Background: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients. Methods: This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications. Results: The median (interquartile range [IQR]) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT; P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. Conclusions The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

Background: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery. Methods: We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively. Results: The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7], 3 [3–5], and 3.5 [2.25–4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period. Conclusion The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022)

Background: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery. Methods: We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively. Results: The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7], 3 [3–5], and 3.5 [2.25–4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period. Conclusion The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022)

Background: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery. Methods: We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively. Results: The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7], 3 [3–5], and 3.5 [2.25–4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period. Conclusion The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022)

Background: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery. Methods: We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively. Results: The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7], 3 [3–5], and 3.5 [2.25–4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period. Conclusion The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022)