MEDICINE

ABSTRACT:Objective: Emergence agitation is a major problem during recovery from anesthetic agents like sevoflurane, particularly in children. This study had compared the effects of oral clonidine with oral midazolam in reducing the incidence of emergence agitation following sevoflurane anesthesia.Methods: 50 children of ASA status I and II aged between 3-8 years were randomly allotted to one of the two groups, each group comprising 25 children. Group I children were given oral Midazolam 0.5 mg/kg and Group II children were given oral Clonidine 4 mcg/kg 30 min before the induction of anesthesia. Emergence reaction was analyzed using modified objective pain scale in all children following sevoflurane administration.Results: The total agitation score was significantly less in clonidine group in comparison to midazolam group during the first hour of post operative period (P<0.05).No remarkable change in the hemodynamics or oxygen saturation was observed in both groups.Conclusion: Pre...

Objective: Stellate ganglion (SG) block can provide pain relief in sympathetically mediated painful conditions. SG block at the sixth cervical (C6) vertebra level through lateral approach under the ultrasonogram (USG) guidance is very safe but may spare the fibres supplying the upper limb. When the drug is given at the C6 subfascially, it spreads along the cervical sympathetic chain, blocking the head/ neck and upper limb. In this study, we assessed the efficacy of the SG block given at the C6 level after confirming the subfascial needle position under USG and downward spread of dye under fluoroscopy. Methods: Ten patients with sympathetically mediated painful conditions belonging to the American Society of Anesthesiologists (ASA) Class I and II and aged between 18 and 60 years were included in the study. The SG was approached laterally under the USG guidance, and the dye was injected after confirming the subfascial needle position. A downward spread of dye was confirmed on fluoroscope, and 4 mL of 0.25% of bupivacaine with 40 mg of methylprednisolone was injected. Patients were assessed in terms of the pain relief, an increase in axillary temperature and adverse events after 30 minutes. A statistical analysis was done with Student's t-test and paired samples t-test. Results: There was a statistically significant reduction in the post-block pain scores with the rise in temperature in the ipsilateral arm (p=0.000). The dye spread was observed from the fourth cervical vertebra to the first thoracic vertebra in all patients. Transient hoarseness was seen in 20% of patients, and the sensation of a lump was seen in 10% of patients. Conclusion: We conclude that SG can be blocked effectively and safely through the lateral approach at the C6 level under ultrasonogram and fluoroscopic guidance.

I read an article published in the February 2019 issue, which compared the ease of nasal intubation using Airtraq through the right or left nostril [1]. I greatly appreciate the efforts of the authors for conducting this thoughtprovoking study. I wish to provide my reflections on some points which do not correspond to the viewpoints of the authors of this study [1]. The concept of comparing the right versus left nostril for the ease of nasal intubation based on the literature [2] quoted by authors is understandable. However, the point of contention is that we cannot conclude that choosing the right nostril would make the intubation safer and quicker in all patients, because Takasugi et al. had observed in their retrospective study that left nostril had to be chosen in 15% of the cases following failure through right nostril due to anatomical variations [2]. Indeed, it is difficult to conclude which nostril is more patent clinically, as the clinical predictors do not correlate well with the endoscopic findings [3]. Hence, it is better to prepare both nostrils as anesthesiologists usually do and try the one which is more patent, not as per the surgeon's preference (oral/nasal can be of surgeon's preference, not right/left nostril) as mentioned in the introduction section of the current study [1]. In case of difficulty, the other nostril can be tried.

Introduction: Ultrasonography has revived the infraclavicular approach to brachial plexus block resulting in many studies available in the literature. However, very few studies have assessed the sensory block characteristics of individual nerve territories by this approach. Aim: To compare the supraclavicular with the infraclavicular approach with special emphasis on the assessment of block characteristics of each nerve domain. Materials and Methods: This randomised controlled trial was conducted on 40 patients of American Society of Anesthesiologists (ASA) physical status I and II, aged between 20-60 years of age undergoing elective surgical procedures of the upper limb. They were randomly allocated into either group Supraclavicular (SC group) or Infraclavicular (IC group). Ultrasound-guided block was performed using 30 mL of 0.25% bupivacaine. The primary outcome measure was the efficacy of block, and the secondary outcome was the time taken for performance of block. Categorical v...

