040917   SHARMA S K, THAKUR K, MUDGAL S K, PAYAL Y S (AIIMS, Rishikesh - 249 203, Uttarakhand, Email: sk.aiims17@gmail.com) : Acute postoperative pain experiences and satisfaction with its management among patients with elective surgery: An observational study. Indian J Anaesth 2020, 64(5), 403-8.

There is a paucity of regional data on acute postoperative pain. The present study was conducted with an aim to assess the acute postoperative pain experiences, its interference with ADLs, emotions, sleep, IPR and satisfaction with pain management among patients who had undergone elective surgeries. In this observational study, 200 postoperative adult patients; who had undergone elective surgery were interviewed using American Pain Society’s Patient Outcome and Satisfaction Survey Questionnaire. Pain perception and interference of pain with ADLs, emotions, sleep, and IPR was measured on 0–10 numerical scale and satisfaction on 6 point Likert scale, i.e., very satisfied to very dissatisfied. There was high incidence (82.5 %) of acute postoperative pain experience and mean score for worst episodes of pain was significantly high, i.e., 7.6 ± 1.5, which had significant interference with ADLs (5.6 ± 2.1), sleep (3.6 ± 1.7), and emotions (3.6 ± 1.6). Majority of patients reported that pain was assessed only once (17 %) or twice (48.5 %) in each shift. Despite of poor pain control, a large number of patients were satisfied with overall pain treatment (69 %), and response of physicians (81 %) and nurses (62 %) for their pain complaints. Acute pain score was directly associated with the duration of postoperative hospital stay (P = 0.001). Acute postoperative pain was inadequately assessed and undertreated but still a large number of participants were satisfied with acute postoperative pain management probably because patients expects that pain is inevitable after surgery. Postoperative pain had significant interference with ADLs, emotions and sleep of patients, which may affect postoperative comfort and recovery.

1 illus, 3 tables, 25 ref

040916   BARIK A K, KUMAR A, DHAR M, RANJAN P (Anaesthesiology Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: ajitdr.ajit@gmail.com) : A prospective comparative study of arterial blood gas parameters in smoker versus non‑smoker patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 2020, 64(5), 397-402.

Smoking is a risk factor for postoperative pulmonary complications in patients undergoing general anaesthesia. These may get amplified with effects of pneumo‑peritoneum and carbon dioxide (CO₂) insufflation during laparoscopic surgeries. Our aim was to compare metabolic and blood gas analysis of smokers versus non‑smoker patients during laparoscopic surgeries under general anaesthesia. After permission from institutional review board, 60 patients undergoing laparoscopic cholecystectomy were divided into two groups, smokers and non‑smokers (30 each). Along with baseline haemo‑dynamic parameters, arterial blood gas sampling was done to assess and compare PCO₂ , pH and bicarbonate (HCO₃) values at various time intervals with respect to pneumo‑peritoneum creation, between smokers and non smokers. Baseline systolic blood pressure was higher and oxygen saturation was significantly lower in smoker group. PCO₂ and end‑tidal CO₂ were significantly higher in smokers at all intervals (P < 0.001). pH was significantly lower and HCO₃ higher, in smokers after creation of pneumo‑peritoneum. Increase in PCO₂ due to pneumo‑peritoneum was higher in the smoker group (3.49 ± 8.5) mmHg versus non smoker (0.56 ± 4.86) mmHg, although statistically not significant. Change in pH and HCO₃ was similar between smokers and non‑smokers. There is a significant difference in baseline arterial blood gas characteristics between smokers and non‑smokers. Metabolic effects of CO₂ insufflation and increased intraabdominal pressure appears to be more enhanced in smokers.

1 illus, 3 tables, 19 ref

040915   GARG H, PODDER S, BALA I, GULATI A (Anaesthesia and Intensive Care Dep, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: podder_s@yahoo.co.in) : Comparison of fasting gastric volume using ultrasound in diabetic and non‑diabetic patients in elective surgery: An observational study. Indian J Anaesth 2020, 64(5), 391-6.

Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non‑diabetic patients scheduled for elective surgery using USG. This prospective observational study included 53 diabetic and 50 non‑diabetic patients aged >18 years, American Society of Anesthesiologists’ physical status I‑III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross‑sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm² and 3.73 ± 1.61 cm² in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm² and 2.30 ± 1.18 cm² of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group. Diabetic patients have higher gastric antral cross‑sectional area and gastric volumes as observed by gastric ultrasound than the non‑diabetic patients.

2 illus, 2 tables, 20 ref

040914   SOLIMAN R, YACOUB A, ABDELLATIF M (Anesthesia Dep, Cairo Univ, Cairo, Egypt, Email: rabiesoliman@hotmail.com) : Comparative effect of desflurane and sevoflurane on liver function tests of patients with impaired hepatic function undergoing cholecystectomy: A randomized clinical study. Indian J Anaesth 2020, 64(5), 383-90.

Desflurane and sevoflurane are the most common volatile anesthetics used during laparoscopic and hepatic surgery. The objective of the study was to evaluate the effect of desflurane and sevoflurane in patients with elevated preoperative liver functions undergoing laparoscopic cholecystectomy. The study was a randomized study and included 162 patients classified randomly into two groups: Desflurane group: The patients received desflurane (end‑tidal concentration 4 %–6 %) as an inhalational agent during the whole procedure. Sevoflurane group: The patients received sevoflurane (end‑tidal concentration 2 %–4 %) as an inhalational agent during the whole procedure. The investigations included serum level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma‑glutamyltransferase (GGT), and total bilirubin. The values were serially collected at the following timepoints; T0:at the preoperative period, T1:directly after surgery, T2:1^st postoperative day, T3:2^nd postoperative day, T4:3^rd postoperative day, T5:5^th postoperative day, T6:7^th postoperative day, and T7:10^th postoperative day. The statistics were described in terms of mean ± standard deviation, frequencies, and percentages. The preoperative liver enzymes and total bilirubin were higher than the normal range in patients of the two groups. Postoperatively, there was a decrease in the AST and ALT with desflurane more than sevoflurane from T1 to T6(P < 0.05). The ALP, GGT, and bilirubin decreased in patients of the two groups, but the comparison was insignificant (P > 0.05). The desflurane is a safe inhalational volatile for maintenance of anesthesia in patients with impaired liver function undergoing laparoscopic cholecystectomy. It was associated with a decrease in the liver enzymes more than the sevoflurane.

1 illus, 4 tables, 32 ref

040913   LI J, YE H, SHEN W, CHEN Q, LIN Y, GAN X (Anesthesiology Dep, Sun Yat?sen Univ, Guangdong Province, China, Email: ganxl@mail.sysu.edu.cn) : Retrospective analysis of risk factors of postoperative nausea and vomiting in patients undergoing ambulatory strabismus surgery via general anaesthesia. Indian J Anaesth 2020, 64(5), 375-82.

Postoperative nausea and vomiting (PONV), one of the common complications following strabismus surgery, would delay the ambulatory discharge time. The aim of this retrospective study was to determine the risk factors of PONV in patients undergoing ambulatory strabismus surgery under general anaesthesia, with the treatments of dexamethasone and 5‑HT₃ antagonist combination. We reviewed 721 consecutive patients (12–60 years old) undergoing ambulatory strabismus surgery under general anaesthesia at an academic eye centre between December 2016 and January 2019. Patients received prophylactic treatment of dexamethasone and 5‑HT₃ antagonist combination during anaesthesia induction, and PONV was evaluated during the early recovery period before discharge. The dexamethasone and 5‑HT₃ antagonist combination effectively reduced the incidence of PONV (3.05 %, 22/721), and the patients who experienced PONV had statistically prolonged phase II recovery time as compared those who did not (P = 0.006). The sum of the extraocular muscles manipulated and the use of nalbuphine (vs flurbiprofen axetil) were the independent risk factors for PONV (P < 0.05). The sum of the extraocular muscles manipulated and the use of nalbuphine are potentially modifiable risk factors for PONV after strabismus surgery with the treatments of dexamethasone and 5‑HT₃ antagonist combination.

1 illus, 4 tables, 27 ref

040912   KHEZRI M B, RAJABI M, YAGHOOBI S, BARIKANI A (Anesthesiology Dep, Qazvin Univ of Medical Sciences, Qazvin, Iran, Email: dr.108162@gmail.com) : Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double‑blind study. Indian J Anaesth 2020, 64(5), 369-74.

Systemic lignocaine has been shown to have sedative effects. We designed this randomised‑double‑blind, placebo‑controlled study to evaluate the effect of intravenous lignocaine on the bispectral index (BIS) during caesarean section under spinal anaesthesia. 80 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated to 2 study groups. Group L received intravenous 1.5 mg/kg of lignocaine bolus, 15 minutes before spinal anaesthesia followed by an intravenous infusion 1.5 mg/kg/h for 60 minutes intravenously. The patients in the control group (C group) were given 0.9 % sodium chloride in a double‑blind fashion. Spinal anaesthesia was performed with 10 mg of 0.5 % bupivacaine. The changes of Sao2, BIS and hemodynamic variables during caesarean section, Apgar score of neonate and the incidence of adverse effects were recorded. BIS values were lower in the L group compared to C group (P ≤ 0.001). Comparison of mean arterial pressure (MAP) changes during spinal anaesthesia and surgery reveal statistically significant difference between two groups through repeated measure analysis (P ≤ 0.001), but comparision of heart rate (HR) changes during spinal anaesthesia and surgery failed to reveal any statistically significant difference between two groups. (P = 0.261). The Apgar scores did not reveal a significant difference between the two groups at first and five minutes after delivery (P = 0.99). Intravenous lignocaine infusion given with spinal anaesthesia in women undergoing elective caesarean delivery providing lower BIS values without respiratory depression, in the absence of foetal compromise.

3 illus, 2 tables, 21 ref

040911   UDAYASANKAR M, UDUPI S, SHENOY A (Anaesthesiology Dep, Kasturba Medical Coll and Hospital, Manipal - 576 104, Karnataka, Email: doctor.sandesh@gmail.com) : Comparison of perioperative patient comfort with ‘enhanced recovery after surgery (ERAS) approach’ versus ‘traditional approach’ for elective laparoscopic cholecystectomy. Indian J Anaesth 2020, 64(4), 316-21.

