Anesthesia: Essays and Researches  Reader Login | Users Online: 720 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Home | About us | Editorial board | Ahead of print | Search | Current Issue | Archives | Submit article | Instructions | Copyright form | Subscribe | Advertise | Contacts
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2018| April-June  | Volume 12 | Issue 2  
    Online since June 14, 2018

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
Postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl in cesarean section: A double-blind randomized comparative study
Tripat Kaur Bindra, Parmod Kumar, Garima Jindal
April-June 2018, 12(2):561-565
DOI:10.4103/aer.AER_41_18  PMID:29962635
Background: Nalbuphine when used as adjuvant to hyperbaric bupivacaine has improved the quality of perioperative analgesia with fewer side effects. Fentanyl is a lipophilic opioid with a rapid onset following intrathecal injection. It does not cause respiratory depression and improves duration of sensory anesthesia without producing significant side effects. Aim: This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section. Methodology: A prospective, randomized, double-blind, and comparative study was conducted on 150 parturients of American Society of Anesthesiologists (ASA) physical status I and II of age group 20–45 years with normal coagulation profile undergoing cesarean section under spinal anesthesia. These patients were randomized into three groups with fifty patients in each group. Group I received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group II received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 μg), and Group III received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. Results: The mean duration of effective analgesia was 259.20 ± 23.23 min in Group I, 232.70 ± 13.15 min in Group II, and 168.28 ± 7.55 min in Group III. The mean number of rescue analgesics required was significantly lower (P < 0.001) in Group I as compared to Group II and III. Conclusion: Both intrathecal nalbuphine 0.8 mg and fentanyl 20 μg are effective adjuvants to 0.5% hyperbaric bupivacaine in subarachnoid block. However, intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section.
  2,369 259 -
Dexmedetomidine and fentanyl as an adjunct to bupivacaine 0.5% in supraclavicular nerve block: A randomized controlled study
Mohamed Ahmed Hamed, Saffa Ghaber, Ahmed Reda
April-June 2018, 12(2):475-479
DOI:10.4103/aer.AER_50_18  PMID:29962619
Background: Brachial plexus block is gaining popularity day by day for upper limb surgery. The supraclavicular brachial plexus block may be used for surgical anesthesia alone or in conjunction with general anesthesia. Aims: We intended to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine on onset and duration of block and postoperative analgesia during ultrasonic guided supraclavicular nerve block for upper limb surgeries. Settings and Design: This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods: Sixty patients with American Society of Anesthesiologists physical status Classes I and II, aged 18–50 years, scheduled for upper limb surgery were randomly divided into three study groups each group contains 20 patients: C Group: receive 0.5 mL/kg up to a maximum of 40 mL volume. The dose of bupivacaine was 1.5 mg/kg. D Group: Bupivacaine as control group + 1 mg/kg dexmedetomidine. F Group: Bupivacaine as control group + 1 mg/kg fentanyl. Patients were observed for onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain, and adverse effects. Statistical Analysis Used: One-way ANOVA test and Chi-square test were used. Results: The onset time of sensory and motor blockade was shortened. and the duration of the block was significantly prolonged in the D Group (P < 0.001) and F Group (P < 0.001). The duration of postoperative analgesia was also longer in the D Group 13.5 h compared with the F Group 8.3 h and C Group 7.5 h. Hypotension and bradycardia were recorded in 2 patients in D Group, and nausea and vomiting were recorded in F Group. Conclusions: Addition of dexmedetomidine was better in prolongation of the duration of supraclavicular brachial plexus block and improvement of postoperative analgesia than fentanyl and bupivacaine alone without significant adverse effects in patients undergoing upper limb surgeries.
  2,397 225 -
Postoperative analgesic efficacy of intrathecal fentanyl compared to nalbuphine with bupivacaine in spinal anesthesia for lower abdominal surgeries
Bhavana B Gurunath, Ravi Madhusudhana
April-June 2018, 12(2):535-538
DOI:10.4103/aer.AER_55_18  PMID:29962630
Context: Subarachnoid block or spinal anesthesia is a commonly used technique for lower abdominal and lower limb surgeries. Bupivacaine is the commonly used cost-effective drug which gives satisfactory analgesia for 90–120 min. Additives such as opioids and α2 agonists extend the analgesia in the postoperative period. In this study, we compared the effects of nalbuphine with fentanyl. Aims: The aim of this study is to compare the effects of intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine in regard to time of onset of sensory blockade, duration of sensory blockade, two-segment sensory regression time, duration of effective postoperative analgesia, and incidence of side effects. Settings and Design: This was a prospective, randomized double-blind study. Subjects and Methods: After ethical committee permission and patient consent, 124 patients aged 18–55 years with American Society of Anesthesiologists physical status I and II were randomly divided into two groups – Group N: hyperbaric bupivacaine with nalbuphine (300 μg); Group C: hyperbaric bupivacaine with fentanyl (25 μg). Results: Duration of onset of sensory blockade was 3.9 ± 0.35 min in Group C and 3.1 ± 0.18 min in Group F. Two-segment sensory regression time was prolonged in Group C (193.16 ± 39.55) compared to Group F (167.41 ± 30.17 min). Conclusions: Intrathecal nalbuphine at a dose of 300 μg in 3 ml 0.5% heavy bupivacaine in patients undergoing elective lower abdominal surgeries showed delay in onset time for sensory blockade and produced prolonged postoperative analgesia, prolonged sensory blockade, and minimal bradycardia which could be easily managed.
  2,005 222 -
Assessment of job satisfaction and quality of life among practicing Indian anesthesiologists
Akshaya N Shetti, Shivanand L Karigar, Rachita Govind Mustilwar
April-June 2018, 12(2):302-308
DOI:10.4103/aer.AER_59_18  PMID:29962587
Introduction: Anesthesiologists are exposed to extreme level of stress from beginning of career. With evolution of super-specialty branches, level of stress faced has also raised. Prolonged working hours, poor hospital facilities and dependencies on surgeon are main contributing factors. Stress and unsatisfactory remuneration may lead to decrease in job satisfaction. One should have a good quality of life, but high level of stress may itself compromise quality of life. This study aims at assessment of stress, quality of life spent, job satisfaction, and health issues. Aim: The aim is to study stress level, job satisfaction, and quality of life of practicing Indian anesthesiologists. Setting and Design: This was an online survey, descriptive study. Subjects and Methods: An online survey consisting of 21 questions was sent to Indian anesthesiologists by E-mail using SurveyMonkey platform. The responses were collected and analyzed. Results: Out of 1219 anesthesiologists, 81% were satisfied being anesthesiologist, but 58% are unsatisfied with remuneration. More than one role was played by 47.7% of anesthesiologists. Nearly 83% of anesthesiologists agreed that the stress is highest among anesthesiologist compared to other medical professionals. Stress does reduce with the presence of another anesthesiologist while managing cases. Most anesthesiologists practiced various stress reduction methods of which spending time with the family was most popular method. Conclusion: This study divulges working pattern, job satisfaction, level of stress faced, methods to alleviate stress, and quality of life of anesthesiologists in India. A balanced family and professional life with proper utilization of leisure will reduce the stress.
  2,027 159 -
The effect of single-dose intravenous dexamethasone on postoperative pain and postoperative nausea and vomiting in patients undergoing surgery under spinal anesthesia: A double-blind randomized clinical study
Prabha Parthasarathy, Kavitha Babu, RS Raghavendra Rao, Shreyavathi Raghuram
April-June 2018, 12(2):313-317
DOI:10.4103/aer.AER_159_17  PMID:29962589
Background: The use of neuraxial anesthesia has dramatically increased. Acute postoperative pain is an undesirable outcome that can delay functional recovery for patients undergoing surgery. Nausea and vomiting in the postoperative period occurs in 20%–30% of the patients and together are the second-most common complaint reported (pain is the most common). Efficacy of glucocorticoids for reducing pain and inflammation after surgery is being explored. Glucocorticoids are strong anti-inflammatory agents, which can be used for a short-time postoperative pain control in various surgeries. Dexamethasone is a glucocorticoid with little mineralocorticoid effect commonly used perioperatively to reduce postoperative nausea and vomiting (PONV) and has a beneficial role in postoperative analgesia. Dexamethasone has also an antiemetic effect, in addition to its anti-inflammatory and analgesic effects. Aim: The main purpose of this study is to evaluate the effect of administration of single-dose intravenous (i.v.) dexamethasone on postoperative pain and PONV in patients undergoing surgery under spinal anesthesia. Settings and Design: A double-blind randomized clinical study was performed in our institute between November 2014 and October 2015 after obtaining clearance from the ethical committee. Materials and Methods: A double-blind randomized clinical study was performed on 60 patients posted for surgery under spinal anesthesia. Patients were randomly assigned into two groups: A (study: 2 ml [8 mg] dexamethasone) and B (control: 2 ml saline). In both the groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate, severity of pain (based on visual analog scale), and other symptoms such as nausea and vomiting were recorded at different time points during the first 24 h after surgery. Statistical methods using Student t-test (two-tailed, independent) and Fischer's exact test were used for analyzing the data. Results: Between-group comparisons indicated significant differences in terms of severity of postoperative pain and PONV (P < 0.001), MAP (P = 0.063), and HR (P = 0.071), which in the study group were lower than the control group. Conclusion: i.v. dexamethasone is efficient in reducing postoperative pain, requirement of rescue analgesia on the first postoperative day, and incidence of PONV with no significant changes in vital signs.
  1,856 238 -
Comparison of epidural bupivacaine and dexmedetomidine with bupivacaine and fentanyl for postoperative pain relief in lower limb orthopedic surgery
Arindam Sarkar, Narendra Singh Bafila, Raj Bahadur Singh, Mohd Asim Rasheed, Sanjay Choubey, Vishal Arora
April-June 2018, 12(2):572-580
DOI:10.4103/aer.AER_70_18  PMID:29962637
Context: Different trials have shown that multimodal analgesia through different techniques is associated with superior pain relief. Opioids as epidural adjunct to local anesthetics have been in use for long and α2agonists are being increasingly used for same. The present study aims at comparing the hemodynamic, sedative, and analgesic effects of epidurally administered fentanyl and dexmedetomidine when combined with bupivacaine. Aims: The aim of this study was to compare the efficacy of epidural dexmedetomidine with bupivacaine versus epidural fentanyl with bupivacaine for postoperative pain relief. Subjects and Methods: In this ongoing randomized double-blind study, 70 patients with ASA physical status classes I and II of either sex between 20 and 60 years scheduled for lower limb orthopedic surgeries under epidural block were randomly divided into two Groups (n = 35). After epidural block with 15 ml of 0.5% bupivacaine, Group I received 1 μg/kg of fentanyl and Group II received 1 μg/kg of dexmedetomidine. Onset and duration of sensory block, motor block, and time to request for the first postoperative analgesia were recorded. Statistical Analysis Used: The statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) Version 15.0 Statistical Analysis Software, Mann–Whitney U-test and Chi-square test. Results: The time to achieve T10sensory block was early in Group I (dexmedetomidine) (8.10 + 1.03 min) as compared to Group II (15.03 + 1.67 min). Onset of motor was earlier in Group I (15.10 + 1.49 min) as compared to Group II (22.77 + 1.41 min). In Group I (dexmedetomidine), the majority of patients required 2–3 rescue doses, while in Group II (fentanyl), the majority of patients required 3–4 rescue doses. Conclusions: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant due to early onset of sensory anesthesia, prolonged postoperative analgesia, and lower consumption of rescue analgesia.
  1,896 189 -
Comparison of effect of airway nebulization with lignocaine 2% versus ropivacaine 0.25% on intubation and extubation response in patients undergoing surgery under general anesthesia: A randomized double-blind clinical trial
Ramyavel Thangavelu, Ranjan R Ventakesh, Kandasamy Ravichandran
April-June 2018, 12(2):338-343
DOI:10.4103/aer.AER_83_18  PMID:29962594
Context: Both intubation and extubation are associated with pressor response. Aims: We aimed to evaluate if ropivacaine 0.25% nebulization would prevent hemodynamic and cough responses to intubation and extubation and compared it with lignocaine 2% and saline group. Settings and Design: This was a randomized double-blind clinical trial. Materials and Methods: A total of 75 patients classified as the American Society of Anaesthesiologists physical status Classes I and II belonging to 18–60 years were included in the randomized double-blind trial and divided into three groups; Group 1: received 5 ml of normal saline, Group 2: received 5 ml of 0.25% ropivacaine, Group 3: received 5 ml of 2% lignocaine through nebulization before the induction. Patients were then administered general anesthesia. Mean arterial pressure (MAP), heart rate (HR), and saturation were recorded at baseline (T1), at intubation (T2), upon anesthetic withdrawal (T3), upon eye opening (T4), upon extubation (T5), and 2 min after extubation (T6). Cough response was recorded at emergence and extubation. Statistical Analysis Used: Repeated measures analysis of variance were used to compare hemodynamic variables and Chi-square test to compare the grades of cough between the two groups. Results: The drug ropivacaine was found to be effective in reducing the hemodynamic responses to both intubation and extubation when compared to saline (P < 0.05). At extubation, though the mean values of HR and MAP were lower in ropivacaine compared to lignocaine group, the difference did not achieve statistical significance (P = 0.103 and 0.153 respectively). Only 40% of patients who received ropivacaine had cough at extubation (P < 0.001). Conclusion: Ropivacaine when used through nebulization preinduction effectively reduced both intubation and extubation responses when compared to saline. However, there was no significant difference between the ropivacaine and lignocaine on extubation response.
