Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation.

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

Comparison of insertion characteristics of LMA ProSeal from the front and head-end of the patient: A randomized pilot study.

Background and Aims: LMA ProSeal (PLMA) is a commonly used airway maintenance device in elective procedures and is routinely inserted from the head-end of the patient. It is also used in pre-hospital emergencies where it may not always be possible to access the head-end. This study aims to compare the insertion characteristics of PLMA when inserted while standing, either at the head-end or from the front. Material and Methods: After institutional ethics committee approval, 60 consenting patients of either sex, between 18 and 60 years, ASA class I/II, and scheduled to undergo elective surgeries were randomly allocated to either group H (head-end insertion) or group F (front-end insertion). Patients with anticipated difficult airway, chronic respiratory disease, obesity, and who were pregnant were excluded. Insertion time, ease of insertion, fiber optic view, ease of drain tube insertion, number of attempts and success rate were noted. Normally distributed quantitative variables were compared using t-test, and qualitative variables were compared using Chi-squared test. A P < 0.05 was considered significant. Results: Insertion time in group H (23.76 ± 4.48 s) was lesser than in group F (30.53 ± 6.23s) (P = 0.027). Ease of insertion (P = 0.052), fiber optic view, ease of drain tube placement (P = 1.000), and number of attempts (P = 1.000) were comparable among the groups. Conclusion: Although the insertion time from the front is longer than from the head-end, the other insertion characteristics of PLMA including ease of its insertion, placement and success rate of placement are similar when it is inserted from the front or from the head-end. It is an appropriate airway device for securing the airway when the head-end is inaccessible.

Suppression of perioperative stress response in elective abdominal surgery: A randomized comparison between dexmedetomidine and epidural block.

Background and Aims: Stress response after surgery induces local and systemic inflammation which may be detrimental if it goes unchecked. Blockade of afferent neurons or inhibition of hypothalamic function may mitigate the stress response. Material and Methods: A total of 50 consenting adult ASA I/II patients undergoing elective abdominal surgery were randomized to receive either dexmedetomidine (Group D) or epidural bupivacaine (Group E) in addition to balanced general anesthesia. Laparoscopic surgery, contraindications to epidural administration, history of psychiatric disorders, obesity (BMI >30 kg/m2), on beta blockers or continuous steroid therapy for >5 days over last 1 year, and known case of endocrine abnormalities or malignancy were excluded. Serum cortisol, blood glucose, and blood urea were estimated. Hemodynamic parameters, total dose of dexmedetomidine, bupivacaine, emergence characteristics, and analgesic consumption over 24 h postoperatively were recorded. Statistical comparisons were done using Student's t-test, repeated measure analysis of variance followed by Dunnett's test, generalized linear model and Chi-square/Fisher's exact test. A P value <0.05 was considered significant. Results: Serum cortisol levels were significantly lower in group E than group D 24 h after surgery (P = 0.029). Intraoperative and postoperative glucose level was lower in group E compared with group D. Time to request of first rescue analgesic was longer in group E than group D (P = 0.040). There was no significant difference between the number of doses of paracetamol required in the postoperative period (P = 0.198). Conclusion: Epidural bupivacaine was more effective than intravenous dexmedetomidine for suppression of neuroendocrine and metabolic response to surgery. Dexmedetomidine provided better hemodynamic stability at the time of noxious stimuli and postoperatively.

Efficacy of fixed-dose phenylephrine bolus for treating post-spinal hypotension: Comparison between pre-eclamptics and normotensives.

Background and Aims: Pre-eclamptic parturients may have an exaggerated response to vasopressors. This study compares the efficacy of a 50 µg fixed bolus of phenylephrine for treatment of post-spinal hypotension in pre-eclamptic versus normotensive parturients. Material and Methods: After written informed consent and ethics committee approval, 30 normotensive and 30 pre-eclamptic parturients between 18 and 40 years with singleton term pregnancy about to undergo cesarean section (CS) under spinal anesthesia were included. Post-spinal hypotension was treated with a 50 µg fixed bolus of phenylephrine. The cumulative dose of phenylephrine, the number of boluses, and the median dose required to treat the first hypotensive episode, total number of hypotensive episodes, maternal side effects, neonatal appearance, pulse, grimace, activity, and respiration (APGAR) scores, and umbilical arterial cord blood pH were noted. Statistical analysis was done using Student's t-test, Mann-Whitney U-test, Chi-square test/Fisher's exact test as appropriate. A P <0.05 was considered significant. Results: The cumulative dose and number of boluses of phenylephrine required to treat post-spinal hypotension were comparable. The median dose required to treat the first episode of post-spinal hypotension was also similar (p = 0.792). The time to develop the first hypotensive episode was significantly earlier for group N (p = 0.002). The efficacy of a single fixed bolus of 50 µg phenylephrine was similar in both groups (p = 1.000). Neonatal median APGAR scores at 1 min after birth were significantly higher for group N (p = 0.016). Conclusion: A fixed-dose bolus of 50 µg phenylephrine is safe and effective in treating post-spinal hypotension in pre-eclampsia. The efficacy of phenylephrine is comparable in pre-eclamptic and normotensive parturients.