Perioperative anxiety, hunger, thirst, fatigue, pain along with nausea and vomiting can influence a patient’s recovery after surgery. We aimed to compare ‘enhanced recovery after surgery’ (ERAS) protocol with a traditional perioperative approach to evaluate a patient’s recovery after elective laparoscopic cholecystectomy. A prospective randomised controlled study was conducted after institutional ethical clearance on 50 patients undergoing elective laparoscopic cholecystectomy, and divided equally into two groups. In group 1 (traditional); standard fasting guidelines and routine perioperative management was implemented. In group 2 (ERAS); patients received appropriate multimedia information about surgery and anaesthesia besidecarbohydrate loading with tender coconut water on the previous night and on the morning of surgery. Standard guidelines of fasting for solids were followed. Intraoperatively, goal‑directed fluid therapy and an inspired oxygen concentration of 60 % were administered. Postoperatively, early diet and mobilisation were initiated. The primary outcome was the assessment of perioperative anxiety. Hunger, thirst, fatigue, pain, nausea, vomiting and overall perioperative experience were also evaluated. ERAS group had reduced anxiety prior to surgery: median (interquartile range) 3 (3–4) vs 2 (2–3) (P = 0.003), and at 6 h postoperatively: 4 (3–6) vs 3 (1–4) (P = 0.001). Hunger, thirst and fatigue (P < 0.01) were also decreased with better overall perioperative experience (5 [4–5] vs 6 [5–7], P = 0.004). Pain, nausea, vomiting and blood glucose were similar between the groups. ‘ERAS approach reduces anxiety in addition to hunger, thirst and fatigue with enhanced overall perioperative comfort in patients undergoing laparoscopic cholecystectomy.

3 tables, 22 ref

040910   DESHPANDE J P, PATIL K N (Anaesthesiology and Critical Care Dep, Shrimati Kashibai Navale Medical Coll and General Hospital, Pune - 411 060, Maharashtra, Email: kalyanish19@gmail.com) : Evaluation of magnesium as an adjuvant to ropivacaine-induced axillary brachial plexus block: A prospective, randomised, double-blind study. Indian J Anaesth 2020, 64(4), 310-5.

Axillary brachial plexus block is commonly performed for surgeries on the hand and forearm. However, there are very few studies on the use of magnesium sulphate in axillary brachial plexus block and, hence, the study was designed to evaluate magnesium as an adjuvant to ropivacaine-induced axillary block with respect to onset and duration of sensorimotor block and postoperative analgesia. Sixty patients of the American Society of Anesthesiologists (ASA) physical status I and II, undergoing surgeries on the hand and forearm were randomly recruited to receive ultrasound-guided axillary block with either 150 mg magnesium sulphate or 1 mL normal saline added to 0.5 % ropivacaine. The primary outcome measure was to compare block characteristics including postoperative analgesia and the secondary outcome was to compare the use of rescue analgesia and the side‑effect profile. Data were statistically analysed using Statistical Package for Social Sciences (SPSS version 21.0). Categorical variables were compared using the Chi-square test or Fisher’s exact probability test; continuous variables compared using unpaired t-test or Mann-Whitney U test. Onset of sensory (9.93 ± 1.31 vs 8.83 ± 1.12 min) as well as motor block (13.37 ± 1.63 vs 11.57 ± 1.30 min) was significantly hastened with addition of magnesium to ropivacaine (p < 0.001) and so was the duration (sensory 386.60 ± 18.26 vs 526.37 ± 27.43, motor 323.73 ± 15.17 vs 436.97 ± 18.99 min) (p < 0.001) and postoperative analgesia (425 ± 21.39 vs 572.83 ± 32.04 min) (p < 0.001) which reflected in decreased requirement of rescue analgesic and total postoperative analgesic dosage. Magnesium is an effective and safe adjuvant to local anaesthetics and improves all characteristics of axillary brachial plexus block along with postoperative analgesia.

2 illus, 2 tables, 22 ref

040909   YADAV S, VYAS V, HAZARI S, GEHDOO R P, PATIL S (Dr. D. Y. Patil Medical Coll and Hospital, Navi Mumbai - 400 706, Maharashtra, Email: Varsha.vyas011@gmail.com) : Awareness of safety protocols for prevention of needle stick injuries in anaesthesiologists from Maharashtra: A survey study. Indian J Anaesth 2020, 64(4), 306-9.

Needle stick injury (NSI) has a serious risk of transmission of various blood borne pathogens amongst healthcare personnel and more so in anaesthesiologists. This survey assessed the prevalence of NSI and awareness of safety protocols for its prevention amongst the anaesthesiologists from Maharashtra, India. This self-administered survey was completed by 403 anaesthesiologists across Maharashtra from August 2019 to October 2019. The pre-validated and pretested 18-item questionnaire was administered using Google forms and the link was circulated amongst anaesthesiologists electronically. The questionnaire items included information on the awareness of safety protocols and immediate measure after NSI, knowledge of immunisation and safety practices followed in routine practice. Data were collected, tabulated and coded in Microsoft Excel. Descriptives are presented for the different items and prevalence of NSI. Comparison of prevalence of NSI in subgroups based on gender, period of experience and type of practice were analysed using Chi-square test. The prevalence of NSI was 73.7 % (n = 403) in anaesthesiologists with 71.1 % (n = 235) in males and 77.4 % (n = 168) in females. The anaesthesiologists from the medical schools had a prevalence of 75.0 % (n = 148), those in private practice had a prevalence of 72.7 % (n = 216), whereas those working in both medical school and private practice had a prevalence of 74.4 % (n = 39). A greater prevalence was observed in those working for longer periods. The prevalence of NSI’s is alarmingly high amongst anaesthesiologists and there is an immediate need of creating awareness and practice safety protocols in routine practice. Training and education are required in the formative years of healthcare curriculum.

2 tables, 18 ref

040908   GHAI B, GUDALA K, ASRAR M M, CHANANA N, KANUKULA R, BANSAL D (Pharmacy Practice Dep, National Institute of Pharmaceutical Education and Research, Mohali - 160 062, Punjab, Email: dipikabansal079@gmail.com) : Development, validation and evaluation of a novel self-instructional module in patients with chronic non‑specific low back pain. Indian J Anaesth 2020, 64(4), 299-305.

Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the same with respect to Indian context is still lacking. The study was aimed to develop, validate and assess the acceptability and effectiveness of self-instructional educational module among Indian chronic LBP (CLBP) patients. A prospective single-arm open-label study was conducted in a pain clinic of a tertiary care public hospital in North India with ‘Backcare booklet-self-instructional module (SIM)’ as an intervention in patients with CLBP. SIM was developed with the intent to provide up-to-date evidence-based information in an easy understanding way to patients with CLBP. 132 patients were administered SIM with a single session of verbal explanation. Pain intensity (numeric rating scale [NRS]), disability, fear-avoidance belief Questionnaire (FABQ), quality of life (EQ5D) and knowledge level were assessed at baseline and after 3 months of intervention. Student’s paired t-test and Chi-square test were used. Data were analysed using SPSS version 15.0. 120 patients successfully completed the 3 months’ follow‑up. Significant reductions were observed in pain intensity (76[12] vs 55 [15, P < 0.01); disability (51[14] vs 43 [10], P < 0.01); FABQ (46[12] vs 41 [10], P < 0.01); EQ5D (0.35 [0.27] vs 0.18 [0.26], P < 0.01). Backcare booklet as an intervention, along with usual pharmacological care is a cost-effective educational medium to promote self-management of CLBP in the clinical outpatient settings.

1 illus, 2 tables, 31 ref

040907   PRASAD R, SONI S, JANWEJA S, RAJPUROHIT J S, NIVAS R, KUMAR J (Anaesthesiolgy and Critical Care Dep, Dr S.N. Medical Coll, Jodhpur, Rajasthan, Email: shikhasoni.19@gmail.com) : Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance. Indian J Anaesth 2020, 64(4), 292-8.

Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications. In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator. Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups. Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ² test, the Mann–Whitney U-test, Fisher’s exact test and Student’s t-test as appropriate. Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100 % in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups. Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.

4 illus, 2 tables, 19 ref

040906   SINGH S A, KRISHNAN G, ASHRAF H, SUBRAMANIAN R, PANDEY V, NASA V K, GOYAL S, GUPTA S (Max Super Speciality Hospital, New Delhi - 110 017, Email: drshwetasingh29@ gmail.com) : Correlation between thromboelastography and rotational thromboelastometry values in adult liver transplant recipients. Indian J Anaesth 2020, 64(4), 286-91.

Viscoelastic haemostatic assays (VHA) namely Thromboelastogram (TEG) and Rotational thromboelastometry (ROTEM) are used for global assessment of coagulopathy and guiding transfusion during living donor liver transplant (LDLT).We conducted a study to compare the interchangeability of the values obtained from these devices in patients with End stage liver disease (ESLD) undergoing LDLT. In 76 patients undergoing LDLT, ROTEM and TEG were performed and assessed for interchangeability using Spearman Correlation. The direction and strength of correlation between equivalent parameters was calculated using Inter Class Correlation (ICC) and Bland Altman analysis. The correlation ρ between CT (clotting time) of ROTEM and R of TEG was 0.16 (P = 0.19).The ICC was 0.15, with 95 % confidence interval (CI) of -0.38-0.48 (P = 0.25).The ρ of CFT (ROTEM) with K (TEG) was 0.425 (P=<0.001). The ICC was0.49 with 95 % CI of 0.17-0.69, P = 0.003.Alpha of ROTEM correlated with Angle of TEG with ρ of 0.475 (P=<0.001). The ICC was 0.61, with 95 % CI of 0.36-0.76, P=<0.001.Maximum Clot firmness (MCF) correlated with maximum amplitude (MA) with ρ=0.76 (P=<0.001).The ICC was 0.86, with 95 % CI of 0.77-0.92, P=<0.001. Lysis index (L30) of ROTEM correlated clot lysis (CL30) of TEG with ρ of 0.16 (P = 0.18).However, the ICC was 0.45, with 95 % CI of 0.11-0.66, P = 0.08. The correlation between CT of ROTEM and R of TEG as well as L30 of ROTEM and CL30 of TEG was not significant.The strongest correlation was found between MCF and MA (P < 0.001). However the MCF/MA showed an agreement of only 86 % (ICC = 0.86). Values from ROTEM and TEG were not found to be interchangeable. Key words: Rotational thromboelastometry, thromboel

2 illus, 3 tables, 20 ref

040905   RANGANATHAN P, TADVI A, JIWNANI S, KARIMUNDACKAL G, PRAMESH C S (Anaesthesiology Dep, Homi Bhabha National Institute, Mumbai - 400 012, Maharashtr, Email: drpriyaranganathan@gmail.com) : A randomised evaluation of intercostal block as an adjunct to epidural analgesia for post-thoracotomy pain. Indian J Anaesth 2020, 64(4), 280-5.

