Reader Login
| Users Online: 30
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
Citation statistics : Table of Contents
2014| January-April | Volume 8 | Issue 1
Online since
March 15, 2014
Archives
Previous Issue
Next Issue
Most popular articles
Most cited articles
Show all abstracts
Show selected abstracts
Export selected to
Cited
Viewed
PDF
ORIGINAL ARTICLES
Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty
Walid Mohamed Emara, Khaled K Moez, Abeer H Elkhouly
January-April 2014, 8(1):48-53
DOI
:10.4103/0259-1162.128908
Background:
This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]).
Patients and Methods:
After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded.
Results:
There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in "r" and "k" times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A.
Conclusion:
Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
20
3,339
153
REVIEW ARTICLES
A basic review on the inferior alveolar nerve block techniques
Hesham Khalil
January-April 2014, 8(1):3-8
DOI
:10.4103/0259-1162.128891
The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
10
14,852
650
ORIGINAL ARTICLES
Enhancement of ropivacaine caudal analgesia using dexamethasone or magnesium in children undergoing inguinal hernia repair
Gamal T Yousef, Tamer H Ibrahim, Ahmed Khder, Mohamed Ibrahim
January-April 2014, 8(1):13-19
DOI
:10.4103/0259-1162.128895
Background:
Caudal analgesia is the most commonly used technique providing intra- and postoperative analgesia for various pediatric infraumbilical surgical procedures but with the disadvantage of short duration of action after single injection. Caudal dexamethasone and magnesium could offer significant analgesic benefits. We compared the analgesic effects and side-effects of dexamethasone or magnesium added to caudal ropivacaine in pediatric patients undergoing inguinal hernia repair.
Materials and Methods:
A total of 105 (1-6 years) were randomly assigned into three groups in a double-blinded manner. After a standardized sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.15% 1.5 mL/kg combined with either magnesium 50 mg in normal saline 1 mL (group RM), dexamethasone 0.1 mg/kg in normal saline 1 mL (group RD), or corresponding volume of normal saline (group R) according to group assignment. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h.
Results:
Addition of magnesium or dexamethasone to caudal ropivacaine significantly prolonged analgesia duration 8 (5-11) h and 12 (8-16) h, respectively compared with 4 (3-5) h with the use of ropivacaine alone. The incidence of postoperative rescue analgesia was significantly higher in group R compared with groups RM and RD. The time to 1
st
analgesic dose was significantly longer in groups RM and RD (500 ± 190 and 730 ± 260 min) respectively compared with group R (260 ± 65 min). Group R patients achieved significantly higher Children's Hospital of Eastern Ontario Pain Scale and Faces Legs Activity Cry Consolability scores (4
th
hourly) compared with groups RM and RD patients (8
th
and 12
th
hourly, respectively).
Conclusion:
The addition of dexamethasone or magnesium to caudal ropivacaine significantly prolonged the duration of postoperative analgesia in children undergoing inguinal hernia repair. Also the time to 1
st
analgesic dose was longer and the need for rescue postoperative analgesic was reduced and without increase in incidence of side effects.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
8
3,979
280
Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia
Rajesh Rajgopal, Sunil Rajan, Kavitha Sapru, Jerry Paul
January-April 2014, 8(1):32-35
DOI
:10.4103/0259-1162.128903
Context:
Medical guidelines advise perioperative continuation many antihypertensives, but discontinuing angiotensin antagonists before surgery.
Aims:
This study is aimed to determine the effect of preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) on intra-operative blood pressure after induction of general anesthesia.
Settings
and
Design:
The study was a randomized, prospective and double blinded one done in 60 hypertensive patients, receiving these drugs.
Materials
and
Methods:
Patients were randomized into two equal groups. In Group A, ACEI or angiotensin II receptor antagonist was stopped the day before surgery, but in Group B it was continued. Anesthetic management was standardized by a study protocol. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured just before induction and after induction at 1 min, 3, 5, 10, 15, 30, 45 and 60 min.
Statistical
Analysis:
Difference between means and difference between two proportions was analyzed using Normal test for means and corresponding
P
values were calculated.
Results:
Pre-induction SBP, DBP and MAP were comparable between groups. However when the pre-induction values were compared with subsequent readings at 3, 5, 10, 15, 30, 45 and 60 min, it was found that there was a significant reduction in SBP, DBP and MAP in Group B up to 60 min.
