear fluid versus plain water in adults undergoing elective laparoscopic surgery: A randomised controlled study Akshitha Swamy, Rajnish Kumar AIIMS, Patna [...]

ABSTRACT The World Health Organization defines healthy ageing as ‘the process of developing and maintaining the functional ability that enables well-being in older age'. This functional ability is the characteristic of the individual's own physical and mental status influenced by the environmental and socio-economic factors. Preoperative preparation of the elderly patients includes functional assessment to identify preexisting cognitive impairment or cardio-pulmonary reserve, frailty, nutrition, polypharmacy and anti-coagulation issues. Intraoperative management includes anaesthetic mode and pharmacology, monitoring, intravenous fluid and transfusion management, lung protective ventilation and hypothermia. Postoperative checklist includes perioperative analgesia, postoperative delirium and cognitive dysfunction. Keywords: Aged, frailty, geriatric assessment, perioperative care, Author(s): Anuradha Mahender (corresponding author) [1]; Surekha S. Chavan [2]; Richa Saroa [3]; Meenal Chauhan [4] INTRODUCTION Advances in modern healthcare have improved the life expectancy of the population and [...]

Samuel Debas Bayable,1 Netsanet Temesgen Ayenew,1 Abebaw Misganaw,1 Melaku Bantie Fetene,2 Wubet Dessie Amberbir3 1Department of Anesthesia, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia; 3Department of Anesthesia, Menelik II Health Science College, Addis Ababa, EthiopiaCorrespondence: Samuel Debas Bayable, Tel +251 911437507, Email Samuel_debas@dmu.edu.et; samueldebas88@yahoo.comBackground: The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery.Methods: A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant.Results: This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride.Conclusion: Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.Keywords: fasciculation, muscle pain, postoperative myalgia, succinylcholine, vecuronium

The objective – to summarize the current literature data on the etiology, pathogenesis, diagnosis and treatment of malignant hyperthermia. The search and analysis of literature data on malignant hyperthermia in the medical information systems PubMed, Сochrane librarу, Cyberleninka for the last 10 years was performed with using the keywords: «malignant hyperthermia», «dantrolene», «general anesthesia», «succinylcholine», «inhalation anesthetics». The search criteria were met by 96 publications. In addition, references to selected articles were manually checked for applicable articles including recent reports of malignant hyperthermia, in addition to works of historical significance. It was shown that malignant hyperthermia develops in susceptible individuals during or after general anesthesia with the use of trigger agents – inhaled halogen-containing anesthetics and succinylcholine. Until recently, the problem of treatment in Russia remained unresolved, since specific therapy for this syndrome was not available. In connection with the official registration of Dantrolene in the Russian Federation, this problem no longer has a life-threatening potential. Doctors should recognize the symptoms of this disease as early as possible in order to quickly begin the pathogenetic treatment of malignant hyperthermia in order to prevent fatal complications. The material is intended for a wide audience of anesthesiologists, resuscitators and surgeons who may encounter this pathology in clinical practice.

Author(s): Barry L. Friedberg (corresponding author) [1] All cosmetic surgeries, including abdominoplasty, can be performed under local anaesthesia alone. A new sedative has emerged for awake cosmetic surgery, including rhytidectomy [...]

Author(s): Sunil Rajan (corresponding author) [1]; Gayathri Sreekumar [1]; Lokeshshiva Arul [1]; Roniya A. Roy [1] Dear Editor, Supine, left head rotation (LeHeR) manoeuvres have been reported to improve glottic [...]

The safe anesthesiological care of patients with neuromuscular diseases poses a particular challenge for anesthetists. Only a small group of muscle diseases and syndromes are associated with an increased risk of malignant hyperthermia and therefore require trigger-free anesthetic procedures avoiding volatile anesthetics and succinylcholine. These diseases are frequently associated with mutations in the RYR1, CACNA1S or STAC-3 genes. In other neuromuscular diseases, anesthetic-induced rhabdomyolysis can occur. Therefore, volatile anesthetics should be avoided in these patients in addition to the contraindication for succinylcholine. In other neuromuscular diseases the risk of a propofol infusion syndrome or myotonic crises can be elevated or the duration of the effect of non-depolarizing muscle relaxants can be changed in an incalculable way. In every case an individual anesthetic aproach including the avoidance of potential pharmacological or non-pharmacological triggers is essential for the safety of the patients. [ABSTRACT FROM AUTHOR]