Post-thoracotomy pain can be severe and disabling. The aim of this study was to examine the efficacy of intercostal nerve block when used as adjunct to thoracic epidural analgesia in patients undergoing posterolateral thoracotomy. This was a parallel-group randomised patient and assessor-blinded study carried out at a tertiary-referral cancer center. We included 60 adult patients undergoing elective lung resection under general anaesthesia with thoracic epidural analgesia. In addition, the intervention arm received single-shot intercostal blocks with 10 ml of 0.25 % bupivacaine at the level of and two levels above and below the thoracotomy. We assessed post-operative pain scores at 2 to 4 hours and 18 to 24 hours after surgery, peri-operative fentanyl requirement, percentage of patients who needed fentanyl PCA and maximum volume achieved on bedside spirometry 18 to 24 hours after surgery. Groups were compared using the unpaired t‑test for continuous data and the chi square test for categorical data at a 5 % level of significance. 2 to 4 hours post-operatively, mean pain scores at rest were 3.0 in both groups (difference 0.04, 95 % CI -1.1 to + 1.1) and on coughing were 4.6 (ICB group) and 4.9 (C group) (difference 0.32, 95 % CI -1.0 to + 1.6). There were no differences between the groups for any of the other outcomes. Addition of intercostal block to epidural analgesia does not confer any benefit in terms of post‑operative pain, fentanyl requirements or volume achieved on spirometry.

1 illus, 3 tables, 19 ref

040904   MATHEW R R, RAJU K, NAIR B R, MARIAPPAN R (Neuroanaesthesia Dep, Christian Medical Coll, Vellore - 632 002, Tamil Nadu, Email: ramamani@cmcvellore.ac.in) : An observational case‑control study comparing the recovery profile in patients receiving additional dose of anticonvulsant vs. regular dose during supratentorial craniotomy. Indian J Anaesth 2020, 64(3), 222-9.

Anticonvulsants are used routinely for seizure prophylaxis in patients with supratentorial tumour who present with/without seizures. Excessive use of prophylactic anticonvulsant may delay the recovery from anaesthesia. We have studied the recovery profiles of patients who received an additional dose of anticonvulsant in comparison with those who received only the regular dose. In this prospective observational study, patients were anaesthetised using standard anaesthesia protocol. An additional dose of anticonvulsant was administered in one group, while the other group received only the regular dose. Time taken for extubation, eye opening, obeying commands and orientation were compared between the two groups. Haemodynamics, depth of anaesthesia, the plasma anticonvulsant levels and the incidence of seizures were compared between the two groups. A total of 36 patients were studied, of which 19 received regular dose and 17 received an additional dose. There was no significant difference in recovery time between the two groups. Subgroup analysis was performed for phenytoin and sodium valproate. There was a clinically significant delay in recovery in patients who received an additional phenytoin compared to those who received regular dose (time to obey commands >15 min and orientation time >1hour) but, it was not statistically significant. Administration of an additional dose of valproate did not prolong the recovery time. An additional dose of sodium valproate did not cause a delay in recovery both, clinically and statistically. However, the administration of an additional dose of phenytoin caused a clinically significant delay in recovery but was not statistically significant.

2 illus, 4 tables, 9 ref

040903   UDHAYACHANDHAR R, OTOKWALA J, KORULA P J, RYMBAI M, CHANDY T T, JOSEPH P (Critical Care Div, CMC Hospital, Vellore - 632 004, Tamil Nadu, Email: pritishkorula@gmail.com) : Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study. Indian J Anaesth 2020, 64(3), 216-21.

Whipple procedure is associated with perhaps the most perioperative morbidity and mortality amongst surgical procedures. Current data regarding their ICU profile and outcomes are lacking. Thus, in the present study, we aimed to determine perioperative factors affecting patient‑centred outcomes following the Whipple procedure. In a cohort of patients undergoing pylorus‑sparing pancreaticoduodenectomies, we strove to determine perioperative variables that may impact outcomes. Unfavourable outcomes (composite of mortality, prolonged ICU stay of more than 14 days or ICU readmission) of patients who underwent the procedure were recorded and logistic regressions analysis of significant variables conducted. Around 68 patients recruited over a 20‑month period which included 57 males (83.8 %); mean age was 53.4(±11.2) with mean acute physiology and chronic health evaluation (APACHE) II score12.5 (±6.1). Nineteen patients remained intubated at the end of procedures (27.9 %). Median ICU stay was 2 days (IQR 2–3). Unfavourable ICU outcomes were 14 in number (20.6 %) and 2 (2.9 %) hospital deaths occurred. Pulmonary complications occurred in 12 patients (17.7 %) and non‑pulmonary complications occurred in 41 patients (60.3 %). In a multiple logistic regression analysis, the APACHE score 1.34 (1.09–1.64) and pulmonary complications 17.3 (2.1–145) were variables that were identified as predictors of unfavourable outcomes. The APACHE II score may reliably predict adverse outcomes following Whipple procedure. Although non‑pulmonary complications are common, pulmonary complications in these patients adversely impact patient outcomes.

4 tables, 25 ref

040902   SINGLA K, BALA I, JAIN D, BHARTI N, SAMUJH R (Anaesthesia and Intensive Care Dep, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: jaindivya77@rediffmail.com) : Parents’ perception and factors affecting compliance with preoperative fasting instructions in children undergoing day care surgery: A prospective observational study. Indian J Anaesth 2020, 64(3), 210-5.

Fasting guidelines have been recommended in the paediatric population to minimise the risk of pulmonary aspiration. The present study was planned to assess the compliance with fasting instructions in children undergoing ambulatory surgery and identify the factors affecting it. A total of 1,050 ASA I and II children aged 1–12 years, scheduled for day care surgery were enrolled. Parents of these children were given a questionnaire with specific questions like fasting instructions, source of instructions, actual fasting times and reasons for not following instructions. Only 90 (8.5 %) parents followed fasting instructions as advised. Of the 960 non‑compliant patients, 31 (2.9) inadequately fasted while 929 (88.4 %) fasted more than advised. While only 5.2 % mentioned aspiration, 25 % cited vomiting as the reason for fasting. Younger parents (OR = 0.853, 95 % CI‑0.796 to 0.915), fasting instructions in writing (OR = 10.808, 95 % CI‑1.459 to 80.059) and separate instruction for solids and liquids (OR = 6.016, 95 % CI‑ 3.663 to 9.883) were found to affect compliance with fasting instructions. To avoid risks of prolonged or inadequate fasting in day care surgical patients, good coordination between the anaesthetist and the surgeon and an updated knowledge about the preoperative fasting instructions among the health‑care providers is essential. Separate written fasting instructions for liquids and solids should be given to the parents according to their order in the operating list to ensure better compliance with fasting instructions.

4 tables, 16 ref

040901   AMMAR M A, ABDOU A M H (Anesthesia and Intensive Care Dep, Ain Shams Univ, Cairo, Egypt, Email: Mona_3mmar@hotmail.com) : Benefits of N-acetylcysteine on liver functions in living donor hepatectomy. Indian J Anaesth 2020, 64(3), 204-9.

The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. The aim of this study was to evaluate the post‑hepatectomy effect of using N‑Acetylcysteine (NAC) infusion in living donors undergoing donor hepatectomy. In a prospective randomised non‑blinded study, 50 healthy donors were enrolled; following hepatectomy patients were randomised into 2 groups: Group NC receiving NAC 150 mg/kg diluted in 100 ml glucose 5 % over 40 minutes, followed by NAC 12.5 mg/kg in 500 ml glucose 5 % over 4 hours. This was followed by NAC 6.25 mg/kg for 2 post‑operative days, Group C (Control group) received ringer acetate infusion at same rate for 2 days. The primary outcome was serum lactate levels. Secondary outcomes were liver function tests, serum creatinine and urine output on intensive care unit (ICU) admission (0 hr.), after 24 hours and 48 hours, length of ICU stay. Our study revealed significant reduction in serum lactate in Group NC at 0, 24 and 48 hours compared to C group (P = 0.017, 0.002, 0.014). INR values showed significant reduction after 48 hours in Group NC compared to Group C (P = 0.049). Total Bilirubin, ALT, and Creatinine, urine output and ICU stay showed no statistical difference between the 2 groups. The NAC protocol is a safe, cost‑effective tool for improvement of post hepatectomy liver function and early stabilisation of the metabolic profile.

2 illus, 3 tables, 26 ref

040900   PUTHENVEETTIL N, SANDHYA S, JOSEPH N, NAIR S, PAUL J (Anaesthesiology and Critical Care Dep, Amrita Institute of Medical Sciences, Kochi, Kerala, Email: nituveesundeep@gmail.com) : Comparison of cross‑legged sitting position with the traditional sitting position for the ease of insertion of an epidural catheter in parturient for providing labour analgesia: A randomised control trial. Indian J Anaesth 2020, 64(3), 199-203.

The patient’s position during the insertion of the epidural catheter plays a major role in the success of labour analgesia. In our study, we compared the ease of insertion of the epidural catheter in either traditional sitting position (TSP) or crossed‑legged sitting position (CLSP). The primary objective was to compare the number of successful first attempts at epidural placement between the groups. Secondary objective included patient comfort, ease of landmark palpation and the number of needle‑bone contacts. The prospective non‑blinded randomised control study was conducted on 50 parturient with uncomplicated pregnancy during active labour. Patients were randomly assigned into two groups using a computer‑generated random sequence of numbers by closed envelope technique. Group TSP received epidural in a traditional sitting position and group CLSP received an epidural in a crossed‑legged sitting position with knee and hip flexed. The parturient in both groups were comparable with respect to the distribution of age, height, weight and parity. The baseline visual analogue score (VAS) and VAS scores at 15 min were comparable between groups. Percentage of a parturient with successful epidural placement in the first attempt was higher in CLSP group than in TSP group (88 % versus 44 %, P = 0.004). The landmark, needle‑bone contact and comfort during positioning were comparable between the two groups. Cross‑legged sitting position is a better position than the traditional sitting position for the ease of insertion of labour epidural catheter.

2 illus, 3 tables, 19 ref

040899   LAL J, BHARDWAJ M, VERMA M, BANSAL T (Anaesthesiology and Critical Care Dep, Pt. BD Sharma Univ of Health Sciences, Rohtak - 124 001, Haryana, Email: drbmamta@gmail.com) : A prospective, randomised, comparative study to evaluate long axis, short axis and medial oblique axis approach for ultrasound‑guided internal jugular vein cannulation. Indian J Anaesth 2020, 64(3), 193-8.

