Potential role of mitochondrial uncoupling protein 2 as a biomarker in patients with sepsis and septic shock: A prospective observational study.

Background and Aims: Early diagnosis of sepsis is crucial. The primary objective of this study was to explore the role of uncoupling protein 2 (UCP2) in diagnosing sepsis and septic shock. Methods: This prospective observational study was conducted over 19 months. All adult patients aged more than 18 years with a diagnosis of sepsis or septic shock based on quick sequential organ failure assessment (qSOFA) score were enroled. Blood was drawn for procalcitonin (PCT) and UCP2 on days 0, 3, 7 and 28. Blood samples from 50 healthy volunteers were used as controls. An electrochemiluminescence test was done for PCT. A quantitative enzyme-linked immune sorbent assay was used for UCP2. The Chi-square test was used for qualitative variables and the independent t-test for quantitative variables. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of UCP2. Results: A total of 128 subjects were included in the study. Out of these, 78 patients (qSOFA score ≥2) were subcategorised into the infection group, sepsis or septic shock group based on the PCT levels. The UCP2 levels in the infection, sepsis or septic shock group were significantly higher than in the control group (P > 0.001). The UCP2 levels correlated with PCT on admission, day 3 and day 7. Conclusion: The UCP2 levels were significantly higher in sepsis and septic shock groups compared to controls and hence could be a potential diagnostic biomarker of sepsis.

Comparison of standard weight-based and thenar eminence dimension-based selection of I-gel in pediatric patients - A randomized controlled study.

Background and Aim: Supraglottic airway devices are increasingly being used for airway management. I-gel is being widely used even for pediatric patients. Although the weight-based selection of the size of the device seems to be the standard technique, this method may not be possible in all patients. The aim of the study was to compare the standard weight-based method with the thenar eminence dimension-based method for I-gel selection. Material and Methods: A prospective randomized study was conducted on 74 pediatric patients of either sex, aged between 6 months and 15 years, belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III and who were posted for various surgical procedures under general anesthesia. The study population was divided into two groups of 37 patients each. I-gel was inserted based on weight in group A patients and based on thenar eminence size in group B patients. Parameters like first attempt success rate, ease of insertion, and complications were compared between the two groups using Student's t-test and Chi-square test. Results: The demographic values between the groups were comparable. The first attempt success rate was 97.4% in group A and 91.7% in group B (P = 0.358). Insertion of I-gel was unsuccessful in two patients in group B. Two patients of group B had blood staining of the device. None of the patients had complications related to insertion. Conclusion: The thenar eminence dimension can be used instead of weight while choosing the size of I-gel in pediatric patients. None of the patients had complications related to device insertion.

Prevalence, distribution and correlates of pain in patients with mucormycosis-A cross-sectional study.

Context: COVID-19 has led to a spate of rhino-orbital-cerebral mucormycosis cases in India, the epidemiology of which was least understood before. Only a few case series and case reports discuss the symptomatology of mucormycosis. Aims: The primary objective of our study was to estimate the prevalence of pain in patients with mucormycosis. The secondary objectives include the type, regional distribution, characteristics and determinants of pain in patients with mucormycosis. Settings and Design: A cross-sectional study was conducted on consecutive adult patients with mucormycosis in our hospital. Materials and Methods: Following recruitment, a preplanned written questionnaire that was tested for validity with peers, with closed-ended queries was filled on a sole visit by an anesthesia postgraduate based on the response by the patient. Statistical analysis used: Categorical variables were summarized as proportion and percentage. To compare quantitative variables, Chi-square test was used. Results: A total of 69 out of the 80 patients recruited complained of pain (P value = 0.468). A total of 76.8% of patients had pain in the supraorbital region with 84% of the patients complaining of throbbing pain and 98.6% needing analgesics. Gender, pre-existing diabetes mellitus, organs affected due to mucormycosis, prior steroid usage, prior COVID illness, surgical intervention, and previous experience of pain in the same region had no influence on the presence or severity of pain. Conclusions: Pain is one of the presenting symptoms in patients with mucormycosis which is usually in the supraorbital and maxillary region, nociceptive type and throbbing in nature, and moderate to severe in intensity usually managed with simple analgesics.

