Anaesthesia, Pain & Intensive Care

Published- Integrating artificial intelligence (AI) in the identification of pain

Aleena Waheed — 2025-02-01

Pain is a crucial health concern that needs an accurate diagnosis, deeper understanding, treatment, and follow-up depending on the pain identification process.¹ Although determining the right therapy requires a thorough assessment of pain, the self-reported pain level assessment has several drawbacks.² As the pain is subjective and people’s experiences of pain may vary, it can be difficult sometimes to determine the underlying biopsychosocial components. This can lead to a lack of diagnosis of the exact cause of pain and its etiological factors.³ This editorial outlines the importance of integrating AI into pain identification to enhance the quality parameter of assessment in research and clinical practice.

Comparison of the efficacy of radiofrequency ablation at 60°C, 65°C and 70°C for managing trigeminal neuralgia

Trianggoro Budisulistyo — 2025-01-31

Introduction: The observed efficacy of radiofrequency ablation (RFA) in patients with trigeminal neuralgia (TN) ranged from 42.2% to 97.2% at 2 to 15 years' follow-up. The temperature used varied from 60°C to 95°C, with nonsignificant differences for durations of 2 min or more. Here we compare the analgesic efficacy of 60°C, 65°C and 70°C for a single 90-sec duration.

Methodology: The study was conducted in 100 patients (57 females, 43 males), at Dr Kariadi Hospital Semarang, using the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) in patients with trigeminal neuralgia. They were divided into control and three RFA groups, e.g., 60°C, 65°C, and 70°C. Carbamazepine 100-200 mg every 8-12 hours and vitamin B12 50 µg every 12 hours, were administered in the control group. While RFA was applied in three RFA groups by placing the electrode needle as close to the target branch(es) at prescribed temperatures for 90 sec duration. Follow-up was done pre-intervention, at 2 weeks, 3 months and 6 months.

Results: All one hundred patients included showed significant improvement in pain (P < 0.001). The RFA groups showed significant improvement compared to the control group (P < 0.05). Comparison by RFA 60°C group was not significant (P = 0.083) at 3- and 6-months follow-up, but it was significant in RFA 65°C group (P < 0.001). Comparison between RFA 60°C and RFA 65°C groups was not significant.

Conclusions: RFA 60°C has similar efficacy results to 65°C or 70°C in the treatment of trigeminal neuralgia patients and may cause less tissue damage. Needle placement to the nearest affected branch(es) was more important than temperature of RFA procedures.

Abbreviations: TN: trigeminal neuralgia, SCA: superior cerebellar artery, MVD: microvascular decompression, RTC: radiofrequency thermocoagulation, RFA: radiofrquency ablation, EMF: electromagnetic field, PRF: pulsed radiofrequency, NRS: numerical rating scale, GABA: gamma-aminobutyric acid

Keywords: trigeminal neuralgia; radiofrequency ablation: electrode placement: temperature: neuropathic pain; LANSS

Citation: Budisulistyo T, Husni A, Pudjonarko D. Comparison of the efficacy of radiofrequency ablation at 60°C, 65°C and 70°C for managing trigeminal neuralgia. Anaesth. pain intensive care 2025;29(1):03-08. DOI: 10.35975/apic.v29i1.2662

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Efficacy of hemoperfusion in COVID-19 patients with difficult weaning from mechanical ventilation

Shahnaz Fooladi-Sarabi — 2025-01-31

Background: Weaning of ventilated COVID-19 patients from ventilators has been a major problem in some of these patients. We performed hemoperfusion in a selective group of COVID-19 patients to facilitate weaning from the mechanical ventilation (MV).

Methodology: The present study was a retrospective case series of 30 consecutive COVID-19 patients, who showed difficulty with weaning off the ventilator. Hemoperfusion was performed by the HA330 disposable hemoperfusion cartridge (Jafron, China). Before and after hemoperfusion, changes in patients' hemodynamics, improvement in consciousness level, oxygen saturation, hypercapnia, initiating spontaneous breathing, and changes in lung involvement were assessed.

Results: The patients average age was 48.38 ± 15.04 years, with 17 (56.7%) females. The post-hemoperfusion values of SpO₂ (P < 0.001), mean arterial pressure (P = 0.003), positive end-expiratory pressure (P < 0.001), heart rate (P < 0.001), and ratio of arterial oxygen partial pressure to fractional inspired oxygen (P < 0.001) were significantly different compared to their pre-hemoperfusion values. The outcome of patients showed a significant relationship with age (P = 0.017) and spontaneous ventilation (P = 0.001).

Conclusions: The findings endorse the implementation of hemoperfusion for ICU-hospitalized COVID-19 patients experiencing difficulty in weaning from mechanical ventilation. Hemoperfusion demonstrated significant improvements in vital signs for the majority of patients and was associated with a successful weaning and survival rate of 63.3%. While these results are promising, further evidence is needed to consider hemoperfusion as an accepted clinical approach.

Detection of the role of biomarkers (IL-18 and ICM-1) in the progression of diabetic nephropathy in type 2 diabetic patients

Wisal RY Al-Hayali — 2025-02-03

Background: Diabetic kidney disease (DKD) is one of the most common complications in diabetic patients and is the leading cause of renal disease. It is also a significant risk factor for cardiovascular disease in these patients. The current study was conducted on patients with diabetes-related nephropathy in Saladin's governorate, Iraq. The study aims to assess the association between the levels of interleukin 18 (IL-18) and Intercellular Adhesion Molecule1(ICAM-1) in type 2 diabetic patients and their relation with the development of diabetic nephropathy.

Methods: The recent study focused on patients with diabetes-related nephropathy. We detected IL-18 and ICAM-1 biomarkers in 250 blood samples, distributed as follows: 127 samples from patients with stage II DKD patients, 123 samples from stage IV DKD patients, and 65 blood samples from healthy controls. The samples were grouped based on the estimated glomerular filtration rate (eGFR), calculated using the concentration of creatinine and blood urea nitrogen (BUN) in the blood with the Modification of Diet in Renal Disease (MDRD) eGFR (6 variables).

