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Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section:A metaanalysis

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World Journal of Methodology 2025年第2期15卷 154-165页

作者： Rishi Anand Deb Sanjay Nag Roushan Patel Prashant Sharma Vamsi Krishna Uppalapati Umesh Kumar Singh Department of anaesthesiology Tata Main HospitalJamshedpur 831001JhārkhandIndia

BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential *** meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean *** To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in *** A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during ***,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion *** were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect *** standardized mean difference with 95%CI was used for continuous *** variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds *** Total 8 RCTs were selected from a pool of 119 search results for *** meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the *** primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local *** analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine ***,the duration of the first analgesic

关键词： Ropivacaine Bupivacaine Anesthesia Spinal Cesarean section Meta-analysis

Novel flangeless video laryngoscope for limited mouth opening

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World Journal of Critical Care Medicine 2025年第1期14卷 118-121页

作者： Mohd Mustahsin Harshita Singh Division of Critical Care Medicine Department of Anaesthesiology and Critical CareEra UniversityLucknow 226003Uttar PradeshIndia Department of anaesthesiology Era UniversityLucknow 226003Uttar PradeshIndia

Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and *** patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal *** overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful *** types of VL blades are *** devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.

关键词： Video laryngoscope Difficult intubation Intubation Airway management Laryngoscopy

Beneficial effects of hirudotherapy in a chronic case of complex regional pain syndrome

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Journal of Integrative Medicine 2019年第5期17卷 383-386页

作者： Rebecca Kulbida Alexander Mathes Johannes Loeser Department of anaesthesiology and Intensive Care Medicine University Clinic of Cologne

We report about hirudotherapy in a patient with chronic complex regional pain syndrome(CRPS) in the right hand. CRPS is a multifactorial disease associated with disabling pain as well as sensory and motor deficits. The optimal therapeutic management is based on personalized multimodal treatment approaches;however, hirudotherapy has not been described in the available literature. To date, we have completed five medicinal leech treatments. Altogether, hirudotherapy led to rapid and substantial relief of symptoms, especially with respect to pain intensity ratings and skin temperature asymmetries. In addition, the patient’s active and passive agility of the affected limb improved obviously.

关键词： Hirudotherapy Complex regional pain syndrome Chronic pain Medicinal leeches

Shenmai Injection Attenuates Myocardial Ischemia/Reperfusion Injury by Targeting Nrf2/GPX4 Signalling-Mediated Ferroptosis

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Chinese Journal of Integrative Medicine 2022年第11期28卷 983-991页

作者： MEI Sheng-lan XIA Zhong-yuan QIU Zhen JIA Yi-fan ZHOU Jin-jian ZHOU Bin Department of anaesthesiology Renmin Hospital of Wuhan UniversityWuhan(430060)China

Objective:To examine the effect of Shenmai Injection(SMJ)on ferroptosis during myocardial ischemia reperfusion(I/R)injury in rats and the underlying ***:A total of 120SPF-grade adult male SD rats,weighing 220–250 g were randomly divided into different groups according to a random number *** I/R model was established by occluding the left anterior descending artery for 30 min followed by 120 min of *** was injected intraperitoneally at the onset of 120 min of reperfusion,and erastin(an agonist of ferroptosis),ferrostatin-1(Fer-1,an inhibitor of ferroptosis)and ML385(an inhibitor of nuclear factor erythroid-2 related factor 2(Nrf2))were administered intraperitoneally separately 30 min before myocardial ischemia as different *** function before ischemia,after ischemia and after reperfusion was *** changes in the myocardium and the ultrastructure of cardiomyocytes were observed,and the myocardial infarction area was ***,the concentration of Fein heart tissues and the levels of creatine kinase-MB(CK-MB),troponin I(cTnI),malondialdehyde(MDA)and superoxide dismutase(SOD)in serum were measured using assay kits,and the expressions of Nrf2,glutathione peroxidase 4(GPX4)and acyl-CoA synthetase long-chain family member 4(ACSL4)were examined by Western ***:Compared with the sham group,I/R significantly injured heart tissues,as evidenced by the disordered,ruptured and oedematous myocardial fibres;the increases in infarct size,serum CK-MB,cTnI and MDA levels,and myocardial Feconcentrations;and the decreases in SOD activity(P<0.05).These results were accompanied by ultrastructural alterations to the mitochondria,increased expression of ACSL4 and inhibited the activation of Nrf2/GPX4 signalling(P<0.05).Compared with the I/R group,pretreatment with 9 mL/kg SMJ and 2 mg/kg Fer-1 significantly reduced myocardial I/R injury,Feconcentrations and ACSL4 expression and attenuated mitochondr

关键词： ferroptosis Shenmai Injection myocardial ischemia reperfusion injury pretreatment

Intracranial pressure monitoring:Gold standard and recent innovations

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World Journal of Clinical Cases 2019年第13期7卷 1535-1553页

作者： Deb Sanjay Nag Seelora Sahu Amlan Swain Shashi Kant Department of anaesthesiology and Critical Care Tata Main Hospital

Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate noninvasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortionproduct oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.

