Anaesthesia, Pain & Intensive Care

Why we need pain psychologists / pain psychiatrists as integral part of every pain clinic?

Muhammad Arslan Zahid, Huma Nasir, Muhammad Saleh, Shafique Ahmed — Fri, 20 Dec 2024 03:58:33 -0700

The term ‘chronic pain’ itself is often multifaceted, and for many patients with this condition it exacts a toll on physical and psychological well-being. Yet most conventional pain management methods do not take into account the massive role mental health plays in pain sensation and healing. The current paper promotes for a specially trained pain psychologist and psychiatrist role in the pain clinic, concentrating mainly on emotional, cognitive and behavioral part of the composite psychological-biological-environmental model controlling chronic pain. Treatment with pharmaceuticals has a high cost to both the patient and the healthcare system. While psychological interventions (cognitive behavioral therapy [CBT], mindfulness) have shown better outcomes in coping skills, stress reduction and in improving the quality of life. Pain psychiatrists overall are responsible for treating the mental health comorbidities, such as depression and anxiety which tend to worsen with chronic pain. In addition, they address the common problems of opioid dependence and substance abuse in chronic pain patients. Although such integration has numerous advantages, there are several hurdles that must be overcome, including the compartmentalization of healthcare, stigma and lack of access to mental health experts. Parity in participation was seen as key to the future of pain management, which will continue to evolve and be delivered by multidisciplinary teams using novel digital health tools that support holistic patient-centered care.

Keywords: Chronic pain; pain psychiatrists; pain psychologists; mindfulness; opioid dependency; mental health; cognitive behavioral therapy; multidisciplinary teams; interdisciplinary pain management.

Citation: Zahid MA, Nasir H, Saleh M, Ahmed S. Why we need pain psychologists / pain psychiatrists as integral part of every pain clinic? Anaesth. pain & intensive care 2024;28(6):977-981;

DOI: 10.35975/apic.v28i6.2614

Received: Sep 19, 2024; Reviewed: September 20, 2024; Accepted: October 09, 2024

Perioperative supplementation with immunonutrition and its impact on surgical outcome and pain in oral cavity or mandibular tumor resection; A randomized controlled study

Thu, 19 Dec 2024 00:00:00 -0700

Objectives: The current research investigated the impact of adding immunonutrition mixture before surgery to the standard feeding regimen for patients undergoing oral cavity or mandibular tumor resections.

Methodology: This randomized double-blind controlled trial comprised 176 cancer patients undergoing resection of oral cavity or mandibular tumors. Participants were evenly divided into two groups: Group I (Immunonutrition group) got perioperative supplementation with omega-3 taken orally and L-Alanyl-L-Glutamine (Dipeptiven) administered via intravenous infusion, in addition to the standard feeding. Group C (Control group) received only standard feeding, which included a caloric distribution of protein 10-35%, fats 20-35%, and carbohydrates 45-65%. Both groups were followed for the primary outcome, set as wound infection and duration of hospital stays. The secondary outcome, included total dose of intraoperative opioids, postoperative VAS at 0 h ,4 h, 8 h and 12 h, intraoperative hemodynamics and any postoperative complications e.g., fever, neutropenia and pneumonia.

Results: A significant difference in postoperative complications in both groups was observed; wound infection was (1.14% vs. 7.95%) for Groups I and C respectively (P = 0.03). Group I was significantly lower in fever and neutropenia vs Group C (P < 0.01). No significant difference in hospital stay, intraoperative opioid consumption, Postoperative VAS score at 0 h ,4 h, 8 h and 12 h and intraoperative HR, MAP, SBP, DBP in both groups.

Conclusion: Immunonutrition has a substantial effect in lowering the rate of postoperative complications. However, it does not affect decreasing postoperative pain or length of hospital stay.

Keywords: Perioperative Supplementation; Immunonutrition, Outcome; Pain; Oral Cavity Tumors; Mandibular Tumors

Citation: Kotb TA, El Baradie SY, Abdelwahab M, Abed SM, Saeed S, Zedan MH, Thabet T. Perioperative supplementation with immunonutrition and its impact on surgical outcome and pain in oral cavity or mandibular tumor resection; a randomized controlled study. Anaesth. pain intensive care 2024;28(6):982-989; DOI: 10.35975/apic.v28i6.2602

Received: May 23, 2024; Revised: October 14, 2024; Accepted: October 26, 2024

Conventional versus diluted spinal anesthesia for lower limb tumescent liposuction: a randomized clinical trial

Fri, 20 Dec 2024 00:00:00 -0700

Background & Objectives: Liposuction is being increasingly done as a daycare procedure under spinal anesthesia. The aim of daycare surgery is to have fast recovery of psychomotor and cognitive functions, that allow early discharge of the patients. This study was done to compare conventional versus diluted spinal anesthesia in lower limb liposuction procedures in terms of time to discharge, patient satisfaction and redo rate.

Methodology: We recruited 108 female patients, and randomly allocated them into either a conventional spinal group (Group CS), that received 15 mg of bupivacaine or a diluted spinal group (Group DS) that received a diluted 7.5 mg bupivacaine. All patients underwent tumescent liposuction. The primary outcome was to assess time to home readiness and secondary outcome was patient satisfaction, the incidence of complications and the redo rate. Data were analyzed by analysis of variance test, Student’s t‑test, Whitney U test and Chi‑square tests. P < 0.05 was taken as statistically significant.

Results: The Group DS was found to have a significantly less duration of hospital stay (216.89 ± 34.99 min) as compared to Group CS (302.23 ± 22.35 min) (P < 0.001). Patients in DS group were found to have a significantly high satisfaction score as compared to Group CS (P < 0.001). Overall Incidence of complications was found to be less in Group DS as compared to Group CS (P < 0.001).

Conclusion: The use of a diluted, lower dosage of bupivacaine intrathecally provides early discharge with satisfactory anesthesia in lower limb liposuction procedures. The complication and redo rates were also significantly less with the use of diluted bupivacaine for spinal anesthesia.