Results: The present study revealed that the concentration of IL-18 differed significantly (P ≤ 0.01) between grade IV diabetic kidney patients (3227 ± 205.7 ng/mL) compared to grade II patients (653.4 ± 52.9 ng/mL) and healthy controls (78.278 ± 5.89 ng/mL). Additionally, ICAM-1 levels were significantly higher (P ≤ 0.01) in stage IV patients (3552 ± 167.2 ng/mL) compared to stage II patients (910 ± 75.6 ng/mL) and healthy individuals (76.12 ± 11.3 ng/mL).

Conclusion: The current study suggests that IL-18 and ICAM-1 biomarkers may contribute to the development of diabetic nephropathy and potentially be used as early indicators of the disease progression.

Abbreviations: DKD: Diabetic kidney disease, DN: Diabetic nephropathy, eGFR: estimated glomerular filtration rate, ICAM-1: Intercellular Adhesion Molecule1, MDRD: Modification of Diet in Renal Disease,

Keywords: Interleukin-18, Intercellular adhesion molecule-1, eGFR, diabetic nephropathy.

Citation: Al-Hayali WRY, Atiyea QM. Detection of the role of biomarkers (IL-18 and ICM-1) in the progression of diabetic nephropathy in type 2 diabetic patients. Anaesth. pain intensive care 2025;29(1):14-20

DOI: 10.35975/apic.v29i1.2577

Received: October 15, 2024; Revised: December 02, 2024; Accepted: December 10, 2024

The atherogenic indices in people with type 2 diabetes mellitus as predicted by serum levels of SMAD4, ACS, and G-CSF

Yusra Sebri Abdulsaheb — 2025-02-03

Background & objectives: Atherogenic indices provide a broad picture of the risk of cardiovascular disease (CVD) in people with type 2 diabetes mellitus (T2DM). A broad range of factors influence atherogenic index values. Given the low-grade inflammatory characteristic of T2DM, we assessed three proteins in T2DM patients: 1-aminocyclopropane-1-carboxylate synthase (ACS), granulocyte-colony stimulating factor (G-CSF), and Mothers Against Decapentaplegic Homolog-4 (SMAD-4), and their association with the atherogenic indices.

Methodology: The current case-control research included sixty T2DM patients with no severe complications and thirty healthy controls. The chosen proteins were quantified using the ELISA technique, while the remaining biomarkers were measured using a spectrophotometer.

Results: T2DM patients exhibited significantly greater levels of ACS, G-CSF, and SMAD4 compared to control participants. After adjusting for all cofounders, serum ACS level may accurately predict a considerable portion of changes in the atherogenic index of plasma (AIP) and Castelli risk index (CRI)-I and II. AIP, CRI-II, and the atherogenic coefficient can all predict serum SMAD4 levels. Glucose levels may predict the amount of inflammatory cytokine (G-CSF), demonstrating that inflammation is dependent on hyperglycemia.

Conclusion. T2DM patients had dyslipidemia, high atherogenic indices, and greater levels of SMAD4, ACS, and G-CSF compared to controls. Once confounders are accounted for, serum ACS levels are proven to be a significant predictor of atherogenic indices. These findings contribute to our understanding of these proteins and their role in T2DM consequences including CVD.

Abbreviations: ACS - 1-aminocyclopropane-1-carboxylate synthase; AIP - atherogenic index of plasma; CRI - Castelli risk index; G-CSF - granulocyte-colony stimulating factor; SMAD-4 - Mothers Against Decapentaplegic Homolog-4

Keywords: Atherogenic Index; SMAD4; ACS; G-CSF; T2DM

Citation: Abdulsaheb YS, Abdalsada HK, Moustafa SR, Al-Hakeim HK. The atherogenic indices in people with type 2 diabetes mellitus are predicted by serum levels of SMAD4, ACS, and G-CSF. Anaesth. pain intensive care 2024;29(1):21−31; DOI: 10.35975/apic.v29i1.2659

Received: April 18, 2024; Reviewed: April 19, 2024; Accepted: April 20, 2024

Anesthesia ready time for emergency surgery at the 24-hour operating room of the central surgical installation in a tertiary hospital in Indonesia

Erwin Pradian — 2025-02-03

Background: Anesthesia Ready Time (ART) is the time required by an anesthesiologist, calculated from the time the monitor is placed on the patient until the patient is declared by the anesthesiologist to be ready for the surgery. ART varies based on the patient's ASA classification, equipment availability, preoperative invasive procedures, drug preparation, and waiting for the surgical team. The aim of this study was to determine the ART of patients undergoing emergency surgery and identify the affecting factors at a tertiary hospital in Indonesia.

Methodology: Samples were collected from patients consulted for emergency surgery at the 24-hour Central Operating Room of a tertiary hospital in Indonesia from August 2023 until February 2024, that included 116 patients. We used consecutive sampling and non-probability data collection methods.

Results: Overall, in 91.4% of cases, ART complied with the standards, with an average of 14.22 min. All regional spinal procedures met the standard, while general anesthesia procedures achieved the standard by 98.46%. The lowest ART rate was for regional epidural procedures, at 30.76%. Based on ASA status, only samples with ASA status 3 achieved a 100% compliance rate. While samples with ASA status 1 achieved 88%, and ASA status 2 achieved 89.7%. Several causes influenced prolonged ART in 8.6% of cases. Difficulty with the anesthesia procedure was the most common (60%), followed by waiting for the surgical team (30%), and monitor malfunction at 10%.

Conclusion: Anesthesia ready time in our tertiary hospital in Indonesia is satisfactory. Factors found to influence prolonged anesthesia ready time were mostly correctable ones.