The Ultrasound (USG)-guided internal jugular vein (IJV) cannulation can be performed using different approaches like short axis (SAX), long axis (LAX), oblique axis (OAX) or medial oblique axis (M-OAX). We aimed to determine which view was optimal for IJV cannulation. After ethical committee approval and written informed consent, this prospective, randomised, controlled trial was conducted on 108 patients. Patients were allocated into one of the three groups: A (SAX), B (LAX) and C (M‑OAX approach) for USG‑guided IJV cannulation. The number of needle passes, the success of IJV cannulation and its diameter, venous access time, guidewire time, catheterisation time and complications if any were recorded. Statistical analysis was performed by SPSS version 17.0. First needle pass success rate was highest in M‑OAX (97.2 %) followed by SAX (88.9 %) and then LAX (77.8 %) but it was statistically insignificant among the groups. Mean venous access, guidewire insertion and catheterisation time were shortest in M‑OAX followed by SAX and then LAX approach. It was statistically significant between LAX and SAX and between LAX and M‑OAX group. (P < 0.001). The carotid puncture was noticed in two patients in the LAX group. The overall success rate and the number of needle passes were comparable among the groups. The M‑OAX approach is a safe and effective technique for USG‑guided IJV cannulation when compared to SAX and LAX approaches.

3 illus, 3 tables, 16 ref

040898   DAGGUPATI H, MAURYA I, SINGH R D, RAVISHANKAR M (Anaesthesiology Dep, Super Speciality Cancer Institute and Hospital, Lucknow - 226 002, Uttar Pradesh, Email: indubala.maurya@gmail.com) : Development of a scoring system for predicting difficult intubation using ultrasonography. Indian J Anaesth 2020, 64(3), 187-92.

Ultrasound measurement of anterior neck soft tissue thickness by skin to epiglottis distance (SED) has been shown to predict difficult laryngoscopy. In this study, we developed an airway scoring system incorporating SED into three clinical predictors and assessed whether it would improve accuracy in prediction of difficult intubation. Mentohyoid distance, mandibular subluxation, head extension and ultrasound measurement of skin to epiglottis distance were measured a day before surgery in 310 adult patients. During direct laryngoscopy, Cormack–Lehane grading was noted (Grade 1 and 2 = Easy, Grade 3 and 4 = Difficult). We constructed a score named MSH, which included mentohyoid distance, mandibular subluxation and head extension. Then, SED was added to the MSH score to form another new score named U_SED‑MSH. Student’s t‑test, Mann‑Whitney U test and Chi‑square test or Fisher exact tests were used. Both scoring systems were compared under the receiver‑operating characteristic curve and area under the curve (AUC) were calculated. Difficult intubation was observed in 62/310 patients (20 %). The AUC for U_SED‑MSH score was greater than the MSH score (0.93, 95 % CI [0.89–0.97] vs 0.76, 95 % CI [0.69–0.84], P value <0.001). USED‑MSH score had higher sensitivity (93.6 % vs 59.7 %) and lower specificity (85.9 % vs 91.1 %) with similar positive predictive value (62.7 % vs 62.4 %) in comparison with MSH score. An airway scoring system using the ultrasound measurements of skin‑to‑epiglottis distance along with the clinical predictors would be helpful in the prediction of difficult intubation.

4 illus, 2 tables, 16 ref

040897   SHASTRI P S, GUPTA P, KUMAR R (Critical Care and Emergency Medicine Dep, Sir Gangaram Hospital, New Delhi, Email: prakashshastri@live.in) : A prospective 3 year study of clinical spectrum and outcome of dengue fever in ICU from a tertiary care hospital in North India. Indian J Anaesth 2020, 64(2), 181-6.

The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection. Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76 %) cases were serologically proven as dengue fever. Median age (IQR) of study population was 36.0 (26.0–52.0) years. Liver (65.7 %) was the main organ involved followed by acute kidney Injury (AKI) (18.6 %). Dengue Shock Syndrome (DSS) was found in 18.6 % of cases. Fifty‑two patients died and the crude mortality was 38.0 %. On multivariate analysis APACHE Score >10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality. This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted.

1 illus, 5 tables, 21 ref

040896   KUNDRA P, GOSWAMI S, PARAMESWARI A (Anaesthesiology and Critical Care Dep, Jawaharlal Institute of Medical Education and Research, Puducherry - 605 006, Email: p_kundra@hotmail.com) : Advances in vaporisation: A narrative review. Indian J Anaesth 2020, 64(3), 171-80.

The output of inhalational agents from modern vaporisers are both electronically and pneumatically controlled. They are designed to deliver set agent concentrations accurately with low fresh gas flows and possess enhanced safety features. The purpose of this review article is to give an overview of three modern vaporisers, namely, the Aladin cassette vaporiser, injection vaporisers and AnaConDa™. The Aladin cassette is integrated with Datex Ohmeda S/5 ADU and GE Aisys anaesthesia machines. The electronic vapour control unit is incorporated within the anaesthesia machine. The agent specific cassettes act as a detachable vaporising chamber. The system can work as a variable bypass and measured flow vaporiser but requires a power supply to function. Injection vaporisers can achieve the set end‑tidal agent concentration very rapidly with even metabolic flow rates. Hence, anaesthetic depth can be rapidly altered with minimal wastage and theatre pollution. The two types of injection vaporisers, namely, Maquet and DIVA™ are customised to function with Maquet FLOW‑i and the Drager Zeus anaesthesia machine, respectively. AnaConDa™ is a combination of vaporiser and humidity and moisture exchange filter which can be fitted in the ventilatory circuit. It is primarily designed for use in intensive care for sedation and out of operating room use.

8 illus, 14 ref

040895   RAVISHANKAR M, MATHEW D M, HEMANTHKUMAR V R, SRINIVASAN P (Anaesthesiology Dep, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, Email: dalenamathew@gmail.com) : Quantifying influence of epidural analgesia on entropy guided general anaesthesia using sevoflurane – A randomised controlled trial. Indian J Anaesth 2020, 64(2), 131-7.

Minimum alveolar concentration (MAC) of inhalational agent denotes the requirement of it to maintain adequate plane of general anaesthesia. The precision to the maintenance of anaesthesia can be further guided by use of entropy to titrate the depth of anaesthesia. Regional anaesthesia and the concomitant deafferentation will decrease the need of general anaesthetics. We conducted a randomised double-blind trial to quantify the effect of addition of regional anaesthesia to sevoflurane based general anaesthesia technique guided by entropy to achieve satisfactory depth of anaesthesia. Forty patients posted for elective laparotomies were randomised to two groups. All patients received a bolus followed by an epidural infusion. Group GE (general anaesthesia + epidural bupivacaine) received 0.25 % epidural bupivacaine and Group GS received epidural saline. Both groups received narcotic, relaxant and sevoflurane anaesthesia guided by entropy monitoring. The state entropy (SE) was maintained at 40–60 by titrating end tidal sevoflurane concentration (ET_sevo). Heart rate, blood pressure, SpO₂ , end tidal carbon dioxide (ETCO₂) and sevoflurane were recorded. Both groups were similar in heart rate and mean blood pressure during anaesthesia maintenance. The minimum ET_Sevo required to maintain entropy between 40 and 60 in group GE was 0.53 % compared to 0.95 % in group GS the epidural saline group (P < 0.001). The end‑tidal sevoflurane requirement to maintain adequate depth of anaesthesia dropped by 44.2 % in group GE. Lower concentrations of volatile anaesthetic are required when entropy-guided general anaesthesia is combined with regional blockade.

5 illus, 1 table, 20 ref

040894   THAKUR D P, MALDE A D (Anaesthesiology Dep, LTMMC and LTMG Hospital, Mumbai - 400 077, Maharashtra, Email: dradmalde@yahoo.com) : A study of effect of lateral position on oropharyngeal seal pressure of i‑gel® and ProSeal™ LMA in children. Indian J Anaesth 2020, 64(2), 125-30.

Supraglottic airways (SGAs) should have good oropharyngeal seal pressures (OSP) for adequate ventilation and prevention of aspiration. Our aim was to study the effect of lateral position on OSP and thereby on ventilatory parameters for i-gel® and ProSeal™ laryngeal mask airway (PLMA) in children. In this prospective observational study, 86 children of ASA I-II, aged 1 month to 12 years, scheduled for elective surgery under general anaesthesia using i-gel® or PLMA and requiring lateral position either for surgery or regional blocks were included. In both supine and lateral position OSP (constant flow method), expired tidal volume, fractional volume loss (%), and end-tidal carbon dioxide (ETCO₂ ) were noted. Intragroup and intergroup difference in OSP from supine to lateral position was analyzed using paired and unpaired t-test respectively. In lateral position, there was a significant decrease in the OSP (cm H₂O) in both i-gel® (supine: 21.94 ± 5.82, lateral: 15.54 ± 5.37) and PLMA (supine: 17.53 ± 5.05, lateral: 12.76 ± 3.37) groups (P = 0.000). Percentage reduction in OSP from supine to lateral with i-gel® (28.14 ± 18.86) and PLMA (24.06 ± 19.75) were comparable (P = 0.339). With both i-gel® and PLMA significant increase in fractional volume loss and ETCO₂ were noted in lateral position. I-gel® group had higher OSP compared to PLMA in supine (P = 0.001) and lateral position (P = 0.009). In lateral position there was significant reduction in OSP compared to supine position with both i-gel® and PLMA.

4 tables, 15 ref

040893   MALAWAT A, VERMA K, JETHAVA D, JETHAVA D D (Anaesthesiology Dep, Mahatma Gandhi Medical Coll and Hospital, Jaipur - 302 022, Rajasthan, Email: d_jethava@yahoo.com) : Erector spinae plane block for complete surgical anaesthesia and postoperative analgesia for breast surgeries: A prospective feasibility study of 30 cases. Indian J Anaesth 2020, 64(2), 118-24.

Several regional anaesthesia techniques have been described for carcinoma of the breast surgeries in the past but all of them failed to provide adequate surgical anaesthesia and are associated with multiple complications, thus limiting their use. This prospective study was designed to assess the efficacy of erector spinae plane (ESP) block to provide complete surgical anaesthesia without general anaesthesia (GA) and postoperative analgesia in patients undergoing modified radical mastectomy (MRM) surgery. Thirty females of the American Society of Anaesthesiologists physical status I, II or III scheduled for MRM were included in the study to receive unilateral ultrasound-guided ESP block preoperatively (25 ml of 0.5% bupivacaine with dexamethasone 8 mg on the operating side). The primary objective of the study was to evaluate the efficacy of ESP block to provide complete surgical anaesthesia in terms of total number of cases converted to GA. Our study shows that ultrasound-guided single-shot ESP block provided complete surgical anaesthesia in all the patients within an average of 31.50 minutes and an average long-lasting postoperative analgesia of 41.73 hours following MRM. Our study proves that ESP block is a novel, predictable, secure, and safe option for carcinoma of the breast surgery. Thus, ESP block would surely provide a clinical advantage in these population group.