Keywords: Lower limb liposuction; Bupivacaine; Discharge time; Patient satisfaction; Complications

Citation: Abdelmoaty Elfeky HA, Bahgat N, Abdelsalam Elmilegy AA, Habeeb RM. Conventional versus diluted spinal anesthesia for lower limb tumescent liposuction: a randomized clinical trial. Anaesth. pain intensive care 2024;28(6):990-995; DOI: 10.35975/apic.v28i6.2616

Received: April 13, 2024; Revised: February 21, 2024; Accepted: July 05, 2024

A comparative study between ultrasound guided thoracic paravertebral block vs ultrasound guided serratus anterior muscle block in video-assisted thoracoscopic surgeries

Mon, 23 Dec 2024 04:20:21 -0700

Background & Objective: Video-assisted thoracoscopic (VATS) procedures, are becoming increasingly popular. It is recommended to utilize loco-regional analgesia for reducing post-surgical pain because it encourages early postoperative recovery and provides opioid sparing. Various regional analgesic methods, such as paravertebral, intercostal, and serratus plane blocks, may be utilized to alleviate pain after thoracic surgery. This study compares serratus anterior muscle blocks (SAPB) and thoracic paravertebral blocks (TPVB) in providing postoperative pain alleviation following VATS using ultrasound.

Methodology: In this randomized prospective comparative trial, 80 patients scheduled for VATS were allocated at random to one of two equal groups; group A received USG- TPVB, and group B received USG-guided SAPB. The postoperative VAS score, time of rescue analgesia, and postoperative nalbuphine consumption were documented throughout a 24-hour period. We also documented the onset of ambulation and any nerve block consequences.

Results: VAS was considerably lower in the TPVB group at 12 and 24 h compared to SABP with P value (< 0.001 & 0.029) respectively; also, patients in the TPVB group took longer to request rescue analgesia (10.77 ± 2.28) vs (6.12 ± 1.43) in SABP group with P < 0.001. Also, TPVB group consumed fewer nalbuphine doses (5.56 ± 1.56) than patients in the SAPB group (9.5 ± 3.49) with P < 0.001.

Conclusion: When compared to SAPB block, TBVP block was more successful in lowering postoperative pain scores and lowering the overall 24-h postoperative opioid intake following VATS procedures performed under general anesthesia.

Keywords: Serratus anterior muscle block; thoracic paravertebral blocks; Pain control; Video-assisted thoracoscopic procedures; VATS

Citation: Hussien RM, Afifi GAS, Elshantory SFE, Mohie AGM, Salem MMH. A comparative study between ultrasound guided thoracic paravertebral block vs ultrasound guided serratus anterior muscle block in video-assisted thoracoscopic surgeries. Anaesth. pain intensive care 2024;28(6):996-1003; DOI: 10.35975/apic.v28i6.2489

Received: June 11, 2024; Revised: August 29, 2024; Accepted: September 28, 2024

Correlation between tracheostomy timing and length of stay in critically ill patients

Septian Adi Permana, Alya Amelia, Bara Adithya — Fri, 20 Dec 2024 03:50:51 -0700

Background & objective: Tracheostomy is the most frequently performed operative procedure in the Intensive Care Unit (ICU). The most common indication for a tracheostomy is the need of prolonged mechanical ventilation (PMV). The benefits of tracheostomy over an endotracheal tube include the safer, more comfortable breathing support, better oral hygiene, less need for sedation, and faster weaning of mechanical ventilation. The most appropriate and optimal time to perform a tracheostomy procedure is still controversial. Therefore, we wanted to describe the relationship between tracheostomy timing and length of stay (LOS) in the ICU of Dr. Moewardi Hospital during 2019 - 2020.

Methodology: This study was an observational, analytical retrospective cohort study. We used consecutive sampling technique from 79 patients, based on inclusion and exclusion criteria. Tracheostomy timings were assigned into two groups; early tracheostomy (during first 8 days) and late tracheostomy groups (after 8 days) . To analyze the relationship between tracheostomy timing and LOS, chi-square test was performed.

Results: Of the 79 subjects, 52 samples were in early tracheostomy and 27 in late tracheostomy group. Chi-square test revealed a significant correlation between tracheostomy timing and length of stay (P = 0.000). Also, age, sex, did not correlate with LOS (P > 0.05). The only factor related to LOS significantly was severity with APACHE II score and initial indication of tracheostomy (P = 0.000). After making gradual adjustments to other variables that affect LOS, tracheostomy timing and APACHE II score, only tracheostomy timing had a significance value of 0.000 in the second stage of the multivariate analysis.

Conclusion: In conclusion, tracheostomy timing was significantly associated with LOS. Early tracheostomy significantly shortens length of hospitalization.

Keywords: Early Tracheostomy; Length of Stay; Intensive Care Unit.

Citation: Permana SA, Amelia A, Adithya B. Correlation between tracheostomy timing and length of stay in critically ill patients. Anaesth. pain intensive care 2024;28(6): 1004-1009; DOI: 10.35975/apic.v28i6.2620

Received: December 21, 2021; Reviewed: February 11, 2023; Accepted: February 12, 2023

Comparison of the effects of normal and cesarean delivery methods and general and spinal anesthesia techniques on the inflammatory response

Egemen Ümit Hazar, Hatice Betül Altınışık — Fri, 20 Dec 2024 00:00:00 -0700

Background: Childbirth induces an inflammatory response that varies with the delivery mode and anesthesia type. This study investigates how normal delivery (ND) versus cesarean section (CS) under spinal anesthesia (SA) or general anesthesia (GA) affects inflammatory markers, including mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Methods: This retrospective study included patients who underwent ND or CS at a tertiary care hospital in Turkey between 2013 and 2017. Patients with significant illnesses were excluded. Patients were categorized into three groups: CS-SA, CS-GA, and ND. Blood samples were taken preoperatively and 24 h postpartum to measure MPV, NLR, and PLR.

Results: The mean age was 27.8 ± 3.8 years. Hemoglobin and platelet counts decreased significantly in all groups, while NLR increased. PLR increased in the CS-SA and CS-GA groups but not in the ND group. MPV decreased significantly only in the CS-SA group. Postoperative NLR, PLR, and MPV showed significant differences between the groups, with the highest response in the CS-GA group.

Conclusion: Cesarean section under general anesthesia is associated with a higher inflammatory response compared to spinal anesthesia or normal delivery. Normal vaginal delivery results in the lowest inflammatory response.

Keywords: Cesarean Section; Anesthesia, Spinal; General; Inflammatory Response; Neutrophil-to-Lymphocyte Ratio

Citation: Hazar EU, Altınışık HB. Comparison of the effects of normal and cesarean delivery methods and general and spinal anesthesia techniques on the inflammatory response. Anaesth. pain intensive care 2024;28(6):1017-1022; DOI: 10.35975/apic.v28i6.2608

Evaluating the reliability and validity of the Urdu translation of Nijmegen questionnaire for patients with hyperventilation syndrome

Fri, 20 Dec 2024 00:00:00 -0700

Background & Objective: Nijmegen Questionnaire (NQ) was developed in order to screen hyperventilation syndrome (HVS) and for better understanding of its questions and in lieu with the patient-centric model, it has been translated into other languages. This study aimed at translating English version of NQ in to Urdu and for evaluating the reliability and validity of Urdu based NQ (UNQ) in healthy population and in patients with hyperventilation.