Keywords: Anesthesia; Anesthesia Ready Time; ART; Emergency Surgery

Citation: Pradian E, Kestriani ND, Putra GA. Anesthesia ready time for emergency surgery at the 24-hour operating room of the central surgical installation in a tertiary hospital in Indonesia. Anaesth. pain intensive care 2025;29(1):32-39. DOI: 10.35975/apic.v29i1.2658

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Evaluation of midkine, cortisol, and other biochemical indicators in patients with atherosclerosis

Furqan Moein Auda — 2025-03-02

Background & objective: Atherosclerosis is a condition where fat deposits cause blood arteries to stiffen and become hard instead of flexible. Many factors cause arterial stiffness, including hyperlipidemia, hypertension, hyperglycemia. In the current study, we attempted to shed light on the effect of chronic high cortisol and its relationship to early predictive indicators of atherosclerosis.

Methodology: This was a case-control study which included 60 Patient and 30 control are participated in this study. Their ages ranged between 45-70 y, all patients diagnosed with vascular diseases by ultrasound and diagnostic catheterization. Samples were taken in the morning when they were fasting, and it taken from the Open-Heart Institute, Al-Sadr Teaching Hospital, Najaf, Iraq.

Results: The study showed that patients with atherosclerosis suffer from increase in the level of cortisol, in addition to a significant increase in the concentration of midkine, cholesterol, low-density lipoprotein and atherogenic index. On the other hand, the study revealed a notable drop in the amounts of high-density lipoprotein in patients compared to the control group. Finally, we can conclude from this study that patients with atherosclerosis may have cortisol resistance, although patients continue to take treatment, the levels of midkine, cholesterol, and low-density lipoprotein remain high in patients with atherosclerosis. On the other hand, cortisol is considered more sensitive than midkine for diagnosing atherosclerosis.

Conclusions: From this study it be can concluded that patients with atherosclerosis may have cortisol resistance, although patients continue to take treatment, the levels of midkine, cholesterol, and low-density lipoprotein remain high in patients with atherosclerosis. On the other hand, cortisol is considered more sensitive than midkine for diagnosing atherosclerosis.

Abbreviations: MDK - midkine; HDL - high density lipoprotein; LDL - low density lipoprotein; VSMC - vascular smooth muscle cells; NO - nitric oxide; TG - triglyceride; BMI - body mass index

Keywords: Atherosclerosis, cortisol resistance, midkine and atherogenic index.

Citation: Auda FM, Rehman A. Evaluation of midkine, cortisol, and other biochemical indicators in patients with atherosclerosis. Anaesth. pain intensive care 2025;29(1):40-46. DOI: 10.35975/apic.v28i6.2661

Received: June 03, 2024; Reviewed: June 16, 2024; Accepted: December 29, 2025

Understanding the perceptions and attitudes of Saudi women towards mammography

Pakeeza Shafiq — 2025-02-03

Objectives: Breast cancer (BC) is one of the leading cause of morbidity and mortality among women worldwide. Mammography remains the main screening tool for BC. However, despite its effectiveness, the percentage of women undergoing early mammography is very low; leading to more patients presenting at advanced stages of cancer. The objective of this study was to investigate the perceptions and attitudes of Saudi women towards mammography as a screening tool for BC.

Methodology: This cross-sectional study included 309 women residents of Arar City, above 18 years of age and was conducted in the College of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia, from August 1,2024 to September 30, 2024. All participants were asked to complete a pre-designed questionnaire. The questionnaire was thoroughly validated and reviewed by two consultants for content validity. The received back responses were then converted to Google Form and distributed online to the participants through WhatsApp. Data was analyzed using SPSS version 29.0, and a P-value of ≤ 0.05 was considered significant.

Results: The results indicated a significant relationship between Saudi women’s perceptions and attitudes towards mammography and their engagement with the procedure. The regression sum of squares was 54.757, with 8 degrees of freedom, yielding a mean square of 6.845. The F-value was 2174.447, which was highly significant, with P < 0.001.

Conclusion: This study highlights the significant role that Saudi women’s perceptions and attitudes towards mammography play in influencing their engagement with the procedure as a critical tool for BC screening.

Keywords: breast cancer, mammography, Saudi women, screening, perception, attitude

Citation: Shafiq P. Understanding the perceptions and attitudes of Saudi women towards mammography. Anaesth. pain intensive care 2025;29(1):47-53; DOI: 10.35975/apic.v29i1.2671

Received: December 22, 2024; Reviewed: December 24, 2024; Accepted:

Arthritis cannot break my spirit: functional disability, social support and life orientation in patients with rheumatoid arthritis

Hafiza Marriyam Zulfiqar — 2025-01-31

Background & objective: A chronic autoimmune disease that affects millions of humans worldwide is known as Rheumatoid arthritis. In addition to joint discomfort and swelling, this disorder can cause systemic symptoms and long-term joint damage, which can cause a harmful effect on the person's quality of life. So, this study aimed to assess the association between functional disability, social support, and life orientation in patients with rheumatoid arthritis.

Methodology: A research design with cross-sectional and purposive sampling techniques was used to collect data (N = 150) from patients with rheumatoid arthritis. The ‘Functional Status Questionnaire’, the ‘Multidimensional Scale of Perceived Social Support’, and the ‘Modified Life Overview Test’ were used for data collection.

Results: Results showed that functional disability was significantly negatively associated with social support and negatively with life orientation. Similarly, social support was found positively correlated with life orientation. Additionally, functional disability was found to be a significant negative predictor while social support was found a positive predictor of life orientation. Function disability was high in female patients.

Conclusion: It was concluded that rheumatoid arthritis affects a person badly. This study can be helpful for psychologists and mental health relievers to investigate the psychological problems linked with this problem and then manage them accordingly.