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study.

Background and Aims: Etomidate is a popular induction agent, but its use is associated with myoclonus in 50%-80% of non-premedicated patients. This study aims to compare dexmedetomidine and butorphanol for their relative efficacy in preventing etomidate-induced myoclonus. Methods: This randomised study was conducted after obtaining institutional ethical committee clearance and written informed consent from sixty American Society of Anesthesiologists (ASA) I or II consenting patients between 18 and 60 years of age of either sex who had been scheduled for elective surgeries under general anaesthesia. Patients were randomly allocated to dexmedetomidine 0.5 µg/kg (Group D) or butorphanol 0.015 mg/kg (Group B). Both the drugs were given as an infusion over a period of 10 min before induction of anaesthesia. The primary outcome was the incidence of myoclonic movements after etomidate, and the secondary outcomes were the severity of myoclonus, changes in the haemodynamic parameters and incidence of airway complications. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using Mann-Whitney U test. Qualitative data were analysed using Chi-square/Fisher's exact test. A P-value <0.05 was considered significant. Results: The incidence of etomidate-induced myoclonus was significantly higher in group B compared to group D (P = 0.035). The median (interquartile range [IQR]) of myoclonus grade in patients of group D was 0.00 (0.00-3.00), and group B was 2.50 (0.00-3.00) (P = 0.035). Haemodynamics and airway-related complications were comparable between the groups. Conclusion: Dexmedetomidine was more effective than butorphanol in preventing etomidate-induced myoclonus.

Incompetent memory immune response in severe COVID-19 patients under treatment.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide and declared a Public Health Emergency by the World Health Organization (WHO) on January 30, 2020. Albeit, unprecedented efforts have been made from the scientific community to understand the pathophysiology of COVID-19 disease, the host immune and inflammatory responses are not explored well in the Indian population. Continuous arrival of new variants fascinated the scientists to understand the host immune processes and to eradicate this deadly virus. The aim of this study was to see the helper and cellular host immune responses including memory and activated cell subsets of COVID-19 patients admitted to the intensive care unit (ICU) at different time intervals during the treatment. PBMCs separated from nine patients with SARS-CoV-2 infection were incubated with fluorescent conjugated antibodies and acquired on flow cytometer machine to analyze the T and B cell subsets. The results in COVID-19 patients versus healthy volunteers were as follows: elevated helper T cells (57.4% vs 44.9%); low cytotoxic T cells (42.8% vs 55.6%), and activated T (17.7% vs 21.2%) subsets. Both, TREG (40.15% vs 51.7%) and TH17 (13.2% vs 24.6%) responses were substantially decreased and high expression of TREG markers was observed in these patients compared with controls.

Minimum effective dose of oxytocin bolus during the caesarean section for patients at high vs low risk of uterine atony: A non-randomized, dual-arm, dose-finding prospective trial.

Background and Aims: There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony. Methods: This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated 'success', while inadequate tone constituted 'failure'. If the response was 'failure', the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged. Results: The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3-6.0) IU for the high-risk group and 2.2 (1.3-3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar. Conclusion: Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors.

Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study.

BACKGROUND: Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries.  Method: Sixty-three American Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. RESULTS: Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. CONCLUSION: Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.

Comparison of Intrathecal Chloroprocaine With Bupivacaine in Short Gynecological Procedures: A Randomized Double-Blind Study.