  1,871 165 -
A comparative study of three vasopressors for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries
Dilpreet Kaur, Aamir Laique Khan, Amitesh Pathak
April-June 2018, 12(2):333-337
DOI:10.4103/aer.AER_199_17  PMID:29962593
Introduction: Subarachnoid block, although being highly efficient with lesser drug doses, often has limitation such as hypotension, continues to be a matter of concern to the anesthetist. The present study was aimed to compare the use of phenylephrine, ephedrine, and mephentermine bolus for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries. Subjects and Methods: In a randomized, prospective study, 90 adult patients of either sex who developed hypotension during surgery under subarachnoid block were allocated into three groups to receive bolus phenylephrine, ephedrine, and mephentermine. The number of boluses and time taken to recover from hypotension was noted. Occurrence of adverse effects in the perioperative and postoperative period was also noted. Results: Results were analyzed by Student's paired t-test and Chi-square test. The ANOVA test was used to compare the group variances among the study groups. P < 0.05 was considered statistically significant. Thirty-four hypotensive events (average 1.03 events/patient) took place in mephentermine group. In phenylephrine group, a total of 53 hypotensive events took place. On an average, the group had a total of 1.61 hypotensive events per patient. No hypotensive event took place in ephedrine group after the first bolus of drug (average 1 event/patient). Mean heart rate in phenylephrine group was significantly lower as compared to the other two groups (P < 0.001). Conclusion: Mephentermine and ephedrine were similar in performance, offered a better hypotensive control, and had lower recurring events as compared to phenylephrine.
  1,801 157 -
A comparative study evaluating effects of intravenous sedation by dexmedetomidine and propofol on patient hemodynamics and postoperative outcomes in cardiac surgery
Tufail Ahmad Sheikh, Bashir Ahmad Dar, Nihida Akhter, Nadeem Ahmad
April-June 2018, 12(2):555-560
DOI:10.4103/aer.AER_46_18  PMID:29962634
Background: The use of intravenous sedation during cardiac surgery to reduce awareness has been practised routinely during past few years and the two most commonly used drugs include propofol and dexmedetomidine, but their effects on hemodynamics and postoperative outcomes in cardiac surgery is continually being evaluated. Aims: The aim of this study was to compare the effects of anesthesia by dexmedetomidine and propofol on the hemodynamic variables and postoperative outcomes in patients who were planned for elective cardiac surgery. Settings: Cardiac operating room of a tertiary care hospital. Design: A prospective, randomized controlled, double-blind clinical trial. Materials and Methods: Sixty patients were randomized to receive either a continuous infusion of propofol (0.25–1 mg/kg/h) or dexmedetomidine bolus of 1 μg/kg over 10 min followed by infusion (0.2–0.6 μg/kg/h) after induction of anesthesia. The anesthesia technique and physiological monitoring including bispectral index monitoring were similar among both the groups. Hemodynamic variables (mean heart rate [HR], mean arterial pressure [MAP]) were noted at predefined time intervals, intraoperative vasopressor or inotrope requirements and postoperative outcomes including postoperative ventilation time and length of stay in the Intensive Care Unit (ICU) were also recorded. Statistical Analysis: Statistics was done using SPSS V 20 (IBM, NY) using Student's t-test, analysis of variance, and Mann–Whitney U-test, and a P < 0.05 was considered to indicate a significant difference. Results and Conclusions: HR and MAP were significantly less in dexmedetomidine group compared to propofol group (P < 0.05). Both the groups had a similar requirement of vasopressors and inotropes. The duration of postoperative ventilation and length of stay in the ICU were significantly shorter in the dexmedetomidine group (P < 0.05). The risk of delirium was significantly less in dexmedetomidine group (P < 0.05). From our study we concluded, that the perioperative infusion of dexmedetomidine produces better hemodynamic stability, reduces the risk of postoperative delirium, and leads to shorter ICU stay.
  1,770 124 1
A comparative study of dexmedetomidine and clonidine as an adjuvant to intrathecal bupivacaine in lower abdominal surgeries
Mallika Ganesh, Dinesh Krishnamurthy
April-June 2018, 12(2):539-545
DOI:10.4103/aer.AER_54_18  PMID:29962631
Context: Spinal block is the first choice for lower abdominal surgeries. Bupivacaine is the most common local anesthetic used but has a shorter duration of action. Many adjuvants have been used to improve the quality of analgesia till postoperative period. In this study, we used α2-agonists. Aims: The aim of this study is to compare the effects of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine with respect to onset and duration of sensory and motor blockade duration of analgesia and incidence of side effects. Settings and Design: This was a prospective randomized double-blind study. Subjects and Methods: One hundred and fifty patients of physical status American Society of Anesthesiologists Classes I and II were randomly divided into Groups B, C, and D each administered with bupivacaine with normal saline, clonidine, and dexmedetomidine, respectively. Statistical Analysis Used: Data were entered into Microsoft excel data sheet. Analysis software used in this study was SPSS 22 version IBM. Categorical data were represented in the form of frequencies and proportions. Chi-square test was the test of significance. Continuous data were represented as mean and standard deviation. Independent t-test was used for mean difference between two groups. P < 0.05 was statistically significant. Results: Mean sensory onset in Group B was 2.8 ± 0.7 min, in Group C was 1.4 ± 0.5 min, and in Group D was 1.2 ± 0.4 min. Mean sensory regression by two segments in Group B was 78.5 ± 9.9 min, in Group C was 136.7 ± 10.7 min, and in Group D was 136.4 ± 11.7 min. Conclusions: α2-agonists with hyperbaric bupivacaine intrathecally have a faster onset of both motor and sensory block. It also prolongs the duration of analgesia.
  1,671 153 -
Study comparing phenylephrine bolus and infusion for maternal hypotension and neonatal outcome during cesarean section under spinal anesthesia
Manish Choudhary, Jeetendra Kumar Bajaj
April-June 2018, 12(2):446-451
DOI:10.4103/aer.AER_23_18  PMID:29962614
Background: Phenylephrine(PE) bolus and infusion have been compared for post spinal hypotension and neonatal effects during cesarean section(CS) under spinal anesthesia(SA). Aim: The primary aim of this study was to compare bolus doses of 50μg of PE with a fixed infusion rate of 50 μg/min of the same drug given prophylactically. The secondary aim was to study the neonatal outcome and side effects with the two regimes. Settings and Design: This prospective,randomized,comparative study was conducted in the department of Anesthesia in a tertiary care teaching hospital. Materials and Methods: This study was conducted on 100 normotensive women undergoing CS under SA. The patients were randomized into two groups of 50 each. Group A received bolus of 50 μg PE after the systolic BP(SBP) fell by 20% from the baseline and Group B received a prophylactic infusion of 50 μg/min PE. The changes in heart rate (HR), BP and side effects were compared till delivery. The neonatal APGAR scores were compared at 1 and 5 minutes and an umbilical artery sample was sent for blood gas analysis. Statistical Analysis: Categorical variables were shown in number and percentage. Normally distributed continuous variables were presented as mean ± SD and compared using unpaired t-test. Non normally distributed continuous variables were displayed as median and were compared using Mann-Whitney test. A P value of <0.05 was considered significant. Results: In group A, the HR was higher than in group B throughout the monitoring period. (P < 0.001). In group A, SBP trend showed a fall of more than 20% from the base line in 44 patients. The mean fall in SBP was -28.06 ± 5.3 mmHg% in Group A while in group B the mean fall in SBP was only -0.44 ± 4.3mmHg%. Nausea and vomiting was less in group B. There was no difference in APGAR or neonatal acidosis on ABG. Conclusion: There was a tighter control of BP in the infusion group vs. the bolus group while the neonatal outcome was similar in both the groups.
  1,647 150 1
LETTERS TO EDITOR
Supra-axillary block: A novel ultrasound-guided supplement to brachial plexus block for surgery around elbow
Chelliah Sekar, Tuhin Mistry, Poonoly Varkey Sheela, Vipin Kumar Goel
April-June 2018, 12(2):604-605
DOI:10.4103/aer.AER_78_18  PMID:29962643
  1,624 148 -
ORIGINAL ARTICLES
Inter scalene block: Revisiting old technique
Vinendra Nath Vaid, Aparna Shukla
April-June 2018, 12(2):344-348
DOI:10.4103/aer.AER_231_17  PMID:29962595
Background and Aims: The technique of percutaneous brachial plexus block has persisted in many variations since first such block given by Hirsheli in 1911.[1] Both supraclavicular and infraclavicular approaches have been described. Consequent to perivascular technique (Winnie and Collins 1964), Winnie described interscalene block (ISB) in 1970.[2],[3] Winnie's was a single deposit block which relied upon volume for its success. It is nearly 50 years that ISB has stood the test of time and has evolved from single to multiple deposits Block. In mid-90s, ultrasound guidance was first explored by anesthetists for regional anesthesia in University of Vienna.[3] As ultrasound guidance is becoming popular and is increasingly available to budding anesthetist, popularity of old technique has started waning. In this study, old technique of ISB was revisited with a view to assess its success rate with established drugs and examine if in light of ultrasound guidance, this technique has become irrelevant for anesthetist today. Methods: A retrospective study, a survey with high response rate, was done on success rate of three variations of old technique of ISB in 100 patients. In variation-1, thirty patients received two deposits of local anesthetic in interscalene groove. In variation-2, thirty patients received four deposits of local anesthetic in interscalene groove. In variation-3, forty patients received six deposits of local anesthetic in interscalene groove along with infiltration of both scalene muscles. In none of the variations, paraesthesia was sought or peripheral nerve stimulator (PNS) or imaging gadget was used. Demographic data in three variations were compared statistically using Chi-square and one-way ANOVA test. Success rate among variations was analyzed by Fisher's exact test. Results: In variation-1, 17 out of 30, in variation-2, 23 out of 30, and in variation-3, 37 out of 40 blocks were successful. Conclusion: Success of ISB given without PNS or ultrasound guidance is directly proportional to the number of deposits of local anesthetic made in interscalene groove.
  1,626 126 -
Intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in laparoscopic cholecystectomy
Radhe Sharan, Manjit Singh, Amar Parkash Kataria, Kamal Jyoti, Vishal Jarewal, Rohit Kadian
April-June 2018, 12(2):377-380
DOI:10.4103/aer.AER_6_18  PMID:29962601
Background: Intraperitoneal instillation of local anesthetics in laparoscopic cholecystectomy (LC) has been used to reduce postoperative pain and to decrease the need for postoperative analgesics. Aims: This study aimed to compare intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in patients undergoing LC. Settings and Design: This was a prospective, randomized, double-blind study. Materials and Methods: After obtaining ethical committee's clearance and informed consent, sixty patients, aged 18–65 years, of either gender, and American Society of Anesthesiologists physical status I to III scheduled for LC were included and categorized into two groups (n = 30). Group A patients received 20 mL of 0.5% bupivacaine intraperitoneally after cholecystectomy and Group B patients received 20 mL of 0.5% ropivacaine intraperitoneally after cholecystectomy. Statistical Analysis: The data were analyzed using paired t-test. The results were analyzed and compared to previous studies. SPSS software version 22 was used, released 2013 (IBM Corp., Armonk, NY, USA). Results: Pulse rate, systolic blood pressure, and diastolic blood pressure were comparatively lower in Group B than in Group A. The visual analog scale (VAS) score was significantly lower in Group B. Rescue analgesia was given when VAS was >6. Verbal rating scale score was significantly lower in Group B, showing longer duration of analgesia in this group. Rescue analgesic requirement was also less in Group B. Conclusion: The instillation of bupivacaine and ropivacaine intraperitoneally was an effective method of postoperative pain relief in LC. It provided good analgesia in immediate postoperative period with ropivacaine, providing longer duration of analgesia.
  1,552 199 -
Effect of using ringer's lactate, with and without addition of dextrose, on intra-operative blood sugar levels in infants undergoing facial cleft surgeries
Kaushik Barua, Sunil Rajan, Jerry Paul, Pulak Tosh, Anju Padmalayan, Lakshmi Kumar
April-June 2018, 12(2):297-301
DOI:10.4103/aer.AER_53_18  PMID:29962586
Background: Addition of glucose in the intraoperative fluid is a routine practice in infants. Under general anesthesia, due to neuroendocrine stress response, this could result in overt hyperglycemia. Aims: The aim of this study was to find whether the addition of 2% dextrose to Ringer's lactate (RL) caused hyperglycemia compared to no addition of dextrose to RL. Settings and Designs: This prospective randomized study was conducted in 100 infants undergoing facial cleft surgery at a tertiary care institution. Subjects and Methods: Group D received RL with 2% dextrose and Group R received RL without the addition of dextrose. Blood sugars were measured at induction, 1 h and 2 h later. Hyperglycemia was defined as blood sugar >150 mg/dL and hypoglycemia as <70 mg/dL. Statistical Analysis Used: Pearson's Chi-square test, Paired t-test, Mann–Whitney test, and Independent sample t-test were used as applicable. Results: Baseline blood sugar was comparable in both groups. A significant increase in blood sugar values from baseline was seen in both groups, but the increase was significantly more in Group D at 60 min (136.5 ± 41.9 vs. 109.2 ± 20.5) and at 120 min (150.1 ± 45.5 vs. 123.1 ± 31.7). The incidence of hyperglycemia was 50% in Group D and 12% in Group R. No patient developed hypoglycemia intraoperatively. No significant correlation between blood sugar and hours of fasting was established. Conclusion: Routine addition of dextrose to RL is not essential during short surgeries under general anesthesia in infants, provided preinduction blood sugar level is >70 mg/dL and intraoperative sugars are periodically monitored.
