She has worked in various teaching capacities as lecturer, Asst Prof, Associate Prof in the Dept of Anaesthesia, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka from January 1997. She is working as Professor in the same department since 2006. She took over as Professor and Head of the department on 1st Aug 2021. Her grand undergraduate and post graduate teaching experience is 26 years to date. She is a Post Graduate teacher and guide of the Rajiv Gandhi University of Health Sciences, Bengaluru since 2004. She is postgraduate examiner for several prestigious universities.
KIMS is one of the largest multi-speciality hospitals in North Karnataka. Established in 1957 , it is a Karnataka Government accorded autonomous Institute recognised by the MCI and offering undergraduate courses and a wide array of postgraduate courses in various specialities.
Dr Madhuri Kurdi further did her WHO Fellowship in Neurointensive Care at NIMHANS, Bengaluru in 2003. She completed her A
EDUCATION
Dr Madhuri Kurdi passed MBBS in 1991 & M D Anaesthesiology in 1996, both from B J Government Medical College and Sassoon General Hospitals, Pune, Maharashtra
RESEARCH INTERESTS
Dr Madhuri has a keen interest in research and publications. She has been a peer reviewer for several indexed journals including the Indian Journal of Anaesthesia. She won ISA-IJA Best Peer reviewer Award in 2016-17. She has been working as assistant editor of Journal of Anaesthesiology Clinical Pha
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Scopus Publications
Scopus Publications
Sugammadex in India: Still on the runway, cleared for take-off, grounded by economic constraints… Madhuri S. Kurdi, Nitin Choudhary Indian Journal of Anaesthesia, 2026 Neuromuscular blocking agents (NMBAs) are indispensable elements for providing balanced anaesthesia. Moreover, their role has extended beyond the realms of the operating room (OR), and they are now being routinely used in emergency settings and intensive care units.[1,2] Despite their well-established benefits, they do come with their safety concerns. Residual neuromuscular blockade is one of the most feared complications with NMBAs, which can compound to postoperative pulmonary complications (POPC), prolonged recovery, and diminished airway reflexes, resulting in increased morbidity and mortality.[1,3] Thus, the unceasing search for an efficient, reliable, and predictable reversal agent for NMBAs has led to the discovery of sugammadex. Sugammadex was first produced in 1999 while its human trials got successfully completed in the year 2005. Following this, the European Union approved its clinical use from 2008.[4] Keeping pace with the developments of the western world, a seminal editorial on sugammadex in 2009 in the Indian Journal of Anaesthesia (IJA) introduced this drug to the Indian anaesthesia fraternity.[5] Having discussed the index drug in the light of the available evidence, its potential for rapid recovery and the possible limitations are addressed in this editorial.[5] Despite the stated advantages, the journey of sugammadex has not been far from straightforward. Early reports on alleged hypersensitivity reactions, bradycardia, and rare instances of cardiac arrest raised safety concerns. They acted as a major hurdle in procuring the United States Food and Drug Administration approval which was granted much later in the year 2015.[4,6] In India, this drug became available for clinical use much later, around 2022, owing to several concerns such as the cost constraints, greater familiarity of consultants with conventional drugs, delayed regulatory availability, and limited access to quantitative neuromuscular monitoring in various healthcare facilities.[4] This delay in the availability of the drug for clinical use has had a tangible impact on the Indian research ecosystem, restricting early clinical experience and slowing the generation of indigenous evidence compared to developed nations. Nevertheless, research on sugammadex and its clinical application in various clinical conditions and patient populations is underway in our nation and the globe, as evidenced by the number of postgraduate theses being submitted on topics related to this drug and the increasing number of manuscript submissions to IJA and publications in IJA on this topic.[7-9] This issue of IJA features original research by Srihitha et al.,[10] wherein the authors have compared the effects of sugammadex and neostigmine/glycopyrrolate combination on peak expiratory flow rate (PEFR) in adult patients undergoing laparoscopic cholecystectomy under general anaesthesia. The authors of this study assessed 112 patients, out of which 86 could be enroled in the study (43 per group). The neuromuscular blockade in these patients was reversed using a group-specific reversal agent (sugammadex 2mg/kg versus neostigmine 50 μg/kg + glycopyrrolate 10 μg/kg) on attaining a train-of-four count of 4. The pre-operative and post-operative (30 min post extubation) PEFRs were compared. The mean percentage reduction in PEFR from baseline was significantly lower in the sugammadex group (9.66 ± 6.11%) in comparison to the neostigmine/glycopyrrolate group (16.33 ± 10.9%), and this difference was found to be statistically significant (P = 0.001).