Exploring the Impact of Prior Beta-Blocker and Calcium Channel Blocker Usage on Clinical Outcomes in Critically Ill Patients With Sepsis: An Observational Study.

Background Sepsis is associated with increased Ca++ levels in many cell types that can cause cytotoxicity and cell death through multiple mechanisms. In patients with sepsis, limiting beta-adrenergic stimulation may also be beneficial. The intense adrenergic stimulation of sepsis results in cardiac and extra-cardiac effects. In the intensive care unit (ICU), the question of whether to continue calcium channel blockers (CCBs) and beta-blockers in patients with sepsis who were using these medications before ICU admission is of significant concern. Methodology In this prospective observational study, we have included 114 patients who met the inclusion criteria of being diagnosed as having sepsis, aged 18 to 65 years, and expected to stay in the ICU for more than 72 hours. These patients were divided into three groups: group 1 consisted of patients taking CCBs before admission, group 2 included those taking beta-blockers before admission, and group 3 served as the control group, comprising patients who had not taken either of these medications before admission. Disease severity in the ICU was assessed and documented by the Sequential Organ Failure Assessment (SOFA) score. Clinical outcomes among three groups were compared regarding the need for vasopressor support, serum procalcitonin (PCT), serum lactate, serum quantitative C-reactive protein (qCRP), SOFA score, and 28 days mortality. Parametric data were expressed as mean ± standard deviation. The Kruskal-Wallis test was used to analyze parametric data between the two groups and among three groups. Results Mortality was found lower in group 1 (21.05%) and group 2 (26.31%) than in group 3 (47.36%), and this association was found to be statistically significant (P = 0.033). We also found a significant difference in mortality between groups 1 and 3 (P = 0.015) and no significant difference between groups 2 and 3 (P = 0.057). Mortality was found to be significantly associated with high SOFA scores on days 1, 3, and 7. Conclusions From the aforementioned results, we concluded that the mortality rate in patients with sepsis was improved when they were pretreated with beta-blockers or CCBs before admission to the ICU and that medication should be continued if not contraindicated in the ICU course.

Study of foetomaternal outcomes in COVID-19 afflicted parturients who underwent operative delivery - A retrospective analysis.

Background and Aims: Parturients with coronavirus disease (COVID)-19 are increasingly presenting for operative delivery. The aim of this study was to outline the foetomaternal outcome in COVID-19-afflicted pregnant women who underwent lower segment caeserean section (LSCS). Methods: Data of all COVID-19 positive pregnant females who underwent caesarean section surgery between 1 April and 30 June 2021 was collected. Clinical parameters, including oxygen requirement, laboratory investigations, treatment measures, complications, length of hospital and intensive care unit/neonatal intensive care unit stay, and outcome of parturients and neonates, were collected and analysed. All patients were followed up either during their visits to the obstetric outpatient department or by making phone calls between 1 and 2 months of discharge. Statistical Package for the Social Sciences statistical software 16.0 was used for analysis. Independent group t-test or Mann-Whitney test was used for mean of continuous data. Chi-square test or Fisher's test was used for proportion of categorical data. A P value of <0.05 was considered significant. Results: A total of 71 parturients delivered by caesarean section. 36.51% had mild COVID-19, and 87.5% had moderate COVID-19 at admission. One each with mild and moderate disease expired. The median (interquartile range) length of hospital stay was 7 (5-5.9) days for those with mild disease, and it was significantly longer for those with the moderate disease at 14 (9.5-17.5) days. Our study found that after a mean of 41.72 days of follow-up, of the 69 surviving mothers, 17 complained of fatigue, five complained of myalgia and one needed intermittent supplemental oxygen. Out of 74 babies born, seven died, which is 94.6 per 1000 live births. Conclusion: COVID-19 parturients delivered by LSCS stand a higher risk of maternal and neonatal mortality and adverse effects, including more hospital stay and increased mortality.

Comparison of LMA Supreme, i-gel, and Baska Mask for Airway Management during Laparoscopic Cholecystectomy: A Prospective Randomized Comparative Study from North India.