2 illus, 2 tables, 26 ref

040892   KHALED G M, SABRY A I (Anaesthesiology Dep, Menoufia Univ, Menoufia, P.O: 32511, Egypt, Email: khgaballah@gmail.com) : Outcomes of intrathecal analgesia in multiparous women undergoing normal vaginal delivery: A randomised controlled trial. Indian J Anaesth 2020, 64(2), 109-17.

Although intrathecal analgesia is an effective option during labour, there is a need to establish sustainable and assured analgesia during the entire labour process. We aimed to assess the effect of adding dexmedetomidine, fentanyl or morphine to low-dose bupivacaine-dexamethasone for intrathecal labour analgesia in multiparous women. This was a triple-blind, randomised controlled trial that included 140 multiparous women. Eligible women were randomly allocated to have intrathecal bupivacaine-dexamethasone with dexmedetomidine (group D), fentanyl (group F), morphine (group M) or saline (placebo) (group C). The duration of analgesia, intrathecal block characteristics and maternal and foetal outcomes were assessed and analysed. The longest analgesia duration and S1 regression time was recorded in group D followed by groups M, F and C, respectively, with statistical significance between all of them (P < 0.001). The shortest analgesia onset time and the highest sensory levels were recorded in group D followed by group F then group M with statistical significance between all of them (P < 0.001 and 0.003, respectively). Visual analogue scale values were comparable among groups M, F and D (P > 0.05) at most of the measurement time points and at the peak of the last uterine contraction before delivery while being significantly lower than those in group C (P < 0.001). However, there were similar motor block characteristics and normal neonatal outcomes in all groups. In comparison to morphine and fentanyl, dexmedetomidine addition to intrathecal bupivacaine‑dexamethasone significantly prolonged the duration and accelerated the onset of labour analgesia, with a good maternal and neonatal outcome.

5 illus, 4 tables, 43 ref

040891   MAKIREDDY R, CHERIAN A, ELAKKUMANAN L B, BIDKAR P U, KUNDRA P (Anaesthesiology and Critical Care Dep, awaharlal Institute of Post Graduate Medical Education and Research, Pondicherry - 605 006, Email: anushacherian@gmail.com) : Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in paediatric population. Indian J Anaesth 2020, 64(2), 103-8.

Conventional age-based formulae often fail to predict correct size of endotracheal tube (ETT). In this study, we evaluated usefulness of ultrasound in determining appropriate tube size and derived a formula which enables us to predict correct tube size. A total of 41 American Society of Anesthesiologists’ physical status 1 and 2 children in the age group of 2–6 years, undergoing elective surgery under general anaesthesia with uncuffed ETT were included in the study. Ultrasonography (US) was used to measure the subglottic diameter after induction of anaesthesia. The trachea was intubated with an ETT that allowed an audible leak between 15–30 mmHg. Pearson’s correlation was used to assess the correlation between US measured subglottic diameter (US-SD) with diameter of ETT used. Linear regression was used to derive a formula for predicting ETT size. We found that US-SD and patient’s age correlated well with actual ETT OD (r: 0.83 and 0.84, respectively). Age-based formula, ETT ID = (Age/3) +3.5 [r: 0.81] had better correlation with actual ETT OD than conventional age-based Cole’s formula, i.e., ETT ID = Age/4 + 4 [r: 0.77]. Our results enabled us to derive a formula for selecting uncuffed ETT based on US-SD. Our study concludes that although US-SD correlates with actual tracheal tube used and may be useful in choosing appropriate size ETT, there was no difference in number of correct predictions of ETT size by US measurement, universal formula, and locally derived formula.

4 tables, 15 ref

040890   BANSAL T, SINGHAL S, MITTAL H (Anaesthesiology and Critical Care Dep, Pt. B.D. Sharma Univ of Health Sciences, Rohtak - 124 001, Haryana, Email: aggarwalteenu@rediffmail.com) : A study to evaluate and compare intubating laryngeal mask airway and air‑Q intubating laryngeal airway for intubation using Parker flex tip tube. Indian J Anaesth 2020, 64(2), 97-102.

Though manufacturer recommendations suggest use of specific endotracheal tube (ETT) with intubating laryngeal mask airway (ILMA) and air-Q intubating laryngeal airway (ILA), Parker Flex Tip tube introduced by J D Parker has certain advantages and is also cost-effective. This study was conducted to compare ILMA and air-Q ILA for intubation using Parker Flex Tip tube. Patients of either gender, aged 18–60 years, scheduled for elective surgery requiring endotracheal intubation were included in this study. In group A (n = 55), blind intubation was done through ILMA using Parker Flex Tip tube and in group B (n = 55), blind intubation was done through air-Q ILA using Parker Flex Tip tube. Success rate, number of attempts, ease and a total time of intubation were recorded. Intubation was successful in 54 patients (98.2 %) in group A and in 46 patients (85.2 %) in group B (P = 0.026). Intubation was significantly easy with ILMA (P = 0.048). Manoeuvres for intubation were used in 10.9 % patients in group A while it was used in 27.8 % patients in group B. Significantly, more manoeuvres were required with air‑Q ILA for intubation (P = 0.026). Number of attempts for ETT placement (P = 0.092), insertion time of ETT (TT) (P = 0.472) and total time taken for successful intubation (P = 0.526) were comparable in both the groups. The intubating laryngeal mask airway was superior to the air-Q intubating laryngeal airway for blind intubation using Parker Flex Tip tube.

1 illus, 2 tables, 12 ref

040889   KOUZ K, HOPPE P, BRIESENICK L, SAUGEL B (Anesthesiology Dep, Medical Center Hamburg-Eppendorf Univ, Hamburg, Germany, Email: bernd.saugel@gmx.de) : Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches. Indian J Anaesth 2020, 64(2), 90-6.

Intraoperative hypotension (IOH) i.e., low arterial blood pressure (AP) during surgery is common in patients having non-cardiac surgery under general anaesthesia. It has a multifactorial aetiology, and is associated with major postoperative complications including acute kidney injury, myocardial injury and death. Therefore, IOH may be a modifiable risk factor for postoperative complications. However, there is no uniform definition for IOH. IOH not only occurs during surgery but also after the induction of general anaesthesia before surgical incision. However, the optimal therapeutic approach to IOH remains elusive. There is evidence from one small randomised controlled trial that individualising AP targets may reduce the risk of postoperative organ dysfunction compared with standard care. More research is needed to define individual AP harm thresholds, to develop therapeutic strategies to treat and avoid IOH, and to integrate new technologies for continuous AP monitoring.

1 illus, 41 ref

040888   SATHYAPRASAD S L, THOMAS M, PHILIP F A, KRISHNA K M J (Anaesthesiology Dep, Regional Cancer Centre, Thiruvananthapuram, Kerala, Email: binamary@gmail.com) : Performance in 6-min walk test in prediction of post‑operative pulmonary complication in major oncosurgeries: A prospective observational study. Indian J Anaesth 2020, 64(1), 55-61.

Post‑operative pulmonary complications (PPC) contribute to increased morbidity and mortality, necessitating pre‑operative functional assessment. Six‑minute walk test (6MWT) is a simple option for functional assessment. This is a prospective observational study conducted in 75 patients who underwent elective abdominal or thoracic oncosurgery under general anaesthesia with either age above 60 years or with cardiopulmonary diseases or obstructive sleep apnoea or low serum albumin or smoking. Patients with history of acute coronary syndrome in past 6 months, dyspnoea at rest, severe pain, inability to walk or interpret instructions and haemodynamic instability were excluded. Preoperatively 6MWT was conducted according to the American Thoracic Society guidelines and patients were observed for PPC. Patients were divided into two groups: group 1–no PPC and group 2–developed PPC. Statistical analysis was done using SPSS software (version 11.0.1). Categorical variables were assessed using Chi‑square/Fisher’s exact test and continuous variables using student’s t‑test/Mann‑Whitney U test. Association was tested using logistic regression. Out of the 75 patients, 40 patients had no PPC (group 1) and 35 patients had PPC (group 2) including a death. The 6MWD of group with PPCs was significantly less (344 ± 61.927 m) compared to the group without PPCs (442.28 ± 83.194 m, P value = 0.001). The cut‑off 6MWD obtained was 390 m, which correlated with longer duration of hospital stay and ICU stay (P = 0.001). Six‑minute walk test is a reliable predictor of post‑operative pulmonary complications with a cut‑off 6MWD of 390 m in the studied oncosurgery patients.

1 illus, 5 tables, 28 ref

040887   MOUSTAFA M A, ALABD A S, AHMED A M M, DEGHIDY E A (Alexandria Univ, Alexandria - 21563, Egypt, Email: moustafa.abdelaziz@alexmed.edu.eg) : Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth 2020, 64(1), 49-54.

Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound‑guided erector spinae plane block (ESPB) versus parasagittal in‑plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy. One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in‑plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1^st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia. All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1^st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics. ESPB may be a simple and safe alternative to parasagittal in‑plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.

2 illus, 4 tables, 18 ref

040886   KUMARI A, ACHARYA B, GHIMIRE B, SHRESTHA A (Anaesthesiology Dep, Tribhuvan Univ Teaching Hospital, Kathmandu - 44600, Nepal, Email: aanilsh@hotmail.com) : Post‑operative analgesic effect of intraperitoneal ropivacaine with or without tramadol in laparoscopic cholecystectomy. Indian J Anaesth 2020, 64(1), 43-8.

Intraperitoneal instillation of local anaesthetics has been shown to minimise post‑operative pain after laparoscopic surgery. This study was aimed to evaluate the post‑operative effect of intraperitoneal ropivacaine with and without tramadol in patients undergoing laparoscopic cholecystectomy. Eighty patients undergoing laparoscopic cholecystectomy were randomised into two groups. Group R received 0.5 % ropivacaine 18 mL with normal saline (NS) 2 mL and Group RT received 0.5 % ropivacaine 18 mL with tramadol (100 mg, 2 mL) at the end of surgery intraperitoneally through the port. The pain score was monitored using a numerical rating scale (NRS) every 30 min till 4 h post‑operatively and then at 6 h, 12 h and 24 h. The primary objective of the study was to compare the severity of pain between the groups. The secondary objectives were to compare the total dose of rescue analgesic and the time to first rescue analgesia between the groups Statistical analysis was performed using statistical package for the social sciences. Chi‑square test and Mann Whitney U test were used for analysis. The pain score in Group RT was significantly lower than Group R at 2.5 h to 24 h (P = 0.005). Only 42.5 % in Group RT demanded rescue analgesia as compared to 75 % in Group R (P = 0.003). Total analgesic consumption of fentanyl was also reduced in the tramadol group (785 µg vs 1800 µg). No significant adverse effects were found. Intraperitoneal instillation of ropivacaine with tramadol reduces the post‑operative pain and analgesic requirement in laparoscopic cholecystectomy as compared to ropivacaine alone.