Methodology: This study followed cross sectional design with non-probability convenient sampling technique. Study was completed over the period of 6 months w.e.f. 19th June, 2021 and recruited a total of 70 participants (50 with HVS and 20 healthy people) after getting approvals from pulmonary department based in a government hospital and institutional ethical research board committee. Urdu translation of NQ was a four steps process involving two bilingual translators and a backward translation. Intra class correlation coefficient (ICC), Cronbach’s alpha, Pearson Correlation and content validity index were utilized for assessing reliability and validity.

Results: ICC was 0.96, representing good test re-test reliability. The reliability and internal validity gave a value of 0.96. Pearson’s correlation coefficients were measured at 0.78 for tightness across chest and 0.82 for shortness of breath.

Conclusion: UNQ is a valid assessment tool for the patients with HVS. It represented overall good reliability, content and construct validity.

Abbreviations: ICC - Intra class correlation coefficient; NQ - Nijmegen Questionnaire; UNQ - Urdu based NQ;

Keywords: Hyperventilation, Translation, Questionnaire, Language, Urdu.

Citation: Ilyas S, Ul Ain Q, Masood R, Sajjad Y, Habib A, Zahid SZ. Evaluating the reliability and validity of the Urdu translation of Nijmegen questionnaire for patients with hyperventilation syndrome. Anaesth. pain intensive care 2024;18(6):1023-1028; DOI: 10.35975/apic.v28i6.2610

Received: July 15, 2024; Reviewed: October 03, 2024; Accepted: October 03, 2024

Comparative risk of pulmonary microaspiration in intubated versus sedated patients undergoing ERCP

Mohamed Ahmed Maher, Hend Fayed Hassan, Ahmed Ibrahim Refaat, Moshira Sayed Amer — Mon, 23 Dec 2024 00:00:00 -0700

Introduction: Endoscopic retrograde cholangio-pancreatography (ERCP) is by far considered the cornerstone in the diagnosis and treatment of biliary and pancreatic diseases. The optimal anesthetic choice for ERCP remains under debate. While general anesthesia offers certain benefits, some drawbacks limit its routine use in ERCP. Monitored anesthesia care (MAC) or deep sedation offers a viable alternative in remote locations, avoiding these drawbacks. Pulmonary aspiration may lead to a serious complication or even death. Potential microasprition during ERCP is an underreported complication and data about it is scarce. We assessed the comparative risk of pulmonary micro aspiration in intubated versus sedated patients undergoing ERCP

Methodology: 130 ASA I-III patients were enrolled in the study and divided into two groups: general anesthesia with endotracheal intubation (Group-I) and deep sedation (Group-S). Each group had 65 patients. All patients were monitored for hypoxic episodes in the HDU unit for 48 HRs after ERCP. Also, they were subjected to Computed Tomography (CT) chest after 48 HRs to detect acute pulmonary infiltrates of micro aspiration.

Results: The incidence of positive postoperative CT findings for micro aspiration was statistically significantly higher in the Group-S (24.62%) than Group-I (4.62%) with P-value: of 0.002. The incidence of postoperative hypoxic episodes was higher in the Group-S 27.69% versus 6.15% in Group-I but there was no statistically significant difference between both groups. Also, it was found that the incidence of postoperative micro aspiration was statistically significantly higher in patients of ≥ 65 years (52%) than < 65 years (7.5%) of the Group-S with P = 0.014. Incidence of postoperative fever, cough, tachypnea, and the need for O₂ supplementation were comparable in both groups.

Conclusion: The incidence of positive postoperative CT findings for microaspiration was higher in the sedation group. It was also higher in patients aged ≥ 65 years in the sedation group. Despite these findings, none of the patients developed clear signs of postoperative chest infection.

Abbreviations: CT - Computed Tomography; ERCP - Endoscopic retrograde cholangio-pancreatography; ETT- endotracheal intubation; MAC - Monitored anesthesia care

Keywords: ERCP, MAC, GA with ETT, pulmonary micro aspiration.

Citation: Maher MA, Hassan HF, Refaat AI, Amer MS. Comparative risk of pulmonary microaspiration in intubated versus sedated patients undergoing ERCP. Anaesth. pain intensive care 2024;28(6):1029-1034; DOI:10.35975/apic.v28i6.2611

Received: August 02, 2024; Reviewed: September 06, 2024; Accepted: September 18, 2024

Association between interleukin-39 (IL-39) with hormonal and metabolic changes in women with polycystic ovarian syndrome

Kawther Mejbel Hussein, Hanaa Addai Ali — Mon, 23 Dec 2024 00:00:00 -0700

Background & Objective: The most prevalent endocrine defect affecting women in their reproductive years is called polycystic ovarian syndrome (PCOS). It is strongly correlated to metabolic syndrome, insulin resistance, and an increased risk of diabetes and cardiovascular disease in the future. The heterodimer of interleukin-39 (IL-39) is 54 kDa. The IL-12 family subunits p19 and Ebi3 have been found to create a novel complex known as IL-39 (p19/Ebi3), according to the researchers. This study aimed to assess additional hormonal and metabolic abnormalities as well as the blood level of IL-39 in patients with PCOS.

Methodology: The study employed 180 samples of Iraqi women in the 20–40 age range. Ninety newly diagnosed PCOS patients and ninety healthy, fertile women made up the age-matched case-control research group. The groups were gathered between December 2023 and March 2024 from private laboratories and the Al-Sadr Teaching Hospital, Al-Hakeem Hospital, and Al-Zahraa Hospital in the Najaf Governorate. An enzyme-linked immunosorbent assay (ELISA) was used to measure each subject's IL-39 level and calculate their hirsutism scores. The relevant statistical methods were applied to analyze the data.

Results: The BMI, LH, LH/FSH ratio, TT, FAI, FIN, FSG, and HOMA-I R values of the PCOS patient women were considerably greater than those of the healthy women group. The difference in the blood level of IL-39 between the PCOS women and the control group was statistically significant (P < 0.0001). Furthermore, a noteworthy inverse relationship was noted between IL-39 and an IL-39 cut-off value (ng/mL), yielding 82.2% sensitivity and 80.4% specificity; (AUC: P < 0.0001; 95% CI: 0.848–0.965).