Conclusions:
Intraoperative hemodynamics can be safely managed when ACEI or ARA are withheld on the day of surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
5
1,825
137
Apneic Oxygenation during simulated prolonged difficult laryngoscopy: Comparison of nasal prongs versus nasopharyngeal catheter: A prospective randomized controlled study
Shreepathi Krishna Achar, Archana Jagdish Pai, U Kailasnath Shenoy
January-April 2014, 8(1):63-67
DOI
:10.4103/0259-1162.128911
Background:
Apneic oxygenation by insufflating O
2
through nasal prongs (NP) and nasopharyngeal catheter (NC) has been proven to be effective. We conducted this study to compare the relative efficacy of these two techniques in a simulated difficult airway situation.
Objective:
The objective of this study is to evaluate the influence of two techniques of apneic oxygenation (NP vs. NC) on the duration of oxygen saturation ≥95% during simulated prolonged difficult laryngoscopy.
Methods:
A randomized non-blinded study was conducted in 56 adult patients, 28 in each group belonging to American Society of Anesthesiologists physical status class I and II scheduled for elective surgical procedures under general endotracheal anesthesia randomized to either NC or NP group. After pre-oxygenating for an end tidal oxygen concentration of 90% and induction, ability to mask ventilate was checked and paralyzed with rocuronium. Apneic oxygenation using 5 L/min of O
2
was established either by NP or NC. After laryngoscopy the laryngoscope was withdrawn to simulate a Grade 4 laryngoscopy and held in this position for an apnea time (T
1
) of 10 min with SpO
2
maintained at ≥95% or until SpO
2
dropped to < 95%, whichever is earlier. An arterial blood gas analysis was performed at the end of T
1
. Desaturation to < 95% were compared between the groups using Chi-square test (
P
< 0.05 as significant). Arterial blood gas analysis among those who sustained T
1
for 10 min between the groups were compared using independent sample
t
-test (
P
< 0.05 was considered as significant). None of patients were excluded from the study.
Results:
In NP group nine patients desaturated as against none in the NC group (
P
= 0.001). Arterial blood gas analysis among non-desaturated patients was comparable with respect to PO
2
, PCO
2
and pH.
Conclusion:
Nasopharyngeal catheter is a better device than nasal prongs in maintaining safe oxygenation during apnea in a simulated prolonged difficult laryngoscopy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
5
2,370
117
CASE REPORTS
Unanticipated cardiac arrest under spinal anesthesia: An unavoidable mystery with review of current literature
Anita Kumari, Ruchi Gupta, Sukhminder Jit Singh Bajwa, Amrinder Singh
January-April 2014, 8(1):99-102
DOI
:10.4103/0259-1162.128923
Cardiac arrest during anesthesia and perioperative period is a matter of grave concern for any anesthesiologist. But such mishaps have been reported for one reason or the other in the literary sciences. We are reporting the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in two young and healthy patients. Fortunately, these patients were successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. Occurrence of such cases needs timely reporting and exploring all the possible causes of these unusual and possibly avoidable events. The present case reports are an important addition to a series of recently published mishaps that occurred during spinal anesthesia in young and healthy patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
3
3,060
485
Anaesthetic management in a case of huge plunging ranula
Jagabandhu Sheet, Anamitra Mandal, Swapnadeep Sengupta, Debaleena Jana, Sudakshina Mukherji, Sarbari Swaika
January-April 2014, 8(1):114-116
DOI
:10.4103/0259-1162.128929
Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
2,225
123
Anaesthetic management of a case of dilated cardiomyopathy for emergency appendectomy
Ravi Raj, Mritunjay Kumar, Meenu Batra
January-April 2014, 8(1):105-107
DOI
:10.4103/0259-1162.128925
The anesthetic management of a patient with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery poses a challenge for anesthesiologist either due to pre-existing or a risk of precipitating congestive heart failure. We report a successful use of combined spinal epidural for emergency appendicectomy in a patient of DCM. Different anesthetic concerns and agents, some recent advances are also discussed.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
5,571
369
LETTERS TO EDITOR
Rare complication of nasogastric tube insertion
Tim Thomas Joseph, Laxmi Shenoy, A Harshan, Sagar Maddani Shanmukhappa
January-April 2014, 8(1):118-119
DOI
:10.4103/0259-1162.128931
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
1,527
108
ORIGINAL ARTICLES
A comparative study of pre-operative oral clonidine and pregabalin on post-operative analgesia after spinal anesthesia
Anu Prasad, Susmita Bhattacharyya, Atanu Biswas, Mrityunjaya Saha, Sudeshna Mondal, Dona Saha
January-April 2014, 8(1):41-47
DOI
:10.4103/0259-1162.128907
Objectives:
Pregabalin and clonidine have anti-nociceptive properties. This study assesses their efficacy in prolonging the analgesic effect of spinal anesthesia and post-operative analgesic requirement in patients undergoing vaginal hysterectomy.