Introduction: Agitation immediately after EA operation is one of the common problems during recovery, especially in children. In general, agitation is defined as a set of physical symptoms or emotional distress that includes the following symptoms alone or together: crying, restlessness, clutching, demonstrations, verbal kicking, and purposeful or purposeless behaviors that may have a logical connection. Method: In this study, 60 patients in the age range of 20 to 50 years who were in ASA I and II categories were subjected to tracheal intubation in two groups by rapid sequence induction method. The first group received 3 μg/kg of fentanyl and 0.5 mg/kg of lidocaine for premedication and were given induction with 1 mg/kg of succinylcholine and 5 mg/kg of nesdonal. The second group received 3 μg/kg of fentanyl and 0.5 mg/kg of lidocaine for premedication and were given induction with 0.6 mg/kg of rocuronium and 5 mg/kg of nesdonal. After surgery, the incidence, intensity and duration of agitation when the patient woke up in both groups was recorded by a physician based on Riker's criteria. Also, the occurrence of myalgia and its persistence from one to 24 hours after the operation were assessed. Results: According to the results of this clinical trial, succinylcholine and rocuronium were not significantly different from each other in terms of the occurrence of agitation, its intensity and duration, but based on the results of the odds ratio, the probability that in patients who took rocuronium they found that agitation is 0.6 times less than the patients who received succinylcholine. Logistic analysis of the data also showed that in patients who received succinylcholine, the probability of agitation being more severe is 2.47 times higher than in patients who received rocuronium. The duration of agitation in patients receiving succinylcholine was also higher than in patients receiving rocuronium. In terms of the incidence and severity of myalgia, there was no significant difference in the people who received rocuronium or succinylcholine, however, a total of 50% of the patients showed agitation symptoms, showed myalgia, of which 16.6% were related to the people who received rocuronium and 33.3% were related to patients who received succinylcholine. The results of the myalgia odds ratio also showed that the probability of myalgia symptoms being observed in patients who received rocuronium is 0.5 times lower than in patients who received succinylcholine. Conclusion: In aggregate, the results of this trial showed that rocuronium can be a suitable alternative to succinylcholine in applications outside the operating room. [ABSTRACT FROM AUTHOR]

Rhabdomyolysis in adults after anesthetic administration is uncommon in those without underlying risk factors. We present a 34-year-old female with history of severe gastroesophageal reflux disease (GERD), hypothyroidism, and migraines who developed severe rhabdomyolysis following an uncomplicated general anesthetic for esophagogastroduodenoscopy (EGD) and placement of Bravo esophageal pH monitor. The patient did not have any known risk factors for malignant hyperthermia, and halogenated agents were not used during the procedure. We speculate that the rhabdomyolysis was caused by the use of succinylcholine. Providers should be aware that even patients without known risk factors may be at risk for developing rhabdomyolysis, and it is important to remain vigilant about this potentially life-threatening complication.

Abstract Background Anesthesia-associated rhabdomyolysis is a rare complication of surgery that causes postoperative myalgia, weakness, and potential renal failure if not managed promptly. Predisposing conditions that may lead to this complication include muscular dystrophies and myopathies. Case presentation This rare case describes a pediatric non-Indigenous Australian patient developing this complication, with no known predisposing risk factors, and no clear etiology. A 9-year-old child with a background of asthma underwent an elective removal of keloid scar on her chest wall. The procedure was brief and uncomplicated, with an uneventful induction of anesthesia. During the emergence period, she developed acutely raised airway pressures with bronchospasm and laryngospasm requiring the use of salbutamol and suxamethonium with good effect. In the initial postoperative period, the patient complained of generalized myalgia and muscle weakness and was unable to mobilize independently. There was transient recovery to normal function; however, a recurrence of symptoms the following day with associated myalgias warranted admission to hospital. She was found to have rhabdomyolysis that was managed conservatively with a full recovery of several weeks. She was thoroughly investigated for any underlying cause, including genetic testing for malignant hyperthermia susceptibility (she had a variant of unknown significance but was negative for the known genetic abnormalities that cause malignant hyperthermia). Conclusion This case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms.