Background: The supraglottic airway device (SAD) has proved to be an appropriate alternative to endotracheal intubation in laparoscopic surgeries owing to various advantages, namely, decreased airway manipulation and stable hemodynamics. Aims: We compared the efficacy in terms of oropharyngeal leak pressure (OLP) and safety of laryngeal mask airway (LMA)-Supreme (LMA-S), i-gel, and Baska mask in patients undergoing laparoscopic cholecystectomy. Settings and Design: Ninety patients posted for elective laparoscopic cholecystectomy were selected for a prospective randomized comparative study in a tertiary care center. Materials and Methods: The study comprised three groups of 30 each based on the different SADs used Group-LS with LMA-Supreme, Group-IG with i-gel, and Group-BM with Baska mask. The secondary objectives were device insertion time, ease of insertion, changes in the peak airway pressure (PAP), heart rate, mean arterial pressure, and airway complications (sore throat, dysphagia. dysphonia, lip/tongue or dental injury, etc.) between three groups. Statistical Analysis: The quantitative data were analyzed using the one-way analysis of variance test and Bonferroni post hoc multiple comparison test. Qualitative data were compared using Chi.squared test. Results: OLP was significantly higher (P = 0.005) in the Baska mask than i-gel and LMA-S groups just after insertion and during carboperitonium. There was no significant difference in time for device insertion, number of attempts, ease of insertion, and use of manipulation (P > 0.05). However, the gastric tube insertion time was significantly lower in Group BM (9.59 ± 2.78) than Group IG with 12.79 ± 3.47 and Group LS with 10.84 ± 3.68 (P < 0.05). There were no significant differences between the groups with regard to changes in the PAP, heart rate, mean arterial pressure at different time intervals, and complications. Conclusion: Baska mask provided a significantly higher OLP compared to i-gel and LMA-S without significant airway morbidity in laparoscopic surgeries.

Effect of Gelfoam Soaked Epidural Dexmedetomidine or Bupivacaine for Postoperative Analgesia in Lumbar Laminectomy: A Prospective Randomized Clinical Study.

BACKGROUND AND AIMS: Postoperative pain is spine surgery can last for an average of two to three days. Epidural catheter management are difficult in spine surgery for postoperative pain. Still, there have been not much studies on epidural administered gelfoam soaked dexmedetomidine or bupivacaine, to enhance postoperative analgesia. METHODS: Ninety six adult patients were randomized into three groups. Gelfoam soaked in 0.1 mg dexmedetomidine (0.02 mg. mL-1) in group D, 0.25% isobaric bupivacaine (5 mL) in group B and gelfoam soaked in 0.9% normal saline (5 mL) in group C. The Primary outcome was to compare the total amount of rescue analgesic consumption till 48 hours. The Secondary outcome was to compare time to first dose of rescue analgesia (duration of analgesia), the visual analogue scale and side effects up to 48 hours. Chi-square test, independent t test and analysis of variance test were used, and P < 0.05 was considered significant. RESULTS: Ninety patients completed the study. Total dose of rescue analgesic consumed in 48 hours was significantly higher in control group (paracetamol 4.17 ± 0.75 gm with tramadol 205 ± 37.94 mg). Bupivacaine soaked gelfoam group (paracetamol 3.04±0.71 gm with tramadol 151.85 ± 35.31 mg) had more rescue analgesic consumption than dexmedetomidine soaked gelfoam group (paracetamol 1.72 ± 0.57 gm with tramadol 86.11 ± 28.73 mg). Time for first rescue analgesic requirement with dexmedetomidine soaked gelfoam group was significantly longer (14.67 ± 7.76 hours) than in bupivacaine soaked gelfoam group (11.33 ± 6.08 hours) and control group (6.40 ± 2.77 hours). Postoperative mean VAS scores were lower in group D and group B compared with group C along with no significant adverse effects. CONCLUSION: Patients undergoing lumbar laminectomy with gelfoam soaked epidural dexmedetomidine or bupivacaine decreases rescue analgesic consumption, prolongs the duration of analgesia and decreases mean VAS score postoperatively.

