Evaluation of quality of abstracts of randomized controlled trials on procedural sedation in children after publication of CONSORT guidelines for abstracts: A systematic review.

The extension of the Consolidated Standards of Reporting Trials (CONSORT) statement provides guidelines for abstracts of randomized controlled trials (RCTs). This study was done to assess the reporting quality of abstracts of RCTs, on procedural sedation in children and identify factors associated with better quality. A PubMed search was conducted from inception of database till July 2017 to identify RCTs on procedural sedation in children. Search terms used were (procedural [All Fields] AND sedation [All Fields]) AND ("child" [MeSH Terms] OR "child" [All Fields] OR "children" [All Fields]) were included in the analysis, while primary RCTs, published in the English language unstructured abstracts, secondary analysis of primary RCTs and studies not exclusively on children we excluded. Our search strategy initially yielded 582 abstracts. Out of these, 535 abstracts were excluded. 47 articles were included in the final analysis. We extracted basic information and data on CONSORT items from abstracts. Each abstract was assessed using a 16-item composite abstract score (CAS) based on the CONSORT guidelines. This abstract quality was further explored by Method Score and by Result Score. Regression analysis was conducted to analyze factors associated with reporting quality. In majority of the abstracts, only objectives and conclusion were adequately reported. Inadequately reported items in >90% of abstracts included randomization, trial status, registration & funding. There was no significant difference in the CAS of abstracts (mean ± SD) published in & before 2008 (12.63 ± 4.0), to those published after 2009 (12.48 ± 4.23). Similarly, there was no significant difference in Result Score and Method Score of the abstracts. After the publication of 'CONSORT for abstracts' guideline, the quality of abstracts of RCTs on procedural sedation has shown suboptimal improvement. We suggest stricter adherence to guidelines by editors and reviewers. A checklist for adherence to CONSORT guidelines could be introduced during submission for the same.

Risk Recognition and Multidisciplinary Approach for Non-Cardiac Surgeries in Paediatric Cardiac Patients: A Retrospective Observational Study.

Background Congenital heart disease (CHD), a structural and functional heart disease, is the commonest birth defect with an incidence of one in 125 live births worldwide with ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of Fallot (TOF) constituting the majority. Surgery for associated extra-cardiac anomalies (airway, skeletal, genitourinary, and gastrointestinal) may be required in 30% of these patients. Delivery of uneventful anaesthesia in these children requires an understanding of not only paediatric anaesthesia but also of the pathophysiology of the cardiac lesion and its associated risks. Aims The purpose of this retrospective review was to highlight the approach to the anaesthetic management and outcomes of patients with significant cardiac lesions presenting for non-cardiac surgeries. Material and methods A retrospective chart review of all children with congenital heart disease (CHD) (repaired or unrepaired) who were posted for a non-cardiac surgery in this tertiary care Paediatric super-specialty hospital from January 1, 2018 to December 31, 2019 was carried out. Data on demographics, peri-operative management, and clinical course was retrieved. Inclusion criteria were paediatric patients (0-18 years) of either gender with a diagnosis of a CHD (repaired or unrepaired) undergoing any non-cardiac surgeries (NCS) under anaesthesia/Monitored Anaesthesia Care (MAC). Exclusion criteria were procedures only under local anaesthesia (LA) or a minor procedure done solely under sedation not involving an anaesthesiologist. Results During the study period, we found five eligible cases who underwent a total of six procedures. Five procedures were elective and one was an emergency. Preoperative optimization was conducted by a multidisciplinary team including paediatric surgeons, anaesthesiologists, physicians, and cardio-thoracic surgeons. Anaesthesia was conducted by at least a consultant paediatric anaesthesiologist. Overall all patients tolerated anaesthesia well without any adverse events or complications. All six anaesthetic encounters were safe and uneventful.

Difficulties Encountered While Using PPE Kits and How to Overcome Them: An Indian Perspective.

Background After a slow start due to an effective lockdown, the coronavirus disease 2019 (COVID-19) pandemic in India has been raging at a rapid pace, posing a formidable challenge to the healthcare system in the country. The personal protective equipment (PPE) undoubtedly provides a shield of protection for the healthcare workers (HCWs) fighting the disease as a valuable asset to the nation. However, there have been various problems associated with the PPE, ranging from its shortage to problems arising from heat, dehydration, etc while wearing them. There is a need to assess these problems faced by HCWs both qualitatively and quantitatively for their timely and effective redressal. Methods An electronic questionnaire survey was conducted among a cohort of HCWs who had performed COVID-19 duties and used PPE kits. The cohort consisted of different categories of doctors, nursing personnel, and other paramedical staff. Results The most common problems associated with using PPE kits was excessive sweating (100%), fogging of goggles, spectacles, or face shields (88%), suffocation (83%), breathlessness (61%), fatigue (75%), headache due to prolonged use (28%), and pressure marks on the skin at one or more areas on repeated use (19%). Occasional problems reported were skin allergy/dermatitis caused by the synthetic material of the PPE kit, face shield impinging onto the neck during intubation, and nasal pain, pain at the root of the pinna, and slipperiness of shoe covers. Various ways and means have been employed by the HCWs to actively address and solve these problems. Conclusion These plausible solutions will definitely help the HCWs to deal with and solve the problems arising out of the PPE use.