Keywords: Rheumatoid arthritis, functional disability, social support, life orientation

Citation: Zulfiqar HM, Iqbal MN, Javed F, Rafiq M, Zahid R. Arthritis cannot break my spirit: functional disability, social support and life orientation in patients with rheumatoid arthritis. Anaesth. pain intensive care 2024;29(1):54−60; DOI: 10.35975/apic.v29i1.2663

Received: August 01, 2024; Reviewed: September 8, 2024; Accepted: September 10, 2024

Impact of neuromuscular electrical stimulation (NMES) on duration of mechanical ventilation in ICU patients: A systematic review and meta-analysis

Rahmadius Eka Santoso — 2025-02-04

Background: Intensive care unit acquired weakness (ICUAW) is associated with prolonged mechanical ventilation (PMV), increasing risk and mortality in intensive care unit (ICU) patients. Early mobilization along with neuromuscular electrical stimulation (NMES), has shown potential in reducing mechanical ventilation duration, but remains inconclusive. This study evaluates the impact NMES on the mechanical ventilation duration in ICU patients.

Methodology: A systematic literature search was conducted using Cochrane, EBSCOhost, Scopus, and PubMed databases, employing specific keywords and Boolean operators. The inclusion criteria were randomized controlled trials (RCTs) assessing NMES and the duration of mechanical ventilation. The included studies were evaluated for bias using the Cochrane Risk of Bias tool 2.0 (RoB 2). The effect size was estimated using a random-effects model in Review Manager 5.4 software.

Results: A total of 320 patients from 9 RCTs were included in this meta-analysis. Pooled data indicated that NMES administration significantly reduced the duration of mechanical ventilation (MD -1.68 days; 95% CI: -3.09 to -0.27, P = 0.02), with moderate heterogeneity (I² = 30%).

Conclusion: NMES administration appears to reduce the mechanical ventilation duration in ICU patients. However, further large-scale RCTs and inclusion of grey literature are necessary to confirm these findings.

Abbreviations: ICU: Intensive care unit, ICUAW: Intensive care unit acquired weakness, NMES: neuromuscular electrical stimulation, RCT: randomized controlled trials

Keywords: Neuromuscular electrical stimulation; duration of mechanical ventilation; ventilator duration; ICU-acquired weakness; prolonged mechanical ventilation

Citation: Santoso RE, Madjid AS, Sedono R, Marcelia M. Impact of neuromuscular electrical stimulation (NMES) on duration of mechanical ventilation in ICU patients: A systematic review and meta-analysis. Anaesth. pain intensive care 2025;29(1):61-69. DOI: 10.35975/apic.v29i1.1887

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Comparison of Baska mask airway and i-gel for ease of insertion and hemodynamic stability in patients undergoing general anesthesia

Ankita Gupta — 2025-04-02

Background and Aim: The use of i-gel and Baska masks in patients receiving general anesthesia has been shown to cause predictable changes in hemodynamic parameters and ease of insertion, according to published research. Better sealing pressure has also been demonstrated when using Baska masks.

However, it is still need to assess whether these methods are preferable to i-gel in terms of insertion ease and hemodynamic stability. In order to assess the Baska mask and i-gel for hemodynamic stability and ease of insertion in patients receiving general anesthesia, this study was carried out.

Methodology: A total of 110 patients were examined for predetermined goals in this randomized prospective observational trial. Patients between the ages of 18 and 45 year, both male and female, were included. Strict inclusion and exclusion standards were adhered to, and each participant gave their informed consent. A questionnaire was filled with personal information of the patient, the diagnosis, the course of treatment, and any complications that were experienced.

The patients were allocated into two groups of fifty-five each. After routine general anesthesia, patients in Group B were ventilated using a Baska mask, while patients in Group I were ventilated using i-gel. Ease of insertion, number of attempts required and hemodynamic parameters including, systolic, diastolic and mean BP and pulse rates, were noted. Using SPSS software version 22, basic statistical analysis of the data generated, was performed.

Results: The results found no significant differences between Group B and Group I, regarding mean HR before onset, after onset at one min, at 3 min, and at 5 min. There was no significant difference between Group B and Group I, regarding mean systolic SBP at pre-insertion, post-insertion at one min, at 3 min, and at 5 min. However, the mean DBP between Group B and Group I at pre-insertion, at 3 min, and at 5 min were highly significant.

Conclusion: Given the limitations of the study, we conclude that, although the Baska mask required more time and attempts to insert than the i-gel, it was still one of the more innovative supraglottic airway devices that produced a better peri-laryngeal seal. Before and after insertion, there was no discernible difference in the hemodynamic parameter between the two groups.

Keywords: Baska Mask Airway, i-gel, Anesthesia, Hemodynamic Stability, Complications

Citation: Gupta A, Rastogi K, Khan AL, Pathak A, Shahid R. Comparison of Baska mask airway and i-gel for ease of insertion and hemodynamic stability in patients undergoing general anesthesia. Anaesth. pain intensive care 2025;29(1):70-76. DOI: 10.35975/apic.v29i1.2664

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Evaluation of new tumor marker CA 27-29 as a diagnostic biomarker for breast cancer in comparison to the standard CA 15-13

Samah Fadhil HadI — 2025-01-31

Background: Breast cancer diagnostics often employ tumor markers for disease diagnosis, monitoring, progression, and recurrence. CA 15-3 and CA 27-29 are two such markers used in the clinical management of breast cancer. The aims of this research to evaluate the efficacy of new CA 27-29 as a diagnostic biomarker for breast cancer and risk assessment capability in comparison with well-established CA 15-3.

Methodology: A case- control study, that included 70 Iraqi women diagnosed with breast ductal carcinoma and 67 age- matched healthy women as a control group. Peripheral blood samples were collected from all participants. Biochemical parameters were analyzed by using standard techniques.

Results: The findings revealed that CA 15-3 is the best reliable biomarker for breast cancer diagnosis, with an area under the curve (AUC) of 1.00 with cut-off value of 22.25. CA 15-3 demonstrated perfect sensitivity and specificity, establishing it as an ideal marker for detecting breast cancer. The odds ratios were 13.313 for CA 15-3 and 2.561 for CA 27-29.s

Conclusion: CA 15-3 stands out as an exceptionally reliable biomarker with perfect sensitivity, specificity, and a high odds ratio, making it a strong candidate for both diagnosis and risk assessment.