[10] The results of this index study suggest a more complete functional recovery of respiratory mechanics with sugammadex over the conventional neostigmine/glycopyrrolate combination as a reversal agent for NMBAs. That being said, the authors do acknowledge the limitation of isolated use of PEFR in the assessment or exclusion of the likelihood of POPC as far as the study drugs are concerned. Future research studies may incorporate more comprehensive endpoints such as lung ultrasound, arterial blood gas analysis, and chest radiograph to evaluate and compare the incidence of POPC between the drugs under investigation.[10] Although a cost-effectiveness analysis between the study groups was not done in the study, the authors propagate sugammadex as a more cost-effective alternative to neostigmine/glycopyrrolate combination for reversing the effect of NMBAs. They justify these claims on the grounds of decreased OR time mounting to high productivity, decreased incidence of POPC and subsequent re-admissions, and decreased length of hospital stay.[10] Nonetheless, there are studies wherein the cost of the drug has been compared to the savings incurred with shorter OR time, decreased hospital stay, and lower incidence of POPC. Zaouter et al.[11] showed that sugammadex could lead to cost savings as the decreased OR time would reciprocate as an increased number of cases. Hurford et al.[12] also performed a cost analysis which reflected that routine use of sugammadex would lower the average cost of OR time valued at $8.6/min. But these studies are from the western world with a different healthcare system and economic infrastructure when compared to many developing countries. With the advent of sugammadex in India, it is important to address certain concerns pertaining to its use in clinical practice. The concerns include the readiness of the Indian healthcare system to accept it as the ‘go to drug’ for all cases receiving NMBAs. Currently, sugammadex is an expensive drug, especially in comparison to neostigmine/glycopyrrolate combination.[4,6] In the absence of large multicentric trials in the Indian population addressing the financial concerns with sugammadex and comparing it with conventional reversal agents, it would be too early to take a decision on its final place in routine anaesthesia practice.[4] As of now, its use in our nation is limited in financially constrained patients, selected based on risk factors after weighing the risk–benefit ratio and routinely in well-to-do patients and those with health care insurance. Another concern regarding the rationale use of sugammadex is the requirement of quantitative neuromuscular monitoring as it helps in titrating the drug dosage, thereby preventing underdosing as well as overdosing.[13] These monitoring devices are not part of the mandatory standard American Society of Anesthesiologists’ (ASA) recommendations and therefore may not be readily available in all healthcare setups. However, recently, the ASA has emphasised on the use of neuromuscular monitoring while administering NMBAs.[1] These devices may incur additional financial burden on the health economy of developing nations. Apart from the logistic problems, the patient-specific concerns merit concurrent attention. In this context, the use of sugammadex in special patient cohorts such as obstetrics, paediatrics, end-stage kidney disease, and obesity has been under scanner and requires careful consideration owing to the physiological/pathological changes which would alter the drug’s pharmacokinetics as well as pharmacodynamics.[6,14] At the same time, sugammadex is usually being well tolerated and has been linked to adverse effects such as anaphylaxis, hypersensitivity, bradycardia, hypotension, laryngospasm, bronchospasm, impaired coagulation pathway, and untoward interaction with hormonal contraceptives.[6,15-17] However, the above-stated side effects are dose-dependent and more frequently reported with the free form of the drug.[18] Meanwhile, another gamma-cyclodextrin, adamgammadex is now coming up. It has currently successfully completed phase III trials, is awaiting regulatory approval and is associated with less allergic reactions.[19] Sugammadex has undoubtedly transformed the science of neuromuscular blockade reversal. In India, however, its journey reflects a balance between innovation and pragmatism. Its journey reflects a measured and thoughtful integration into practice rather than rapid adoption. More than a novel agent, it is an evolving presence—making the way upward, finding its niche with the generation of context-appropriate evidence on the evolving opportunities and challenges in routine clinical adoption.[10,20,21] Often referred to as a ‘revolutionary drug’ and predicted 12 years back to produce the demise of suxamethonium,[22] the journey of sugammadex still continues. The passing bells for suxamethonium and neostigmine have started ringing; however, whether and when the death knell will ring for both is not yet clear. It is certain that at present, and since the last several years, the trajectory of sugammadex remains constrained—cleared for take-off, yet grounded by cost! Will sugammadex ultimately fly? Author contributions MSK was involved in concepts, design, definition of intellectual content, literature search, manuscript preparation, review and approval. NC was involved in concepts, design, definition of intellectual content, literature search, manuscript preparation and review. Disclosure of use of artificial intelligence (AI)-assistive or generative tools No AI-assistive or generative tools were used. Declaration of use of permitted tools No permitted tools were used.