关键词： Intracranial pressure increase Craniocerebral trauma Subarachnoid hemorrhages

Multidisciplinary approach toward enhanced recovery after surgery for total knee arthroplasty improves outcomes

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World Journal of Clinical Cases 2024年第9期12卷 1549-1554页

作者： Deb Sanjay Nag Amlan Swain Seelora Sahu Ayaskant Sahoo Gunjan Wadhwa Department of anaesthesiology Tata Main HospitalJamshedpur 831001India Department of anaesthesiology Manipal Tata Medical CollegeJamshedpur 831001India

Knee osteoarthritis is a degenerative disorder of the knee,which leads to joint pain,stiffness,and inactivity and significantly affects the quality of *** an increased prevalence of obesity and greater life expectancies,total knee arthroplasty(TKA)is now one of the major arthroplasty surgeries performed for knee *** enhanced recovery after surgery(ERAS)was introduced in TKA,clinical outcomes were enhanced and the economic burden on the healthcare system was *** is an evidence-based scientific protocol aimed at ameliorating the surgical stress *** aims to enhance the recovery phase,which encompasses multidisciplinary strategies at every step of perioperative care,including the rehabilitation *** of ERAS in TKA aids in reducing the length of hospital stay,improving pain management,reducing perioperative complications,and enhancing patient *** collaboration,integrating the expertise of anesthesiologists,orthopedic surgeons,nursing personnel,and other healthcare professionals,is the cornerstone of ERAS in patients undergoing TKA.

关键词： Arthroplasty Replacement Knee Recovery of function Anesthesia Care Nursing

Perioperative cardiac risks in myasthenia gravis

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World Journal of Clinical Cases 2024年第13期12卷 2147-2150页

作者： Deb Sanjay Nag Abhishek Chatterjee Pratap Rudra Mahanty Merina Sam Murari Kumar Bharadwaj Department of anaesthesiology Tata Main HospitalJamshedpur 831001India Department of anaesthesiology Manipal Tata Medical CollegeJamshedpur 831017India

Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular *** primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative and quantitative reductions in the availability of functional *** muscles are also affected,resulting in various perioperative cardiac *** antibodies are commonly reported in MG cases with cardiac *** the presence of thymoma,the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%.Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia,myocarditis,conduction disorders,heart failure,and sudden *** incidence of atrial fibrillation,ventricular and supraventricular extra systoles,and prolonged QTc have also been reported in patients with *** should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.

关键词： Myasthenia Gravis Perioperative period Receptors Cholinergic Anesthesia

Pain management in chronic pancreatitis

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World Journal of Clinical Cases 2024年第12期12卷 2016-2022页

作者： Deb Sanjay Nag Bhanu Pratap Swain Rishi Anand Tapas Kumar Barman Vatsala Department of anaesthesiology Tata Main HospitalJamshedpur 831001India

Pain in chronic pancreatitis(CP)is difficult to *** patients suffer from inadequate pain relief,completely incapacitating them in their daily ***,despite their well-known adverse effects,opioids have been the pillar of treatment regimens in painful *** management is now gradually evolving with a better understanding of the underlying pathophysiology of CP-related *** should follow a holistic approach to the management of CPassociated pain,which must involve lifestyle changes that are coupled with analgesic medications and other pain-relieving ***,there is no easy cure for vanquishing CP-associated *** patient must be evaluated on a case-by-case basis by a multidisciplinary team to decide which treatment option is best suited for that individual.

关键词： Pancreatitis Abdominal pain Palliative care Analgesics Life style Psychology

Ultrasound: A promising tool for contemporary airway management

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World Journal of Clinical Cases 2015年第11期3卷 926-929页

作者： Rakesh Garg Anju Gupta Department of anaesthesiology Pain and Palliative Care Dr BRAIRCH All India Institute of Medical Sciences Department of anaesthesiology Maulana Azad Medical College

Airway evaluation and its management remainsan ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound(US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents(clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords(children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.

关键词： Airway Ultrasound Evaluation Difficult Management