Background Neuraxial anesthesia, compared to general anesthesia, offers better patient comfort, early ambulation, and discharge with excellent post-operative pain relief for short gynecological procedures. Recently chloroprocaine, a short-acting local anesthetic agent became available for intrathecal use. This study aimed to compare intrathecal chloroprocaine with bupivacaine in short gynecological procedures. Methodology Consecutive patients undergoing short gynecological procedures, patients belonging to the American Society of Anesthesiology (ASA) I and II, between 18 and 60 years of age, and patients with a height between 150 cm and 180 cm were included in the study. Randomization was done using a computer-generated random number table. Patients were allocated to one of the two study groups. Group B received 4 mL of isobaric bupivacaine (0.25%) 10 mg intrathecal, and Group C received 4 mL of isobaric chloroprocaine (1%) 40 mg intrathecal. The primary outcome criteria were time to ambulation and discharge readiness. The secondary outcome criteria were onset, duration, and intensity of sensory and motor blockade, time to voiding, and any adverse effects. Results Patients receiving chloroprocaine had a significantly (p=0.001) faster time (158±31 min) to ambulation compared to bupivacaine (241±23 min). The regression of sensory blockade was substantially faster (p=0.001) with chloroprocaine (60±13 min) than with bupivacaine (94±24 min). Mean time to motor onset was significantly (p=0.05) faster in chloroprocaine (8±3 min) than bupivacaine (12±3 min) group. Significantly faster (p=0.001) recovery of motor blockade was observed with chloroprocaine (130±32 min) than bupivacaine (211±22 min). The time to first voiding was also significantly earlier with stable hemodynamics and no adverse effects in chloroprocaine group. Conclusion Intrathecal chloroprocaine may be an attractive alternative and is superior to isobaric bupivacaine as it provides early ambulation and discharge readiness for daycare anesthesia in short gynecological procedures.

Comparison of insertion characteristics of LMA ProSeal and Ambu AuraGain in adult patients under controlled ventilation: A randomised study.

Background and Aims: Supraglottic devices are preformed or flexible, and the insertion characteristics of the two types may be different. This study aims to compare the insertion characteristics of Ambu AuraGain (AAG), preformed) and LMA ProSeal (PLMA), flexible, requires an introducer tool for placement. Methods: Forty American Society of Anesthesiologists (ASA) physical status I/II patients of either sex between 18 and 60 years with no anticipated airway difficulty were randomly allocated to either group AAG or PLMA (n = 20 each). Pregnant females, known case of chronic respiratory disorders and gastroesophageal reflux were excluded. After induction of anaesthesia and muscle relaxation, appropriately sized AAG or PLMA was inserted. Time for successful insertion (primary outcome), ease of device insertion and gastric drain insertion, first attempt success rate (secondary outcomes) were recorded. Statistical analysis was done using SPSS version 20.0. Quantitative parameters were compared using Student's t-test, and qualitative parameters were compared using Chi-square test. A P value of <0.05 was considered significant. Results: Time taken for successful insertion of PLMA was 22.94 ± 6.12 s and for AAG was 24.32 ± 4.96 s, (P = 0.458). Device insertion was significantly easy in PLMA group (P < 0.002). First attempt success rate was achieved in 17 (94.4%) cases in PLMA group compared to 15 (78.9%) cases in AAG group (P = 0.168). Ease of drain tube insertion was comparable among the groups (P = 0.298). The haemodynamic variables were also comparable. Conclusion: PLMA is easier to insert as compared to AAG, but the insertion time and first attempt success rate are similar. The preformed curvature in AAG does not provide any added advantage over the non-preformed PLMA.

COVID-19 Vaccination Among Healthcare Workers: Trend and Protection in a Tertiary Care Hospital in Northern India.

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that poses health risks to everyone exposed to the virus and frontline healthcare workers (HCWs) are at very high risk. COVID-19 vaccines have been developed to offer protection from the disease and reduce the severity of illness. Objective This questionnaire-based cross-sectional survey aimed to determine COVID-19 vaccination trends and protection among HCWs in a dedicated COVID-19 tertiary care hospital in Northern India. Methods A printout of the questionnaire was distributed. Part 1 of the questionnaire included voluntary consent and demographics information, and part 2 dealt with COVID-19 vaccination, COVID-19 illness, and post-vaccination illness. The outcomes of the study comprised trends and protection offered by COVID-19 vaccination, post-vaccination side-effects, and reasons for vaccine hesitancy. The responses were analyzed using Stata version 15.0. Results: A total of 256 HCWs were approached to take the questionnaire, out of whom 241 consented to participate in the survey. One-hundred and fifty-five (64.3%) of these HCWs were fully vaccinated, 53 (21.9%) were partially vaccinated, and 33 (13.7%) were non-vaccinated. The overall rate of infection was 45.64% (110/241). The rate of infection was 58.18% among non-vaccinated HCWs, 21.81% after partial vaccination, and 20% after full vaccination. The odds of infection among vaccinated versus non-vaccinated HCWs was 0.338 (95% CI: 0.224 to 0.512; P<0.001). The overall hospitalization rate among infected HCWs was 6.36% and there was no incidence of hospitalization among fully vaccinated HCWs. Conclusions: Vaccination was shown to reduce the rates of infection and hospitalization among HCWs. A sizeable number of HCWs remained unvaccinated due to either recent COVID-19 infection or apprehension about vaccine-related side-effects.