Indian expert consensus on intra-operative consciousness monitoring using processed electroencephalogram-based indices: A Delphi-based approach Sukhminder Jit Singh Bajwa, Sangeeta Khanna, Ti Lian Kah, T Jithendra, Ajay Prasad Hrishi, et al. Indian Journal of Anaesthesia, 2026 Background and Aims: In India, depth of anaesthesia monitoring with processed electroencephalogram (pEEG) is not routinely implemented. During volatile-based anaesthesia, end-tidal anaesthetic gas concentrations and age-adjusted minimum alveolar concentration values are widely accepted surrogates of anaesthetic depth. However, these measures do not directly reflect cortical activity, and no equivalent objective surrogate exists during total intravenous anaesthesia (TIVA). pEEG monitoring provides a direct assessment of cerebral activity and may support optimised anaesthetic titration, particularly in TIVA and other high-risk scenarios. The primary objective of this Delphi consensus was to develop expert-based, India-specific recommendations for the use of pEEG-based indices in intra-operative anaesthesia practice. Methods: A modified Delphi approach was employed with 15 anaesthesiology experts (13 Indian and 2 international). A Preferred Reporting Items for Systematic Reviews and Meta-analyses-based literature review, covering studies from 2016 to 2025, was conducted to develop 27 draft statements across 10 themes, including indications, target ranges, interpretation, and integration of pEEG with existing monitoring. Through structured iterative rounds involving a steering committee meeting (March 2025), and two rounds of advisory board (May 2025), the statements were revised, eliminated, or accepted based on high (≥80%), moderate (60-80%), or low (<60%) consensus. Results: Of the 27 initial statements, 19 achieved consensus and were included in the final statements. The statements spanned key clinical domains, including the need for depth of anaesthesia monitoring, role of pEEG-based indices, clinical benefits, indications based on anaesthetic techniques (TIVA and inhalational anaesthesia), patient characteristics, surgical context, and practical usage guidance, including target ranges and interpretation. Overall, the consensus supports the use of pEEG monitoring as an adjunct to optimise anaesthetic delivery, reduce drug consumption, and improve recovery profiles, particularly in high-risk and TIVA settings. Conclusion: This Delphi-based consensus provides a clinically relevant framework for integrating pEEG monitoring into anaesthesia practice in India. These recommendations aim to support personalised anaesthetic titration, enhance patient safety, and align peri-operative care with evolving global standards while accounting for local practice variability.
