JMIRxMed JMIRx Med JMIRx Med 2563-6316 JMIR Publications Toronto, Canada v2i2e29608 10.2196/29608 Authors’ Response to Peer Reviews Authors’ Response to Peer Reviews Authors’ Response to Peer Reviews of “Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series” Meinert Edward Hannan Md Jafrul MS 1
Department of Pediatric Surgery South Point Hospital Apt B3, House 72/A, Road 1, Panchlaish Chittagong, 4100 Bangladesh 880 1819345305 jafrulhannan@gmail.com
https://orcid.org/0000-0002-2714-2418 Parveen Mosammat Kohinnor MPhil 2 https://orcid.org/0000-0003-0782-9201 Nandy Alak DA 3 https://orcid.org/0000-0002-1829-3740 Hasan Md Samiul MS 4 https://orcid.org/0000-0001-5470-2241 Department of Pediatric Surgery South Point Hospital Chittagong Bangladesh Department of Pharmacology & Therapeutics Rangamati Medical College Rangamati Bangladesh Department of Anesthesiology Chattagram Maa-O-Shishu Hospital Medical College Chittagong Bangladesh Department of Pediatric Surgery Dhaka Shishu Hospital Dhaka Bangladesh Corresponding Author: Md Jafrul Hannan jafrulhannan@gmail.com Apr-Jun 2021 28 4 2021 2 2 e29608 13 4 2021 13 4 2021 ©Md Jafrul Hannan, Mosammat Kohinnor Parveen, Alak Nandy, Md Samiul Hasan. Originally published in JMIRx Med (https://xmed.jmir.org), 28.04.2021. 2021

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 https://preprints.jmir.org/preprint/25204 https://med.jmirx.org/2021/2/e29604/ https://med.jmirx.org/2021/2/e29607/ https://med.jmirx.org/2021/2/e29605/ https://med.jmirx.org/2021/2/e25204/ pediatrics appendectomy spinal anesthesia general anesthesia laparoscopy vomiting keyhole surgery anesthesia appendix

This is the authors’ response to peer-review reports for "Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series."

Round 1

The authors of the manuscript [1] thank the editor and the reviewers [2-4] for their valuable comments and suggestions to improve the paper. We have substantially modified the manuscript to address the issues raised. We will address them individually.

Anonymous [<xref ref-type="bibr" rid="ref2">2</xref>] Specific Comments Minor Comments

1. We have changed the wording in the Abstract and Introduction sections.

2. We have addressed this and moved the descriptive statistics table to the Results section.

3 and 4. We have significantly modified the results and their presentation. The mosaic plots in the figures have been replaced with tables with P values from the Fisher exact tests for all comparisons. We have also now included odds ratios for these with upper and lower confidence levels (95%). We believe this adds to the robustness of the statistical analysis while enabling the written description of the results to follow with more brevity. We believe it is easier to read.

5. We have deleted this part as we agree it is a bit ambiguous.

 Anonymous [<xref ref-type="bibr" rid="ref4">4</xref>] General Comments

1. The groups were similar in age and gender.

2. Yes, the presence of postoperative nausea or vomiting was a binary response.

 Specific Comments Major Comments

We agree that the attempts to correlate pain scores with anesthesia were going to be confounded by the analgesics, which is why we had those figures as supplemental material. However, this was described in the manuscript proper, which we have since removed (and the supplemental figures as well).

We have left the incidence of vomiting as a measure of patient comfort in the paper. It was our goal to compare the two procedures (spinal vs general anesthesia), and by procedure, this includes the usual standard-of-care protocols for each anesthetic. Naturally, it would have been better if the exact same protocols could have been used during the administration of both anesthetics, but that is not possible. Even if the vomiting is largely a result of nitrous oxide use in the general anesthetic, that could be a good enough reason to use spinal anesthesia all by itself. Our results verify this. Additionally, there is evidence that this nitrous oxide effect is mostly predominant in longer procedures. According to Peyton and Wu [5], a “duration of exposure to nitrous oxide less than 1h has little effect on the rate of postoperative nausea and vomiting.” The maximum operation times in our study were ~45 minutes.

 Minor Comments

1. A native English speaker has reviewed and made further copyediting changes.

2. The currency (Bangladesh taka) has now been listed in the text and along the figure axis title.

 Round 2 Further Editorial/Peer-Reviewer Comments

The study has been labeled a “case-series report” as advised.

 Hannan MJ Parveen MK Nandy A Hasan MS Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series JMIRx Med 2021 04 2 2 e25204 https://med.jmirx.org/2021/2/e25204/ 10.2196/25204 Anonymous Peer Review of "Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series" JMIRx Med 2021 04 2 2 e29604 https://med.jmirx.org/2021/2/e29604/ 10.2196/29604 Aslanidis T Peer Review of "Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series" JMIRx Med 2021 04 2 2 e29607 https://med.jmirx.org/2021/2/e29607/ 10.2196/29607 Anonymous Peer Review of "Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series" JMIRx Med 2021 04 2 2 e29605 https://med.jmirx.org/2021/2/e29605/ 10.2196/29605 Peyton Philip J Wu CY Nitrous oxide-related postoperative nausea and vomiting depends on duration of exposure Anesthesiology 2014 05 120 5 1137 45 10.1097/ALN.0000000000000122 24401771