3 illus, 4 tables, 21 ref

040885   SYAL K, CHANDEL A, GOYAL A, SHARMA A (Anaesthesia Dep, Indira Gandhi Medical Coll and Hospital, Shimla, Himachal Pradesh, Email: ankitachandelchauhan@gmail.com) : Comparison of ultrasound-guided intermediate vs subcutaneous cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy: A randomised double-blind trial. Indian J Anaesth 2020, 64(1), 37-42.

Intermediate cervical plexus block (CPB) is a new procedure whose analgesic efficacy compared to superficial cervical plexus block is yet to be established. We compared the analgesic efficacy of superficial vs intermediate CPB for post‑operative analgesia after thyroid surgery. Forty‑five patients with American Society of Anaesthesiologists’ physical status 1 or 2 undergoing total thyroidectomy were recruited. Forty‑four patients in superficial/subcutaneous CPB group (n = 22) and intermediate CPB (n = 22) received 20 mL 0.25 % bupivacaine with adrenaline 100 µg bilaterally in ultrasound‑guided superficial and intermediate cervical plexus block before induction of general anaesthesia., respectively. The primary outcome measure was the postoperative visual analogue scale (VAS) scores at 0, 2, 4, 6, 12 and 24. Secondary outcome measures included the total dose of rescue analgesic required, duration of postoperative analgesia and patient’s satisfaction score. Statistical analysis was with the Mann‑Whitney U test and independent t‑test. The post‑operative VAS scores were lower in intermediate CPB group compared to superficial CPB group at 2, 4, 6, 12, 18 and 24 h [P < 0.05]. Time to first rescue analgesic demand was prolonged 10.06 ± 3.62 h in intermediate group compared to 7.94 ± 3.62 h in superficial group [P = 0.017] and total analgesic consumption were lower in intermediate group (71.25 ± 16.70 µg) than the superficial group (101.25 ± 50.31 µg) [P = 0.011]. Ultrasound‑guided intermediate CPB reduces post‑operative pain scores, prolongs duration of analgesia and decreases demands for rescue analgesia compared to superficial CPB.

3 illus, 2 tables, 12 ref

040884   GUPTA C, VALECHA U K, SINGH S P, VARSHNEY M (Anaesthesiology Dep, Dr. B.L Kapur Memorial Hospital, New Delhi - 110 005, Email: chandan631@gmail. com) : Systemic lidocaine versus ultrasound‑guided transversus abdominis plane block for postoperative analgesia: A comparative randomised study in bariatric surgical patients. Indian J Anaesth 2020, 64(1), 31-6.

The multimodal analgesia strategies to minimise opioid‑related side effects are highly desirable in bariatric surgical procedures. We evaluated the efficacy of ultrasound‑guided transversus abdominis plane (USG‑TAP) block and intravenous lidocaine for postoperative analgesia in obese patients undergoing laparoscopic bariatric surgery. We studied 56 patients with body mass index >35 kg/m². They were randomly allocated to Lidocaine group (Group A) and USG‑TAP group (Group B). Group A patients were given intravenous Lidocaine (1.5 mg/kg) bolus followed by (1.5 mg/kg/h) infusion. Group B patients were given ultrasound‑guided bilateral TAP block using 20 cc of 0.375% ropivacaine each side. Postoperative numeric rating pain scale score (NRS) hours were compared. Other parameters compared were total fentanyl requirement, sedation score, postoperative nausea vomiting (PONV) score and patient satisfaction score. A P value < 0.05 was considered statistically significant. The patient in the Group A had lower resting NRS score (P < 0.05) postoperatively and less fentanyl consumption (P < 0.001) than in Group B. The difference in the sedation scores (P = 0.161) and PONV (P = 0.293) score was found to be statistically insignificant between Group A and B. The difference between the two groups was statistically significant with respect to patient satisfaction score with majority of patients having an excellent patient satisfaction score in Group A as compared to Group B. Intravenous Lidocaine as part of multimodal analgesic technique in obese patients undergoing laparoscopic bariatric surgery improves pain score and reduces opioid requirement as compared to USG‑TAP Block.

3 illus, 5tables, 10 ref

040883   CHHABRA A, SAINI P, SHARMA K, CHAUDHARY N, SINGH A, GUPTA S (Anaesthesiology and Critical Care Dep, Geetanjali Medical Coll and Hospital, Udaipur, Rajasthan, Email: drkarunasharma07@gmail.com) : Controlled hypotension for FESS: A randomised double-blinded comparison of magnesium sulphate and dexmedetomidine. Indian J Anaesth 2020, 64(1), 24-30.

Intense bleeding during general anaesthesia (GA) is the major limitation during functional endoscopic sinus surgery (FESS). This study was aimed to compare the efficacy of dexmedetomidine and magnesium sulphate (MgSO₄) for controlled hypotension in FESS. Sixty eight patients undergoing FESS were randomised to receive either dexmedetomidine 1 µg/kg over 10 min followed by infusion at 0.2 to 0.7 µg/kg/h (Group D) or MgSO₄ 40 mg/kg over 10 min followed by an infusion at 10 to 15 mg/kg/h (Group M). Anaesthesia and infusion rates for study drugs were maintained with sevoflurane to keep MAP between 60–70 mmHg throughout the surgery. The time to reach the target MAP, the number of patients requiring a minimum and maximum infusion doses of study drugs were noted. The mean time to achieve target mean arterial pressure (MAP) was less in group D (10.59 ± 2.04) as compared with (21.32 ± 4.65 min) group M (P < 0.001). The target MAP was achieved between 5–15 min in 73.52 % patients (Group D) with an infusion dose of 0.2–0.4 µg/kg/h of dexmedetomidine without the use of sevoflurane, while 82.35 % patients in group M required 4 % sevoflurane along with >12–15 mg/kg/hr infusion of MgSO4 to achieve target MAP in 10–20 min. Dexmedetomidine is superior to MgSO₄ in achieving target MAP in lesser time with minimum infusion dose.

1 illus, 4 tables, 17 ref

040882   ALGHANEM S M, MASSAD I M, ALMUSTAFA M M, AL-SHWIAT L H, EL-MASRI M K, SAMARAH O Q, KHALIL O A, AHMAD M (Anesthesiology Dep, Jordan Univ, Amman, Jordan, Email: Mahmoud_juh@hotmail.com) : Relationship between intra‑operative hypotension and post-operative complications in traumatic hip surgery. Indian J Anaesth 2020, 64(1), 18-23.

The relationship between intra‑operative hypotension and post‑operative complications has been recently studied in non‑cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra‑operative hypotension. Hypotension was defined as ≥30 % decrease in the pre‑induction systolic blood pressure sustained for ≥10 min. The relationship between intra‑operative hypotension and post‑operative complications was evaluated. Post‑operative complications were defined as new events or diseases that required post‑operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre‑operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non‑parametric statistics. A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra‑operative hypotension developed in 91 patients (18.1 %) and 42 patients (8.4 %) developed post‑operative complications. Significantly more patients with hypotension developed post‑operative complications compared to patients with stable vitals (18.7 % vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post‑operative complication in patients receiving general or spinal anaesthesia. Pre‑operative comorbidities had no significant relationship with post‑operative complications. Intra‑operative blood transfusion was related to both intra‑operative hypotension and post‑operative complications. There was an association between intra‑operative hypotension and post‑operative complications in patients undergoing traumatic hip surgery.

1 illus, 3 tables, 28 ref

040881   GUPTA S (Anaesthesia Dep, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, Email: sushangupta@gmail.com) : Supraglottic jet oxygenation and ventilation – A novel ventilation technique. Indian J Anaesth 2020, 64(1), 11-7.

Supraglottic jet oxygenation and ventilation (SJOV) is a novel minimally invasive supraglottic technique of jet ventilation which has shown superior results in maintaining oxygenation without any major complications. Theoretically, it could maintain PaO₂ and PaCO₂ within physiological limits for as long as required, the maximum duration reported till now is 45 min. The distinct advantage of SJOV over techniques of nasal oxygenation is its ability to record EtCO₂ during the periods of ventilation. In addition, it also provides reliable airway access by the blind passage of the endotracheal tube into the trachea with a high success rate even in Cormack‑Lehane‑III (CLIII) grading patients. Potential complications seen with SJOV include nasal bleed and sore throat. No studies have shown to cause severe barotrauma. In this article, we review the evidence regarding oxygenation, ventilation, indications, airway patency and complications of SJOV in comparison to other more commonly used supraglottic oxygenation and ventilation devices.

1 illus, 1 table, 34 ref

040879   VASUDEV B N, RAVI R, MUKHERJEE M, TRIPATHY N K (Station Medicare Centre, Suratgarh - 344001, Rajasthan, Email: vasudrvims@gmail.com) : To study the efficacy of zolpidem in inducing daytime sleep and maintaining mental alertness subsequent to awakening. Indian J Aerosp Med 2020, 64(2), 88-92.

In operational environment, naps in the daytime could help in maintaining alertness and hence performance. However, due to operational constraints and circadian effect, an aircrew may not get good quantity and quality sleep during the day, even though adequate sleep window is available. In such situations, zolpidem could be effectively utilized to induce sleep. This study intended to examine the beneficial effects of zolpidem 5 mg and 10 mg in inducing daytime sleep and maintaining mental alertness in the subsequent awake period. In a double-blind, placebo-controlled, repetitive measure design, 20 healthy male volunteers were longitudinally evaluated for their mental alertness and subjective perception of quality of sleep, sleepiness, and fatigue for a period of 12 h following zolpidem-induced daytime sleep. In addition, feedback was obtained on known untoward effects of zolpidem. Zolpidem, in doses of both 5 mg and 10 mg, could induce daytime sleep in all participants. Quality of sleep induced by zolpidem was similar to that of night sleep quality. With 5 mg zolpidem, the alertness was maintained soon after awake from daytime sleep, whereas participants perceived sleepiness for a period of 1–2 h with 10 mg zolpidem. Following awakening, there was a significant increase in the number of lapses with time in the placebo group, which was not found significant with administration of zolpidem. The occurrence of untoward effects with 10 mg zolpidem was more than 5 mg zolpidem. Zolpidem 5 mg and 10 mg were found to be effective in inducing daytime sleep and maintaining performance subsequent to arousal. The sleepiness following arousal as well as adverse effects was found to be more for zolpidem 10 mg as compared to 5 mg. A mandatory ground observation of minimum of 8 h should be ensured following intake of zolpidem before undertaking any flying duties.