Intrathecal sufentanil versus fentanyl for lower limb surgeries - a randomized controlled trial.

BACKGROUND: To compare the efficacy and safety of intrathecal sufentanil or fentanyl as adjuvants to hyperbaric bupivacaine in patients undergoing major orthopaedic lower limb surgeries in terms of onset and duration of sensory block, motor block and post-operative pain relief. PATIENTS #ENTITYSTARTX00026; METHODS: Ninety patients were recruited in this Prospective, randomized double blind study to receive either intrathecal sufentanil 5 µg (Group S), fentanyl 25 µg (Group F) or normal saline 0.5 ml (Group C) as adjuvants to 15 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block were assessed intraoperatively. The pain scores were assessed postoperatively. Duration of complete and effective analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering and PDPH was recorded. RESULTS: The Demographic data, hemodynamic and respiratory parameters were comparable in the three groups. There was a significantly earlier onset and prolonged duration of sensory block in the sufentanil and fentanyl groups. The duration of complete and effective analgesia were also significantly prolonged in the fentanyl and sufentanil groups. Pruritus was noticed in the study groups (Groups S&F). CONCLUSIONS: Intrathecal sufentanil (5 µg) and fentanyl (25 µg), as adjuvants lead to an earlier onset and prolonged duration of sensory block. The duration of effective analgesia with intrathecal sufentanil and fentanyl as adjuvants to hyperbaric bupivacaine is longer than that of bupivacaine alone.

Intrathecal sufentanil versus fentanyl for lower limb surgeries - a randomized controlled trial.

BACKGROUND: To compare the efficacy and safety of intrathecal sufentanil or fentanyl as adjuvants to hyperbaric bupivacaine in patients undergoing major orthopaedic lower limb surgeries in terms of onset and duration of sensory block, motor block and post-operative pain relief. PATIENTS #ENTITYSTARTX00026; METHODS: Ninety patients were recruited in this Prospective, randomized double blind study to receive either intrathecal sufentanil 5 µg (Group S), fentanyl 25 µg (Group F) or normal saline 0.5 ml (Group C) as adjuvants to 15 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block were assessed intraoperatively. The pain scores were assessed postoperatively. Duration of complete and effective analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering and PDPH was recorded. RESULTS: The Demographic data, hemodynamic and respiratory parameters were comparable in the three groups. There was a significantly earlier onset and prolonged duration of sensory block in the sufentanil and fentanyl groups. The duration of complete and effective analgesia were also significantly prolonged in the fentanyl and sufentanil groups. Pruritus was noticed in the study groups (Groups S&F). CONCLUSIONS: Intrathecal sufentanil (5 µg) and fentanyl (25 µg), as adjuvants lead to an earlier onset and prolonged duration of sensory block. The duration of effective analgesia with intrathecal sufentanil and fentanyl as adjuvants to hyperbaric bupivacaine is longer than that of bupivacaine alone.

Pre-operative intravenous fluid therapy with crystalloids or colloids on post-operative nausea & vomiting.

BACKGROUND & OBJECTIVE: Post-operative nausea and vomiting (PONV) is a frequent complication and may be a reason for increased morbidity and cost of treatment. Following elective surgery, it is believed to result from gut ischaemia consequent to hypovolemia from overnight fasting. This study was carried out to study the effects of pre-operative intravenous fluid supplementation, either crystalloids or colloids, on PONV. METHODS: In this prospective randomized clinical trial, 60 female patients undergoing elective open cholecystectomy were randomly allocated to three equal groups A, B and C. All patients received preoperative fluid supplementation. Group A patients received 2 ml/kg Ringer lactate iv (intravenously) and served as control, Group B patients received 12 ml/kg Ringer lactate iv whereas Group C patients received 12 ml/kg of 4.5 per cent hydroxyethylstarch (Hetastarch) iv. All patients underwent cholecystectomy under standard anaesthesia technique with intraoperative fluid replacement by Ringer's lactate (6 ml/kg/h). An independent blinded observer assessed PONV during first 24 h following surgery using visual analogue scale (VAS) score (0 = no nausea, 10 = worst imaginable nausea or vomiting). Rescue antiemetic was given whenever VAS was > 5. RESULTS: The three groups were comparable in terms of age, body weight and duration of surgery. VAS scores in Groups B and C patients were less than that of Group A patients at all time intervals post-operatively and became significantly different at 4 h post-operatively. The VAS scores of Groups B and C patients were comparable throughout. A significantly large number (90%) of Group A patients required rescue antiemetic as compared to 50 and 55 per cent patients in Group B and Group C, respectively. INTERPRETATION & CONCLUSION: Pre-operative intravenous fluid supplementation using crystalloids and colloids results in significantly decreased incidence of PONV. Both, crystalloids as well as colloids were found to be equally effective in preventing PONV.