Conclusion: A lower level of IL-39 may contribute to the etiology of PCOS patients. Further research is necessary to fully comprehend the pathophysiology and clinical significance of the IL-39 system in PCOS. According to the study's findings, compared to healthy, fertile control subjects, women with PCOS had lower serum IL-39 levels.

Abbreviations: TT - Total testosterone; FT - free testosterone; FAI TC - Free androgen index; total cholesterol; TG - Triglycerides; "LDL-C" - low-density lipoprotein; "HDL-C" - high-density lipoprotein and cholesterol; PTX-3 - Pentraxin-3; WHR - Waist-to-hip ratio; BMI - Body mass index; FSG - Fasting serum glucose; HOMA-IR HOMA%S - Insulin Resistance Homeostatic Model Assessment, or: Insulin sensitivity HOMA, LH - Luteinizing hormone; FSH - Follicle stimulating hormone; IL-39 - interleukin-39.

Key words: IL-39, insulin resistance, obesity, polycystic ovarian syndrome; LH, FSH and LH/FSH.

Citation: Hussein KM, Ali HA. Association between interleukin-39 (IL-39) with hormonal and metabolic changes in women with polycystic ovarian syndrome. Anaesth. pain intensive care 2024;28(6):1035-1042;
DOI: 10.35975/apic.v28i6.2612

Received; August 16, 2024; Reviewed: August 21, 2024; Accepted: December 09, 2024

Comparison of ultrasound guided transversus abdominis plane block with different concentrations of ropivacaine combined with fentanyl: a randomized double-blind trial

Mon, 23 Dec 2024 00:00:00 -0700

Objectives: This study was conducted to assess the duration of analgesia using different concentrations of ropivacaine (0.2%, 0.375% and 0.5%) combined with fentanyl in Transversus Abdominis Plane (TAP) block. In addition to analgesic effects, hemodynamic effects, sedation and side effects were also evaluated in this study.

Methodology: A total of 90 patients scheduled for elective total abdominal hysterectomy (TAH) surgery under spinal anesthesia were randomly allocated to one of the three groups: R1 group received - 29 mL 0.2% ropivacaine combined with 50 μg fentanyl (1 mL) to make a total of 30 mL in TAP block; R2 - 29 mL 0.375% ropivacaine combined with 50 µg fentanyl (1 mL) to make a total of 30 mL; and group R3 - 29 mL 0.5% ropivacaine combined with 50 µg fentanyl (1 mL) to make a total of 30 mL. With the help of visual analogue scale (VAS) duration of analgesia was assessed also total rescue analgesic requirement was recorded.

Results: Duration of analgesia was significantly increased in group R3 (410.52 ± 70.18 min vs. 353.17 ± 92.03 min vs. 309.28 ± 83.66 min; [R3 vs. R2 vs. R1 respectively (P > 0.05)]. Significantly fewer patients in the R3 group required rescue analgesia. (23.3% vs. 36.6% vs. 63.3%; [R3 vs. R2 vs. R1 respectively (P > 0.05)].

Conclusion: We conclude that higher concentration of ropivacaine provided prolonged analgesia compared to lower concentrations in TAP block. However, 0.2% ropivacaine provides statistically similar postoperative analgesia to 0.375% ropivacaine.

Abbreviations: ASA - American Society of Anesthesiologists; LAST - local anesthetic systemic toxicity; PONV - post-anesthesia care unit; RSS - Ramsey sedation scale; TAP block - Transversus Abdominis Plane block; TAH - total abdominal hysterectomy;

Keywords: Anesthesia, ropivacaine, spinal cord, fentanyl, hysterectomy.

Citation: Nallam SR, Darsi A, Veeramalla P, Sunkesula A, Chiruvella S. Comparison of ultrasound guided transversus abdominis plane block with different concentrations of ropivacaine combined with fentanyl: a randomized double-blind trial. Anaesth. pain intensive care 2024;28(6):1043-1049.

DOI: 10.35975/apic.v28i6.2613

Received: August 20, 2024; Reviewed: October 16, 2021; Accepted: October 18, 2024

Molecular detection of Toll-like receptors 1, 4, and 5 genes among patients with appendicitis

Zainab Nihad shaker, Dawood S. Mahdi, Ihsan Edan AlSaimary — Mon, 23 Dec 2024 00:00:00 -0700

Background & Objective: Acute appendicitis is the predominant etiology of emergency cases on a global scale, and it may have serious consequences. If there is no precise diagnosis. Toll-like receptors (TLRs) are a crucial group of receptors that form the initial barrier against infections. The study aimed to investigate the molecular structure of Toll-like receptor (TLRs) genes by conventional Polymerase Chain Reaction) PCR) and deoxyribonucleic acid (DNA) sequencing in acute appendicitis patients and investigate whether any alteration in this gene may act as a risk factor for appendicitis.

Methodology: A case-control investigation was conducted at Al-Sadr Teaching Hospital and Al-Shifaa Teaching Hospital in Basrah, Iraq, from July to November 2023. The study involved 20 blood samples from 15 patients previously diagnosed with appendicitis; and 5 healthy individuals included as a control group. We randomly selected six samples from patients with appendicitis, with two samples for each primer, for DNA sequencing.

Results: The results of conventional PCR and electrophoresis showed different molecular weights at different temperatures for TLR1, TLR4, and TLR5. DNA sequencing results showed several different mutations for each TLRs gene primer for both reverse and forward when compared by the Basic Local Alignment Search Tool (BLAST) to sequences from the National Centre for Biotechnology Information (NCBI). Six new mutations were recorded in the gene bank (NCBI), two mutations per TLR. The study found that TLR1’s forward primer had two mutations, while the reverse primer had four. Four alterations were found in TLR4, while one in TLR5 was found in the reverse primer.

Conclusion: Through altering the immune system’s reaction to pathogenic stimuli, excessive immunological activation, and inflammation, genetic differences in TLRs may influence the pathophysiology or outcome of disease. These factors can also contribute to the development of appendicitis.

Abbreviations: AA, Acute Appendicitis; AHC, apparently healthy controls, “BLAST, Basic Local Alignment Search Tool”; CD, cluster of differentiation; EDTA, ethylene diamine tetra acetic acid; GBD, Global Burden of Disease Study; GC, gastric cancer; GIT, gastrointestinal tract; IBD, inflammatory bowel disease; LPS, lipopolysaccharide; “MyD88, myeloid differentiation primary response 88”; NCBI, National Center for Biotechnology Information; PRRs, “Pathogen Recognition Receptors; PAMPs Pathogen Associated Molecular patterns”; SNPs, single-nucleotide polymorphisms; TE, Tris-EDTA; TIR, Toll-interleukin (IL)-1 receptor.

