Rationale: Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse.Objectives: To evaluate across countries/regions of differing income status in Asia 1) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and 2) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality.Methods: A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited.Measurements and Main Results: The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in lowincome countries/regions [LICs]/lower middle-income countries/ regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; P , 0.001).Patients were younger and had lower severity of illness in LICs/ LMICs. Hospital mortality was 32.6% and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis (adjusted odds ratio, 1.84; 95% confidence interval, 1.00-3.37; P = 0.049). Sepsis bundle compliance was 21.5% at 1 hour (26.0%, 22.1%, and 16.2% in LICs/LMICs, upper middle-income countries/regions, and HICs, respectively; P , 0.001) and 36.6% at 3 hours (39.3%, 32.8%, and 38.5%, respectively; P = 0.001). Delaying antibiotic administration beyond 3 hours was the only element independently associated with increased mortality (adjusted odds ratio, 2.53; 95% confidence interval, 2.07-3.08; P , 0.001).Conclusions: Sepsis is a common cause of admission to Asian ICUs. Mortality remains high and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotic administration beyond 3 hours from diagnosis is associated with increased mortality.Clinical trial registered with www.ctri.nic.in (CTRI/2019/01/016898).
Introduction: Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Methods: Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student’s t-test were used for analysis. Level of significance used was P<0.05. Results: Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Conclusions: Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.
Background: With the advent of anesthesia, surgery is no longer a race against the clock and surgeons. Many studies in the past have demonstrated limited knowledge among patients about various aspects of anesthesia.Objectives: To assess the awareness and concern of elective surgical patients towards anesthesia.Methodology: A cross-sectional questionnaire survey was conducted over two months’ period in adult patients of age eighteen years and above. Two hundred surgical patients accessing services at the pre-anesthesia check-up clinic were interviewed using 12 questions assessing demographic characteristics, educational status and their knowledge about anesthesia.Results: Out of 200 patients, only 32% knew that anesthesiologists provide anesthesia. It was found that 63% didn’t have any knowledge about the types of anesthesia. The most common fear among the participants about anesthesia was the fear of pain during surgery.Conclusion: The study showed poor knowledge of patients regarding anesthesia.
Background: Adequate pain management is essential for every patient to recover and return to their normal activity quickly. Central sensitization is one of the mechanism which increases excitability of spinal neurons and results persistent pain postoperatively. Objectives: The aim of the study was to investigate the effects of addition of 100 mg 50% Magnesium Sulphate intrathecally to 0.5% heavy Bupivacaine on sensory onset up to T4 level, complete motor block, post-operative analgesia and complications in patients planned for vaginal hysterectomy under spinal anesthesia. Methods: The design of the study was prospective randomized and double blind. With the Institutional improvements and informed consent in Kathmandu Medical College from January 2011 till December 2012, 60 American society of Anesthesiologist class (I, II) patients of age between (40 to 70) years, weight between (45 to 70) kg and height between (4.8 to 5.2) feet undergoing routine vaginal hysterectomy not exceeding one and half hour in spinal anaesthesia were included in the study. The exclusion criteria were patients not following above criteria, having coagulopathy, renal function derangements, uncontrolled hypertension or severe hypotension and having dysarrhythmias. Total patients were randomized into two groups of thirty each. Group A was allocated to receive four ml 0.5% Bupivacaine +0.25 ml normal saline and group B was allocated to receive four ml 0.5% Bupivacaine + 100 mg of 50% Magnesium Sulphate. The anaesthesiologist who was double blind to the drug preparation performed spinal anaesthesia with either of the drug for the whole study.The recorded parameters were time of onset of sensory block upto T4 level, onset of complete motor block, total duration of analgesia and complications in both the groups. Data analysis was done by Computer software polystat XLS using Student's "t" test. P value <0.05 was considered statistically signifi cant. Result: The addition of 100 mg of 50% Magnesium sulphate to 0.5% Bupivacaine intrathecally resulted early onset of sensory block upto T4 level in (Mean± SD) (3.79 ± 0.25) min Vs (9.61 ± 0.75) min with sole 0.5% Bupivacaine where p value was < 0.05. Similarly onset of complete motor block with 0.5% Bupivacaine plus Magnesium Sulphate was (1.9 ± 0.23) min verses (10.4 ± 0.63) min with 0.5 % Bupivacaine only. Here again p value was < 0.05. Duration of analgesia with 0.5 % Bupivacaine plus Magnesium Sulphate was (176.8 ± 19. 85) min than that of 0.5% Bupivacaine (105 ± 26.82) min with P value< 0.05. Conclusion:The study concluded that onset as well as analgesic effect of 0.5% Bupivacaine was potentiated by intrathecal Magnesium Sulphate without major side effects.
This is a case report of successful use of ultrasound for stellate ganglion (SG) blocks in CRPS I in 11 patients using local anesthetic bupivacaine with injection dexmedetomidine as an adjunct. Ultrasound helped us to deposit Local anesthetics in target area without any noticeable side effects and trauma to adjacent structures.
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