Retention of Knowledge and Efficacy of a Hands-on Training Session in Oxygen Therapy for COVID-19 among Healthcare Workers.

Introduction: We conducted basic hands-on training in oxygen therapy and ventilatory management of coronavirus disease-2019 (COVID-19) patients to health care workers (HCWs) at our tertiary care hospital. We designed this study aiming to find out the impact of hands-on training in oxygen therapy for COVID-19 patients on the knowledge and degree of retention of this gained knowledge 6 weeks after the training session among HCWs. Materials and methods: The study was conducted after obtaining approval from the Institutional Ethics Committee. A structured questionnaire consisting of 15 multiple-choice questions was given to the individual HCW. This was followed by a structured 1-hour training session on "Oxygen therapy in COVID-19", following which the same questionnaire was given to the HCWs with the questions in a different order. After 6 weeks, the same questionnaire with questions in a different format was sent to the participants as a Google form. Results: A total of 256 responses were obtained for the pre-training test and post-training test. The median [IQR] pre-training test scores and post-training test scores were 8 [7-10] and 12 [10-13], respectively. The median retention score was 11 [9-12]. The retention scores were significantly higher than the pre-test scores. Conclusion: About 89% of the HCWs had a significant gain of knowledge. About 76% of the HCWs were able to retain knowledge, which also means the training program was successful. A definitive improvement in baseline knowledge was observed after 6 weeks of training. We propose conducting reinforcement training after 6 weeks of primary training to further augment retention. How to cite this article: Singh A, Salhotra R, Bajaj M, Saxena AK, Sharma SK, Singh D, et al. Retention of Knowledge and Efficacy of a Hands-on Training Session in Oxygen Therapy for COVID-19 among Healthcare Workers. Indian J Crit Care Med 2023;27(2):127-131.

Use of Pearson and Spearman correlation testing in Indian anesthesia journals: An audit.

Background and Aims: Correct usage and interpretation of biostatistical tests is imperative. Aim of the present article was to evaluate the use of "correlation test" for biostatistical analysis in two leading Indian journals of anesthesia and sensitize the readers regarding its correct usage. Material and Methods: A prospective analysis was done for all original articles using the correlation test (Pearson or Spearman) that were published in "Indian Journal of Anaesthesia" (IJA) or "Journal of Anaesthesiology and Clinical Pharmacology" (JOACP) in the years 2019 and 2020. Results: Amongst all included original studies, correlation test were used in 6% (JOACP) and 6.5% (IJA) respectively (averaged for the years 2019 and 2020). Correlation test was usedinappropriately) for evaluating an aim of prediction/agreement/comparison, rather than association, in 25% and 10% instances each (JOACP and IJA). In both JOACP and IJA, there were high rates of using and interpreting results without citing 95% confidence intervals (CIs) of correlation coefficient (88% and 90%, respectively), P value for significance of the association (50% and 90%, respectively), or coefficient of discrimination (88% and 70%, respectively). In majority of the instances, test to ascertain presence of mandatory prerequisites such as normal distribution of data could not be found (62% and 90%, respectively). Conclusion: The complete potential of correlation test in exploring research questions is probably underappreciated. Further, even when used, its application and interpretation are prone to errors. We hope that the present analysis and narrative is a well-timed appropriate step in bridging the gaps in existing knowledge regarding use of correlation test in national anesthesia literature.

Comparison of face-to-face tracheal intubation and conventional head-end tracheal intubation using Airtraq™ video-laryngoscope in adults - A randomised study.

Background and Aims: Tracheal intubation can be difficult in certain scenarios where the head-end of the patient is not accessible as in entrapped casualties. A face-to-face technique using a video-laryngoscope can prove to be useful in such scenarios. However, the two positions of tracheal intubation namely, face-to-face and head-end, using video-laryngoscope have never been compared in patients. Material and Methods: Fifty patients of either sex, between 18 and 60 years, ASA class I/II, MPC I/II, scheduled to undergo surgical operations requiring general anesthesia with tracheal intubation were randomly allocated to either Group F (face-to-face intubation) or Group H (head-end intubation). Intubation was performed using Airtraq™ video-laryngoscope in both groups. Time taken for successful intubation, device insertion time, glottic view as per Cormack and Lehane (CL) grade, ease, attempts, the incidence of failed intubation, and hemodynamic parameters were noted. Results: The time taken for successful intubation in Group F was significantly longer than in Group H (38.09 ± 19.45 s vs. 19.32 ± 9.86 s, respectively; P < 0.001). Three cases of failed intubation were noted in Group F compared to none in Group H (P = 0.235). Glottic view, ease, attempts, and hemodynamic parameters were comparable among the groups (P > 0.05). Conclusion: The time taken for successful tracheal intubation was longer in face-to-face technique than in head-end technique in patients with the normal airway. However, both techniques were similar in terms of glottic view, ease of intubation and number of intubation attempts, the incidence of failed intubation, and hemodynamic changes. Therefore, face-to-face tracheal intubation is a good alternative to secure the airway when the head-end is not accessible.