This article (Correspondence) is in response to the recently published article on the role of Pecto-intercostal Fascial Block for cardiac procedures by Zhang et al. in “BMC Anesthesiology”. I greatly appreciate the authors for publishing this study in which Pecto-intercostal Fascial Block, a novel technique for providing pain relief in open cardiac surgical procedures was evaluated. I wish to present my reflections on this article as well as to add a few more points on this topic.

This article (Correspondence) is in response to the recently published study by Elewa et al. in BMC Anesthesiology that compared the erector spinae plane block (ESPB) versus paravertebral block (PVB) regarding postoperative analgesic consumption following breast surgeries. I greatly appreciate the authors for publishing this study which is one among a very few studies available on this topic. I wish to present my reflections on this article as well as add a few more points on this topic.

I read with immense interest the editorial in the Korean Journal of Anesthesiology (KJA) [1] that elaborated on the editorial/peer review process regarding the inclusion of a retracted article in a systematic review and meta-analysis (SRMA) published recently in the KJA [2]. I greatly appreciate the vigilance of the production team of the KJA for identifying this during the proof check and the efforts of the Editorial Board of the KJA for making a balanced decision after analyzing this grave issue from various angles during the review process. I also greatly respect the views expressed in the editorial and wish to emphasize the importance of preventing this perennial menace in this letter. While I fully agree that the inclusion of the retracted article happened at an "ambiguous time" on this particular occasion, I feel that this problem must be further analyzed to prevent it from happening in the future. Although the authors of the editorial [1] stated that the date of retraction of the article was September 9, 2021, the first notification occurred on June 1, 2021 [3]. While Jo et al. [2] completed their search of the literature in May 2021, they submitted their SRMA on July 26, 2021. Here, I would like to suggest that all journals require authors to acknowledge that they have not cited any retracted article in their manuscript during the submission process itself, as this precautionary measure might have prevented this problem. While submitting a manuscript as an author about a year ago, I noted that one of the journals in the field of anesthesiology namely "Anaesthesia" was following this practice, and I believe that it could contribute more to preventing the citation of retracted articles. I also strongly value the suggestion made in the editorial that, as a part of the peer-review process, it should be confirmed that no retracted articles are included in the references. However, I feel that the primary responsibility lies with the authors to cross-check the current status of all their references during submission and periodically until their article is published. Also, the reference cited (reference #7 of the editorial [1], reference #4 here) did not match for that sentence. Grey et al. [4] suggested that the integrity of publications be determined through a special checklist "REAPPRAISED" to prevent the delay in retracting the articles and its impact on science. The unique feature of this particular instance is that it happened at an "ambiguous time" especially for an article of the SRMA type. It would have been relatively easier for authors of any other type of article to make corrections at this juncture. Fortunately, it was identified in the nick of time and the Editorial Board of the KJA went to great lengths to make the review process credible. I hope my suggestion in this letter will assist the KJA in eradicating this problem in the future.

This article (Correspondence) is in response to the recently published article on the role of Pecto-intercostal Fascial Block for cardiac procedures by Zhang et al. in "BMC Anesthesiology". I greatly appreciate the authors for publishing this study in which Pecto-intercostal Fascial Block, a novel technique for providing pain relief in open cardiac surgical procedures was evaluated. I wish to present my reflections on this article as well as to add a few more points on this topic.

Although at present, many medications are accessible for PSA in the Emergency Departments. On the other hand, their adverse effects are still a considerable aspect in this regard. One of the recommendations to reduce the adverse effects of medications for PSA, is the use of drug combinations. According to available studies, the use of drug combinations, together with lowering the dose of drugs can compare with monotherapy and prevent the occurrence of adverse effects (Cevik et al., 2013). According to the recent studies ketamine, midazolam and fentanyl which are the most commonly used drugs for PSA, will be useful if they are used for sedation of patients in appropriate doses under necessary supervision and monitoring (Cevik et al., 2013). The objective of the current study was to compare the effectiveness and side effects of two pharmaceutical groups of lowdose midazolam-ketamine and fentanyl-midazolam used for PSA during the reduction of dislocations and fractures in the Emergency Department. Materials and Methods Study design This is a prospective double-blind randomized clinical