  1,593 132 -
Comparison of palonosetron, dexamethasone, and palonosetron plus dexamethasone as prophylactic antiemetic and antipruritic drug in patients receiving intrathecal morphine for lower segment cesarean section
Swastika Swaro, Daisy Karan, Anwesha Banerjee
April-June 2018, 12(2):322-327
DOI:10.4103/aer.AER_183_17  PMID:29962591
Background: Intrathecal morphine is commonly used for postcesarean analgesia. Its use is frequently associated with opioid-induced nausea, vomiting, and pruritus. Palonosetron (0.075 mg) combined with dexamethasone (8 mg) is postulated to have an additive effect over each drug alone. The study, therefore, compared the effect of intravenous (i.v.) palonosetron, dexamethasone, and palonosetron with dexamethasone combination in preventing intrathecal morphine-induced postoperative vomiting and pruritus in lower segment cesarean section (LSCS) patients. Settings and Design: Randomized, prospective, double-blinded, observational clinical study. Methods: Ninety pregnant women, American Society of Anesthesiologists physical status class I undergoing LSCS were included in the study. They were randomly assigned to three groups – Group P received 0.075 mg palonosetron i.v., Group D received dexamethasone 8 mg i.v., and Group PD received palonosetron 0.075 mg along with dexamethasone 4 mg i.v., just after spinal anesthesia with bupivacaine 2.2 ml (12 mg) and 150 μg morphine. The incidence of pruritus, nausea, vomiting, and need for rescue drug were recorded for 24 h. Statistical Analysis: Statistical analysis was performed using Student's t-test for categorical variables and Chi-square test for noncategorical variables. Results: The incidence of nausea, vomiting was significantly more in Group D (40%) than Group P (27%) and Group PD (20%) in 24 h. The incidence of pruritus was significantly more in Group D (6%) than Group P and PD (3%). The need of rescue antiemetic was more in Group D (30%) than Group P (6%) and Group PD (3%). No difference in three groups requiring rescue antipruritic drug. Conclusion: Prevention of intrathecal morphine-induced vomiting and pruritus was more effective with palonosetron alone or with dexamethasone combination than dexamethasone alone. Combination of palonosetron and dexamethasone proved no better than palonosetron alone.
  1,577 109 -
Effect of cuff pressures on postoperative sore throat in gynecologic laparoscopic surgery: An observational study
Nitu Puthenveettil, Kiran Kishore, Jerry Paul, Lakshmi Kumar
April-June 2018, 12(2):484-488
DOI:10.4103/aer.AER_72_18  PMID:29962621
Context: Postoperative sore throat (POST) is a very common complaint following tracheal intubation. Although it resolves spontaneously, efforts must be taken to reduce it. Aims: This study aims to compare the effect of cuff inflation using manometer versus conventional technique on the incidence of POST. Secondary objectives were to assess the incidence postoperative hoarseness and cough. Settings and Design: A total of 120 patients were included in this prospective observational comparative study. Subjects and Methods: After approval from the hospital ethics committee, consenting American Society of Anesthesiologists physical status Class I and II patients, scheduled for gynecologic laparoscopic surgery under general anesthesia, were included. They were randomly allocated by closed envelope technique to either Group A where the cuff pressure was adjusted to 25 cmH2O using a manometer or Group B where cuff inflation was guided clinically. Patients were monitored for sore throat, hoarseness of voice, and cough postoperatively. Statistical Analysis Used: To calculate the incidence of sore throat, hoarseness, and cough, descriptive statistics were applied. For checking association of sore throat and cuff pressure, Chi-square test and for comparing numerical values independent sample t-test were applied. Results: The incidence of POST was significantly less in Group A than in B (P < 0.001) up to 24 h. Incidence of hoarseness was less in Group A and incidence of cough was higher in Group B, but these differences were not statistically significant. Conclusion: Cuff inflation guided by manometer significantly reduces the incidence of POST.
  1,506 136 1
Would “suction above cuff” be a better option than the “standard” endotracheal tube for the prevention of ventilator-associated pneumonia: A randomized study in postoperative neurological patients
Gunjan , Ankesh , Saurav Shekhar, Akhileshwar , Priyesh Kumar
April-June 2018, 12(2):480-483
DOI:10.4103/aer.AER_39_18  PMID:29962620
Context: Ventilator associated pneumonia is one the most common nosocomial infection encountered in the ICU patients. Despite of the implementation of the VAP prevention bundle, the incidence remains high. This can be attributed to the peritubal leak and the aspiration of the oropharyngeal secretions. The secretions further forms a nidus for the growth of organisms in the lower respiratory tract. In this study, a specialised tube, named 'suction above cuff endotracheal tube' is used, which has an additional suction port opening above the cuff. This is to facilitate timely aspiration of the secretion which pent-up above the cuff and gradually trickles down the trachea resulting in pneumonia. Aim: to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurological post-operative patients and its impact on clinical outcome. Settings and Design: 60 patients of post-operative neurological cases aged ≥ 18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. Results: In this study involving neurological population, there was no significant difference in incidence of clinical and microbiological VAP between SETT and SACETT group, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.
  1,487 126 -
Comparative evaluation of sevoflurane, propofol, and combination of sevoflurane and propofol on insertion characteristics of reusable classic laryngeal mask airway
Yamini Gupta, Tek Chand Kriplani, Vansh Priya
April-June 2018, 12(2):386-391
DOI:10.4103/aer.AER_30_18  PMID:29962603
Background and Aim: Adequate depth of anaesthesia is needed for successful placement LMA.under lighter plane of anaesthesia inadequate mouth opening,coughing,body movements can lead to rejection of LMA and may be associated with breath holding and bronchospasm. Use of propofol in doses which allow adequqate jaw relaxation and prevent patient reaction to LMA commonly results in hypotension and prolonged apnoea.Apart from minimal respiratory irritant properties sevoflurane as compared to propofol has the advantage of providing better hemodynamic stability and a smoother transition to the maintainance phase without a period of apnea.However sevoflurane is associated with delayed jaw relaxation and a longer time for the insertion of the LMA.Our hypothesis is that induction of anaesthesia with the combination of sevoflurane and small dose of propofol may optimize the insertion conditions of LMA and decrease the side effects of individual drugs. Methods: 90 patients aged 18-65 yrs ASA physical status I and II undergoing elective procedures were randomly allocated into 3 groups of 30 patients each. No patient had been given any premedication.Patients in group P were induced with iv inj propofol 3 mg/kg. Patients in group S an SP were induced with tidal volume breathing induction technique using sevoflurane 8% along withN20: 02: 67:33 @ 6L/MIN In addition, in group SP after loss of eye lash reflex patients were given IV propofol 1.5 mg/kg.An independent observer assessed insertion characteristics. Results: our results showed that induction of anesthesia using the combination of sevoflurane and propofol resulted in the most frequent successful LMA insertion at first attempt as compared with induction of anesthesia with either sevoflurane or propofol alone.
  1,489 83 -
Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries
Harish Karanth, US Raveendra, Rithesh B Shetty, Pramal Shetty, Padmini Thalanjeri
April-June 2018, 12(2):434-439
DOI:10.4103/aer.AER_38_18  PMID:29962612
Background and Objectives: Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties. Hence, we sought to compare effectiveness of propofol with sevoflurane in achieving good intubation conditions without the use of muscle relaxants. Materials and Methods: In this prospective randomized study, eighty children belonging to American Society of Anesthesiologist physical status Class I and II, aged 1–10 years, scheduled for cleft surgery were included. All participants were premedicated. Patients were allotted to Group A and Group B randomly. Group A received propofol and Group B received sevoflurane as induction agents. Tracheal intubation was attempted in all patients at 150 s. Intubation conditions were assessed by using Steyn modification of Helbo–Hansen intubating conditions score. Statistical analysis was done using Student's t-test and Chi-square test with P < 0.05 regarded as significant. Results: Group B patients receiving sevoflurane had significantly more clinically acceptable intubation conditions than patients of Group A receiving i.v. propofol (P = 0.001). Conclusion: We conclude that intubation conditions using inhalational 8% sevoflurane are superior to i.v. propofol of 3 mg/kg for tracheal intubation without muscle relaxants in children undergoing cleft surgeries.
  1,393 104 -
Efficacy of pectoral nerve block using bupivacaine with or without magnesium sulfate
Ahmed A Abdelaziz Ahmed
April-June 2018, 12(2):440-445
DOI:10.4103/aer.AER_37_18  PMID:29962613
Background: Worldwide, breast cancer is the main common cancer among females. In the United States, it affects one in eight women during their lifespan. In breast cancer surgery, chronic pain can be developed from poorly managed acute postoperative pain. The aim of the study was to use a safe, easy, and less complicated method of regional block for reducing the postoperative pain after mastectomy, which will reduce the incidence of chronic postmastectomy pain. Materials and Methods: Ninety adult female patients with American Society of Anesthesiologists Physical Status I, II, and III were allocated randomly into three groups: Group C had general anesthesia; Group B had ultrasound-guided pectoral nerve block (PECS block) (28mL 0.25% bupivacaine+2mL normal saline) plus general anesthesia; and Group M had ultrasound-guided PECS block (total 28 mL of Bupivacaine 0.25%+2mL of magnesium sulfat 50%) plus general anesthesia. Results: The intraoperative fentanyl (μg) used was significantly lower in Group B (110.4 ± 26.3) and Group M (108.7 ± 14.1) than in Group C (214.3 ± 20.1) and also the same as regards the total postoperative pethidine (mg) in Group C (220 ± 25.5), Group B (100.6 ± 24.3), and Group M (52.3 ± 12.3). The Group M was the least group suffered from postoperative pain at all times of measurement. Conclusion: The Group M was the least group suffered from postoperative pain at all times of measurement.
  1,380 117 -
Prevention of emergence delirium in children – A randomized study comparing two different timings of administration of midazolam
Gerard Gonsalvez, Deepa Baskaran, Vasudeva Upadhyaya
April-June 2018, 12(2):522-527
DOI:10.4103/aer.AER_52_18  PMID:29962628
Background: Emergence delirium (ED) is a distressing side effect of sevoflurane anesthesia in children. Midazolam is a widely studied drug for the prevention of ED with conflicting results. Aim, Settings and Design: We designed this prospective randomized double-blind study to compare the effect of 0.03 mg/kg midazolam administered at induction and the same dose administered 10 min before the end of surgery in the prevention of ED in children undergoing sevoflurane anesthesia and also the effect on the time to recovery in both groups. Materials and Methods: Eighty children between 2 and 8 years belonging to patient physical status American Society of Anesthesiologist Classes 1 and 2 undergoing infra-umbilical surgeries under general anesthesia were randomly allocated to receive 0.03 mg/kg midazolam at induction (Group A) and 10 min before the end of surgery (Group B). Caudal block was administered for analgesia after induction. The primary outcome, the incidence of ED was evaluated using the Paediatric Anaesthesia Emergence Delirium Scale from the time of extubation till 30 min postsurgery. The secondary outcome measured was the time to recovery (time from discontinuation of sevoflurane to the time of extubation) and the results were statistically analyzed. Results: The incidence of ED was comparable between the groups (30%, 10%, 5%, and 2.5% at 5, 10, 15, and 20 min, respectively in Group A and 25%, 10%, 5%, and 2.5% of children at 5, 10, 15, and 20 min, respectively in Group B). Recovery was significantly prolonged in Group B (42.5% of patients in Group A recovered within 6 min of discontinuation of sevoflurane in Group A compared to only 20% of patients in Group B). Conclusion: There is no difference in the reduction of incidence of ED following sevoflurane anesthesia when midazolam is administered at induction or the end of surgery. However, the time to recovery was longer when the drug was administered at the end of the surgery.
  1,347 146 -
A randomized comparison of pain control and functional mobility between proximal and distal adductor canal blocks for total knee replacement
Christopher Romano, Andrew Lloyd, Singh Nair, Jenny Y Wang, Shankar Viswanathan, Amaresh Vydyanathan, Karina Gritsenko, Naum Shaparin, Boleslav Kosharskyy
April-June 2018, 12(2):452-458
DOI:10.4103/aer.AER_17_18  PMID:29962615
Background: Adductor canal blocks (ACBs) have become a popular technique for postoperative pain control in total knee arthroplasty patients. Proximal and distal ACB have been compared previously, but important postoperative outcomes have yet to be assessed. Aims: The primary objective of this study is to compare postoperative analgesia between proximal and distal ACB. Secondary outcomes include functional mobility, length of stay (LOS), and adverse events. Settings and Design: This study was a single-center, assessor-blinded, randomized trial. Subjects and Methods: Fifty-seven patients were randomly assigned to receive a proximal (n = 28) or distal (n = 29) ACB. A 20 mL bolus of 5 mg/mL ropivacaine was injected at the respective location followed by 2.0 mg/mL ropivacaine infusion for 24 h. Statistical Analysis: The primary outcome was intra- and postoperative 24-h opioid consumption in intravenous (IV) morphine equivalents. Secondary outcomes include percentage change in timed “Up and Go” (TUG) times, LOS, and average postoperative pain scores. Continuous variables were compared using Student's t-test. Results: The mean (±standard deviation) 24-h intra-and postoperative opioid consumption showed no difference between the proximal and distal groups (39.72 ± 23.6 and 41.28 ± 19.6 mg IV morphine equivalents, respectively, P = 0.793). There was also no significant difference in the median [minimum, maximum] percentage change in TUG times relative to preoperative performance comparing proximal and distal ACB (334.0 [131, 1084] %-change and 458.5 [169, 1696] %-change, respectively, P = 0.130). In addition, there were no differences in postoperative pain scores or LOS. Conclusions: ACB performed at either proximal or distal locations shows no difference in postoperative pain measured by opioid consumption or pain scores. Better TUG performance seen in the proximal group was not statistically significant but might represent a clinically important difference in functional mobility.