Key Words: Breast cancer, CA 27-29, CA 15-3, Tumor Markers.

Citation: Hadi SF, Ibraheem SAHA, Abbas JA. Evaluation of new tumor marker CA 27-29 as a diagnostic biomarker for breast cancer in comparison to the standard CA 15-13. Anaesth. pain intensive care 2025;29(1):77-84.

DOI: 10.35975/apic.v29i1.2666

Received: September 27, 2024; Reviewed: October 24, 2024; Accepted: January 01, 2025

A prospective, observational study of changes in endotracheal tube cuff pressure according to different patient positions in neurosurgery

Sena Saricaoglu Oktem — 2025-01-31

Objective: Underinflation of the cuff of endotracheal tube (ETT) used during general anesthesia can cause complications such as air leakage and aspiration during ventilation. At the same time, overinflation can lead to serious complications such as postoperative sore throat, tracheomalacia, and tracheal rupture. In this study, we aimed to evaluate the effect of different surgical positions, e.g., prone, supine, and semi-fowler positions, on ETT cuff pressure and the effect of cuff pressure changes on postoperative sore throat in neurosurgical operations.

Methodology: We included a total of 150 patients (50 patients each in two groups) undergoing neurosurgery in prone, supine, and semi-fowler positions in this prospective and observational study. After intubation, ETT cuff pressure was adjusted to 25 cmH₂O with a manometer (T0), and continuous monitoring was provided by connecting to the transducer via a three-way tap. We recorded the cuff pressure immediately after positioning the patient (T1), before correcting the position (T18), and after correcting the position (T19). We evaluated patients for sore throat using the Visual Analog Scale (VAS) after extubation and at the 1st, 12th, and 24th postoperative hours.

Results: After positioning, cuff pressure increased only in the pronated group, whereas it decreased in the other groups. The difference between the prone and semi-fowler groups was statistically significant (P = 0.042). During the follow-up period, it was determined that the cuff pressure decreased over time in the prone and semi-fowler groups and increased from time to time in the supine group, but the cuff pressures before extubation in all three groups were significantly lower than the initial values (P < 0.001). The supine group had the highest sore throat VAS score at the 24th postoperative hour, and this difference was statistically significant (P = 0.017).

Conclusion: To ensure patient safety, we recommend making continuous cuff pressure monitoring a routine practice, given that ETT cuff pressure may vary depending on the patient position.

Keywords: Position, Prone, Supine, Semi-Fowler, Endotracheal Cuff Pressure, Sore Throat

Citation: Oktem SS, Sahap M, But A. A prospective, observational study of changes in endotracheal tube cuff pressure according to different patient positions in neurosurgery. Anaesth. pain intensive care 025;29(1):85-90.

DOI: 10.35975/apic.v29i1.2667

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Preoperative oral carbohydrate loading versus fasting in patients undergoing major abdominal surgery: a randomized controlled study

Eman Mohammed Taher Salem Abo-Omar — 2025-02-04

Objectives: Insulin resistance and the stress hormones released by surgery accompany a catabolic response. We intended to validate the impact of preoperative carbohydrate (CHO) loading on the metabolic and inflammatory subsequence of elective major abdominal surgery.

Methodology: This prospective randomized trial was carried out on 54 participants scheduled for elective major abdominal surgery. Patients were randomly assigned to two equal groups: the FAST group followed typical fasting protocols. and received a placebo drink (200 mL of clear water) two hours before the procedure, while the CHO group received a CHO drink at least two hours before the anesthesia induction.

Results: The major outcomes were a statistically significant decrease in muscle mass measured 5 days postoperatively in the FAST group compared to the CHO group, HOMA- IR, and GPS that increased significantly in the FAST group postoperatively compared to the baseline preoperatively. There was a decreased time to independent ambulation and duration of hospitalization in the CHO group than in the FAST group.

Conclusions: Preoperative oral carbohydrate loading significantly mitigates postoperative insulin resistance, maintains better muscle mass, and improves subjective well-being in cases experiencing major abdominal surgery compared to traditional fasting.

Keywords: Oral Carbohydrate Loading, Fasting, Major Abdominal Surgery, Glasgow Prognostic Score, Bioelectrical Impedance Analysis

Citation: Abo-Omar EMTS, Abo-Elnasr LM, Soliman SM, Taysser Mahmoud Ahmad Abdalraheem TMA, Mohamed Yousef NK, Preoperative oral carbohydrate loading versus fasting in patients undergoing major abdominal surgery: a randomized controlled study. Anaesth. pain intensive care 2025;29(1):91-98.

DOI: 10.35975/apic.v29i1.2668

Received: October 16, 2024; Reviewed: October 28, 2024; Accepted: October 30, 2024

Intravenous dexmedetomidine versus intravenous lidocaine in attenuating airway reflexes during recovery of thyroidectomy patients

Ola Nasser Hussain Zaher — 2025-04-02

Background: Cardiac and other airway reflexes are linked to intubation and extubation processes. These hemodynamic and respiratory responses during extubation have previously been attenuated with the use of intratracheal instillation and intravenous administration of lidocaine. In surgical intensive care units, dexmedetomidine, a strong α2 receptor agonist, considered to make extubation easier. However, its effect on reducing cardiopulmonary reflexes during extubation process under general anesthesia is currently being investigated.

Objective: To evaluate the capability of IV lidocaine or Dexmedetomidine to suppress the coughing reflex during extubation process following thyroid surgery.

Methods: This clinical trial was carried out in the operating rooms of Ain shams university hospitals. It included 140 participants, with 70 patients in each group. NCT05657028 is the clinicaltrials.gov registration number for this trial.