Comparison of Oral versus Intramuscular Clonidine for Prolongation of Bupivacaine Spinal Anesthesia in Patients Undergoing Total Abdominal Hysterectomy.

BACKGROUND: Clonidine is a commonly used agent for premedication through oral, intravenous, and intramuscular route. Very few studies mentioned intramuscular clonidine as premedication. AIMS AND OBJECTIVES: The aim of the present study is to compare oral and intramuscular clonidine as predication agent in bupivacaine spinal anesthesia patients. MATERIALS AND METHODS: In our study, recruited patients were randomly allocated in three groups of 32 each. All patients received intrathecal bupivacaine heavy 3 mL with oral 150 µg clonidine in Group 1, intramuscular 150 µg clonidine in Group 2, and oral placebo tablet in Group 3 1 h before taking the patient in operation theater. We have assessed for duration of sensory block, duration of motor block, duration of analgesia, sedation score, and hemodynamic changes in groups. STATISTICAL ANALYSIS: The parametric data were expressed as mean ± standard deviation. Primary analysis of parametric data between the two groups was done by student's t-test, and among three groups, analysis of variance was used. RESULTS: Duration of motor block was found significantly high in Group 2 than Group 1 (208.06 ± 9.48 vs. 200.25 ± 9.42; P < 0.05). Duration of sensory block was also found significantly high in Group 2 than Group 1 (219.69 ± 9.44 vs. 210.25 ± 9.68; P < 0.05). Time to give first dose of analgesia was also found greater in Group 2 than Group 1 (234.66 ± 11.76 vs. 217.75 ± 10.09; P < 0.05). Sedation score and other side effects were found statistically nonsignificant between Group 1 and 2. CONCLUSION: We can conclude that preoperative intramuscular clonidine is a better alternate of oral clonidine for bupivacaine spinal anesthesia in terms of long duration of motor and sensory block and less requirement of analgesic with clinically insignificant side effects.

Comparative Study of Postoperative Pain Relief Using Preincisional Versus Postincisional Infiltration With 0.25% Bupivacaine in Abdominal Hysterectomy Under General Anesthesia.

Background and Aims: Hysterectomy, probably the most common non-pregnancy related surgery performed in gynaecology, is associated with moderate to severe post-operative pain. Wound infiltration with local anaesthetic agent reduces the transmission of pain from the wound, in addition, local inflammatory response to the injury is also suppressed. The infiltration of local anaesthesia can be done either pre- or post-operatively. The present study was designed to determine the efficacy of pre-incisional infiltration versus post-incisional infiltration with 0.25% Bupivacaine in providing post-operative pain relief in patients undergoing abdominal hysterectomy. Methods: In Prospective Interventional Randomised study, 90 female patients posted for elective abdominal hysterectomy under general anaesthesia were randomly allocated into three equal groups of 30 patients each. Group I: Patients receiving subcutaneous infiltration with 40 mL of 0.25% Bupivacaine 5 mins before skin incision. Group II: Patients receiving subcutaneous infiltration of surgical area with 40 mL of 0.25% Bupivacaine at end of surgery (after peritoneal closure). Group III Control Group: Patients receiving no local anaesthetic infiltration. Observations were made for the duration of effective analgesia from end of the surgery until the first use of rescue analgesic along with the frequency and cumulative amount of rescue analgesics in 24 hours. Results: We found that at baseline, pain score of patients in Group III (3.87±1.17) was maximum followed by that in Group I (2.57±0.90) and minimum in Group II (2.20±0.61). Requirement of first analgesia was earliest in Group III (79.50±23.90 minutes) followed by Group I (136.83±13.16 minutes) and last in Group II (146.17±12.78 minutes), in addition, cumulative dose of analgesia was required by patients in Group III (152.50±36.76 mg) followed by that in Group I (132.50±37.80 mg) and minimum by that in Group II (115.00±38.06 mg). Conclusion: Subcutaneous infiltration of Bupivacaine either pre-incisional or post-incisional, helped to reduce the immediate post-operative pain intensity, delayed the first rescue analgesic requirement, reduced the post-operative dose and frequency of rescue analgesia. However, post-incisional intervention had an edge over pre-incisional intervention.