  1,382 102 -
Comparison of epidural analgesia using 0.2% bupivacaine and 0.2% ropivacaine for the management of postoperative pain in major orthopedic surgery
Sumedha Mehta, Manojkumar Namdeorao Gajbhare, Neha Prabhakar Kamble
April-June 2018, 12(2):586-591
DOI:10.4103/aer.AER_62_18  PMID:29962639
Introduction: Ropivacaine is preferred over racemic bupivacaine for postoperative analgesia as it is less cardiotoxic and has high selectivity for sensory fibers. We aim to compare postoperative epidural analgesia using 0.2% bupivacaine and 0.2% ropivacaine in major lower limb orthopedic surgery. Materials and Methods: In a prospective, randomized, double-blind study, 100 patients, aged 18–70 years, undergoing elective major lower limb orthopedic surgery under spinal anesthesia, were randomly allocated to receive either 7 ml ropivacaine 0.2% (Group R) or 7 ml bupivacaine 0.2% (Group B) for postoperative analgesia through a lumbar epidural catheter. The onset and duration of epidural analgesia, total epidural dose requirement, mean number of epidural topup, rescue analgesia, incidence of motor blockade, and adverse effects were recorded. Results: No differences were noted in demographic data and hemodynamic variables in either group. The onset time of epidural analgesia was 10.46 min ± 0.68 (Group B) and 10.52 min ± 0.71 (Group R). The duration of analgesia was 253.10 ± 17.46 min (Group B) and 251.80 ± 15.77 min (Group R). The total analgesic dose requirement was 78.40 mg ± 6.93 in Group B while in Group R, it was 78.96 mg ± 6.79. Epidural topup requirement and the need for rescue analgesia were similar in both the groups. Motor blockade, hypotension, and nausea were noted more in Group B compared to Group R. Conclusion: In patients undergoing major lower limb orthopedic surgery under subarachnoid block, epidural ropivacaine 0.2% produces effective postoperative analgesia similar to bupivacaine 0.2% with a distinct sensory-motor dissociation resulting in analgesia without motor blockade.
  1,375 106 1
A clinical comparative study of fascia iliaca compartment block with bupivacaine and bupivacaine with dexmedetomidine for positioning and duration of postoperative analgesia in fracture femur under spinal anesthesia
Nikila Devarayasamudram Gopal, Dinesh Krishnamurthy
April-June 2018, 12(2):528-534
DOI:10.4103/aer.AER_56_18  PMID:29962629
Context: Positioning fracture femur cases for sub arachnoid block (SAB) is challenging. Fascia iliaca compartment block (FICB) is low skilled, helps positioning, and provides analgesia. Dexmedetomidine as an adjuvant prolongs analgesia. Aims: The aims were to study and compare FICB with bupivacaine and bupivacaine with dexmedetomidine in fracture femur cases with regard to positioning during SAB, duration of analgesia in terms of Visual Analog Scale (VAS), Numerical Rating Scale (NRS), and Patient Satisfaction Score, and assess side effects. Settings and Design: This was a randomized, double-blind, prospective study. Subjects and Methods: Sixty fracture femur patients were divided into two groups as follows: Group A: FICB with injection bupivacaine 0.25% 38 cubic centimeter (cc) + dexmedetomidine 0.5 μg/kg in 2 cc normal saline (NS) and Group B: FICB with injection bupivacaine 0.25% 38 cc + 2 cc NS. Statistical Analysis Used: Data were analyzed using SPSS 22.0 software. Categorical data were processed by frequencies and proportions, whereas continuous data were processed by mean standard deviation. Chi-square test and independent t-test were used as tests of significance, considering P < 0.05 as statistically significant. Results: In Group A, mean VAS score at 5 min (min) was 3.7 ± 0.9 and in Group B it was 4.3 ± 0.7. Similarly, at 15 min, mean VAS score in Group A was 0.4 ± 0.6 and in Group B it was 1.9 ± 0.9. VAS score was significantly high in Group B at 5, 10, and 15 min. Mean time to rescue analgesia in Group A was 838.3 ± 82.7 min and in Group B it was 461.5 ± 36.6 min, which was significant. Conclusion: FICB ensures patient comfort during positioning for SAB and provides postoperative analgesia. Dexmedetomidine significantly prolongs postoperative analgesia.
  1,339 134 -
The sedative and propofol-sparing effect of dexmedetomidine and midazolam as premedicants in minor gynecological day care surgeries: A randomized placebo-controlled study
Anita Kumari, Arvinder Pal Singh, Jyoti Vidhan, Ruchi Gupta, Jonny Dhawan, Jasleen Kaur
April-June 2018, 12(2):423-427
DOI:10.4103/aer.AER_8_18  PMID:29962610
Background and Aims: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes. Hemodynamic parameters and side effects were evaluated as secondary outcomes. Materials and Methods: A prospective randomized placebo-controlled study was conducted on 150 American Society of Anesthesiologists ASA physical status Classes I and II gynecological patients between 18 and 50 years and were allocated into three groups of fifty each. Group A received intravenous (i.v.) dexmedetomidine 0.1 μg/kg, Group B received i.v. midazolam 0.04 mg/kg, and Group C received normal saline 10 min before induction. Results: Sedation score was statistically highly significant between Group A and B (P < 0.001). Between Group A and C, it was statistically significant (P < 0.05); however, score was nonsignificant between Groups B and C (P > 0.05). During recovery at 120 min after surgery, score 5 was achieved equally by all three groups which was found to be statistically insignificant (P > 0.05). Mean dose of additional propofol used was less in Group A (14 ± 9.25) than B (25 ± 5.40) and C (53 ± 10.96). On intergroup comparison between all three groups, it was found to be statistically highly significant (P < 0.001). Comparison of bispectral index (BIS) values between Groups A and C and Groups B and C were highly significant (P < 0.001). However, it was statistically significant between Groups A and B (P < 0.05). Aldrete scoring and street fitness scores were highly significant between Groups A and B, B and C, and also between Groups A and C (P < 0.001). No significant hemodynamic derangements and side effects were noted in any of three groups. Conclusion: Dexmedetomidine had good sedation and better recovery characteristics than midazolam. BIS monitoring was helpful in maintaining the depth of anesthesia.
  1,364 95 -
Intraperitoneal levobupivacaine alone or with dexmedetomidine for postoperative analgesia after laparoscopic cholecystectomy
Mohamed Maher Beder El Baz, Tamer El Metwally Farahat
April-June 2018, 12(2):355-358
DOI:10.4103/aer.AER_205_17  PMID:29962597
Background and Aims: Local anesthetic injection in the peritoneal cavity decreases intensity of postoperative pain after laparoscopic surgeries. We compared adding dexmedetomidine to intraperitoneal levobupivacaine in patients undergoing laparoscopic cholecystectomy. Methods: A total of 105 patients were included in this prospective, double-blinded, randomized study. Patients were randomly divided into three equal sized (n = 35) study groups. Group C patients received intraperitoneal 40 ml normal saline as controlled group. Group L was given 40 ml 0.25% levobupivacaine. Group LD received 40 ml 0.25% levobupivacaine + dexmedetomidine 1 μg/kg. The degree of postoperative pain was measured by visual analog scale (VAS) score. The time of first analgesic demand was recorded and also total dose of painkiller in the first 24 h and postoperative complications were collected. SPSS version 16 was used for statistical analysis. P < 0.05 was considered statistically significant. Results: Postoperative VAS at different time intervals was significantly lower, time to the first demand of painkiller (min) was longer (30.2 ± 14.4, 45.9 ± 20.1, and 56.5 ± 13.2), and total painkiller consumption (mg) was lower (203.5 ± 42.9, 117.8 ± 63.7, and 46.3 ± 41.3) in Group LD than Group L than Group C. Conclusion: Adding dexmedetomidine to intraperitoneal levobupivacaine is superior to and gives better results than levobupivacaine alone in patients undergoing laparoscopic cholecystectomy.
  1,358 100 -
Therapeutic efficacy of two different doses of dexmedetomidine on the hemodynamic response to intubation, the intubating conditions, and the effect on the induction dose of propofol: A randomized, double-blind, placebo-controlled study
Neha Sharma, Nandita Mehta
April-June 2018, 12(2):566-571
DOI:10.4103/aer.AER_45_18  PMID:29962636
Context: The hemodynamic response associated with laryngoscopy and tracheal intubation is a common concern for the anesthesiologist, especially in high-risk patients. The use of dexmedetomidine has found favor in obtunding this response, in addition to providing better intubating conditions and reducing the dose of other anesthetic drugs. Most of the current literature states a loading dose of 1 μg/kg dexmedetomidine to be superior to lower doses in this regard. However, using a lower dose may be advantageous by reducing incidence of adverse effects such as hypotension and bradycardia which are likelier with the use of higher dose, in addition to being more cost-effective. Aims: The aim of the study was (1) to evaluate and compare the effect of loading doses of 1 μg/kg and 0.5 μg/kg dexmedetomidine on attenuation of hemodynamic response to laryngoscopy and intubation and (2) to evaluate the efficacy of dexmedetomidine in reducing the induction dose of propofol for achieving better intubating conditions. Materials and Methods: A randomized, double-blind, placebo-controlled study was planned on ninety American Society of Anesthesiologists I and II patients scheduled for elective surgery under general anesthesia. Patients were divided into three groups. Two groups received different loading doses of dexmedetomidine infusion before induction and the third group was a control group. The induction dose of propofol required to abolish the verbal response was noted and compared in all the three groups. All patients were assessed for the intubating conditions and hemodynamic response. Statistical Analysis: Nonparametric data were compared using the Chi-square test and parametric data were compared using Student's t-test using SPSS 16.0 software. Results: Both the loading doses of 1 μg/kg and 0.5 μg/kg dexmedetomidine were equally effective in reducing the induction dose of propofol, improving the intubating conditions and blunting the hemodynamic response to laryngoscopy and intubation. The incidence of adverse effects such as hypotension and bradycardia was lesser with the loading dose of 0.5 μg/kg. Conclusions: Dexmedetomidine when used as infusion in the loading dose of 0.5 μg/kg is therapeutically as effective as when used in the dose of 1.0 μg/kg not only in reducing the induction dose of propofol but also in providing good intubating conditions and blunting the hemodynamic response to intubation. A lower dose is associated with a lesser incidence of adverse effects such as hypotension and bradycardia.
  1,331 116 -
Clonidine as a sole epidural adjuvant in combined spinal-epidural: Clinical study
M Sathesha, RS Raghavendra Rao, Said Javid Hassan, K Sudheesh
April-June 2018, 12(2):309-312
DOI:10.4103/aer.AER_18_17  PMID:29962588
Background and Aims: Clonidine has been used as an epidural adjuvant along with local anesthetics; however, its use as a sole epidural adjuvant in combined spinal-epidural (CSE) anesthesia has not been explored; thus, this study aimed to assess the effects of clonidine as a sole epidural adjuvant in CSE on sensory and motor characteristics of 0.5% hyperbaric bupivacaine given by subarachnoid route. Methodology: A total of 60 patients belonging to the American Society of Anesthesiologists Classes I and II aged 18–60 years were randomized in two groups; group G300 and group GNS. G300 group received 300 mg clonidine and GNS received normal saline through epidural route followed by 15 mg of 0.5% hyperbaric bupivacaine as subarachnoid block. Onset of sensory block (time to T10) and motor block (time to Bromage 3), level of sedation (using Modified Ramsay Sedation Score), and hemodynamic changes were recorded. Two-segment regression, duration of analgesia (time for 1st rescue analgesia), and motor block (time to Bromage 0) were recorded. Student's t-test (two-tailed, independent) and Chi-square/Fisher's exact probability test were used for statistical analysis. Results: The demographic data were comparable between the groups. The onset of sensory and motor block was significantly faster in G300 (sensory-71.63 ± 4.51 s, motor-55.63 ± 2.54 s) as compared to GNS (sensory-90.13 ± 4.88 s, motor-118.43 ± 9.50 s) (P < 0.001 and < 0.001, respectively). The two-segment regression was 199.33 ± 19.11 min and 79 ± 9.77 min in G300 and GNS, respectively, (P < 0.001). Duration of analgesia was 317.90 ± 15.32 min and 207 ± 20.66 min for G300 and GNS, respectively (P < 0.001), and duration of motor block was 409.9 ± 34.87 min and 204 ± 22.79 min for G300 and GNS, respectively (P < 0.001). The side effects such as hypotension and bradycardia were statistically and clinically not significant. Conclusion: Clonidine used as a sole epidural adjuvant in dose of 300 mg, for infraumbilical surgeries, has significantly faster onset of sensory and motor block with prolonged duration of analgesia and motor blockade and no significant side effects on a conventional subarachnoid block performed with 0.5% hyperbaric bupivacaine.