Results: Showed no statistically significant difference in hemodynamics in both groups regarding MAP and SpO₂. While intraoperative bradycardia has been recorded with the dexmedetomidine group in comparison with lidocaine group, also there was a decrease in the incidence of postoperative cough in dexmedetomidine group in comparison with lidocaine group and no statistically significant difference regarding the pain postoperatively.

Conclusion: Following thyroid surgery, dexmedetomidine was more effective in reducing the cough reflex during the tracheal extubation period. Both intravenous lidocaine and dexmedetomidine achieved acceptable analgesic effect. In terms of hemodynamics, intravenous infusions of dexmedetomidine caused bradycardia,

Keywords: Dexmedetomidine; Lidocaine; Thyroidectomy; cough reflex; Intravenous injection.

Citation: Zaher ONH, Kotb MM, AbdelHamid HM, Abdelaziz MM, AbdelHafiez RH. Intravenous dexmedetomidine versus intravenous lidocaine in attenuating airway reflexes during recovery of thyroidectomy patients. Anaesth. pain intensive care 2025;29(1):99-104. DOI: 10.35975/apic.v29i1.2669

Received: November 12, 2024; Reviewed: December 20, 2024; Accepted: December 29, 2024

Effect of injection speed of hyperbaric bupivacaine 0.5% in spinal anesthesia on block quality and hemodynamic changes in elective cesarean sections

Naveena P — 2025-02-04

Background: Spinal anesthesia (SA) with hyperbaric bupivacaine 0.5% is a standard technique for lower segment cesarean sections (LSCS). However, the impact of injection speed on block quality, hemodynamic stability, and recovery remains unclear. This study compared the effects of slow versus fast injection speeds of hyperbaric bupivacaine on anesthetic outcomes.

Methods: In this prospective, randomized study, 60 ASA PS-II patients, aged 25–35 years, were randomly allocated into two groups: Group A (n = 30) received injection over 25 sec, and Group B (n=30) received injection of hyperbaric bupivacaine over 50 sec. Key outcomes included sensory block onset, maximum block level, hemodynamic trends, recovery parameters, analgesia requirements, and adverse events.

Results: Baseline characteristics were similar between two groups. Time to achieve T10 dermatome (Group A: 3.22 ± 0.85 min; Group B: 3.54 ± 0.92 min) and maximum sensory block level (Group A: T6 ± 1.2; Group B: T7 ± 1.4) showed no significant differences. Hemodynamic stability was comparable, with similar hypotension rates (Group A: 10; Group B: 12). Recovery metrics, including sensory block regression (Group A: 15.2 ± 2.1 min; Group B: 16.0 ± 2.3 min) and full recovery time (Group A: 45.7 ± 6.3 min; Group B: 47.1 ± 6.5 min), were slightly faster in Group A but not statistically significant. Rescue analgesia and adverse events were equivalent in the groups.

Conclusion: Slow and fast injection speeds of hyperbaric bupivacaine 0.5% for LSCS demonstrated equivalent efficacy in block quality, hemodynamic stability, recovery, and safety. These findings support flexibility in injection speed based on clinical context and operator preference.

Keywords: Spinal anesthesia; hyperbaric bupivacaine; cesarean section; injection speed; sensory blockade; motor blockade; hemodynamic stability; postoperative pain management; adverse events; maternal safety; neuraxial anesthesia; recovery metrics; obstetric anesthesia

Citation: Naveena P, Naveenkumar P, Kumar B. A, Shanmugasundaram S. Choudhary AK, Panneerselvam Periasamy P. Effect of injection speed of hyperbaric bupivacaine 0.5% in spinal anesthesia on block quality and hemodynamic changes in elective cesarean sections. Anaesth. pain intensive care 2025;29(1):105-111. DOI: 10.35975/apic.v29i1.2670

Received: December 12, 2024; Reviewed: December 26, 2024; Accepted: January 01, 2025

Unilateral spinal anesthesia with fractionated low-dose hyperbaric ropivacaine and fentanyl can enhance hemodynamic control in high-risk lower limb surgeries: a case series

Pravallika Rallapalli — 2025-02-04

Patients with compromised cardiopulmonary function and multiple comorbidities undergoing spinal anesthesia with conventional bolus dose face significant risks of hemodynamic instability due to sympathetic blockade. In such cases, the necessity of administering vasopressors and large volumes of intravenous fluids often leads to poor postoperative outcomes. However, unilateral spinal anesthesia utilizing fractionated low doses of cardio stable ropivacaine in its hyperbaric form when supplemented with fentanyl has demonstrated remarkable hemodynamic stability. We present five cases of high-risk patients who successfully underwent lower limb surgeries with this approach and with stable perioperative hemodynamics.

Keywords: Fractionated Spinal Anesthesia; Low Dose Hyperbaric Ropivacaine; Unilateral Spinal Anesthesia

Citation: Rallapalli P, Gollamudi U. Unilateral spinal anesthesia with fractionated low-dose hyperbaric ropivacaine and fentanyl can enhance hemodynamic control in high-risk lower limb surgeries: a case series. Anaesth. pain intensive care 2025;29(1):112-118. DOI: 10.35975/apic.v29i1.2655

Received: September 24, 2024; Reviewed: December 26, 2024; Accepted: December 27, 2024

Pitfalls due to improper positioning of Impella®CP device for left ventricular support: a case series

Ahmed Abdalwahab — 2025-02-04

Background: The Impella® device is a type of antegrade left ventricular assist device that includes a pump catheter designed to reside in the mid-left ventricular cavity. It has received approval for temporary use in providing left ventricular support, with the aim of augmenting cardiac output and reducing myocardial oxygen demand. We document four cases in which we encountered challenges in circulatory management during Impella device insertion. These challenges arose from issues such as incorrect positioning leading to restricted maximum flow rate or the development of new-onset aortic insufficiency (AI) associated with the placement of the device.