Keywords: Appendicitis, TLR1, TLR4, TLR5, PCR, DNA sequencing, Molecular Detection

Citation: Shaker ZN, Mahdi DS, AlSaimary IE. Molecular detection of Toll-like receptors 1, 4, and 5 genes among patients with appendicitis. Anaesth. pain intensive care 2024;28(6):1050-1060; DOI: 10.35975/apic.v28i6.2622

Received: August 22, 2024; Reviewed: October 06, 2024; Accepted: October 18, 2024

Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and length of stay

Nurita D. Kestriani, Erwin Pradian, Muhammad R Alifahna — Mon, 23 Dec 2024 00:00:00 -0700

Background: Almost 30-60% of patients treated in the intensive care unit (ICU) experience acute kidney injury (AKI) and approximately 5% of all ICU patients require renal replacement therapy. This study was conducted to determine the difference in length of stay (LOS) and mortality based on continuous renal replacement therapy (CRRT) compared to intermittent hemodialysis (IHD) in AKI patients in the ICU of a tertiary referral hospital in Indonesia.

Methodology: A cross-sectional study was conducted on all patients diagnosed with AKI who were treated in the ICU. The study data included age, sex, comorbidities, The Sequential Organ Failure Assessment (SOFA) score, Acute Physiologic and Chronic Health Evaluation (APACHE) score, treatment modality, LOS, and mortality.

Results: There were 18 patients in each of the IHD and CRRT groups. The number of study subjects with comorbidities was higher in the CRRT group (12 people (66.7%)), compared to the IHD group (11 people (61.1%)). The SOFA score in the IHD group was higher (6.06) than the CRRT group (5.44). APACHE score in the IHD group (18.50) differed greatly from the CRRT group (18.44).

Discussion: Studies have shown no difference in mortality with CRRT compared to IHD. Studies showed higher APACHE scores were associated with shorter LOS, reflecting higher mortality rates.

Conclusion: There is a significant difference in the LOS of AKI patients undergoing CRRT with IHD. However, no significant difference in the mortality rate between the CRRT and IHD groups was found.

Abbreviations: APACHE - Acute Physiologic and Chronic Health Evaluation; CRRT - continuous renal replacement therapy; ICU - intensive care unit; IHD - intermittent hemodialysis; LOS - length of stay;

Keywords: acute kidney injury, continuous renal replacement therapy, intermittent hemodialysis, length of stay, mortality rate

Citation: Kestriani ND, Pradian E, Alifahna MR. Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and length of stay. Anaesth. pain intensive care 2024;28(6):1061-1066; DOI: 10.35975/apic.v28i6.2623

Received: August 30, 2024; Reviewed: September 15, 2024; Accepted: September 15, 2024

Accuracy of d-dimer in predicting mortality of COVID-19 patients in intensive care unit

Hikmatiar Hikmatiar, Rose Mafiana, Mayang Indah Lestari, Erial Bahar — Mon, 23 Dec 2024 00:00:00 -0700

Background: Sars-Cov-2 infection has a high rate of mortality. This infection can cause changes in the hemostatic system including activated partial thromboplastin time (aPTT), international normalized ratio (INR), and prothrombin time (PT), increased D-dimer and fibrin degradation product (FDP). D-dimer level in COVID-19 patients affects the mortality rate of COVID-19 patients.

Methodology: This study was a retrospective observational analytic prognostic study using medical record. Inclusion criteria were patients with confirmed COVID-19 who met the criteria for severe and critical pneumonia, aged >18 years who were admitted to RSMH from March 1, 2020 to February 28, 2021, until a minimum of 77 subjects were included. Data analysis was done using SPSS version 26 with chi square to assess the relationship and using the Medcalc to assess area under the curve (AUC), cutoff value, sensitivity and specificity.

Results: There was a total of 91 research subjects and the total mortality rate was 62 (68.1%). The accuracy analysis of D-Dimer on the first day; the cutoff value was 1.79 and the AUC value was 0.556 which has poor predictability. The results of statistical tests using Chi square obtained P value = 0.009 (p<α) and Relative Risk 1.991. The accuracy analysis of D-Dimer on the third day, the cut off value was 2.45 and the AUC value was 0.801, which had good predictability. The results of the Chi Square statistical test obtained P value = 0.001 (p<α) and Relative Risk 3.157. D-Dimer levels > 2.45 on the third day had a sensitivity value of 90.3% and a specificity of 58.6%. Based on the analysis of the accuracy of the difference in levels of D-Dimer on the first and third day, the Chi Square statistical test results obtained P value = 0.034 (P < 0.05) and Relative Risk 1.674.

Conclusion: D-Dimer level > 2.45 was statistically significant associated with mortality and had a risk of 3,157 times in mortality. From the results of the analysis, it was found that the sensitivity, specificity and AUC value were good, so that the third day D-Dimer could be used as a predictor of mortality in sepsis patients.

Abbreviations: AUC - Area Under Curve; aPTT - activated partial thromboplastin time; DIC - disseminated intravascular coagulation; FDP - Fibrin Degradation Product; IL-6 - interleulin-6; INR - International Normalized Ratio; PT - prothrombin time

Keywords: D-Dimer, COVID-19, mortality, activated partial thromboplastin time (aPTT), international normalized ratio (INR), prothrombin time (PT), fibrin degradation product (FDP).

Citation: Hikmatiar H, Mafiana R, Mayang Lestari MI, BaharE. Accuracy of d-dimer in predicting mortality of COVID-19 patients in intensive care unit. Anaesth. pain intensive care2024;28(6):1067-1076; DOI:10.35975/apic.v28i6.2624

Received: September 01, 2024; Reviewed: September 17, 2024; Accepted: September 30, 2024

Comparative analysis of percutaneous gallbladder aspiration vs percutaneous cholecystostomy in acute calculous cholecystitis

Marwa Abd Alhussein, Mohammed Abdulameer Mahdi — Mon, 23 Dec 2024 00:00:00 -0700

Background & objectives: Acute cholecystitis, a prevalent cause of acute abdomen pain, is primarily induced by gallstone obstruction, leading to significant inflammation and potentially severe complications. This study focuses on comparing the effectiveness and complication rates of percutaneous gallbladder aspiration versus percutaneous cholecystostomy in managing severe acute calculous cholecystitis, aiming to enhance patient care by optimizing treatment strategies.