  1,307 105 -
Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and autocalibrated arterial pressure waveform analysis Vigileo-FloTrac™ system in on-pump coronary artery bypass graft surgery: A randomized controlled study
Mohamed Ahmed Hamed, Abeer Shaban Goda, Reham Mohmmed Salah Eldein
April-June 2018, 12(2):517-521
DOI:10.4103/aer.AER_58_18  PMID:29962627
Background: It is a challenge for anesthesiologists to balance between administering intravenous fluid, vasoactive agents, and inotropic drugs to maintain appropriate cardiac output. Aim: The aim of this study was to evaluate the effect of treatment algorithm guided either by pulmonary artery catheter (PAC) or by the fourth generation FloTrac/Vigileo system combined with monitoring of oxygen transport on hemodynamic management and outcome after coronary artery bypass graft surgery (CABG). Settings and Design: This study design was a prospective randomized controlled clinical study. Patients and Methods: Sixty patients aged 45–65 years, scheduled for CABG surgery for two or more grafts with cardiopulmonary bypass, were randomized into two groups 30 patients in each; (1) (Group P) patients in which PAC was inserted into internal jugular vein and connected to monitor. (2) (Group F) Patients in which arterial pressure catheter was inserted in radial artery and connected to the FloTrac sensor and Vigileo monitor. Statistical Analysis Used: Student's t-test or Mann–Whitney U-test and Chi-square or Fisher's exact tests were used. Results: Central venous pressure rose at the end of surgery in both groups and postoperatively declined transiently. Although the volume of crystalloids administered during surgery did not differ significantly between the groups, Group F received 24% more crystalloids and 3-fold more colloids postoperatively. Duration of postoperative respiratory support increased by 36% in Group P (P = 0.04). Conclusions: Goal-directed therapy based on pulse pressure analysis and oxygen transport increases the volume of fluid therapy, improves hemodynamics, and reduces the duration of respiratory support after CABG surgery.
  1,299 107 -
Geriatric patients with hip fracture: Frailty and other risk factors affecting the outcome
Bindu K Vasu, Kruthika P Ramamurthi, Sunil Rajan, Mathew George
April-June 2018, 12(2):546-551
DOI:10.4103/aer.AER_61_18  PMID:29962632
Background: Hip fracture is a devastating health-care problem in a geriatric patient, leading to high mortality and morbidity. Preoperative risk assessment in the geriatric patient is often inexact because of the difficulty in measuring their poor physiologic reserves. Aims: The primary objective was to find the association of modified frailty index (MFI) with 90-day mortality in geriatric patients who received anesthesia for fractured hip. Secondary objectives were to assess the association of preoperative waiting time with the 90-day mortality and the correlation of preexisting medical conditions with poor functional outcome among the survivors. Settings and Designs: This prospective, observational study was conducted at a tertiary care institution. Subjects and Methods: In this prospective observational study, done over a period of 1 year, 60 geriatric patients aged ≥65 years who received anesthesia for fractured hip and fulfilled selection criteria were recruited. The association of MFI with 90-day mortality and the correlation of preexisting comorbidities with poor functional outcome among the survivors were assessed. Statistical Analysis Used: Independent sample t-test, Mann–Whitney test, and odds ratio were used as applicable. Results: Total 60 patients were available for analysis as two patients dropped off from final 62 on follow up, fifty three patients survived after 90 days. MFI and 90-day mortality showed a significant direct correlation with P < 0.0001. However, no association was found between the preoperative waiting time and 90-day mortality. Preexisting medical conditions showed a significant association of dementia with total dependence afterward with a P = 0.02. Conclusion: There is significant statistical correlation of MFI with the 90-day mortality in the geriatric hip-fractured patients undergoing surgery.
  1,254 135 -
Comparison of two doses of dexmedetomidine for supraclavicular brachial plexus block: A randomized controlled trial
Chandni Sinha, Amarjeet Kumar, Poonam Kumari, Akhilesh Kumar Singh, Shalini Sharma, Ajeet Kumar, Anup Kumar, Nishant Sahay
April-June 2018, 12(2):470-474
DOI:10.4103/aer.AER_33_18  PMID:29962618
Background: Dexmedetomidine is commonly used as an additive in supraclavicular brachial plexus block (SBPB). Due to its adverse effects such as bradycardia and hypotension, finding the appropriate dose of dexmedetomidine is the question. Aims: We aimed to compare two commonly used doses of dexmedetomidine (1 μg/kg and 2 μg/kg) added to levobupivacaine in ultrasound-guided SBPB in terms of its effect on duration of analgesia, hemodynamics, and associated adverse effects. Settings and Design: This randomized, double-blinded prospective study was conducted over a period of 1.5 years in our tertiary care hospital. Materials and Methods: Clearance from the Institutional Ethical Committee and Clinical Trial Registry of India was taken. Ninety patients' physical status American Society of Anesthesiologists Classes I and II undergoing upper limb surgeries under SBPB were included in this study. Patients in Group I received 1 μg/kg dexmedetomidine, whereas patients in Group II received 2 μg/kg dexmedetomidine added to 20 cc levobupivacaine. The primary outcome measure was the duration of analgesia after administering the block. Secondary outcomes included effect on hemodynamics, duration of blockade, and adverse effects. Statistical Analysis: Statistical analysis was carried out using Stata Version 10. Unpaired t-test and Chi-square test were used. Results: The duration of analgesia and sensory and motor blockade were similar in both the groups. The heart rate (HR) and mean arterial pressure were statistically lower in Group II. The incidence of bradycardia and hypotension was more in Group II. Conclusions: Increasing the dose of dexmedetomidine does not prolong the duration of analgesia, but it is associated with lower HR and blood pressure. Incidence of hypotension and bradycardia is also more. Hence, a lower dose of 1 μg/kg dexmedetomidine added to 0.5% levobupivacaine is a good balance between safety and efficacy.
  1,271 116 -
Attenuation of hemodynamic responses to endotracheal extubation with different doses of diltiazem with lignocaine: A placebo-controlled study
Sowmya N Swamy, Ravi Madhusudhana
April-June 2018, 12(2):428-433
DOI:10.4103/aer.AER_28_18  PMID:29962611
Introduction: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate (HR) due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a sodium channel blocker, attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a calcium channel blocker, attenuates hemodynamic response by blocking voltage-sensitive L type channels and inhibiting calcium entry-mediated action potential in smooth and cardiac muscle. Aims and Objectives: The aims and objectives of this are to study and to compare the efficacy of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v. lidocaine 1.0 mg/kg, diltiazem 0.2 mg/kg and lidocaine 1.0 mg/kg, lignocaine 1.0 mg/kg with normal saline given to attenuate exaggerated hemodynamic extubation responses and airway reflexes during extubation. Materials and Methods: This study was undertaken with 105 patients belonging to the age group 20–65 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and preservative-free lignocaine 1 mg/kg. Group B received injection diltiazem 0.2 mg/kg and lignocaine 1 mg/kg. Group C received injection lignocaine 1 mg/kg with normal saline. In this study group, the drug dosage was fixed based on the previous studies. Results: At postextubation, significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were observed from 1 to 10 min between three groups. The difference in HR, SBP, DBP, and MAP were statistically significant between Group C in comparison with Group A and Group B from 1 min postextubation to 10 min. Conclusion: Combined diltiazem and lidocaine are more effective prophylaxis than lidocaine alone for attenuating the cardiovascular responses to tracheal extubation.
  1,291 83 -
Intermittent transcutaneous electrical nerve stimulation versus transversus abdominis plane block for postoperative analgesia after infraumbilical surgeries
Veena Chatrath, Ranjana Khetarpal, Heena Kumari, Harjinder Kaur, Anu Sharma
April-June 2018, 12(2):349-354
DOI:10.4103/aer.AER_16_18  PMID:29962596
Background: Multimodal analgesia is currently recommended for effective postoperative analgesia. Aim: The aim of this study is to compare the efficacy of transversus abdominis plane (TAP) block with intermittent transcutaneous electrical nerve stimulation (TENS) in postoperative patients after infraumbilical surgeries under spinal anesthesia with respect to postoperative analgesia, rescue analgesia, hemodynamic changes, block characteristics, nausea/vomiting score, sedation score, adverse effects, and patient satisfaction. Settings and Design: This was a prospective, observational study randomized controlled trial. Methods: A total of 60 American Society of Anesthesiologists physical status Classes I and II patients of 20–60 years scheduled for infraumbilical surgeries were randomized by a computer-generated list into two groups of 30 each, to receive either TAP Block (Group TAP: 15 ml of 0.25% levobupivacaine on each side of abdomen) or TENS (Group TENS: TENS with frequency of 50 Hz and intensity of electrical stimulation 9–12 mA, continued for 30 min every 2 h till 24 h). The primary outcome was to compare the postoperative analgesia as assessed using visual analog scale score. Secondary objectives were to compare rescue analgesia, nausea/vomiting score, sedation score, the block characteristics, adverse effects, hemodynamic changes, and patient satisfaction. Statistical Analysis Used: Student's t-test, Chi-square test as applicable and Statistical Package for Social Sciences (version 23.0, 2017, SPSS Inc., Chicago, IL, USA) were used. Results: Time to the first analgesic requirement was 12.87 ± 4.72 h in Group TAP and 9.93 ± 3.63 h in Group TENS (P < 0.008), the difference between two groups was significant. Conclusion: TAP block is better modality due to ease of application and prolonged analgesia.
  1,315 59 -
Comparison of ketamine with midazolam versus ketamine with fentanyl for pediatric extracorporeal shock wave lithotripsy procedure: A randomized controlled study
Hakan Akelma, Ebru Tarikçi Kiliç, Fikret Salik, Ayhan Kaydu
April-June 2018, 12(2):459-464
DOI:10.4103/aer.AER_44_18  PMID:29962617
Objectives: To compare the effects of ketamine-fentanyl (KF) and ketamine-midazolam (KM) combinations on hemodynamic parameters, recovery properties, pain, and side effects in pediatric patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedure. Methodology: In this double-blinded, randomized trial, 60 pediatric patients aged between 1 and 13 years with American Society of Anesthesiologists physical status Classes I and II, who scheduled for ESWL procedure, were included in the study. Patients were randomly divided into two groups: Group KM received 0.1 mg/kg of midazolam +1–1.5 mg/kg of ketamine and Group KF received 1 μg/kg of fentanyl +1–1.5 mg/kg of ketamine intravenously. Results: There were similar demographic properties, recovery, and discharge times between groups. No statistically significant difference was found in peripheral oxygen saturation, mean and diastolic blood pressure, Ramsey sedation scores, modified Aldrete recovery scores, side effects, and recovery times (Group KM, 16.067 ± 1.2 min; Group KF, 19.46 ± 0.86 min) between groups (P > 0.05). Conclusion: KF combination offers better hemodynamic properties, less side effects with lower visual analog scores, and face, legs, activity, cry, and consolability scores than KM in the pediatric ESWL procedure.
  1,256 117 -
Comparison of intrathecal nalbuphine hydrochloride and clonidine hydrochloride as an adjuvant to hyperbaric bupivacaine in abdominal hysterectomy
Dikshitha K Chetty, Fareed Ahmed, Rama Chatterjee, Monica Rathore
April-June 2018, 12(2):402-406
DOI:10.4103/aer.AER_5_18  PMID:29962606
Background: Various adjuvants for prolongation of intraoperative and postoperative analgesia have been clinically studied in the literature. Aim: This study was done to evaluate and compare the effects of nalbuphine and clonidine as an adjuvant to bupivacaine in spinal anesthesia. Methods: In this prospective, randomized, placebo control, double-blind, and comparative study, a total of ninety patients of American Society of Anesthesiologists physical status Classes I and II undergoing abdominal hysterectomy under subarachnoid block were randomly divided into three groups. In addition to 15 mg of 0.5% hyperbaric bupivacaine administered, patients of groups BS, BN, and BC received 0.9% normal saline, 1.6 mg nalbuphine, and 30 μg clonidine, respectively. The total volume of drugs administered intrathecally was made up to 3.5 ml by addition of sterile isotonic normal saline in all. The onset time and duration of sensory and motor block, duration of analgesia, and total dose of postoperative analgesic requirement in the first 24 h were compared among groups. Hemodynamic changes and side effects were also recorded. Results: Addition of study adjuvants brought significantly faster onset of sensory and motor block. Patients in clonidine group showed significantly longer mean time two segment sensory block regression (P < 0.05) lowest seen in control group. The regression time of motor block to modified Bromage Grade I was significantly longer in clonidine group and comparable in the other groups. Adjuvants have significantly increased the mean duration of analgesia, highest in clonidine group (P < 0.05). Conclusion: Intrathecal clonidine is associated with prolonged motor and sensory block, better hemodynamic stability, and less postoperative analgesic requirement as compared to nalbuphine.