Materials and Methods:
A total of 90 females in the age group of 30-60 years were randomly allocated in to three groups of 30 each, to receive either oral clonidine (150 μg) or oral pregabalin (150 mg) or oral multivitamin as placebo 1.5 h before spinal anesthesia with 3ml (15 mg) of 0.5% hyperbaric bupivacaine. Intensity of pain was measured on a visual analog scale (VAS) at the end of operation (0 h) then at 1,2,4,6,12 and 24 h thereafter. Diclofenac sodium intramuscularly 1 mg/kg was provided when the VASscore was >4 in the study period. Sedation was defined by Ramsay sedation scale at 0,6,12 and 24 h. Side-effects such as nausea and vomiting, respiratory depression and dryness of mouth were noted.
Results:
The VAS scores were significantly less in the pregabalin group compared with the clonidine group at 6,12 and 24 h post-operatively with a
P
< 0.0001. More sedation was seen in the clonidine group than in the pregabalin group (
P
< 0.05). Analgesic consumption and VAS scores were lower in clonidine and pregabalin group compared with the placebo group (
P
< 0.05).
Conclusion:
Oral pregabalin (150 mg) prolongs the post-operative pain relief after spinal anesthesia but produces less sedation compared with oral clonidine (150 μg).
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
2,873
210
REVIEW ARTICLES
Improved prophylaxis of postoperative nausea vomiting: Palonosetron a novel antiemetic
Akshaya N Shetti, Dewan Roshan Singh, Kusha Nag, Rachita A Shetti, VR Hemanth Kumar
January-April 2014, 8(1):9-12
DOI
:10.4103/0259-1162.128894
Many anti-emetics are used in clinical practice. Palonosetron hydrochloride is one of them. It is a novel, centrally acting antiemetic, and anti-nausea agent. This drug is an antagonist of serotonin receptor subtype 3 (5-HT3). This drug has longer duration of action which makes it useful in the prevention and treatment of acute and delayed onset of nausea and vomiting. This drug was initially used for chemotherapy induced nausea and vomiting. Federal drug agency (FDA) has approved it for prevention and treatment of post-operative nausea and vomiting. The literature search for this article was done using Google scholar and Pubmed using the terms ''Palonosetron,'' ''longer duration of action,'' ''nausea,'' ''vomiting,'' and ''postoperative''.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
3,933
190
CASE REPORTS
A case of negative pressure pulmonary edema in an asthmatic patient after laparoscopic cholecystectomy
Asim Rasheed, Urmila Palaria, Dolly Rani, Shatrunjay Sharma
January-April 2014, 8(1):86-88
DOI
:10.4103/0259-1162.128919
Negative pressure pulmonary edema is often misdiagnosed or can go clinically unrecognized by anesthesiologists. It is characterized by a markedly low intrapleural pressure which leads to exudation of fluid and red blood cells in the interstitium. Recognition of patients with predisposing factors for upper airway obstruction is important in the diagnosis which is often confused with pulmonary aspiration of gastric contents. Signs and symptoms are subtle and edema is usually self-limited. Our patient was management conservatively with maintenance of a patent airway and administration of supplemental oxygen and had a successful outcome.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,914
92
Spinal anesthesia in a caesarian case after dry tap
Hridoy Kumar Das, MK Gunjal, Hemant D Toshikhane
January-April 2014, 8(1):103-104
DOI
:10.4103/0259-1162.128924
The case report here is a case of cesarean operation under subarachnoid block, which resulted after a failed lumber puncture, known to be "dry tap." The result is that it was uneventful surgery without any additive anesthetics being required after injecting 2.2 ml Bupivacaine 0.5% (H). Although cases have been reported with mixed experiences of dry tap and different causes are also explained, but still there is a need to find few other reasons for "dry tap." Hence, thought to present the case for putting forward a question that if there is any more cause for dry tap.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,595
90
LETTERS TO EDITOR
Intubation with oral lightwand with an alternative curvature in a case of temporo-mandibular joint ankylosis
Bikramjit Das
January-April 2014, 8(1):120-120
DOI
:10.4103/0259-1162.128932
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,084
67
ORIGINAL ARTICLES
Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section
Prachee Sachan, Nidhi Kumar, Jagdish Prasad Sharma
January-April 2014, 8(1):20-25
DOI
:10.4103/0259-1162.128898
Background:
Density of the drugs injected intrathecally is an important factor that influences spread in the cerebrospinal fluid. Mixing adjuvants with local anesthetics (LA) alters their density and hence their spread compared to when given sequentially in seperate syringes.