Methodology: In this study we evaluate the efficacy and safety of percutaneous gallbladder aspiration (PGA) versus percutaneous cholecystostomy (PC) in 35 patients with acute calculous cholecystitis. Utilizing ultrasound-guided procedures, patients were either subjected to PGA, using an 18-19-gauge spinal needle for gallbladder drainage, or where an 8-12 French pigtail catheter facilitated gallbladder decompression.

Results: In this study of 35 patients with acute calculous cholecystitis, 25 underwent percutaneous gallbladder aspiration and 10 underwent percutaneous cholecystostomy. Post-procedure, 88% of the aspiration group and 80% of the cholecystostomy group reported no pain, with the majority in both groups showing a positive total response score. Analgesic demand post-procedure was low, with 76% of the aspiration group and 70% of the cholecystostomy group requiring no analgesia. Complication rates were 12% for the aspiration group and 20% for the cholecystostomy group, with overall success rates of 92% and 90%, respectively, indicating no significant difference in outcomes between the two methods.

Conclusions: This study's comparative analysis of PGA and PC offers essential insights into managing acute calculous cholecystitis in high-risk surgical candidates. With both procedures demonstrating high success rates and minimal complications, they emerge as viable alternative treatments. Future studies should focus on evaluating their long-term efficacy and optimizing patient selection criteria to enhance outcomes.

Abbreviations: PC - percutaneous cholecystostomy; PGA - percutaneous gallbladder aspiration; HIDA - hepatoimino diacetic acid scan;

Keywords: percutaneous gallbladder aspiration, percutaneous cholecystostomy, acute cholecystitis, non-surgical, radiology

Citation: Alhussein MA, Mahdi MA. Comparative analysis of percutaneous gallbladder aspiration vs percutaneous cholecystostomy in acute calculous cholecystitis. Anaesth. pain intensive care 2024;28(6):1077-1083; DOI:10.35975/apic.v28i6.2607

Received: December 21, 2021; Reviewed: February 11, 2023; Accepted: February 12, 2023

Apelin-13 and Omentin-1 as biomarkers for estimation of severity of diabetic nephropathy in type-2 diabetes mellitus

Nabaa Najam Alshamiry, Nibras H. Abdalsada — Mon, 23 Dec 2024 03:43:14 -0700

Background & objective: Chronic diabetes affects millions of the people globally, leading to complications like micro-, and macro-vascular problems like neuropathy, and nephropathy. The adipokines Apelin-13 and Omentin-1 play beneficial functions in the early detection of diabetic nephropathy. We aimed to study and investigate the correlation between Apelin-13 and Omentin-1 levels and disease severity in diabetic nephropathy patients and evaluate their potential as biomarkers for early diagnosis.

Methodology: A case-control study at Al-Sadar Teaching Hospital/Al-Najaf Center assessed 180 individuals, including 60 type 2 diabetics with nephropathy (T2DM+Neph group), 60 without nephropathy (T2DM group), and 60 healthy individuals as controls, to provide insights into managing type 2 diabetes.

Results: The research found a notable decline in Omentin-1 (P < 0.001) in the T2DM+Neph group, followed by T2DM, and the highest value in the control group. There was a significant increase (P < 0.001) in the serum Apelin-13 in the patients’ groups T2DM+Neph group and T2DM compared with the control group. There was no significant difference in the serum Apelin-13 between T2DM and T2DM+Neph groups

Conclusion: Our study found a decline in Omentin-1 levels in diabetics with nephropathy patients compared to healthy controls, suggesting using serum Omentin-1 level measurement for early diagnosis and treatment of diabetic nephropathy.

Keywords: ELISA, Nephropathy, Apelin-13, Omentin-1

Citation: Alshamiry NN, Abdalsada NH. Apelin-13 and Omentin-1 as biomarkers for estimation of severity of diabetic nephropathy in type-2 diabetes mellitus. Anaesth. pain intensive care 2024;28(6):1084-1090; DOI: 10.35975/apic.v28i6.2601

Received: April 13, 2024; Revised: February 21, 2024; Accepted: July 05, 2024

The association between retinol binding protein 4 (RBP4) and peripheral neuropathy in type-II diabetic patients

Iman Ali Nafakhi, Nibras H. Abdalsada — Mon, 23 Dec 2024 03:39:51 -0700

Background: The most common microvascular consequence of diabetes is peripheral neuropathy (PN). It is a very common ailment that has a significant impact on patient quality of life. The purpose of this study was to look into the possible link between retinol binding protein 4 (RBP4) and PN in individuals with type 2 diabetes mellitus, as the relationship between the two is still unclear.

Methodology: During August and December 2023, we enrolled 152 participants, who were matched for age and sex, in a case control study. There were 50 healthy controls, 50 diabetic patients without PN, and 52 diabetic patients with PN. ELISA was used to measure serum RBP4.

Results: Diabetic individuals with PN had significantly greater serum levels of RBP4 than diabetic patients without PN (P ˂ 0.001). Increased age (r = 0.262, P ˂ 0.01), DM duration (r = 0.565, P ˂ 0.01), and BMI (r = 0.183, P ˂ 0.05) were all substantially linked with RBP4 levels. RBP4 levels exhibited a negative correlation with HDL and a positive correlation with total cholesterol, triglycerides, LDL, and VLDL.

Conclusion: Elevated RBP4 levels is strongly and independently linked with PN in type 2 diabetic patients, and may play an important role in PN progression.

Keywords: diabetes mellitus; peripheral neuropathy, retinol binding protein 4.

Citation: Nafakhi IA, Abdalsada NH. The association between retinol binding protein 4 and peripheral neuropathy in type II diabetic patients. Anaesth. pain & intensive care 2024;28(6): 1091-1096;

DOI: 10.35975/apic.v28i6.2621

Received: May 93, 2024; Reviewed: June 04, 2024; Accepted: September 26, 2024

The association of atherosclerosis with cortisol and alpha-enolase levels and lipid profile

Basim Ali, Ula Jaball Mohammed — Mon, 23 Dec 2024 03:35:06 -0700

Background & objective: Atherosclerosis is a chronic disease characterized by the gradual buildup of plaque inside the arteries. It is the most common form of arteriosclerosis, which refers to the thickening and hardening of arterial walls. In atherosclerosis, some arteries have been narrowed by atherosclerotic plaque. We investigated the association of atherosclerosis with cortisol and alpha-enolase levels and lipid profile.