Overview of statistical methods usage in Indian anaesthesia publications.

Background and Aims: Despite the importance of statistics being well established for medical research, it remains a neglected area of understanding and learning. The present survey aimed to examine the use of various statistical methods in a two-year sample (2019-2020) of representative Indian anaesthesia journals and compare it with an international top-ranked journal. Methods: The literature survey included analysis of 748 original articles from 'Indian Journal of Anaesthesia' (179), 'Journal of Anaesthesiology Clinical Pharmacology' (125) and 'Anesthesia & Analgesia' (444) published over the period. Original research articles were identified from the table of contents of each issue. Articles were assessed for statistical methods, categorised as being descriptive, elementary, multivariable, advanced multivariate or diagnostic/classification. Results: Compared to Anesthesia & Analgesia, the Indian journals (considered together) had a significantly greater use of mean (standard deviation) (91.2% versus 70%) and percentages (79.5% versus 67.6%) (P = 0.000 each); and lesser for Wilcoxon (5.4% versus 14.6%) and Pearson/Spearman (5.1% versus 13.5%) correlation tests (P = 0.000 each), multivariable tests including various regression methods (P < 0.001), classification/diagnostic tests [Receiver operating characteristic (ROC) curve analysis, P = 0.022; sensitivity/specificity, P = 0.000; precision, P = 0.006; and relative risk/risk ratio, P = 0.010] and a virtual absence of complex multivariate tests. Conclusion: The findings show limited use of advanced complex statistical methods in Indian anaesthesia journals, usually being restricted to descriptive or elementary. There was a strong bias towards using randomised controlled designs. The findings suggest an urgent and focussed need on training in research methodology, including statistical methods, during postgraduation and continued medical training.

Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin.

BACKGROUND: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU. METHODS: Patients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated. RESULTS: A total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240-335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569-0.904)]. CONCLUSIONS: Although AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence. HOW TO CITE THIS ARTICLE: Tyagi A, Yadav P, Salhotra R, Das S, Singh PK, Garg D. Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin. Indian J Crit Care Med 2021;25(9):1013-1019.

Fentanyl versus nalbuphine for intubating conditions during awake fiberoptic bronchoscopy: A randomized double-blind comparative study.

BACKGROUND AND AIMS: Patient cooperation, sedation, anxiolysis, and topicalization are important prerequisites for the successful and safe conduct of awake intubation. Because of the pharmacological properties, opioids can facilitate this process. Fentanyl is an opioid agonist and nalbuphine is an agonist-antagonist. This study aims to compare these two opioids for their effect on sedation and intubating conditions during awake fiberoptic intubation. MATERIAL AND METHODS: This randomized double-blind controlled study was conducted on 62 ASA I/II patients of either sex between the age of 20 and 60 years, weight between 40 and 80 kg, with MP class I/II airways requiring general anesthesia with endotracheal intubation. All patients received standard airway topicalization and nebulization. Patients were randomly allocated to one of the two groups according to a computer-generated random number table. Group F (n = 31) received fentanyl 2 µg/kg i.v. and group N (n = 31) received nalbuphine 0.2 mg/kg i.v. over 10 min before intubation. Fiberoptic intubation was attempted and lignocaine spray and propofol boluses were administered as and when required. Hemodynamic responses and intubating conditions were recorded. Repeated measure ANOVA, McNemar test, and Chi-square test or Fischer's exact test were used for data analysis. A P < 0.05 was considered significant. RESULTS: Cough score (P = 0.458), post-intubation score (P = 1.000), and sedation score (P = 1.000) were comparable among the two groups. Hemodynamic responses and propofol and lignocaine requirements were also comparable. CONCLUSION: Both fentanyl and nalbuphine provide comparable intubating conditions when used before awake fiberoptic intubation with minimal adverse effects on hemodynamic profile.

Early Warning Scores at Time of ICU Admission to Predict Mortality in Critically Ill COVID-19 Patients.

OBJECTIVE: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection. METHODS: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. RESULTS: Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC: 0.720 [95% confidence interval [CI]: 0.630-0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI: 0.715-0.911]) to be the only significant predictor of ICU mortality. CONCLUSIONS: CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.