Cases presentation: Two of our four patients showed improper positioning; either the inlet part was too much in the ventricle or too close to the heart wall. Due to the placement of the Impella, all four patients experienced the development of new-onset aortic insufficiency with a relatively low total assisted flow rate. In one of the cases, sufficient total flow was achieved when the Impella device was utilized alongside veno-arterial extracorporeal membrane oxygenation (ECMO).

Conclusion: Circulatory management with Impella device insertion can be challenging due to certain pitfalls, such as the incorrect positioning of Impella and the development of AI following Impella placement with a restricted flow rate. During the acute phase when patients experience deteriorating cardiogenic shock, the use of ECMO for management is considered to be an effective approach.

Abbreviations: ECMO: Extra-corporeal membranous oxygenation; PCPS: Percutaneous cardiopulmonary support; LVAD: Left ventricular assist device; LVEF: Left ventricular ejection fraction; CCO: Continuous cardiac output; AI: Aortic insufficiency.

Keywords: Aortic Insufficiency; ECMO; Cardiogenic Shock; Impella; Ventricular Assist Device

Citation: Abdalwahab A, Ismail AA, Hammad YM. Pitfalls due to improper positioning of Impella®CP device for left ventricular support: a case series. Anaesth. pain intensive care 2024;28(5):119-123.

DOI: 10.35975/apic.v29i1.2656

Received: November 24, 2024; Reviewed: December 30, 2024; Accepted: December 30, 2024

Topiramate induced angle-closure glaucoma in a healthy female: a case report

Akhtar Purvez — 2025-02-04

Topiramate-induced angle-closure glaucoma (ACG) is rare. This case report details an instance of secondary ACG in a young, relatively healthy female following the administration of topiramate for migraine prophylaxis. Topiramate, an antiepileptic drug, is approved in the United States for the management of seizures, prevention of migraine headaches, and in combination with phentermine, for chronic weight management therapy in adults. Clinical suspicion for topiramate-induced ACG should be high in patients presenting with the appearance of its signs and symptoms within several weeks of therapy initiation. Acute ACG is an ophthalmic emergency that can result in irreversible blindness if not promptly identified, and appropriately treated. The treatment consists of immediate discontinuation of the medication and administration of cycloplegic agents, intra-ocular pressure lowering agents, and topical and oral steroids. Prescribing physicians should identify any risk factors for the condition in patient history and weigh the benefits and risks of initiating the medication. Patients should be made aware of the possible side effects associated with the drug to make informed decisions.

Abbreviations: ACG: angle-closure glaucoma, AE: adverse event, IOP: intraocular pressure, GABA: gamma- aminobutyric acid,

Keywords: Glaucoma; Intra-Ocular Pressure; Migraine; Ophthalmic Emergency; Topiramate

Citation: Purvez A, Tran BN, Bashir M, Lawrence SD. Topiramate induced angle-closure glaucoma in a healthy female: a case report. Anaesth. pain intensive care 2025;29(1):124-126. DOI: 10.35975/apic.v29i1.2651

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Transforming pain relief: intercostal nerve blocks for intractable pain due to metastatic cancer of the ribs

Christian Reza Wibowo — 2025-04-02

Pain is a prevalent symptom in advanced cancer, with 66.4% of patients experiencing moderate to severe pain. Effective management is challenging, as up to 80% of the patients report severe pain, making optimal quality of life a critical goal.

A 23-year-old woman, with rectal cancer, suffered intractable left chest pain due to rib metastasis, worsening over a year. Despite treatment with fentanyl with patient-controlled analgesia (PCA) and oral morphine, the patient experienced intractable cancer pain, requiring 53 attempts at fentanyl PCA administration, with a total of 1 g used within 24 hours during the most severe episodes, when her pain score reached 9-10. An ultrasound-guided intercostal nerve block was performed at levels 7 and 10, using 20 mg triamcinolone and 10 mL of 0.75% ropivacaine. Post-procedure, the patient reported localized pain at the injection site, but experienced a significant reduction in sharp chest pain. This intervention resulted in an 80% decrease in her background opioid usage and reduced the frequency of as-needed doses. This case underscores the effectiveness of interventional pain management techniques, such as nerve blocks, as alternatives or adjunct treatment, when conventional medications fail. The combination of local anesthetics for immediate relief and steroids for long-term benefits, can effectively minimize opioid dependence and side effects.

Abbreviations: ICNB: intercostal nerve block, NRS: Numeric Rating Scale, PCA: patient-controlled analgesia,

Keywords: Cancer Pain; Chronic Pain; Patient-Controlled Analgesia; Intercostal Nerve Block; Interventional Pain

Citation: Wibowo CR, Putri HS, Susila D. Transforming pain relief: intercostal nerve blocks for intractable pain due to metastatic cancer of the ribs. Anaesth. pain intensive care 2024;28(5):127-131. DOI:10.35975/apic.v29i1.2652

Received: November 01, 2024; Reviewed: December 20, 2024; Accepted: December 23, 2024

Airway burn during tracheostomy in the operating room: a case report

Shahana Rahat — 2025-01-31

Fire in operating rooms (ORs) has been a topic of interest for the past many years. Staff persons dealing daily life scenarios in ORs should anticipate and firefighting and rescue gear must be made available. In case of fire during any procedure specially during ENT surgery, maxillofacial surgeries, or whenever the use of diathermy and laser is used in close proximity to airway. We report a case of a 54 yrs old female, who caught airway fire in OR due to the use of unipolar diathermy. She was planned for tracheostomy as prolonged ventilation was expected in that patient. Airway fire algorithm was followed with low FiO₂ as much as patient tolerated, affected area was flushed with normal saline and soaked gauzes were placed. The airway fire was successfully controlled. OR airway fire can be managed with proper planning, baseline knowledge, skills, fire protocols, algorithms awareness and rapid response team work.