  1,261 105 -
Dexamethasone compared to dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar block for vitreoretinal surgery. A prospective randomized study
Ashraf Elsayed Alzeftawy, Mona Blough El Morad
April-June 2018, 12(2):359-365
DOI:10.4103/aer.AER_224_17  PMID:29962598
Background: Dexamethasone or dexmedetomidine may improve the quality of peribulbar block. Aim: The aim of this study is to compare the effects of adding either dexamethasone or dexmedetomidine to peribulbar block on the efficacy, intraocular pressure (IOP), time to first analgesic request, total analgesic requirement, and side effects in patients undergoing vitreoretinal surgery. Design: This was a clinical prospective randomized study. Patients and Methods: One hundred and fifty adult patients scheduled for vitreoretinal surgery with peribulbar block were randomized into three groups (50 patients each). Group I received 3.5 ml of 0.5% bupivacaine and 3.5 ml of 2% lidocaine + 1 ml normal Saline. 4 mg dexamethasone and 25 μg dexmedetomidine in 1 ml were added to the local anesthetic mixture in Groups II and III respectively. Onset and duration of sensory and motor blocks, adequate time to start surgery, IOP, time to first request of rescue analgesia, total analgesic consumption, and side effects were recorded. The statistical software SPSS 16 was utilized for statistical analysis. Results: Dexamethasone and dexmedetomidine groups showed significantly prolonged duration of corneal anesthesia (234.07 ± 1.37 and 233.54.1.97 min respectively), prolonged lid and globe akinesia (194.27 ± 1.63 and 194.73 ± 2.35 min respectively) with prolonged time to first request of analgesia and less consumption of rescue analgesia as compared to control group (P < 0.05) with non significant differences between both groups (P > 0.05). The onset of corneal anesthesia as well as lid and globe akinesia were enhanced in dexmedetomidine group compared to the other two groups (P < 0.05). In addition, the measurement of IOP was significantly less in the dexmedetomidine group after 10 min. All the patients were hemodynamically stable with no side effects observed. Conclusion: The addition of dexamethasone and dexmedetomidine to local anesthetic mixture in peribulbar block for vitreoretinal surgeries provided safe and effective block with prolonged duration and decreased requirements of postoperative analgesia with better quality for dexmedetomidine group regarding the fast onset of the block and reduced IOP.
  1,236 93 -
Intrathecal bupivacaine with neostigmine and bupivacaine with normal saline for postoperative analgesia: A cost-effective additive
Naga Seshu Kumari Vasantha, Ravi Madhusudhana
April-June 2018, 12(2):328-332
DOI:10.4103/aer.AER_184_17  PMID:29962592
Context: In day-to-day practice, subarachnoid block remains the most common type of anesthesia. Bupivacaine is commonly used local anesthetic of neuraxial blockade, though earlier 5% xylocaine and now ropivacaine and levobupivacaine are also used. Additives such as opioids and α2agonists are also used. We are using neostigmine as an additive with bupivacaine to see the duration of postoperative analgesia. Aims: To compare the efficacy of intrathecal hyperbaric bupivacaine with neostigmine when compared to hyperbaric bupivacaine with normal saline with regard to time of onset and duration of sensory and motor blockade, time to two-segment regression. Settings and Design: Randomized, double-blinded study. Subjects and Methods: One hundred patients admitted for lower abdominal and lower limb surgeries done under spinal anesthesia (SA) during the period of February 2015–August 2016. Statistical Analysis Used: Data were entered into Microsoft excel data sheet and analyzed using SPSS 22 version. Categorical data were represented in the form of frequencies and proportions. Chi-square was used as a test of significance. Continuous data were represented as a mean and standard deviation. Independent t-test was used as a test of significance to identify the mean difference between two groups. Results: Mean onset of sensory blockade with neostigmine group was 174.1 ± 107.1 s and in normal saline group 171 ± 35.6 s. Mean onset of motor blockade with neostigmine group was 197.4 ± 111.6 s and in normal saline group was 219.4 ± 73.2 s. Mean two-segment regression with neostigmine group was 110.6 ± 22.7 s and in normal saline group was 71.5 ± 17.1 min. Duration of analgesia with neostigmine group was 336.3 ± 54.5 min and in normal saline group was 188.8 ± 18.4 min. Conclusions: Intrathecal neostigmine is associated with significantly prolonged sensory, motor blockade, and effective postoperative analgesia.
  1,222 103 -
Correlation between weight of the baby and the level of sensory blockade in spinal anaesthesia for caesarean section: An observational study
KS Sushma, Ashwini H Ramaswamy, Safiya I Shaikh
April-June 2018, 12(2):318-321
DOI:10.4103/aer.AER_164_17  PMID:29962590
Background: The spread of local anaesthetics during spinal anaesthesia is affected by various factors and can be unpredictable especially in parturients undergoing caesarean section. Factors like abdominal girth, symphysis fundal height etc have to studied to know their impact on level of sensory blockade. We hypothesized a study to find any correlation between weight of the baby and the level of sensory blockade. Methods: 46 parturients posted for elective caesarean section belonging to American Society of Anaesthesiologists (ASA) physical status 1 and 2 were included in the study. Maternal height and weight were noted down before entering operation theatre. All patients were instituted subarachnoid block with 2 cc of 0.5% of hyperbaric bupivacaine in sitting position. Level of sensory blockade was assessed with pin prick along midline of the patient every min till 5th minute and 5 minutes till 15th minute. The birth weight of baby was recorded soon after delivery. Results: The weight of the baby and height of the mother were correlated with the sensory blockade of T4. The number of babies weighing more than 3.5 kgs were 3 in our study out of which 2 babies were associated with maximum sensory blockade at 15th minute. It amounts to 66.7% when compared with 14.7% in babies weighing 2.5 to 3.5 kgs which is suggestive of significance ('P' value of 0.093). Conclusion: There is no statistically significant correlation between weight of the baby and the level of sensory blockade.
  1,209 112 -
Comparison of morphine and clonidine as adjuvants in paravertebral block
Surabhi Priya, Charu Bamba
April-June 2018, 12(2):465-469
DOI:10.4103/aer.AER_27_18  PMID:29962616
Background: General anesthesia (GA) has been considered as the gold standard for breast cancer surgery. The problem of postoperative pain as well as the high incidence of nausea and vomiting has led to the search for a better modality for pain management with fewer side effects. In the last few years, paravertebral block (PVB) has gained immense popularity either in combination with GA or by itself for the anesthetic management of patients undergoing breast surgery. Context: Paravertebral block in breast surgery. Aims: This study aims to evaluate the efficacy and duration of postoperative analgesia provided by ultrasound (USG)-guided PVB with bupivacaine and morphine versus bupivacaine and clonidine in patients undergoing modified radical mastectomy (MRM). Subject and Methods: In the study, 70 patients who were scheduled for MRM were enrolled and randomly divided into Group M (n = 35) and Group C (n = 35). Both groups received USG-guided PVB at T2–T3 after administering GA. Group M received 2 mg/kg 0.5% bupivacaine with 0.05 mg/kg morphine and Group C received 2 mg/kg 0.5% bupivacaine with 1 μg/kg clonidine in the block. Postoperatively, pain intensity was recorded using the visual analog scale (VAS) (0–10 scale) at 1, 2, 6, 18, and 24 h duration when patients were resting and during a standardized movement. Modified Post Anaesthesia Discharge Scoring System was assessed at 1, 2, 6, 18 and 24 h after surgery. Results: In this study conducted on 70 patients, VAS scores (both at rest and on movement) were found comparable at postoperative 1, 2, 6, 18, and 24 h (P > 0.05). There was no statistical difference in comparing postanesthesia discharging scoring in both the groups. No incidence of postoperative nausea and vomiting was seen in any group. Conclusions: Morphine and clonidine in PVB are equally effective, and there is no superiority of one agent over the other. Hence, both drugs may be used with equal efficacy as adjuvants to bupivacaine in PVB for providing postoperative analgesia.
  1,242 75 -
A comparative study of two different intravenous bolus doses of phenylephrine used prophylactically for preventing hypotension after subarachnoid block in cesarean sections
HS Prajwal Patel, MR Shashank, BT Shivaramu
April-June 2018, 12(2):381-385
DOI:10.4103/aer.AER_228_17  PMID:29962602
Background and Aims: Hypotension occurs in most of the cases following subarachnoid block in for cesarean sections. Studies comparing different bolus doses of phenylephrine for preventing hypotension induced by subarachnoid block in cesarean sections are sparse. Settings and Design: This study was conducted to compare the efficacy of two different bolus doses of phenylephrine for preventing subarachnoid block-induced hypotension in cesarean sections. Materials and Methods: Sixty parturients undergoing cesarean section were allocated into two groups. Group A (n = 30) received 150 mcg phenylephrine intravenously (IV) and Group B (n = 30) received 200 mcg phenylephrine IV prophylactically immediately after subarachnoid block. Then, for every 2 min, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 20 min, and APGAR scores were measured. Statistical Analysis: The observations are expressed as mean ± standard deviation and were compared using unpaired t-test. The statistical significance of difference between groups was based on P value. P <0.05 was considered statistically significant. Results: There was no difference in preventing hypotension in both the groups, the incidence in Group A being 16.6% and Group B also 16.6%. However, the rise in systolic pressure in Group B was higher than Group A in the first 2–6 min. The incidence of bradycardia was higher in Group B (43.3%) than Group A (20%). Conclusions: Both the doses of phenylephrine were equally efficient in prevention of hypotension after subarachnoid block. Lower prophylactic bolus phenylephrine 150 mcg IV is better in the prevention of hypotension after subarachnoid block in cesarean sections as the incidence of bradycardia is higher with phenylephrine 200 mcg.
  1,170 93 -
The comparison of the efficacy and safety of midazolam, ketamine, and midazolam combined with ketamine administered nasally for premedication in children
Mehmet Erdem Akcay, Ebru Tarıkçı Kılıç, Mehmet Salim Akdemir
April-June 2018, 12(2):489-494
DOI:10.4103/aer.AER_80_18  PMID:29962622
Background: In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children. Material and Methods: We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0.1 mg/kg Midazolam + 3 mg/kg ketamine in Group MK. Patients were evaluated for sedation, anxiety scores, respiratory, and hemodynamic effects before premedication, 5 min interval between induction and postoperative period. Results: There was no difference with respect to age, sex, weight, the duration of the operation, and for mask tolerance. Sedation scores were significantly higher in Group MK. There was no statistically difference between the groups for heart rate, oxygen saturation, and respiratory rate. Conclusion: We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.
  1,148 107 -
Advantages of 1-1-12 wash in scheme during induction with low flow anesthesia with and without nitrous oxide
Ranjana Khetarpal, Joginder Pal Attri, Amrita Banerjee, Renu Verma
April-June 2018, 12(2):371-376
DOI:10.4103/aer.AER_20_18  PMID:29962600
Introduction: In the past, many wash-in schemes have been used with initially high fresh gas flow (FGF) to achieve the necessary alveolar concentration of inhalational agent in 10–15 min. This study was designed to show whether 1-1-12 wash-in scheme proposes an earlier achievement of induction or is there any requirement of high FGF phase to know the time taken for induction with and without nitrous oxide (N2O). Aims: The aim of the study was to find out the time required for the alveolar concentration of desflurane to be from 1% to 6% with and without N2O. Design: It was a potential randomized study which was conducted on sixty patients admitted for elective surgery. Materials and Methods: Two groups of thirty patients each were made and randomly assigned. Group N received desflurane with N2O plus oxygen and Group A received desflurane with air plus oxygen. Statistical Analysis: The observations were noted and evaluated accordingly. Analysis was done using unpaired t-test. Results: Hemodynamic parameters were almost similar in both the groups. In Group N, gradual FAD (Alveolar Desflurane concentration, i.e., end-tidal desflurane) from 1% to 6% was achieved at 0.5, 1, 1.5, 2, 3, and 4 min. In Group A, the same was achieved at 0.6, 1, 1.5, 2, 3, and 4 min (P > 0.05). No significant difference was found between the recuperation time and score in both the groups. Rather complications were more in Group N and statistically significant for nausea and vomiting. Conclusion: Time taken to attain FAD from 1% to 6% was 4 min in both the groups. It is concluded that the recitation of 1-1-12 wash-in scheme is autonomous on the use of N2O and high FGF phase.