Changing winds, a silent return, and promises to keep: The journey resumes in an artificial intelligence era Madhuri S. Kurdi, Sukhminder Jit Singh Bajwa Indian Journal of Anaesthesia, 2026 Since its birth in 1953, the Indian Journal of Anaesthesia (IJA) has been the bundle of joy of the Indian Society of Anaesthesiologists (ISA) and has been the glorious academic face of anaesthesiology in our nation.[1] Its growth has been much like that of a prince loved and respected by his kingdom, namely, the members of ISA. The innumerable hours of toil and dedication of the previous Editor-in-Chiefs and editors, thoughtful policies of the various policy makers of the ISA, sincere criticism of its reviewers, enthusiastic research inputs of its authors, and the consistency of its publishers have continued to nurture it and seen it pass through thick and thin, be it the coronavirus disease (COVID)-19 pandemic or times of disasters and war.[2] Every Editor-in-Chief comes with a vision and mission to fulfill and goals to achieve. The change of guard occurs every 3 years at IJA, and editorial teams change as per the changing norms of the academic atmosphere.[3] A fine bond is established over these 3 years between the editors and the journal. They part with a sense of accomplishment, and the scientific journey of IJA continues steadily along the tracks of time with the publication of the monthly issues, supplements, and thematic issues.[1] However, just publishing is not enough. It has to have a strong message for the betterment of the mankind in general and the patient in particular. The editorial team needs to remain alert and grounded as if in a cockpit and has to concentrate on landing safely in the company of journals with a high impact factor and scientific credibility. In fact, a good and stable impact factor is the need of the hour, and we editors, authors, and reviewers have to work hard to establish long-term strategies that will help us achieve this. At present, there are many academic milestones in the vision, some new and some imbibed from old achievements but in a renewed manner. These goals are the lighthouse which will definitely help in taking the sail over the next few years. CHOOSING GOOD QUALITY ARTICLES AND MAINTAINING EDITORIAL RESPONSIBILITIES The publication of good quality studies that will be cited and can improve the impact factor needs silent, smart, and intelligent editorial work; policies; and concrete action. It is not possible to get landmark research articles frequently. However, even small researches sometimes make an extensive contribution to the existing literature. Authors provide us with food from their research pantry in the form of manuscripts. Just as some dishes are just palatable, some delicious, some in need of improvement by virtue of salt and pepper, and some just unpalatable, the articles submitted to IJA have a variety of consistencies, flavours, and textures and are submitted by authors from a variety of institutions and from different parts of our country. Just as food ought to have variety, be tasty, yet healthy and gut-friendly, all of it be presented in an attractive way on the platter, the research articles that are published in IJA or for that matter in any reputed journal have to be built on robust methodologies, accurate results, meticulous analysis and interpretation, and sublime presentation. Just as a gourmet relishes new and tasty foods served in elegant cutlery, the global academic community recognises and notices novel research questions and novel observations that are published in prestigious indexed journals. Nonetheless, the IJA has established its reputation now both nationally and internationally over the last two decades. An Editor-in-Chief is as good as his or her editorial board members. Proactive and sincere editorial board members who are willing to take up the challenge of handling the bulk of the workload and sparing their regular precious time daily for the progress of the journal are an asset for the journal. It is easy for any editor to reject the article on multiple grounds. However, the real challenge starts when an editor makes an effort to help the authors whose manuscript is average or just borderline. This creates a far better learning platform for the authors and improves the overall research and academic atmosphere of the nation. The standards of research with an emphasis on ethical aspects and the reproducibility of the studies, even in the lesser teaching institutes and transparent validation of data, are very important for any journal. With artificial intelligence (AI) making stronger inroads into every field, the task of the editor of a journal, especially a medical journal, has become very tough. With AI-enabled submissions picking up the momentum, it is prudent for any editor, when in doubt, especially to ask for the master charts of the research. The rising impact factor, increased citations, higher progressive ranking, and top quartile put the journal in advanced stages of popularity. It is hard work for any editor, but the effort should always be there for the progress, sometimes ignoring the complex system errors which are constitutive and unavoidable. The invasion of AI and Chat GPT into the peer review process has further compounded the challenges of an editor. AI can pick up any information available on the global virtual database without