Keywords: Airway Fire; Tracheostomy; Diathermy; Laser; Burnt Cuff; ETT

Citation: Rahat S, Ishaq M, Ghafoor AUR, Ahmed I, Ayzed A. Airway burn during tracheostomy in the operating room: a case report. Anaesth. pain intensive care 2025;29(1):132-134. DOI: 10.35975/apic.v29i1.2654

Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Anesthesiologists’ perspective on tracheostomy-assisted bronchoscopy for removal of a migrating foreign body in the airway: a case report

Christian Reza Wibowo — 2025-04-02

Bronchoscopy for foreign body extraction in pediatric patients rarely requires tracheostomy, with only 1.2% of cases necessitating it. In our case, an emergency tracheostomy had to be performed due to laryngeal edema resulting from prolonged bronchoscopy and laryngoscopy attempts.

A 7-year-old boy presented with shortness of breath after inhaling a plastic pen cap 14 days earlier. Physical examination showed left chest retraction, diminished breath sounds, and dullness on percussion, while a chest X-ray indicated atelectasis without visualizing the foreign body. The cap migrated from the left bronchus to the right, compromising both lungs: the left lung was already atelectatic from prior obstruction, while the right lung became obstructed due to the migration. Urgent extraction via rigid bronchoscopy was complicated by laryngeal edema and desaturation episodes. After tracheostomy and direct bronchoscopy through the stoma, the pen cap was successfully removed. The patient received ventilator support and aggressive physiotherapy, eventually weaning off ventilation by day five without complications. Anesthesia strategy was critical; a non-apneic sleep technique was used to maintain spontaneous ventilation but could lead to discomfort and airway complications. Effective communication and quick decision-making were essential for successful team management.

Keywords: Pediatric Anesthesia; Foreign Body; Bronchoscopy; Tracheostomy; Laryngeal Edema; Difficult Airway

Citation: Wibowo CR, Salinding A. Anesthesiologists’ perspective on tracheostomy-assisted bronchoscopy for removal of a migrating foreign body in the airway: a case report. Anaesth. pain intensive care 2025;29(1):135-138. DOI: 10.35975/apic.v29i1.2653

Received: November 04, 2024; Reviewed: December 19, 2024; Accepted: December 19, 2024

Comparison of analgesic properties of propolis with sodium hypochlorite as an endodontic irrigant: a randomized controlled trial

Tayyaba Tahira — 2025-02-12

Background: Despite the growing interest in Propolis as an endodontic irrigant, limited research has compared its clinical efficacy and post-operative outcomes with Sodium Hypochlorite (NaOCl), especially concerning post-operative pain. The aim of this study was to evaluate and compare the analgesic properties of 5.25% NaOCl and 20% Propolis, during the initial phase of multi visit endodontic treatment in patients with symptomatic irreversible pulpitis (SIP).

Methodology: A double blind randomized controlled trial was conducted on 44 teeth of patients presenting with SIP in premolars. The patients were allocated to two groups receiving different endodontic irrigants, Group A: NaOCl, and Group B: Propolis solution. These were used in equal volumes during the chemo-mechanical process, on the first visit of treatment. The pain scores were recorded using the visual analog pain scale, preoperatively and postoperatively at 24, 48 and 72 hours. The number of postoperative rescue medicine used by patients was recorded. Data were analyzed using Chi-square test, two-sample t-tests, and two-way repeated measures ANOVA, with Bonferroni post hoc analysis.

Results: The results revealed a significant decrease in postoperative pain over time across both the groups (p = 0.000). Group A and B exhibited a comparable reduction in pain scores from baseline to post-intervention (P = 0.139). Group B required significantly less rescue analgesia within the first 24 hours (P = 0.014).

Conclusions: Propolis and NaOCl are equally effective endodontic irrigants in reducing pain intensity after endodontic treatment of premolars with SIP. Propolis has better pain control during the initial postoperative period.

Trial registration: Retrospectively registered at ClinicalTrials.gov (NCT05974748).

Abbreviations: NaOCl: Sodium Hypochlorite, SIP: symptomatic irreversible pulpitis, VAS: visual analog scale

Keywords: analogue pain scale, sodium hypochlorite, propolis, pulpitis, root canal irrigant.

Citation: Tahira T, Rao AZ, Naz F, Hasan A, Mubashir M, Rao ZA. Comparison of analgesic properties of propolis with sodium hypochlorite as an endodontic irrigant: a randomized controlled trial. Anaesth. pain intensive care 2025;29(1):139-147.

DOI: 10.35975/apic.v29i1.2665

Received: September 11, 2024; Reviewed: November 08, 2024; Accepted: December 15, 2024

Anesthesia for Jervell and Lange Nielsen syndrome (JLNS)

Bilge Tuncer — 2025-02-04

Keywords: Implantable Cardioverter-Defibrillator; Long QT Syndrome; Jervell and Lange Nielsen Syndrome; Sudden Cardiac death; Syncopy

Citation: Tuncer B, Kadioğlu ZS, Erkiliç E. Anesthesia for Jervell and Lange Nielsen syndrome (JLNS) (Correspondence). Anaesth. pain intensive care 2024;28(2):148−149; DOI: 10.35975/apic.v28i2.2677

Received: December 19, 2023; Accepted: February 20, 2024

Dr Jorge Antonio Aldrete (1937-2025)

Carlos R. Degrandi Oliveira — 2025-02-12

Dr Jorge Antonio Aldrete was the creator of the famous scale that doctors and nurses use in all hospitals to assess the condition of patients after anesthesia. He was born in Mexico City in 1937 and graduated from the National University of Mexico School of Medicine in 1960. He completed a surgical training internship but felt drawn to Anesthesiology. Dr Aldrete began his training in anesthesia in 1963 at Case Western University in Cleveland, Ohio, USA, under the supervision of Dr Robert Hingson. In 1965, he moved to Denver to start a fellowship in anesthesia at the University of Colorado School of Medicine under the guidance of Dr Robert W. Virtue.