  1,173 81 -
Intrathecal tramadol for prevention of postanesthesia shivering after subarachnoid block: A prospective randomized placebo-controlled comparison of two different doses (10 and 20 mg)
Priyanka Gupta, Mayank Gupta
April-June 2018, 12(2):495-500
DOI:10.4103/aer.AER_75_18  PMID:29962623
Background: Shivering is a common and distressing complication following subarachnoid block (SAB). Literature comparing the antishivering efficacy of different doses of intrathecal (IT) tramadol is lacking. Aims: This prospective randomized controlled study was undertaken to evaluate and compare the antishivering efficacy of IT tramadol 10 and 20 mg. Methods: Ninety adult patients undergoing lower limb orthopedic surgeries under SAB were randomized into three groups (n = 30) to receive IL 0.5% hyperbaric bupivacaine 3 ml with tramadol 0 mg (Group C), 10 mg (Group T10), or 20 mg (Group T20) in normal saline. Shivering was assessed using a 5-point intensity scoring system intraoperatively and up to 4-h postoperatively. The onset and duration of sensory and motor block, duration of analgesia, and adverse effects were assessed. Statistical Analysis Used: Analysis of variance and Pearson Chi-square test were used for statistical analysis. Results: The incidence and intensity of shivering were significantly reduced in Group T10 versus C (incidence, P = 0.007; intensity, P = 0.002) and T20 versus C (incidence, P < 0.001; intensity, P < 0.001) but comparable among groups T10 and T20 (incidence, P = 0.133; intensity, P = 0.142). There was a significant dose-dependent prolongation of duration of sensory block (121, 137, and 150.5 min; P = 0.001), motor block (242.83, 298.5, and 344 min; P < 0.001), and analgesia (289.17, 357, and 404.67 min; P < 0.001) with escalating doses of IT tramadol, respectively. All the groups were comparable with respect to hemodynamic variables, core temperature, and adverse effects. Conclusion: The addition of tramadol 10 or 20 mg IT to 0.5% hyperbaric bupivacaine for SAB is associated with significant reduction in the incidence and intensity of postanesthesia shivering and prolongation of the duration of postoperative analgesia. Tramadol 20 mg IT compared to 10 mg IT significantly prolonged the duration of postoperative analgesia but failed to demonstrate any significant attenuation of postanesthesia shivering.
  1,143 104 -
Minimum effective dose of dexamethasone in combination with midazolam as prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy
Rakhi Gupta, Shashi Srivastava, Sanjay Dhiraaj, Puja P Chovatiya
April-June 2018, 12(2):396-401
DOI:10.4103/aer.AER_19_18  PMID:29962605
Background: Postoperative nausea and vomiting (PONV) affects 20% and 30% of patients. As many as 60%–80% patients at high risk may be affected. Dexamethasone (D) and midazolam (M) are well studied as antiemetic. Use of D can be associated with certain undesirable side effects so minimum dose is preferred. M is a routinely used premedicant. Hence, this study was designed with both D and M in high risk patients for PONV to find minimum effective dose of D. Aims: To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy (LC) in patients at high risk for PONV. Setting and Design: This is a prospective, randomized double-blind trial. Materials and Methods: One hundred and fifty-five patients scheduled for elective LC were randomized to 5 groups of 31 each. Group C was given normal saline, and the rest were administered D 1 mg (group MD1), 2 mg (group MD2), 4 mg (group MD4), or 8 mg (group MD8) in combination with 0.04 mg/kg M at induction. The incidence of nausea, vomiting, severity of nausea, and the use of rescue antiemetic and postoperative pain was analyzed. Statistical Analysis: Chi-square test was used to compare incidence of study variables. Independent Student's t-test was used for continuous variables. Demographic data were compared using ANOVA. P < 0.05 was considered statistically significant. Results: The incidence of nausea was significantly lower in group MD4 (29%) and MD8 (6%) compared to placebo group (71%) (P < 0.001) and of vomiting was significantly lower in groups of MD2 (58%), MD4 (48%), and MD8 (6%) compared with placebo (90%) (P < 0.001) at 24 h. There was significant reduction in nausea, pain severity, and incidence of use of rescue antiemetic in MD4 and MD8 groups with no discernable side effects of the drugs. Conclusion: We conclude that 4 mg D with M and 2 mg D with M is effective for prevention of nausea and vomiting, respectively, in patients at high risk for PONV undergoing LC.
  1,165 81 -
Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study
Khaled Elbahrawy, Alaa El-Deeb, Doaa G Diab, Samer Regal
April-June 2018, 12(2):417-422
DOI:10.4103/aer.AER_32_18  PMID:29962609
Background: Palmar hyperhidrosis is a benign disease of excessive sweating in the palm that exceeds the physiological state. Thoracoscopic sympathectomy is an effective surgical treatment for localized hyperhidrosis. Aims: The aim of this study was to compare paravertebral block (PVB) with intrapleural analgesia in thoracoscopic sympathectomy. Settings and Design: A total of 90 patients physical status American Society of Anesthesiologists Classes I or II scheduled for arthroscopic thoracoscopic sympathectomy were enrolled in this study. Subjects and Methods: Patients were randomly allocated into three groups; in the controlled (C) group, no regional block was performed. In the intrapleural (I) group or paravertebral (P) group using a volume of 20 ml of levobupivacaine 0.5%. The first request for analgesia postoperatively was our primary concern. Secondary outcomes included pain scores, the cumulative consumption of fentanyl during the 1st postoperative day, pulmonary functions, blood gases, and complications. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). Results: First request of analgesia in paravertebral group was statistically significantly longer when compared with either control or intrapleural group. In addition, total fentanyl dose was significantly higher in control group when compared with the other groups. Groups I and P showed statistically significant less pain scores, better pulmonary function, and blood gases when compared with control group. Conclusion: We concluded that either intrapleural or paravertebral analgesia compared with control group in thoracoscopic sympathectomy resulted in later request of analgesia, improved pain control, reduced analgesic requirements postoperatively, preservation of lung function and acid-base balance. The PVB, compared to intrapleural, had an advantage of longer and effective analgesia.
  1,172 65 -
Predictors of postoperative ventilation in scoliosis surgery: A retrospective analysis
Eldo Issac, Gokuldas Menon, Bindu K Vasu, Mathew George, Anu Vasudevan
April-June 2018, 12(2):407-411
DOI:10.4103/aer.AER_18_18  PMID:29962607
Background: Patients undergoing corrective surgery for scoliosis may require postoperative ventilation for various reasons. Aim: The aim was to study the correlation of preoperative (pulmonary function test [PFT], etiology, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature at the end of surgery) on postoperative ventilation following scoliosis surgery. Settings and Design: patients' medical records of scoliosis surgery at a tertiary care center during 2010–2016 were retrospectively analyzed. Materials and Methods: We studied retrospectively 108 scoliosis surgeries done in our institute during this period by the same group of anesthetists using standardized anesthesia technique. We analyzed preoperative (etiology, preoperative PFT, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature) influencing postoperative ventilation. Statistical Analysis: For all the continuous variables, the results are either given in mean ± standard deviation, and for categorical variables as a percentage. To obtain the association of categorical variables, Chi-square test was applied. Results: Patients with Cobb's angle above 76° and spinal segment involvement of 11 ± 3 required postoperative ventilation. Forced expiratory volume in 1 s (FEV1%) <38 and forced vital capacity (FVC%) <38.23 of the predicted could not be extubated. Increased blood transfusion and hypothermia were found to affect postoperative ventilation. Conclusion: Preoperative factors such as etiology of scoliosis, Cobb's angle, spirometric values FEV1% and FVC% of predicted and intraoperative factors like number of spinal segments involved, affect postoperative ventilation following scoliosis surgery. Increased blood transfusion and hypothermia are the preventable factors leading to ventilation.
  1,163 73 -
Epidural analgesia during labor: Attitudes among expectant mothers and their care providers
Garg Kamakshi, Grewal Anju, Singh Tania, Gupta Priyanka, Bansal Kamya, Pruthi Gegal, Chuttani Priyanka
April-June 2018, 12(2):501-505
DOI:10.4103/aer.AER_48_18  PMID:29962624
Introduction: Varying levels of knowledge and attitudes among parturients and physicians toward epidural analgesia result in its low utilization. We aimed to assess the knowledge, attitude, and practice of parturients, obstetricians, and anesthesiologists regarding epidural labor analgesia. Methodology: We surveyed obstetricians, anesthesiologists, and parturients availing care and later delivered at our hospital from July 1, 2017, to December 31, 2017. Knowledge, attitude, and practice regarding epidural analgesia were collected using a semi-structured predesigned questionnaire. Data were described as frequencies and analyzed for association between parity and various beliefs and attitudes using Chi-square or Fisher's exact test. Results: About 33% of the parturients knew that delivery is possible without labor pains, but only 18% were satisfied with the procedure. Timely epidural anesthesia could not be availed by 83% of the parturients due to unavailability of service. Among the obstetricians, 64% preferred epidural analgesia and thought that epidural analgesia prolongs the duration of labor, and 55% thought that it would increase the incidence of lower uterine segment cesarean section (LUSCS). In our survey, 48% of all anesthesiologists thought that epidural analgesia would lead to an increase in the incidence of instrumental delivery, 52% required intravenous analgesics with epidural, and 63% thought that it would not increase the incidence of LUSCS. Fear of labor and delivery pain, knowledge status, unwillingness and demand for epidural analgesia, satisfaction level, and reasons for not undergoing the procedure were significantly associated with the gravid status. Conclusion: Wide gap between desire for labor analgesia and its availability exists. A collaborative approach between anesthesiologists and obstetricians is required to disseminate correct information regarding epidural analgesia.
  1,125 103 -
CASE REPORTS
General anesthesia using supraglottic airway device in a myasthenic patient undergoing reverse shoulder arthroplasty
Shaila S Kamath, Julie C. R. Misquith
April-June 2018, 12(2):598-600
DOI:10.4103/aer.AER_26_18  PMID:29962641
Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The decrease in the number of acetylcholine receptors results in decreased efficiency of neuromuscular transmission. Although acetylcholine is released normally, it produces small end-plate potentials that fail to trigger muscle action potentials. Failure of transmission at many neuromuscular junctions results in weakness of muscle contraction. This also makes them susceptible to neuromuscular blocking agents which pose a challenge to the anesthesiologist. Here, we report a case of a patient who was a known case of MG posted for reverse shoulder arthroplasty, who was managed using a supraglottic airway device and spontaneous respiration.
  1,159 66 -
ORIGINAL ARTICLES
Comparative evaluation of three different doses of spinal isobaric ropivacaine in patients undergoing day care perineal surgeries: A randomized double-blind study
Ganpat Prasad, Vansh Priya, Krishna Pratap Mall
April-June 2018, 12(2):392-395
DOI:10.4103/aer.AER_29_18  PMID:29962604
Background and objective: Ropivacaine owing to its propensity of causing motor blockade of reduced duration, is preferred for ambulatory day care surgery. Intrathecal ropivacaine has shown effective analgesia for lower limb surgery. Our study plans to evaluate spinal ropivacaine in three different doses in patients undergoing day care perineal surgery. Methodolgy: 90 ASA-I patients scheduled to undergo day care perineal surgery were randomized to receive intrathecal ropivacaine. Group I (n=30) received 15mg of intrathecal ropivacaine, Group II (n=30) received 18.75 mg of intrathecal ropivacaine and Group III (n=30) received 22.5 mg of intrathecal ropivacaine. Onset of sensory block at T 10, peak sensory block level, duration of sensory block, onset and duration of motor block and relevant safety data were recorded. Result: Onset of analgesia was significantly shorter in Group III (3.5 min ; P<0.0001). However, time taken for peak sensory blockade was comparable in group II and III (12.76 and 11.93 mins). Duration of analgesia was longer and statistically significant in Group III (201.6 mins: P<0.0001) when compared to Group I and II. Onset of motor block was observed to be shortest in Group III (6.7 mins) and duration of motor block was longest in Group III (153.73 mins). These two parameters were statistically significant than Group I and II (P<0.0001). Conclusion: Intrathecal ropivacaine in a dose of 18.75 and 22.5 mg were observed to be equally effective in providing satisfactory analgesia. However, higher dose was associated with profound sensory and motor block.
  1,153 67 -
Intrathecal nalbuphine versus ketamine with hyperbaric bupivacaine in lower abdominal surgeries
Amar Parkash Kataria, Harjeet Singh, Brij Mohan, Milind Thakur, Vishal Jarewal, Sabeena Khan
April-June 2018, 12(2):366-370
DOI:10.4103/aer.AER_3_18  PMID:29962599
Background: Spinal anesthesia is an effective method of anesthesia with fewer side effects. The main limitations include the shorter duration of action and shorter postoperative analgesia when performed only with local anesthetics. Aim: The aim of this study is to compare adjuvants nalbuphine and ketamine to hyperbaric bupivacaine in spinal anesthesia with respect to the duration of analgesia, sensory and motor onset, hemodynamic status, and side effects. Settings and Design: This was a prospective, randomized, double-blind study. Materials and Methods: After ethical committee's clearance and informed consent, 90 patients of the American Society of Anesthesiologists physical status I and II were randomly allocated in three groups N, K, and B who received 3 ml hyperbaric bupivacaine with 0.8 mg nalbuphine, 3 ml hyperbaric bupivacaine with 25 mg ketamine (preservative free), and 3 ml hyperbaric bupivacaine with 0.5 ml normal saline, respectively. Statistical Analysis: Data were analyzed using paired t-test. Results were analyzed and compared to previous studies. SPSS-22 version of software was used, released 2013, IBM Corp., Armonk, NY, USA. Results: Mean duration of analgesia in Group N, K, and B was 290 ± 6.09, 220 ± 5.03, and 154 ± 6.04 min, respectively. Mean time of sensory onset in Group N, K, and B was 2.08 ± 0.34, 3.5 ± 0.25, and 4.5 ± 0.37 min, respectively. Time of motor onset was 7.60 ± 0.58, 7.79 ± 0.37, and 7.82 ± 0.53 min in Group N, K, and B, respectively. Conclusion: Nalbuphine is an effective adjuvant in spinal anesthesia with respect to sensory onset, duration of analgesia, and hemodynamic stability.
  1,093 84 1
Minimum alveolar concentration of desflurane for maintaining BIS below 50 in children and effect of caudal analgesia on it
Jeetinder Kaur Makkar, Deepak Dwivedi, Aswini Kuberan, Balbir Kumar, Indu Bala
April-June 2018, 12(2):512-516
DOI:10.4103/aer.AER_51_18  PMID:29962626
Context: Neuraxial techniques have sedative properties secondary to decreased inputs from sensory and motor afferents. We hypothesized that caudal analgesia decreases the requirement of desflurane as measured by bispectral index (BIS). Aims: This study aims to determine the minimum alveolar concentration (MAC) of desflurane for maintaining BIS below 50 (MACBIS50) in children undergoing infraumbilical surgeries with laryngeal mask airway (LMA) and study the effect of caudal analgesia on the same. Settings and Design: This is prospective and observational study. Subjects and Methods: Thirty-nine American Society of Anesthesiologists physical status Classes I and II children in between 1 and 8 years of age undergoing elective infraumbilical surgery under general anesthesia were allocated randomly into two groups (Group C and Group D) after induction with sevoflurane and LMA insertion. In Group C, caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine and BIS values were recorded after 10 min for 1 min at 10 s intervals. In Group D, BIS was recorded for desflurane for 1 min at 10 s intervals followed by a caudal block with the same dose. Statistical Analysis Used: Dixon up-down method with a step size of 0.5%, and probit analysis were used for analysis. Results: A total of 39 patients were enrolled. MAC of desflurane for maintaining MACBIS50was 5.57 (95% confidence interval [CI] 5.22–5.95) in Group D and 4.31 (95% CI 3.12–5.08) in Group C. The use of caudal anesthesia lowered the MAC of desflurane for maintaining MACBIS50 in children by 22.36% (P < 0.001). Conclusions: The use of caudal analgesia significantly reduced MAC of desflurane for maintaining MACBIS50in children undergoing infraumbilical surgeries using LMA.
  1,082 86 -
A comparison of acute physiology and chronic health evaluation III and simplified acute physiology score II in predicting sepsis outcome in Intensive Care Unit
Parikshit Singh, Sharmishtha Pathak, Ram Murti Sharma
April-June 2018, 12(2):592-597
DOI:10.4103/aer.AER_60_18  PMID:29962640
Context: Acute Physiology and Chronic Health Evaluation (APACHE) III and Simplified Acute Physiology Score (SAPS) II are frequently used to predict the outcome of Intensive Care Unit (ICU) patients of sepsis. Aim: The aim of the study was to compare the predictability of outcome with APACHE III and SAPS II score in ICU patients of sepsis, severe sepsis, and septic shock and the 28-day mortality. Settings and Design: This study was an observational, prospective cohort study. Materials and Methods: A total of 100 consecutive patients of sepsis were studied over 20 months. The worst physiological and biochemical parameters during the first 24 h were recorded for the scores and the patient's 28-day outcome followed up. Statistical Analysis Used: Continuous data were expressed as mean ± standard deviation or median. Receivers operating characteristic (ROC) curve was used to find the cutoff value, area under the curve, sensitivity and specificity of APACHE III score, and SAPS II score. Binary logistic regression with response variable as the outcome was utilized. P < 0.05 was considered statistically significant. Results: The mean APACHE III score in the survivor group was 66.49 ± 18.56 as opposed to 80.67 ± 19.03 for nonsurvivors. The mean SAPS II score for the survivor group was 43.32 ± 13.02 as against the nonsurvivor group at 51.92 ± 12.34. The area under the ROC curve for APACHE III was 0.711 with 95% confidence interval as against 0.686 for SAPS II. The best cutoff value obtained for mortality prediction using the ROC curve was 69 for APACHE III while that for SAPS II was 49. Conclusions: APACHE III was found to be a better predictor of mortality as compared to SAPS II though the margin of difference in mortality prediction was not high.
  1,075 66 -
Suitability of nasotracheal intubation using King Vision and TruviewPCD video laryngoscopes: A randomized clinical trial
Gayatri Mishra, Varghese Mammen Philip, Vadlamudi Reddy Hemanth Kumar, Thiyagarajan Sivashanmugam
April-June 2018, 12(2):581-585
DOI:10.4103/aer.AER_68_18  PMID:29962638
Background: Several video laryngoscopes had demonstrated their superiority over conventional oral and nasal intubation techniques. King Vision video laryngoscope has fewer studies supporting its suitability for oral intubations. However, its suitability as a nasal intubating device has not been yet evaluated. We evaluated the suitability of King Vision video laryngoscope for nasotracheal intubation comparing with TruviewPCD. Methods: Eighty American Society of Anesthesiologists Grade I and II elective surgical patients were studied. After meeting the inclusion criteria, 80 study subjects were randomized into two groups. Group T were intubated using TruviewPCD and Group K were intubated with the nonchanneled King Vision video laryngoscope. Our primary outcome was single successful nasotracheal intubation without use of any additional maneuvers. The time taken for intubation, use of additional maneuverers, Cormack-Lehane grading, and hemodynamics were also analyzed. Results: Seventy-one patients (88.75%) were successfully intubated in a single attempt, i.e. 35 patients (90%) in Group K and 36 patients (87.5%) in Group T. Intubation time (mean ± standard deviation) was 67.9 ± 24.1 s in Group T and 64.9 ± 20.0 s in Group K where comparison was not statistically significant (P = 0.5). The additional maneuvers (P = 0.2) and hemodynamic changes were not clinically significant. There were no associated serious complications. Conclusion: King Vision video laryngoscope is just as effective as TruviewPCD video laryngoscope for successful nasotracheal intubation.
  1,056 71 -
An observational study for knowing the compliance of patients scheduled for major abdominal and thoracic cancer surgeries in a single specialty center
Abhijit S Nair, Vibhavari Naik, Mohammed Salman Saifuddin, Poornachand Anne, Kodisharapu Praveen Kumar, Basanth Kumar Rayani
April-June 2018, 12(2):552-554
DOI:10.4103/aer.AER_49_18  PMID:29962633
Background: Peri-operative incentive spirometry (IS) helps in improving pulmonary function, facilitates sputum clearance and prevents unwanted postoperative pulmonary complications after major abdominal and thoracic surgery. In our hospital, all patients are instructed to practice IS before abdominal and thoracic surgeries so that they can perform it in the postoperative period effectively. However, many patients do not follow our advice. A few unfortunate patients land up with pulmonary complications as it becomes difficult to train them after surgery. Aims: To determine the compliance rate of patients who were instructed to perform incentive spirometry preoperatively. Study design and settings: Observational, single arm study in a single speciality centre. Materials and Methods: After approval from hospital ethics committee the study was registered with Clinical Trials Registry of India (CTRI). 100 patients posted for major abdominal or thoracic cancer surgery were enrolled in the study.They were instructed to perform incentive spirometry(IS) in front of relatives, an information leaflet was provided to them and the spirometry effort was noted in 'ml'. The effort was crossed checked on the day of surgery. Patients performing IS correctly with effort more or equal to that noted earlier were labelled as compliant. Others were labelled as non-compliant. The reason of non-compliance was to be determined using a questionnaire meant for patient and the accompanying family member. Results: Out of 100, 26 patients were found to be non-compliant out of which 10 were males and 16 were female patients. 15 patients did not understand the instructions properly, 8 patients did not get enough time to practice, family members of 10 patients could not help the patient in performing and understanding IS, family members of 8 patients did not have adequate time for the patient. Conclusion: A non-compliance rate of 26% could be because patients and family members did not understand the seriousness of preoperative IS in spite of explaining and giving an information leaflet. The surgeries planned were major ones which require arrangement of finances, abstinence from work and other social issues like not having anybody at home with other family members, location of hospital far from the place they live. Involving respiratory therapist and nursing staff early during pre-anaesthesia check up could help in better understanding of the patient and family regarding benefits of IS.
  1,060 64 -
Comparison of nasopharyngeal temperature measured at fossa of Rosenmuller and blindly inserted temperature probe with esophageal temperature: A cross-sectional study
Arun Kumar Handigodu Duggappa, Shaji Mathew, Dupati Nikkhil Gupta, Shiyad Muhamed, Pawan Nanjangud, Abhishek Rao Kordcal
April-June 2018, 12(2):506-511
DOI:10.4103/aer.AER_47_18  PMID:29962625
Introduction: Monitoring body temperature and maintaining normothermia are now essentially the standard-of-care during anesthesia. This study was designed to compare the temperature measured by nasopharyngeal temperature probes inserted by landmark method and fiberscope-guided method with esophageal temperature. We hypothesized that placing the temperature probe at the level of fossa of Rosenmuller will reflect core temperature as it is in close relationship to the brain. Subjects and Methods: Sixty-five patients aged 18–60 years were enrolled in this cross-sectional study. Two methods were used in our study to place the temperature probes. In landmark-based method, we inserted temperature probe through nostril for a depth equal to philtrum-tragus distance. In fiberscope-guided method, the temperature probe was inserted into nostril and its tip was positioned at fossa of Rosenmuller under fiberscope guidance. Results: The nasopharyngeal temperatures were recorded at seven time intervals along with esophageal temperature. Mean temperatures were calculated at three different sites. The degree of agreement between two methods at seven time intervals was also calculated. Both methods had good correlation with esophageal temperature. Depth of insertion of temperature probes was documented. There was difference in depth of insertion of temperature probe of around 4.26 cm between two methods, probe length from philtrum to tragus (D1) being longer than distance from fossa of Rosenmuller to nares (D2). Conclusions: Nasopharyngeal temperature measured at fossa of Rosenmuller with probe inserted by fiberscope-guided method and that measured by landmark-based method with probe inserted according to philtrum-tragus distance shows good correlation with esophageal temperature.
  1,046 64 -
CASE REPORTS
Anesthetic management for fracture head of radius in a child with glutaric aciduria type-1
Nandita Mehta, Gurleen Kaur
April-June 2018, 12(2):601-603
DOI:10.4103/aer.AER_34_18  PMID:29962642
Glutaric aciduria Type 1 (GA-1) is an autosomal recessive metabolic disorder that results from deficiency of enzyme glutaryl-CoA dehydrogenase. This gives rise to elevated neurotoxic glutaric acid and 3-hydroxyglutaric acid as well as nontoxic glutarylcarnitine in body fluids. The enzyme defect leads to secondary damage to central nervous system due to the accumulation of glutaric acid. Approximately 90% people will develop the neurological disease during a finite period of brain development (3–36 months) following an acute encephalopathic crisis often precipitated by gastroenteritis, immunization, surgical intervention, and intercurrent febrile illness. GA-1 can also develop insidiously without clinically apparent crisis in 10%–20% of the patients. We present a 10-year-old male child with GA-1 who required anesthetic care for fracture (left) neck of radius. Strategies for anesthetic management should include prevention of hypoglycemia, dehydration, electrolyte imbalance, and sufficient analgesia to prevent surgical stress.
  1,007 54 -
LETTERS TO EDITOR
The importance of imaging to guide treatment: Intramuscular psoas mass with lumbosacral plexopathy
Omar Viswanath, Andrew P White
April-June 2018, 12(2):607-608
DOI:10.4103/aer.AER_43_18  PMID:29962645
  937 51 -
Incident reporting of adverse drug reaction to intravenous ranitidine in an emergency department
Saurabh Sud, Deepak Dwivedi, Manish Paul, Sanasam Ushakiran Singh
April-June 2018, 12(2):605-606
DOI:10.4103/aer.AER_40_18  PMID:29962644
  912 60 -
ORIGINAL ARTICLES
A comparative study of intrathecal bupivacaine and bupivacaine with different doses of clonidine in lower limb surgeries
Ruchee Arora, Vandana Pandey, Gurdip Singh Sodhi, BK Mohindra
April-June 2018, 12(2):412-416
DOI:10.4103/aer.AER_31_18  PMID:29962608
Background: Intrathecal clonidine is a very safe, nonopioid adjuvant to local anesthetics to prolong the duration of analgesia without any major side effects. Objective: The purpose of the present study was to evaluate the efficacy of clonidine in two different doses as an adjuvant to bupivacaine intrathecally in lower limb surgeries. Materials and Methods: A total of 75 adult patients scheduled to undergo lower limb surgeries were randomly allocated into either of three groups of 25 patients. Group I received 12.5 mg bupivacaine, Group II patients received bupivacaine 12.5 mg with clonidine 15 μg, and patients in Group III received bupivacaine 12.5 mg with clonidine 30 μg intrathecally. A total volume of 3 ml was made in all groups using normal saline. The hemodynamic parameters, onset, and duration of sensory block, highest dermatomal level of sensory block, motor block onset, time to complete motor block recovery, and mean time to request of the first analgesic were recorded. Side effects or any other complications were noted. Results: The mean time of onset of sensory block and motor block was less in clonidine groups. The mean duration of sensory block was significantly prolonged in clonidine groups as compared to study group. The duration of motor block (in minutes) was significantly prolonged in Group III (171.60 ± 38.20) as compared to Group I (113.20 ± 35.79) and Group II (115.20 ± 38.41). The time of analgesic request in Group I was 148.16 ± 43.99 min, 190.60 ± 38.08 in Group II, and 200.80 ± 59.85 min in Group III. Conclusions: The addition of intrathecal clonidine 15 μg to small dose bupivacaine increased the spread, duration of analgesia, and produced effective spinal anesthesia with stable hemodynamics and did not prolong postoperative motor block.
  879 51 -
  Feedback 
  Subscribe