differentiating the authenticity, validity, and accuracy of the data. The novel purpose of feasibility, reproducibility, and practicality of such studies is defeated. If such factitious data become the platform of future studies and implementation into clinical practice, it can be catastrophic for the patients and the mankind. Editors and reviewers have to learn the basics and advanced modalities of AI in such a manner that whatever research data are presented to them in the manuscripts, should be validated with authenticity rather than relying on an easy process of rapidly generated reviews. The selection of quality articles for publication rests upon the chief editor and the editorial team as only good quality articles are cited in an international high impact journal. It works both ways. If an author chooses the most suitable journal for his hard work, so does the editor have the independence of choosing the right article for the journal depending upon its scope. The quality of a good research manuscript is basically determined by its novelty which is further based on a sound research question, simple yet good keywords, precisely written abstract, use of simple and jargon-free language, avoiding pompous claims, and over-inflating the findings of the study. Most importantly, it should have a robust methodology, meticulous collection and analysis of data, logically but eloquently written discussion, and the most suitable and recent references. Such a study, whether a meta-analysis or research article, will prove to be an asset for the journal and definitely enhance the citations, impact factor, and ranking of the journal apart from contributing to the patient welfare. The stricter norms of the indexing agencies may compel the editor to resort to social media coverage as well as broadcasts, so as to enhance the visibility of the journal. Such methods may appear appealing to the less academically oriented people; however, on the scientific side, such measures fail to live up to the scientific scales and are not capable enough to take the journal to a high impact score or ranking. INCREASING THE PUBLICATION OF GOOD QUALITY ORIGINAL RESEARCH ARTICLES AND META-ANALYSES The sporadic publication of systematic reviews (SRs) and meta-analyses that had started in IJA has now turned into an explosion with the publication of five to six meta-analyses in each issue of IJA in the last 3 years. This is certainly a matter of pride; however, at this juncture, one has to ponder and remember that though SRs and meta-analyses occupy the highest position in the pyramid of evidence-based medicine, they have a darker side to them. Are all SRs and their conclusions reliable? Can we put them into clinical practice? Nonetheless, SRs and meta-analyses have their own dark secrets and are associated with limitations about which clinicians should be aware. For an editor, it may provide an academic and publishing comfort, but their conclusions and messages delivered have to be taken with a pinch of salt.[4] As there is a sheep race for writing meta-analyses nowadays, editors have to ensure that besides authenticity, the researchers should have a sound base in that particular field of research and clinical practice. The category per se does not ensure that the topmost articles of the publication pyramid need to be accepted and published every time. The mad frenzy for publications in indexed journals continues with the continuation of the National Medical Commission rule regarding publication of original research in indexed journals.[5,6] Increasing the number of original articles published is possible only by increasing the number of issues. Like a child in trouble who looks up to their parents and family for support, the publication-driven medical fraternity, especially the anaesthesiology fraternity from our nation, will look up to the IJA family for help. We are happy to announce in this context the relaunching of the zonal supplements of IJA. The Northern supplement has already been launched at the North Zone ISACON on 31 January 2026. The other zonal supplements, namely, the central, western, southern, and north-eastern, will soon follow. MAKING IJA AN AUTHOR-FRIENDLY JOURNAL It is our commitment to make IJA an author-supportive journal. To do this, the provision of author support has already begun, whereby guidance is provided to amateur authors for writing articles and advice is imparted to the authors of rejected articles. It was long due, and this aspect had to be taken seriously as research needs to be refined in every corner of our nation. The provision of timely and quality peer reviews and rational editorial decisions on the submitted manuscripts will be the prime concerns of the new team which is already well experienced with the editing and the publishing standards. MAINTAINING THE EXTERNAL HEALTH OF THE JOURNAL As mentioned by the outgoing Editor-in-Chief of IJA, the last few years have seen IJA experience an increase in manuscript submissions, faster manuscript submission-decision time, broader international authorship, digital transformation, financial stability, and digital innovation.[7] We congratulate him for his focused and hard work. We will continue to maintain this trend and endeavour to get a respectable place for IJA in the global academic community and on library shelves. Social media, in all its forms, has engulfed almost all walks of life including the world of publications, and this has resulted in socialisation of the research metrics.