Methodology: This study focused on measuring alpha-enolase 1 (αENO1) in patients with atherosclerosis. sixty patients diagnosed with atherosclerosis (36 males and 24 females) participated in this study. Their ages ranged from (45 to 65 years). Samples were collected from the open-heart unit at Al-Sadr Teaching Hospital, Najaf Governorate, Iraq. Thirty healthy people (15 males, 15 females) were selected as a control group.

Results: The study showed that patients with atherosclerosis suffer from a clear increase in the concentration of alpha-enolase 1 (αENO1) and a clear increase in the concentration of cortisol, as well as an increase in the lipid profile (total cholesterol, triglycerides, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL).

Conclusions: On the other hand, the study revealed a significant decrease in the amounts of high-density lipoprotein (HDL) in patients compared to the control group. Therefore, the findings of this investigation suggest that individuals suffering from atherosclerosis might.

Abbreviations: αENO1 - alpha enolase 1; HDL - high density lipoprotein; LDL - low density lipoprotein; (2-PG)-2-phospho-D-glycrate; NO - nitric oxide; TG - triglyceride; BMI - body mass index; PEP - phosphoenolpyruvate; ACTH - adrenocorticotropic hormone; ROS - reactive oxygen species.

Keywords: atherosclerosis, αENO1, cortisol, endothelial, macrophages, plasminogen, plasmin, reactive oxygen species.

Citation: Mohammed UJ, Ali BM. The association of atherosclerosis with cortisol and alpha-enolase levels and lipid profile. Anaesth. pain intensive care 2024;28(6):1097-1104; DOI: 10.35975/apic.v28i6.2609

Received: July 10, 2024; Reviewed: September 11, 2024; Accepted: September 11, 2024

Treatment algorithm of neuropathic pain in elderly population

Mon, 23 Dec 2024 03:30:33 -0700

Older persons are usually affected by neuropathic pain (NP). They typically have a number of comorbidities. Drug-drug interactions are more likely in elderly people since they frequently take multiple medications. These patients, particularly those who have cognitive issues, may also have limited communication skills, making it challenging to assess and treat their pain. To recognize and treat neuropathic pain as effectively as possible, clinicians and other healthcare professionals need a decision-making algorithm. We describe a decision-making algorithm created by a multidisciplinary team of experts that concentrates on pain evaluation and treatment options for the treatment of neuropathic pain, especially in the elderly.

Abbreviations: ECPA - Behavioral Scale for Elderly Persons; IASP - International Association for the Study of Pain; S-LANSS - Leeds Assessment of Neuropathic Symptoms and Signs pain scale; NP - neuropathic pain; NRS - numerical rating scale; PHN - Postherpetic neuralgia; PACSLAC - Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PGIC - Patient Global Impression of Change; VRS - verbal rating scale; VAS - Visual analog scales;

Keywords: neuropathic pain, algorithm, treatment or management, elderly.

Citation: Hidayati HB, Puspamaniar VA, Sugondo AT, Firdausa FS. Treatment algorithm of neuropathic pain in elderly population. Anaesth. pain intensive care 2024;28(6): 1105-1112; DOI; 10.35975/apic.v28i6.2618

Received: October 04, 2023; Reviewed: October 23, 2023; Accepted: September 24, 2024

Development and validation of Redeemer's University Primary Dysmenorrhea Screening Tool (RUN-PDST)

Bello Ibukunoluwa Busayo — Mon, 23 Dec 2024 03:27:32 -0700

Background: Primary dysmenorrhea is often overlooked, underdiagnosed, and under-treated. This study attempts to develop a standardized tool for assessing primary dysmenorrhea among women in their reproductive years.

Methodology: This study utilized a mixed-method approach to sample young Nigerian women. Specifically, the development of the Redeemer's University Primary Dysmenorrhea Screening Tool (RUN-PDST) involved a standardized methodology comprising two broad phases: (a) development and refinement of screening tool items and (b) establishment of psychometric properties.

Results: The observed Kaiser-Meyer-Olkin (KMO) measure was .86, and Bartlett's Test of Sphericity (BTS) was (X²=3518.512, df=703, P = .000). The test of the principal components indicated nine extracted components, and the analysis of the components revealed all items that loaded based on the presence of nine components exceeding an eigenvalue of 1. Of the 38 items loaded, 24 were found to be significant and were subjected to principal component analysis using Varimax. The results from the component analysis further reduced the screening tool to 19 items. The item-total statistics of the tool indicate that all items have very good discrimination ability and should be retained. The internal consistency of the RUN-PDST among Nigerian samples revealed that the screening tool is reliable. Furthermore, paired with The Menstrual Symptom Questionnaire (MSQ), RUN-PDST has good concurrent validity.

Conclusion: RUN-PDST is a reliable and valid screening tool for assessing and managing primary dysmenorrhea symptoms.

Abbreviations: RUN-PDST – Redeemer’s University Primary Dysmenorrhea Screening Tool; PCA - Principal Component Analysis; BTS - Bartlett's Test of Sphericity; KMO - Kaiser-Meyer-Olkin; MSQ - Menstrual Symptom Questionnaire

Keywords: Development, validation, primary dysmenorrhea, screening tool.

Citation: Bello IB, Akinnawo EO, Akpunne BC. Development and validation of Redeemer's University Primary Dysmenorrhea Screening Tool (RUN-PDST). Anaesth. pain intensive care 2024;28(6):1113-1121;

DOI; 10.35975/apic.v28i6.2619

Received: October 12, 2021; Reviewed: October 18, 2021; Accepted: November 13, 2024

Comprehensive approaches to emergency airway management during procedural sedation; a narrative review

Nobuyasu Komasawa, Masanori Haba — Mon, 23 Dec 2024 02:53:08 -0700

Procedural sedation is utilized across a variety of clinical settings by healthcare professionals to alleviate anxiety, manage pain, and facilitate diagnostic or therapeutic interventions. The primary aim is to maintain patient comfort while minimizing movement and ensuring the procedure proceeds smoothly. Unlike monitored anesthesia care, which requires the presence of an anesthesiologist, procedural sedation can be safely administered by both anesthesiologists and non-anesthesiologists. However, sedation exists on a continuum with general anesthesia, and the depth of sedation can vary, leading to potential complications, including respiratory depression or airway obstruction. Given the unpredictable nature of patient responses to sedative agents and the associated risks, it is essential to establish robust protocols for monitoring and managing sedation-induced complications, particularly in emergency airway management. Continuous monitoring, pre-procedure assessment, and the availability of airway management tools such as supraglottic device or tracheal intubation using videolaryngoscope are crucial for maintaining patient safety. This review highlights the importance of emergency airway management systems, recent advancements in airway devices, and the critical role anesthesiologists play in improving procedural sedation safety. Effective training programs, simulation-based education, and clear protocols are essential for equipping healthcare providers to respond to sedation-related emergencies, ensuring optimal patient outcomes.