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed. [ABSTRACT FROM AUTHOR]

Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to compare the duration of action of Rocuronium and Suxamethonium during elective thyroidectomy. Methodology : This double-blind experimental study included 60 patients ranging in age from 18 to 60 years old who underwent elective thyroidectomy under general anaesthesia after approval from the Institutional Ethics Committee and written patient consent Result: The Duration of action was comparable between the groups with statistically significant difference (p value is less than 0.05). For analysis of difference in duration of action "t" test was used. P value is less than 0.05, (p=0.000) indicating that highly significant difference between the groups in the duration of action. Conclusion: The study found that Rocuronium has a significantly longer duration of action than Suxamethonium. [ABSTRACT FROM AUTHOR]

Succinylcholine is a depolarizing muscle relaxant that has been used for rapid sequence induction and for procedures requiring only a brief duration of muscle relaxation since the late 1950s. The drug, however, has serious side effects and a significant number of contraindications. With the recent introduction of sugammadex in the United States, a drug that can rapidly reverse even large amounts of rocuronium, succinylcholine should no longer be used for endotracheal intubation and its use should be limited to treating acute laryngospasm during episodes of airway obstruction. Given the numerous risks with this drug, and the excellent ablation of airway reflexes with dexmedetomidine, propofol, lidocaine and the larger amounts of rocuronium that can now be administered even for an anesthesia of short duration. The use of succinylcholine for endotracheal intubation should disappear from clinical practice.

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process.

Objective: We examined the change in foreleg raising power after Sion's local paralysis (SLP) with succinylcholine in the shoulder muscle. Methods: A randomized, double blind, placebo-controlled, porcine study was designed and performed at a research institution. Ten male Korean native pigs were randomized into an intervention group (n = 5) and a control group (n = 5). The injection points were in the middle of the left trapezius muscle and the middle of the left deltoid muscle. The control group received 2 ml normal saline (NS), 1 ml injected in each point. The intervention group received 0.4 mg/kg succinylcholine diluted to 2 ml in NS, and 1 ml was injected in each point. To represent the foreleg raising power, the height of the left forelegs from baseline (experiment table) was measured. We measured the foreleg height and oxygen saturation at −4, −2, 0, +2, +4, +6, +8, +10, +20, +30, and +60 min. Results: After SLP, foreleg height immediately declined in the intervention group. It recovered slightly for a few minutes and declined from 4 to 8 min. In the control group, foreleg height was relatively similar throughout the study period. A repeated-measure analysis of variance revealed a significant group × time interaction (F10,80 = 2.37, P = 0.017), a significant main effect for group (F1,8 = 6.25, P = 0.037), and a significant main effect for time (F10,80 = 4.41, P

Succinylcholine (SUX) is a clinical anesthetic that induces temporary paralysis and is degraded by endogenous enzymes within the body. In high doses and without respiratory support, it results in rapid and untraceable death by asphyxiation. A potentiometric thread-based method was developed for the in-field and rapid detection of SUX for forensic use. We fabricated the first solid-contact SUX ion-selective electrodes from cotton yarn, a carbon black ink, and a polymeric ion-selective membrane. The electrodes could selectively measure SUX in a linear range of 1 mM to 4.3 μ M in urine, with a Nernstian slope of 27.6 mV/decade. Our compact and portable yarn-based SUX sensors achieved 94.1% recovery at low concentrations, demonstrating feasibility in real-world applications. While other challenges remain, the development of a thread-based ion-selective electrode for SUX detection shows that it is possible to detect this poison in urine and paves the way for other low-cost, rapid forensic diagnostic devices. [ABSTRACT FROM AUTHOR]

A 21-year-old woman developed an acute myotonic reaction while undergoing anaesthesia using succinylcholine. Examination later showed she had shoulder, neck and calf hypertrophy, bilateral symmetrical ptosis and eyelid, handgrip and percussion myotonia. Peripheral neurophysiology studies identified significant, continuous myotonic discharges in both upper and lower limbs. Genetic analysis identified a c.3917G>A (p.Gly1306Glu) mutation in the SCN4A gene, confirming a diagnosis of sodium channel myotonia. Succinylcholine and other depolarising agents can precipitate lifethreatening acute myotonic reactions when given to patients with myotonia. Patients with neuromuscular disorders are at an increased risk of perioperative anaesthetic complications. We report a woman who developed an acute myotonic reaction whilst undergoing anaesthesia, in the context of an unrecognised myotonic disorder. We then discuss an approach to the diagnosis of myotonic disorders. [ABSTRACT FROM AUTHOR]