[8] IJA too was a part of this socialisation, and the years 2023–25 saw the journal leap forward in its Altmetric scores.[7] However, it is important to note at this juncture that the actual popularity of a journal can be judged not by the social media coverage but by the traditional indicators of scientific impact, namely, the number of citations, impact factor, quartile placement, h-index, and a few more indices. Meanwhile, the rush of authors at IJA continues. There is little respite at the IJA: manuscript submissions, technical checks, peer reviewing, re-submissions, rejections, acceptance, author-checks, proof reading, and the issue coming on line, all taking place in a continuum, with precision and in perfect rhythm. Nevertheless, the entire process starting from manuscript submission and ending with the issue coming online needs perfect coordination and cooperation between the editors, the authors, the reviewers, and the publishers. We hope to keep this rhythm afloat and row the boat of IJA even more gently, carefully, and with foresight keeping in mind the goals of reaching the rich academic and international shores that lie ahead, keeping the flag of ISA flying high. Disclosure of use of artificial intelligence (AI)-assistive or generative tools No AI-tools were used. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Message by the Editor-in-Chief, Indian Journal of Anaesthesia Madhuri S Kurdi Indian Journal of Anaesthesia, 2026 Respected members of the Indian Society of Anaesthesiologists (ISA), Warm Greetings! It is a happy moment for me as I write this message on the occasion of the restarting of the zonal supplements of the Indian Journal of Anaesthesia. The Northern Zone of the ISA has always been in the forefront of activities of the ISA, and academics is no exception. Northern India boasts of premier and prestigious academic institutions which are known for their academic excellence in our fraternity. The research output that is being delivered from these areas needs to be shared with the global academic community, and for this, it has to appear on the pages of a journal. The supplements will provide space for sharing this research. However, in this endeavour, one should not forget the basics of research and scientific writing. Research conducted by the author should be perfect regarding every aspect, starting from inception of the research question to submission of the manuscript to the journal. This includes a novel research question, a robust study design, sincere data collection, accurate statistics, and appropriate conclusions. Such a study, when complemented by good scientific writing and following of the journal author instructions and research ethics, can never be rejected and will always find a place on the pages of a prestigious journal. I congratulate the Editor In-charge of the Northern Supplement and the entire editorial team of the Northern Supplement for coming out with this issue, which has quality articles authored by anaesthesiologists from almost all the northern states of our nation. Long Live ISA! Warm regards Dr. Madhuri S Kurdi Editor-in-Chief Indian Journal of Anaesthesia
Comparison of perineural dexamethasone and dexmedetomidine as adjuvants in reducing rebound pain in patients undergoing peripheral nerve block: A double blind randomized controlled study Madhuri S. Kurdi, K Abinaya, Dharmesh A. Ladhad, Kaushic A. Theerth, Milon V. Mitragotri Journal of Anaesthesiology Clinical Pharmacology, 2025 Background and Aims: Rebound pain (RP) is a distressing, yet not much explored, entity. This study aimed to evaluate and compare how adjuvants like dexamethasone and dexmedetomidine added to 0.5% ropivacaine for peripheral nerve block (PNB) can impact RP. Material and Methods: In this randomized, double-blinded study, 72 patients posted for elective upper limb surgeries under brachial plexus block were randomly divided into three groups of 24 each. Group A received 28 ml 0.5% ropivacaine +2 ml normal saline, Group B received 28 ml 0.5% ropivacaine + 8 mg dexamethasone (2 ml), and Group C received 28 ml 0.5% ropivacaine +50 µg dexmedetomidine (2 ml). The incidence and onset of RP, as well as the duration of sensory and motor block, were compared between the groups. The distribution of variables was compared using appropriate statistical tests. Results: On postoperative days 1 and 2, the RP incidence was significantly lower in the dexmedetomidine group (12.5%, 16.67%) and dexamethasone group (25%, 20.83%), compared to the control group (54.17%, 58.33%) (P = 0.006 and 0.003 respectively). Patients in the dexmedetomidine group had a significantly delayed onset of RP (P = 0.0475). The motor and sensory block duration was prolonged in both, the dexmedetomidine group (410.83 ± 116.17 min, 442.5 ± 116.4 min) and dexamethasone group (375 ± 90.7 min, 418.54 ± 97.84 min) compared to the control group (321.25 ± 69.85 min, 358.33 ± 75.9 min). There was no significant difference between the two adjuvants in prolongation of sensory (P value 0.676) and motor blockade (P value 0.390). Conclusions: The incidence of RP is significantly reduced when dexmedetomidine and dexamethasone are added as adjuvants to 0.5% ropivacaine in upper limb PNBs, with dexmedetomidine being superior in this regard.