Aims
: To evaluate the efficacy of intrathecal administration of hyperbaric bupivacaine (HB) and clonidine as a mixture and sequentially in terms of block characteristics, hemodynamics, neonatal outcome, and postoperative pain.
Setting and Design
: Prospective randomized single blind study at a tertiary center from 2010 to 2012.
Materials and Methods:
Ninety full-term parturient scheduled for elective cesarean sections were divided into three groups on the basis of technique of intrathecal drug administration. Group M received mixture of 75 μg clonidine and 10 mg HB 0.5%. Group A received 75 μg clonidine after administration of 10 mg HB 0.5% through separate syringe. Group B received 75 μg clonidine before HB 0.5% (10 mg) through separate syringe.
Statistical analysis used:
Observational descriptive statistics, analysis of variance with Bonferroni multiple comparison
post
hoc
test, and Chi-square test.
Results:
Time to achieve complete sensory and motor block was less in group A and B in which drugs were given sequentially. Duration of analgesia lasted longer in group B (474.3 ± 20.79 min) and group A (472.50 ± 22.11 min) than in group M (337 ± 18.22 min) with clinically insignificant influence on hemodynamic parameters and sedation.
Conclusion
: Sequential technique reduces time to achieve complete sensory and motor block, delays block regression, and significantly prolongs the duration of analgesia. However, it did not matter much whether clonidine was administered before or after HB.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
2,059
175
Airway management: A comparative study in cleft lip and palate repair surgery in children
Jayashree Sen, Bitan Sen
January-April 2014, 8(1):36-40
DOI
:10.4103/0259-1162.128905
Background:
Cleft lip with or without palate is one of the common congenital malformations.
Aim:
To evaluate the per-operative complications of anesthesia, a comparative study was conducted in children using the endotracheal tubes available in the Institute so that the complications can be averted in future procedures.
Materials and Methods:
The rural population of Tripura, India.
Result:
Awareness was generated and the incidence of repair surgeries of cleft lip and palate was thus increased considerably in Dr. B. R. Ambedkar Memorial Teaching Hospital, Agartala, Tripura.
Conclusion:
The RAE tube has been found to be the choicest one and at a minimal risk for maintaining patients' patent airway and other related complications.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
3,785
226
Granisetron versus ondansetron for post-operative nausea and vomiting prophylaxis in elective craniotomies for brain tumors: A randomized controlled double-blind study
Priyanka Gupta, Nikki Sabharwal, Suniti Kale, Mayank Gupta, Anoop R Gogia
January-April 2014, 8(1):72-77
DOI
:10.4103/0259-1162.128914
Context:
Post-operative nausea and vomiting (PONV) pose unique challenges in neurosurgical patients that warrant its study separate from other surgical groups.
Setting and Design:
This prospective, randomized, double-blind study was carried out to compare and to evaluate the efficacy and safety of three antiemetic combinations for PONV prophylaxis following craniotomy.
Materials
and Methods:
A total of 75 anesthesiologist status I/II patients undergoing elective craniotomy for brain tumors were randomized into three groups, G, O and D, to receive single doses of dexamethasone 8 mg at induction with either granisetron 1 mg, ondansetron 4 mg or normal saline 2 ml at the time of dural closure respectively. Episodes of nausea, retching, vomiting and number of rescue antiemetic (RAE) were noted for 48 h post-operatively.
Statistical Analysis:
Analysis of variance with
post-hoc
significance and Chi-square test with fisher exact correction were used for statistical analysis.
P
<0.05 was considered to be significant and
P
< 0.001 as highly significant.