Practical approach for safe anesthesia in a COVID-19 patient scheduled for emergency laparotomy.

COVID-19 patients presenting for emergency laparotomy require evaluation of surgical illness and viral disease. As these patients are likely to have a wide spectrum of deranged physiology and organ dysfunction, optimization should start preoperatively and continue through intraoperative and postoperative recovery periods along with appropriate antimicrobial cover. The goal should be not to delay damage control surgery in favor of evaluation and optimization. When a COVID-19 positive or suspected patient is to be operated for laparotomy, the situation often demands general anesthesia with invasive monitoring and analgesia complemented by regional anesthesia to minimize postoperative opioid requirements to facilitate early recovery. This particular article addresses the issues related to emergency laparotomy management in relation to COVID-19 patient. Healthcare workers should diligently use effective PPE and practice disinfection to prevent spread. Video-communication is an effective means of evaluation. Information expected from investigations should be weighed against risk of exposure to healthcare workers/laypersons. Simulation and memory aids should be used to familiarize team members with roles and techniques of management while in PPE. Step-wise detailed planning for patient transfer, anesthesia induction, maintenance and emergence, aid in enhancing HCW safety without compromising patient care.

Prevention of Craniofacial Pain Secondary to Harvesting of Temporalis Fascia - A Novel Technique.

OBJECTIVES: A lesser known after effect of harvesting temporalis fascia is the post-surgical craniofacial pain. The aim of the study was to evaluate this pain after tympanomastoid surgeries and the effectiveness of silastic sheet interpositioning to prevent this pain. MATERIALS AND METHODS: This pilot study that spanned one year, included patients who underwent tympanoplasty with or without mastoidectomy involving the harvesting of temporalis fascia. At the end of surgery, the wound was closed after silastic sheet was secured over the donor site in cases and without silastic sheet in controls. In the post-operative period, patients scored their temporal pain, tenderness and pain during opening of mouth and mastication on a visual analogue scale (VAS) on day 7, 15, 30 and 90. RESULTS: Visual analogue scale (VAS) scores of the silastic group were lower than the control group on day 7 and 15 after surgery and the difference was statistically significant. In the control group, temporal pain and tenderness were 74% and 81% respectively on day 7. VAS scores of both groups decreased over time and were negligible after 3 months. There were no significant postoperative complications in either group and no reaction or rejection of silastic sheet in the cases. CONCLUSION: Post-surgical craniofacial pain secondary to the harvesting of temporalis fascia is observed in a majority of the patients. This novel technique involving silastic sheet interposition can decimate early post-operative temporal pain, tenderness and masticatory pain.

Comparison between the Baska Mask® and I-Gel for Minor Surgical Procedures Under General Anaesthesia.

OBJECTIVE: Minor surgical procedures under general anaesthesia require a patent airway without the use of muscle relaxant. Supraglottic airway devices have been widely used for airway management. A study was undertaken to compare first-time insertion success rate, insertion time, sealing pressure and complications between the Baska® mask and I-gel. METHODS: After approval from the institutional ethical committee, a randomised single-blinded study was conducted on 50 American Society of Anesthesiologists' physical status I and II female patients aged 18-40 years who underwent minor surgical procedures under general anaesthesia. Patients were randomly categorized into two groups of 25 each; group Baska® mask and group I-gel, and the first-time success rate, mean insertion time and sealing pressure were measured. The results were analysed using unpaired t-test, Mann-Whitney U test, Chi-square test and ANOVA. A p value <0.05 was considered to be statistically significant. RESULTS: The first-time insertion success rate of the Baska® mask was 21/24 (88%) when compared with the I-gel, which was 23/25 (92%) (p=0.585). The insertion time of the Baska® mask was 14.9±6.2 s, whereas that of the I-gel was 14.7±4.4 s (p=0.877). The mean sealing pressure of the Baska® mask was significantly higher when compared with the I-gel (28.9±3.5 vs. 25.9±2.5 cmH2O) (p=0.001). CONCLUSION: The Baska® mask had a similar first-time insertion success rate and insertion time as the I-gel. The sealing pressure of the Baska® mask was significantly greater than that of the I-gel. Both devices had complications that were comparable.

Comparison of Prophylactic Intravenous Magnesium Sulfate with Tramadol for Postspinal Shivering in Elective Cesarean Section: A Placebo Controlled Randomized Double-blind Pilot Study.

BACKGROUND AND AIMS: Cesarean sections are performed mostly under spinal anesthesia. Shivering is one of the distressing complications. The aim of the study was to compare the efficacy of intravenous (i.v) magnesium sulfate and tramadol with placebo (normal saline) on postspinal shivering in elective cesarean section when used as prophylaxis. METHODS: One hundred and thirty-five pregnant women between 18 and 35 years age, belonging to the American Society of Anesthesiologists' physical Status II, undergoing elective cesarean section under spinal anesthesia were enrolled into the study. Patients belonging to Group C (control group, n = 45) received isotonic saline 100 mL i.v, Group T (tramadol group, n = 45) received tramadol 0.5 mg/kg in 100 mL isotonic saline i.v, whereas those in Group M (magnesium sulfate group, n = 45) received magnesium sulfate 30 mg/kg in 100 mL isotonic saline i.v after administering spinal anesthesia. Incidence and grades of shivering were noted. Data were analyzed using one-way ANOVA test and Chi-square test. RESULTS: The incidence of shivering in Group C, Group T, and Group M were 67.5%, 43.9%, and 39%, respectively. The incidence of shivering in Group M and Group T was significantly low when compared to Group C (P = 0.008; P = 0.026), whereas there was no statistically significant difference between Groups T and M (P = 0.654). CONCLUSION: Magnesium sulfate and tramadol significantly reduce the incidence of shivering compared to placebo when used as prophylaxis in pregnant women undergoing cesarean section under spinal anesthesia. Magnesium sulfate reduces the severity of the shivering.

Comparison of surgical conditions following premedication with oral clonidine versus oral diazepam for endoscopic sinus surgery: A randomized, double-blinded study.

BACKGROUND AND AIMS: Endoscopic sinus surgery (ESS) provides a challenge and an opportunity to the anesthesiologists to prove their mettle and give the surgeons a surgical field which can make their delicate surgery safer,more precise and faster. The aim of the study was to evaluate the surgical field and the rate of blood loss in patients premedicated with oral clonidine versus oral diazepam for endoscopic sinus surgery. MATERIAL AND METHODS: ASA I or II patients who were scheduled to undergo ESS were randomly allocated to group D (n = 30) or group C (n = 30). The patients' vital parameters, propofol infusion rate, and rate of blood loss were observed and calculated. The surgeon, who was blinded, rated the visibility of the surgical field from grade 0-5. RESULTS: In the clonidine group, the rate of blood loss, the surgical time, propofol infusion rate was found to be statistically lower as compared to the diazepam group. Also a higher number of patients in the clonidine group had a better surgical score (better surgical field) than the diazepam group and vice versa. CONCLUSIONS: Premedication with clonidine as compared to diazepam, provides a better surgical field with less blood loss in patients undergoing ESS.

Epidural anesthesia for cesarean section in a primigravida woman with Ebstein's anomaly with recurrent supraventricular tachycardia.

Ebstein's anomaly is an uncommon congenital heart defect with an extremely variable natural history due to a wide spectrum of pathological features. We report on the anesthetic management of a 24-year-old primigravida woman with Ebstein's anomaly with recurrent supraventricular tachycardia for emergency cesarean section.