Shiv-mix for perioperative hemodynamic stability and analgesia: A new paradigm for limited resource centres

Dear editor, A very interesting article has been published in your esteemed journal titled “Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: prospective randomized study” by Kothari et al., (December 2022|Vol 13|Issue 12). Research is not complete unless it reaches to its potential audience. We, firstly, would like congratulate the authors publishing their research such a important topic. Authors have described findings clear scientific manner. Randomized double-blinded studies provide inferences which are considered more authentic. this study used envelop method allocating patient two groups; intervention control. Findings will definitely help readers practitioners providing safe stable anesthesia patients. In study, concluded that combination effective attenuating responses laryngoscopy intubation. They also found better stability intraoperative post-operative anesthesia. Finally, they opined when given together prolonged analgesia can be obtained. discussed efficacy safety various medications (Lignocaine, fentanyl, esmolol, sulfate) comparing with placebo different combinations attenuate intubation response. However, last paragraph introduction discussion, wrote could find any single using all three drugs (intravenous lignocaine) simultaneously attenuation changes We draw kind attention work utilized same similar effects support conclusions those studies. do agree these were nor RCTs but case series. Two related articles here. Khan Singh narrative review efficacy, safety, satisfaction tramadol, (Shiv-mix 1, 2, 3). opioid free (OFA) regimen (Shiv-mix) laryngoscopic series, hemodynamics absence some commonly seen complications as PONV shivering. another series Ansari OFA describing ten cases laparoscopic cholecystectomy, Shiv-Mix (A infusion preoperatively was safe, opioid‑sparing, feasible option good analgesia, hemodynamics, an uneventful recovery profile. again al. hope discussion researchers course opening new horizons multimodal analgesia.