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action. Aim and objective: The aim of the study was to compare the intubating conditions at 60 seconds after giving Rocuronium 0.6 mg/kg and Suxamethonium 1 mg/kg intravenously. Methods: In this clinical trial, a total of 60 patients were enrolled. Patients were divided into groups A and B. Group A received Rocuronium 0.6 mg/kg intravenously, and Group B received suxamethonium 1 mg/kg, and all were intubated after 1 minute. Intubation conditions were noted and scored according to a modification of the Kreig et al.,. method. Results: It was observed that intubation conditions were excellent in both groups; there was tachycardia associated with the Rocuronium group, and blood pressure was higher in the Suxamethonium group. Conclusion: Rocuronium can be acceptable for intubation instead of Suxamethonium, except in conditions anticipating difficult intubation. [ABSTRACT FROM AUTHOR]

Malignant hyperthermia is a rare, life-threatening pharmacogenetic disorder which presents as a hypermetabolic response to volatile anesthetics and depolarizing muscle relaxants in susceptible individuals. This susceptibility is associated with mutations in three genes: RYR1, CACNA1S and STAC3. Can manifest with mild symptoms or as a fulminant crisis, with severe rhabdomyolysis, ventricular fibrillation and acute renal and circulatory failure, therefore the prognosis depends on how soon the diagnosis is suspected and how fast treatment is started. The definitive diagnosis is based on a fresh muscle biopsy sensitivity test and genetic testing. The best way to prevent an event is the early detection of susceptible, as well as have equipment to respond to a crisis in each center where volatile anesthetics are administered and the training of staff. This review synthesizes current clinical and biomedical concepts for detection, prevention, diagnosis and management of malignant hyperthermia. [ABSTRACT FROM AUTHOR]

Tracheal extubation is a risky phase of anaesthesia. Most complications that occur when an endotracheal tube is removed are of minor nature, but those that require critical action can end in serious complications or even death. Patient – A 55-year-old woman was admitted for elective transabdominal hysterectomy and adnexal procedures. Anaesthesia – Standard monitoring. For induction, we used fentanyl, propofol, and rocuronium. The maintenance phase of anaesthesia was without complications. After extubation, the patient presented with severe trismus and mask ventilation was unsuccessful (cannot ventilate) – It was not until 200 mg of succinylcholine was administered that the masseter muscle spasm subsided.

Byline: Asha. Tyagi, Sonali. Deep, Rashmi. Salhotra, Rajeev. Malhotra, Anshuja. Singla Background and Aims: There are scanty data for oxytocin dose in patients at high risk of uterine atony. We [...]

Background and Aims: Trauma is one of the leading causes of global disease burden. Data on airway management in trauma patients from developing countries, particularly India is sparse. Hence, we planned a prospective observational study to assess the airway management practice patterns and associated complications. Methods: The study was conducted in trauma triage of a tertiary care hospital. Data was collected on all tracheal intubations occurring in trauma victims requiring definitive airway control, a detailed proforma including patient details, mode of injury, drugs used, intubation procedure, and complications were filled out for each patient. Results: We observed that the airway in trauma patients was primarily managed by non-anaesthesia speciality residents (426 patients); anaesthesia residents were primarily called for deferred or difficult intubations. The first attempt success rate of intubation by anaesthesia residents was significantly higher than speciality residents (P = 0.0001; 95 CI 9.02-24.66). Non-anaesthesia residents used midazolam in varying doses (3-12 mg) for intubation, whereas, rapid sequence intubation was the most common technique used by anaesthesia residents. Airway injuries were the most frequent complication observed in 32.8 of patients intubated by specialty residents compared to 5.9 of patients intubated by anaesthesia residents. Conclusion: The trauma triage is a high-volume area for frequent tracheal intubations which are manned by non-anaesthesia speciality teams. A number of factors related to the patient, staff, availability of airway equipment and unfavourable surroundings impact airway management and may explain the high incidence of airway complications, such as airway injuries in these trauma victims. Keywords: Airway management, head injury, intubation, polytrauma, trauma centre, Author(s): Anudeep Jafra [1]; Kajal Jain (corresponding author) [1]; M. Venkata Sravani [2]; Laxmi Narayana Yaddanapudi [1]; Pankaj Kumar [1] INTRODUCTION Emergency airway management is a priority in polytrauma and [...]