2 illus, 2 tables, 19 ref

040878   GHOSH D, GAUR D, SINHA B, ARAVINDAKSHAN B (Station Medicare Centre, Thanjavur - 613 005, Tamil Nadu, Email: dr.dvdpghosh@rediffmail.com) : Concurrent white noise and acute hypobaric hypoxia: Effect on aviation cognitive performance. Indian J Aerosp Med 2020, 64(2), 82-7.

Optimal cognitive performance is the essence of effective execution of a flying mission. Effects of two commonly encountered aviation stressors, hypoxia and noise, on performance have been studied. However, studies on effects of concurrent dual effects of both these stressors on key cognitive parameters are sparse; hence, the objective was to examine these effects. Cognitive performances were assessed among 30 healthy volunteers (28 males and 2 females) sequentially in four different conditions – baseline (without stressors), 85 dB(A) noise, 14,000 ft altitude, and concurrent exposure to 85 dB(A) noise at 14,000 ft altitude. White noise was simulated through software, altitude in the hypobaric chamber and cognitive performance was assessed with tests from Psychology Experiment Building Language (PEBL) test battery. Data were analyzed using descriptive statistics and repeated measures ANOVA. The study revealed statistically significant direct detrimental effect of altitude and noise on implicit reaction time independently as well as concurrently. However, there was insignificant interaction effect between the dual stressors on implicit reaction time. There were no statistically significant effects of dual stressors on implicit correctness, visuospatial working memory, and selective attention. Although statistically not significant, noise enhanced the performance level in the form of increased Corsi block memory span and Corsi block total score. No significant effect of the dual stressors was observed on most of the cognitive parameters. However, implicit reaction time, a measure of pilot’s risk-taking behavior, was found to be significantly affected by the dual stressors. Further research with a larger sample of aircrew population who differ in age, experience, and other potentially influencing factors is recommended.

6 illus, 1 table, 27 ref

040877   MANDAL S, PIPRAIYA R, SINHA B (Institute of Aerospace Medicine IAF, Bengaluru - 560 017, Karnataka, Email: drsoumen83@gmail.com) : Cardiovascular dynamics among differently trained individuals during simulated microgravity exposure in the form of head-down tilt. Indian J Aerosp Med 2020, 64(2), 76-81.

Human morphology and physiology are not designed inherently to function in microgravity. Hence, exposure to hypo or microgravity, as it occurs during space exploration, poses challenges in the form of peculiar adaptive physiological processes in healthy astronauts. These changes may vary (to a certain extent) depending on type of physical fitness (namely, aerobic or anaerobic) and may have definitive impact on short duration space mission. The study aimed to examine the cardiovascular dynamics during short duration exposure to simulated microgravity condition in differently trained individuals. Temporal variations in body fluid distribution were studied during 6° head-down tilt (HDT) for 4-hours in 31 healthy males in age range of 20–40 years divided into three groups based on their physical training, namely; resistance trained (RT), endurance trained (ET), and untrained (UT). This was based on their history of physical training, VO₂ max, and peak anaerobic power. Heart rate in the ET group and RT group showed increasing and decreasing trend respectively, however, statistically remained non-significant. Systolic and diastolic pressures showed a significant increase in the ET group at the 4^th h of HDT as compared to baseline and the 1^st h. No significant variation in pulse pressure could be seen. Mean arterial pressures showed significant increase in the ET group at the 4^th h of HDT as compared to baseline and the 1^st h of HDT. Stroke volume and cardiac output did not vary significantly. ET individuals in the present study demonstrated decreased sensitivity of baroreceptors than RT or UT individuals, whereas, the RT group demonstrated more stability/resilience in terms of cardiovascular dynamics than ET and UT groups under exposure to short duration simulated microgravity

7 illus, 2 tables, 27 ref

040876   MOHAPATRA S S, SARKAR R, GHOSH D D (High Altitude Physiology and Hyperbaric Medicine Dep, Institute of Aerospace Medicine IAF, Bengaluru - 560017, Karnataka, Email: ssmbluewater@yahoo.co.in) : Assessment of fatigue among aviation personnel involved in military flying in India employing Multidimensional fatigue symptom inventory – short form (MFSI-SF). Indian J Aerosp Med 2020, 64(2), 68-75.

Fatigue has been recognized as a major safety hazard in modern aviation. There are numerous studies which have addressed various aspects such as the subjective symptoms, objective measures to diagnose fatigue, and its link with operator’s performance. This study was a novice attempt to assess the chronic fatigue among the aviation personnel employing “Multidimensional Fatigue Symptom Inventory – Short Form (MFSI-SF),” which is a well validated fatigue questionnaire. A total of 93 aircrew and 30 ground crew of either sex from three military air bases were randomly selected for this cross-sectional observational study. The selected participants were requested to respond to 30 items listed in the survey form based on various types of symptoms along with severity that they experienced in the preceding 1 week. The total fatigue score in case of the studied ground crew was higher than the studied aircrew group and this was statistically significant (P = 0.00001). The fighter, transport, and helicopter groups were not different from each other as far as their total fatigue score is concerned. However, ground crew group had significantly higher score in comparison to the score of the fighter, transport, and helicopter groups. In this study, 43.33 % of ground crew participants and 11.82 % of aircrew participants were observed to have fatigue. On stream-wise analysis, 2.94 % of transport aircrew, 14.28 % of fighter aircrew, 20.83 % of helicopter aircrew, 52.17 % Air Traffic Control (ATC) ground crew, and 14.28 % of other ground crew who had participated in this study were fatigued. Fatigue in either form, i.e., acute or chronic, could affect both aircrew and ground crew. The present study had revealed that the proportion of ground crew suffering from chronic fatigue was more than the aircrew. The aircrew who were found to have such type of fatigue were younger in age and experience in comparison to their counterpart ground crew. Among the ground crew, a large percentage of ATC crew had this form of fatigue.

3 illus, 5 tables, 28 ref

040875   KAUR M, SINHA B, RAJU A V K (Institute of Aerospace Medicine IAF, Bengaluru - 560 017, Karnataka, Email: manucore17@gmail.com) : Analysis of cardiovascular responses to head-up tilt testing. Indian J Aerosp Med 2020, 64(2), 62-7.

Head-up tilt (HUT) testing is a widely accepted tool in the clinical evaluation of patients presenting with episodic loss of consciousness. The test has assumed its importance in aviation environment, where a single episode of unconsciousness in-flight may have a catastrophic outcome. To rule out this, HUT is carried out in all cases of syncope as a part of aeromedical evaluation. The present study was undertaken to analyze the CVS response to HUT conducted over a period of 11 years at the Department of Space and Environmental Physiology at the Institute of Aerospace Medicine. A total of 168 subjects had undergone HUT testing from 2002 to 2012. The testing equipment was a standard tilt table with a foot board support for the feet and restraint system at the level of chest, waist, and ankle to support the body during tilting. The testing protocol consisted of passive tilting to an angle of 70° from the horizontal position for 45 min in all the cases. The physiological parameters consisting of heart rate (HR) and blood pressure from the database were analyzed to understand the CVS response to HUT. Out of the total 168 patients, 147 (88.5%) cases showed normal response. Twenty-one (12.5%) cases showed abnormal response. Out of the cases showing abnormal response, 14 cases had syncope with frank loss of consciousness and could not maintain the postural tone. The remaining seven cases showed postural orthostatic tachycardia syndrome (POTS), where the HR increased by more than 30 beats per minute. A retrospective analysis of 168 cases with history of syncope, in a period of 11 years, revealed an abnormal cardiovascular response to HUT in 12.5% of cases. The abnormal physiological responses were mostly consistent with syncope and POTS.

1 illus, 6 tables, 23 ref

040871   KUMAR A, NATARAJA M S (Acceleration Physiology and Spatial Orientation Dep, Institute of Aerospace Medicine IAF, Bengaluru - 560 017, Karnataka, Email: ajay4757giri@gmail.com) : Describing the continuum from ALOC to G-LOC. Indian J Aerosp Med 2020, 64(1), 32-6.

G-induced loss of consciousness (G-LOC) has been extensively investigated and pathophysiology of the same has been well elucidated in the literature. The syndrome of almost loss of consciousness or ALOC has also been described which is a loose collection of signs and symptoms of a physiological, emotional, and cognitive nature. This is believed to occur under +Gz stress which is insufficient to cause G-LOC. Institute of Aerospace Medicine IAF regularly conducts high-G training for its fighter pilots in the High Performance Human Centrifuge. Episodes of G-LOC and ALOC are unintended outcomes of such training. A study was conducted to understand the nature of these episodes in the Department of Acceleration Physiology and Spatial Orientation. A G-LOC/ALOC proforma was designed in the Department of Acceleration Physiology and Spatial Orientation to understand the nature and causes of the G-LOC/ALOC and was filled up by the aircrew on a voluntary basis. The data were analyzed using Microsoft Excel and SPSS 20 with significance set at 95 % confidence interval and alpha at 0.05. Forty-seven aircrew experiencing G-LOC/ALOC agreed to be part of the study and filled up the proforma after the episodes. However, only 42 proforma (31 G-LOC and 11 ALOC) was found suitable for the analysis. There was no statistical difference in heart rate (HR) measured during the rate of onset and G-level at which G-LOC and ALOC resulted. There was no difference in psycho-somatic manifestations of G-LOC and ALOC episodes. ALOC and G-LOC have similar manifestations and operational implications. There is ample evidence to suggest that ALOC is a manifestation of G-LOC syndrome rather than a separate entity.

3 illus, 1 table, 19 ref

040865   SHRIVASTAVA S R, SHRIVASTAVA P S (Community Medicine Dep, Shri Sathya Sai Medical Coll and Research Institute, Chengalpet - 603 108, Tamil Nadu, Email: drshrishri2008@gmail.com) : Coronavirus disease 2019 pandemic: Strengthening health sector response amidst the background of global economic crisis. Indian J Community Fam Med 2020, 6(2), 168-70.