Routine preoperative testing of serum electrolytes, blood urea, serum creatinine in patients undergoing elective surgeries of minor and intermediate risk and its implications on anesthetic management: A prospective observational study Madhuri S. Kurdi, M S Anusha, Dharmesh A. Ladhad, Kaushic A. Theerth, D Bhuvanvijay, K Abinaya Journal of Anaesthesiology Clinical Pharmacology, 2025 Background and Aims: There is limited evidence to suggest that routine testing of serum electrolytes, blood urea, and serum creatinine in low-risk patients significantly improves surgical outcomes or reduces complications. This study aimed to evaluate the need of these investigations in patients of American Society of Anesthesiologists physical status (ASA-PS) I and II scheduled to undergo elective surgeries of minor and intermediate risk. Material and Methods: We conducted a prospective, observational study at a tertiary care hospital, involving 1166 patients aged 18–60 years with ASA-PS grades I and II, undergoing elective minor and intermediate-risk surgeries. Comprehensive preoperative evaluation included documentation of demographic data, medical history, medications, pre- and postoperative values of blood urea, serum creatinine, and serum electrolytes. The study design incorporated assessment of changes in anesthetic management, including ordering of repeat tests, specialist referrals, and surgery postponements or cancelations. Postoperative complications related to electrolyte disturbances were monitored. Statistical analysis included Chi-squared test for categorical variables and dependent t-test for comparing pre- and postoperative changes in biochemical parameters. Data was entered in Excel and analyzed using Statistical Package for the Social Sciences (IBM, Bangalore, India) version 23. Results: A total of 148 (12.69%) patients underwent repeat tests preoperatively; none of them experienced any postponements/cancelations or changes in anesthetic management. Statistically significant changes were observed in blood urea, serum creatinine, and serum electrolyte values across all anesthesia types and comorbidities (P < 0.05). However, these changes remained within clinically acceptable limits and did not necessitate alterations in patient management. Notably, only 0.26% of patients required postoperative repeat tests, and no patients needed referral to superspecialty care. Conclusions: Our study provides substantial evidence indicating that routine preoperative assessment of blood urea, serum creatinine, and serum electrolytes may not be necessary for ASA-PS I and II patients undergoing elective minor and intermediate-risk surgeries.
Systematic Reviews and Meta-analyses: Their darker side… Journal of the Indian Medical Association, 2025
Comparison of the effects of two amino acids, Gamma-aminobutyric acid (GABA) and L-theanine, on sedation, anxiety, and cognition in preoperative surgical patients – A randomized controlled study Shrinidhi S. Deshpande, Madhuri Kurdi, Amrita Baiju, A. S. Athira, Athira G. Sarasamma, Arunima K. Gangadharan Journal of Anaesthesiology Clinical Pharmacology, 2025 Background and Aims: Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality. Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation. Hence, alternative premedicants such as L-theanine and GABA will have a widespread appeal and are safer. The primary objective was to study and compare the effects of L-theanine and GABA on preoperative anxiety, sedation, and cognition in patients posted for major elective surgeries. The secondary objective was to study adverse reactions. Material and Methods: A total of 168 patients aged between 18 and 55 years, belonging to the American Society of Anesthesiologists physical status class I and II, and satisfying all inclusion criteria were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs. Results: Alprazolam produced more sedation than GABA and L-theanine (P = 0.0001). Psychomotor and cognitive functions improved with L-theanine and GABA (P = 0.0001) and decreased with alprazolam (P = 0.0001). Conclusion: GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.
Vegetable gum based gel lubrication of endotracheal tube cuffs improves efficacy of alkalinized intracuff lignocaine in preventing postoperative sore throat: A randomized controlled study Anaesthesia Pain and Intensive Care, 2016