Results:
We found that the incidence and number of vomiting episodes and RAE required were significantly low in Group G and O compared with Group D;
P
< 0.05. However, incidence of nausea and retching were comparable among all groups. The anti-nausea and anti-retching efficacy of all the three groups was comparable.
Conclusions:
Single dose administration of granisetron 1 mg or ondansetron 4 mg at the time of dural closure with dexamethasone 8 mg provide an effective and superior prophylaxis against vomiting compared with dexamethasone alone without interfering with post-operative recovery and neurocognitive monitoring and hence important in post-operative neurosurgical care.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
2,020
130
Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine
Dilip Kothari, Neelima Tandon, Meena Singh, Arun Kumar
January-April 2014, 8(1):78-82
DOI
:10.4103/0259-1162.128916
Objectives:
The objective of the study is to compare the effect of dexmedetomidine versus lignocaine in attenuation of circulatory and airway responses during endotracheal extubation in craniotomies for intracerebral space occupying lesions (ICSOL).
Materials and Methods:
A total of 50 patients of American Society of Anesthesiologists Grade I and II of either sex, aged 18-50 years undergoing craniotomies for non-vascular ICSOL under general anesthesia were divided into two groups according to drug received. Group D (
n
= 25) received dexmedetomidine (0.5 mcg/kg) whereas group L (
n
= 25) received lignocaine (1.5 mg/kg). Both the drugs were given 5 min before the extubation over a period of 60 s. Values for heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), were recorded just before (A0) and 1, 3, 5 (A1, A3, A5) min after the study drug administration, at extubation (E) and 1, 3, 5, 10, 15 min after extubation (E1, E3, E5, E10 and E15). Respiratory rate, oxygen saturation and airway responses like coughing, breath-holding, laryngospasm/bronchospasm were recorded only at extubation (E) and 1, 3, 5, 10, 15 min after extubation (E1, E3, E5, E10, E15). Quality of extubation was recorded with four point scale. After extubation all these patients were also observed for sedation by Ramsey sedation score.
Results:
Both groups showed a statistically significant increase (D < L) in HR, SBP and DBP during (E) and immediately after extubation (E1) (
P
< 0.05). Dexmedetomidine (72%) produced a higher degree of sedation (Grade 3) as compare with lignocaine (0%) and with no incidence of coughing or breath holding (
P
< 0.05).
Conclusion:
Single dose of dexmedetomidine (0.5 mcg/kg) given 5 min before extubation produced significant attenuation of circulatory and airway responses produced during extubation as compared to Lignocaine (1.5 mg/kg) in ICSOL.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
2,201
192
CASE REPORTS
Anesthetic management of a patient with Holt-Oram syndrome undergoing right radial head excision
Akshaya N Shetti, Vithal K Dhulkhed, Vinayak Panchgar, Lokesh Prakash
January-April 2014, 8(1):83-85
DOI
:10.4103/0259-1162.128917
Holt-Oram syndrome also known as heart and hand syndrome, first reported in 1960. It is a rare, inherited, an autosomal dominant disorder with mutation in TBX5. As the name suggests, the feature involves skeletal abnormality mainly involving upper limb, that is, upper-extremity malformations involving radial, thenar, or carpal bones; congenital heart diseases like, atrial-septal defect and ventricular septal defect and conduction problems. This syndrome may also involve other part of skeletal structure. We hereby report a case of a patient who was suffering from this syndrome scheduled for right radial head excision.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,782
68
Anesthetic management of a pregnant patient with pseudo-pancreatic cyst for cysto-gastrostomy
Akshaya N Shetti, Vithal K Dhulkhed, Amrish Gujarati, GS Swetha
January-April 2014, 8(1):89-92
DOI
:10.4103/0259-1162.128920
Non-obstetric diseases during pregnancy are not uncommon. The presence of systemic disease may further insult the pregnancy leading to alteration in the normal function of other system. Hence, it is important to treat the disease depending upon the severity and type of urgency. Several systemic diseases in pregnancy and management have been reported earlier but it is necessary to report a rare pathology, treatment option and its anesthetic management. We report anesthetic management of a rare case of pseudo pancreatic cyst in a pregnant lady operated for cysto-gastrostomy and also highlighting the recent guidelines for non-obstetric surgery in pregnancy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,591
87
Transient aphonia, aphagia and facial tingling following intrathecal administration of fentanyl
Babita Gupta, