Trends in research in Indian Journal of Anaesthesia – A bibliometric analysis

Over the last three decades, the field of anaesthesiology has expanded beyond its traditional boundaries into arenas such as pain medicine, critical care, rehabilitation, patient safety, and quality improvement. As the speciality has grown, it has provided opportunities to explore newer areas of research. Studying the trends of research offers a glimpse into future advancements. In this commentary, we attempt to perform a snap-shot bibliometric analysis of original articles and aim to know the patterns of research and publications published in the Indian Journal of Anaesthesia (IJA) in 2022. In 2022, a total of 65 original articles were published in the monthly issues of IJA. Grossly, the articles could be divided into three categories, namely anaesthesiology (n = 37), critical care medicine (n = 17), and pain medicine (n = 11), based on their primary objective and site of conduct of the study. However, there was an overlap between the sub-specialities. Most of the studies were single-centred, whereas only two studies were multi-centric. Thirteen studies had prospective observational design, whereas an equal number of studies were comparative non-randomised controlled. Randomised controlled trials (RCTs) are considered the gold standard to assess the effectiveness of an intervention in an unbiased manner. The high number of RCTs (n = 36) among the original articles shows a trend towards conducting good-quality research. However, very few retrospective studies (n = 2) could also reflect inadequate data-keeping practices in anaesthesiology. In addition, most of the original studies were single-centred (n = 62). Scarce multi-centric studies could indicate a lack of collaborative research in the field of anaesthesiology. Fifty-one studies were conducted at centres in India, whereas 11 studies were conducted at centres outside India. The coronavirus disease 2019 (COVID-19) pandemic offered the scientific community enormous opportunities to explore new devices. IJA also published eight original articles addressing airway management, ventilation practices, and protective devices in COVID-19 patients.[1-8] Despite the declining trend in the volume of COVID-19-related research, it was interesting to note that a few of the COVID-19-related articles attracted high viewership across the world.[5,7] Airway management is an integral part of anaesthesia practice and hence, a niche area for research in anaesthesiology. The major thrust in the area of airway-related research was on the evaluation of various designs of video laryngoscopes (VL), including the split-type postman VL, a self-assembled VL (Airtraq DLTM), and the C-MAC D-blade.[2,9-14] The utility of VLs was assessed in difficult airway scenarios (e.g. patients with limited neck extension, double-lumen tube insertion, awake orotracheal intubation, etc.), and all the articles demonstrated the superiority of video-laryngoscopes over the conventional laryngoscopes. It was also interesting to note that the training of novice anaesthesiologists with VL improved their performance with the conventional laryngoscope.[13] Post-operative pain management was another prominent area of research. In 11 original articles, newer trends in post-operative pain management were clearly evident.[15-25] The most notable area of interest was the utility of fascial plane nerve blocks. Fascial plane nerve blocks offer somatic pain relief following the surgery and reduce the requirement for other analgesics, such as opioids. These blocks provide an effective alternative for central neuraxial blocks and can be used when central neuraxial blockade is contraindicated. Four comparative studies found the erector spinae plane block (ESPB) useful in the management of postoperative pain following thoracotomy, nephrolithotomy, and laparoscopic upper abdominal surgeries.[16,18,23,24] Another important area of research was to assess the feasibility and effectiveness of opioid-sparing anaesthesia. Opioids, via their effect on immunity during the peri-operative period, have been implicated as a probable cause of cancer recurrence. Studies by Parthasarathy et al.[17] and Ragupathy et al.[18] showed that regional nerve blocks have the potential to reduce the requirement for opioids during the peri-operative period. In recent times, ultrasonography (USG) has greatly improved the safety of anaesthesia procedures by offering real-time visualisation and guidance. USG is increasingly finding new applications for various procedures in anaesthesiology, pain management, and critical care. This trend was evident in IJA, which published 12 original articles exploring the use of USG for haemodynamic assessment, fascial plane nerve blocks, and assessment of the adequacy of ventilation and weaning.[3,17,22,26-34] Some innovative applications of USG include the estimation of the gastric residual volume in pre-operative patients, measurement of the cross-sectional area of the dural sac to determine the dose of local anaesthetic, and assessment of lung parenchyma and diaphragm to help weaning from mechanical ventilation.[27,31,33] Anaesthesiologists are taking a lead role in the propagation of cardio-pulmonary resuscitation (CPR) practices across the world. In 2022, there were three original articles in IJA on assessing the impact of CPR training in medical and non-medical cohorts.[35-37] Thus, IJA, in 2022, published innovative, original research articles, the majority of which were RCTs. The predominant domains were airway management, acute postoperative pain and newer applications of USG in anaesthesiology and critical care.