Keywords: airway management; procedural sedation; respiratory complications; simulation-based education; sedation safety

Citation: Komasawa N, Haba M. Comprehensive approaches to emergency airway management during procedural sedation; a narrative review. Anaesth. pain intensive care 2024;28(6):1122-1127; DOI: 10.35975/apic.v28i6.2634

Received: September 06, 2024; Reviewed: October 29, 2024; Accepted: November 25, 2024

Platelet rich plasma therapy for carpal tunnel syndrome

Tue, 24 Dec 2024 00:00:00 -0700

Carpal tunnel syndrome (CTS) is the most frequent peripheral nerve entrapment neuropathy, accounting for about 90% of cases. CTS arises because of the median nerve compression in the carpal tunnel on the wrist, as the median nerve passes through the tunnel from the forearm to the hand. The available evidence regarding therapy for CTS, reveals that splinting therapy, corticosteroid injection, and surgery are not 100% effective in curing CTS so there is a need to search for other alternative therapies.

One of the pain therapies currently being developed in the medicine sector is platelet rich plasma (PRP). PRP refers to platelet concentrations in plasma higher than normal platelets circulating in the body. PRP has been extensively utilized as new secure therapy in dentistry, bone surgery, ophthalmology, neurosurgery, and plastic surgery for three decades. PRP contains several growth factors that can enhance the process of wound healing, angiogenesis, and regeneration of axons.

Regarding the use of PRP therapy in CTS there is still a lot of debate and the benefits of these therapies have been still questioned. However, there are currently numerous studies on the utilization of PRP therapy in CTS. In vitro and in vivo studies show that PRP has neuroprotective, neurogenic, and neuroinflammatory modulators on nerves. Recent studies have shown satisfactory results from the administration of PRP therapy in CTS cases.

PRP is a promising alternative therapy for mild to moderate CTS cases, but it is not recommended for treatment of severe CTS cases. There are no studies that conduct long-term follow-up after the administration of PRP therapy, so there is no documentation related to the long-term impact of PRP therapy in CTS cases.

Keywords: platelet rich plasma; carpal tunnel syndrome; human; medicine

Citation: Thursina C, Wulandari IA, Hidayati HB, Abror ANF, Puspamaniar VA, Gofir A. Platelet rich plasma therapy for carpal tunnel syndrome. Anaesth. pain intensive care 2024;28(6):1128−1131; DOI: 10.35975/apic.v28i6.2615

Received: October 04, 2023; Reviewed: December 11, 2023; Accepted December 01, 2024

Anesthetic management of a patient with large goiter and necrotizing fasciitis of left breast posted for emergency toilet mastectomy

Aparna Bagle, Shilpa Deshmukh, Ritin Saxena — Tue, 24 Dec 2024 00:00:00 -0700

In surgical emergencies involving complex cases such as large goiter and necrotizing fasciitis of the breast, anesthetic management poses significant challenges. We present a case study of a female patient, who presented with a large goiter and necrotizing fasciitis of the left breast, necessitating emergency total mastectomy. Our case emphasizes on the choice of anesthetic technique, which is very crucial in minimizing risks associated with potential airway compromise and to ensure optimal intraoperative conditions.

Close collaboration between the surgical and anesthesia teams for a multidisciplinary approach and tailored anesthetic management strategies in complex surgical emergencies are required for patient safety and optimal surgical outcomes.

Keywords: Neck swelling, Difficult airway, Fiberoptic intubation, Difficult intubation, Goiter

Citation: Bagle A, Deshmukh S, Saxena R. Anesthetic management of a patient with large goiter and necrotizing fasciitis of left breast posted for emergency toilet mastectomy. Anaesth. pain intensive care 2024;28(6):1132-1134.

DOI: 10.35975/apic.v28i6.2617

Received: April 14, 2024; Reviewed: July 27, 2024; Accepted: July 27, 2024

Allodynia at episiotomy scar as an unusual cause for dyspareunia: a case report

Mon, 23 Dec 2024 02:26:10 -0700

Even though an episiotomy, a common perineal incision made during childbirth, is intended to prevent perineal trauma, significant postpartum complications such as perineal pain and dyspareunia may occur by it.

We describe a case of a 45-year-old mother of two children, who presented with superficial dyspareunia affecting her sexual and social relationships. Despite normal ultrasound and abdominal examination findings, allodynia at the site of a previous episiotomy scar was found during the perineal examination. Surgical excision was performed as conventional analgesics and lidocaine provided inadequate pain relief. The efficacy of surgical intervention is underscored by the non-recurrence of dyspareunia over a one-year follow-up period.

The importance of a thorough evaluation in diagnosing dyspareunia and multidisciplinary approach in management are highlighted in this case report, as pain sources may not be immediately apparent.

Keywords: episiotomy scar; allodynia; postpartum dyspareunia; perineal pain.

Citation: Ratnayake A, Gnanarathne S, Thangavadivale V, Egodage S, Sandaru G. Allodynia at episiotomy scar as an unusual cause for dyspareunia: a case report. Anaesth. pain intensive care 2024;28(6):1135-1137.

DOI: 10.35975/apic.v28i6.2631

Received: September 19, 2024; Reviewed: September 28, 2023; Accepted: September 28, 2023

An innovative technique for best use of Macintosh laryngoscope converted into videolaryngoscope

Teena Bansal, Mamta Jain, Anish Kumar Singh, Jatin Lal, Suresh Singhal — Mon, 23 Dec 2024 02:37:51 -0700

Videolaryngoscopes (VLS) improve the visualisation of the larynx, making intubation easier. However, cost constraints limit their use particularly in resource limited settings where access to VLS is needed.¹ Macintosh laryngoscope converted into VLS using endoscope camera is highly cost effective and can replace VLS to an extent and may prove a boon for airway management.^2,3 However, VLS doesn’t always guarantee easier passage of the endotracheal tube (ETT) despite of good laryngeal view, hence may result in longer time for intubation. We wish to highlight an innovation in the technique for its best use.

Citation: Bansal T, Jain M, Singh AK, Lal J, Singhal S. An innovative technique for best use of Macintosh laryngoscope converted into videolaryngoscope. Anaesth. pain intensive care 2024;28(6):1138-1139.

DOI: 10.35975/apic.v28i6.2633

Correspondence: Dr. Teena Bansal; E-mail: aggarwalteenu@rediffmail.com