The Coronavirus Disease-2019 (COVID-19) pandemic should be looked upon as much more than a public health emergency, as it has significantly impacted the global economy. Owing to the fact that the disease spreads by close contact, many of the nations imposed social restrictions, with an aim to reduce the spread of the disease. However, the bitter truth is that such measures enormously affects the income opportunities of individuals & families, and the financial status of the community and the nation at large. During these difficult times, each nation should start their response by funding all the components of the emergency response plan, strengthen the foundations of the health system and remove the possibility of financial constraints, which can prevent people to access health care. In conclusion, the COVID-19 pandemic has made us to come to a scenario where we have to not only save lives, but even ensure that livelihoods of people are sustained. Thus, the need of the hour is to strengthen the health sector through financial assistance, and simultaneously plan for the release of the lockdown to try to bring our economy back on track.

7 ref

040864   GEORGE M, GEORGE N, AJMAL S, PAUL A, AATHIRA M S, AMRUTHAVANI A K (Community Medicine Dep, Dhanalakshmi Medical Coll, Perambalur, Tamil Nadu, Email: neethumampuzha@gmail.com) : Self‑esteem and body‑image dissatisfaction among adolescents: A cross‑sectional study. Indian J Community Fam Med 2020, 6(2), 157-62.

Adolescence is the time period in which the values about themselves will be created. Hence, self-esteem and correct perception about own body are an important context in their life. The objective of this study is to find out the degree of dissatisfaction with their body size (DDBS) among adolescents and to analyze the influence of it on self-esteem. This study was cross-sectional done among the undergraduate students in a private medical college and students of high-school section of the government school. A questionnaire was used to document the sociodemographic details, subjective assessment of body image, and self-esteem. In this study, majority of the students had high (93; 50.8 %) self-esteem and moderate self-esteem (62; 33.9 %). Out of 183 samples, 53 (29 %) were satisfied with body contour based on DDBS. In those who were underweight, it is shown that 48 (54.5 %) wanted to increase their body weight, and in normal body mass index (BMI) category, 50 % of participants wanted to lose their body weight. Age and BMI were significantly associated with self-esteem and body-image perception. The concept of body image has to be modified to reduce the risk of overweight, obesity, and eating disorders. This, in turn, can increase and sustain the self-esteem of adolescence.

4 illus, 3 tables, 29 ref

040863   DAVE V R, SHUKLA R P, BHAVSAR S, PATEL N, SONALIYA K N (Preventive and Social Medicine Dep, GCS Medical Coll Hospital and Research Centre, Ahmedabad - 380 025, Gujarat, Email: rujulpshukla90@gmail.com) : Assessment of the relation between obesity, serum lipids, and dietary intake of vegetable oils. Indian J Community Fam Med 2020, 6(2), 150-6.

The study was conducted to assess the association between consumption of particular variety of cooking oil and its effect on serum lipid profile and also on body mass index (BMI). The study was conducted at one of the tertiary care hospitals, Ahmedabad city, India. Patients with ≥18 years age who were undergoing “lipid profile” test at central laboratory department of selected hospital and giving consent were the study participants. Details of serum lipid profile were taken from report along with which anthropometric measurements were done and details of diet were taken. Data were entered into MS Excel and were analyzed by frequency, contingency coefficient, and Fisher’s exact test. Total 1000 participants were included in the study, among which 274 (27.4 %) had raised lipid levels and 729 (72.9 %) were preobese or obese. Association between variety of cooking oil used and cholesterol-high-density lipoprotein ratio revealed contingency coefficient value of 0.042 with P value of 0.416. Association between BMI and variety of cooking oil used revealed Fisher’s exact value as 83.015 with P < 0.001. Statistical association was not found between serum lipid profile and type of oil used for cooking. Obesity indices revealed significant statistical association with both variety of cooking oil used and serum lipid profile. Dyslipidemia was found to have statistical significant association with raised blood pressure and raised blood glucose.

5 tables, 27 ref

040862   GUPTA V, CHAWLA S, GOUR N, GOEL P K (Community Medicine Dep, SHKM Government Medical Coll, Nalhar - 122 107, Haryana, Email: surajpgirohtak@gmail.com) : Determinants of injectable depot medroxyprogesterone acetate contraception among women of reproductive age: A study from Southern Haryana, India. Indian J Community Fam Med 2020, 6(2), 144-9.

The safety and effectiveness of Depot Medroxyprogesterone Acetate (DMPA) (available by the name of “Antara” in Government of India supply) has resulted in inclusion of this injectable contraceptive in the basket of family planning choices and thus has opened the way for clients to avail of a safe, effective, and hassle-free method with full confidentiality, which is also free of cost in public health facilities all over India. This community-based study with cross-sectional design was conducted during April 2019–October 2019. During first 3 months of the study, all the females who adopted the DMPA contraception were included in the study and the factors for opting DMPA were assessed. Among those who had previously used contraceptives, oral pills were the most prevalent method. Most of the clients who opted to DMPA agreed that they switched because of privacy and confidentiality attached to DMPA. The side effects were reported by more than four-fifth of subjects, and the most common side effects were irregular spotting per vaginally, amenorrhea, and weight gain. The present study has shown some light regarding the factors responsible for injectable DMPA uptake as a family planning method and the facilitators and barriers to consistent injectable DMPA use. The study findings are expected to be utilized for framing policies to improve compliance of DMPA and making it more acceptable, client-friendly initiative.

5 tables, 20 ref

040861   PRIYANKA, GOEL M K, RASANIA S K (Community Medicine Dep, ESIC Medical Coll and Hospital, Faridabad, Haryana, Email: prynka.06@gmail.com) : A study of factors influencing academic performance of undergraduate medical students. Indian J Community Fam Med 2020, 6(2), 137-43.

An important indicator of quality of medical education is students’ academic performance and the study of factors which influence the academic performance of medical students is important as it can provide information to improve educational programs. This was a cross-sectional study involving medical students who passed their final professional examinations and were about to start their internship training. They were asked to complete an anonymously administered feedback form which contained questions regarding the academic performance of students in all the professional examinations of MBBS along with background characteristics of students. Data entry and statistical analysis was carried out using statistical software SPSS version 12. The primary outcome was the proportion of students in different levels of academic achievement. The secondary outcome was the factors associated with different levels of academic achievement. Descriptive statistics were used to describe the distribution of all variables. For finding out the association, an analysis using Chi-square test was done for qualitative data. The mean age of participants was 22.7 ± 0.67 years (range 21–25). About 43.6 % of the students had scored <60 % marks, while 56.4 % had scored more than that. High-performing students were found to spend more time on hobbies as well as on physical activities and less time on social networking sites as compared to the average-performing students. Study and sleep habits of high performers were significantly different from average performers. Many factors were found to have a significant association with academic performance of students such as residence, having a doctor parent, spending time on personal hobbies and social networking sites, time spent on study, and duration of sleep a day before examination.

4 tables, 14 ref

040860   PATEL S, PADHI P, PRIYA R, NAIK T, NANDA R, MOHAPATRA E (Biochemistry Dep, All India Institute of Medical Sciences, Raipur, Chhattisgarh, Email: drrachitananda@gmail.com) : A cross‑sectional study on parental awareness for newborn screening and assessment of the burden of congenital hypothyroidism and glucose 6‑phosphate dehydrogenase deficiency. Indian J Community Fam Med 2020, 6(2), 132-6.

Newborn Screening (NBS) has been one of the most successful health programs and of most paramount importance worldwide but not so in India. Due to the lack of awareness and paucity of laboratory facilities, the disease burden in our population has not yet been established. The aim and objective of the study was to assess the burden of Congenital Hypothyroidism (CH) and Glucose 6-Phosphate Dehydrogenase (G6PD) deficiency in this area by NBS tests and to assess the impact of awareness sessions on the response rate of parents for NBS. The screening was conducted in 474 babies of age 48 h up to 8 weeks. The dried blood spots collected were subjected to the following analytical protocol. Thyroid-stimulating hormone (TSH) level and G6PD enzyme activity were analyzed by immunofluorescence method-based neonatal kits. All babies with a positive screening test for G6PD deficiency and CH were asked for venous confirmatory testing after 7 days. The efficiency of the program for all live birth babies delivered in the institute was 92 % (n = 410/445). It was 82 % in the first phase of the study period and 98.5 % in the second phase. Repeated training of nursing professional reduced the sampling errors from 14.7 % in the first phase to 6.1 % in the second phase. A total of 11 samples reflected high TSH values, of which one baby confirmed for CH. Of the 24 babies who screened positive for G6PD, four were confirmed for the same. The prevalence for CH and G6PD deficiency was, respectively, 1 in 462 (2/1000) and 4 in 462 (8.7/1000). Development of expansion of NBS program in the state should be made mandatory for all newborns. The recommendations include awareness among parents, during antenatal and postnatal period and also to health professionals and provision for laboratory facilities for NBS testing at low cost.

1 illus, 1 table, 13 ref

040859   ALVI Y, KHALIQUE N, AHMAD A, SHAH M S, FAIZI N (Community Medicine Dep, Aligarh Muslim Univ, Aligarh - 202 002, Uttar Pradesh, Email: najam_km@yahoo.com) : Quality of life among people living with HIV/AIDS receiving highly active anti‑retroviral therapy: A domain‑based analysis. Indian J Community Fam Med 2020, 6(2), 125-31.

With the highly effective antiretroviral treatment, HIV is transforming into a chronic condition, whose management is now experiencing problems of other chronic diseases, where quality of life (QoL) plays a central role. This study was conducted with the objective of determining the QoL among people living with HIV/AIDS (PLHA) taking Anti-Retroviral Therapy (ART) and examine the factors affecting it. A cross-sectional study was conducted at ART center, Aligarh. 434 PLHA on antiretroviral therapy, were interviewed using a pretested questionnaire, assessing QoL with the World Health Organization (WHOQoL) HIV-BREF. For domain-based analysis, we examined the association of various factors with the individual domain. The P < 0.05 was considered statistically significant. The mean score in all the domains of WHOQoL was maximum for the level of independence (15.7 ± 2.6) followed by the physical domain (15.5 ± 3.0), while environment domain (11.7 ± 1.8) had the least mean. All the domains, including overall QoL scored above average QoL. This study also showed that a strong relationship exists between QoL with lower socioeconomic status, presence of side effects from ART and depression. The QoL of HIV patients taking ART from Aligarh was adequate, reflecting the efforts of NACO and other agencies in managing the disease. With respect to its determinants, providing good family support, better employment opportunities, reducing stigma, and proper and timely management of side effects and depression could further increase levels of QoL.

1 illus, 2 tables, 33 ref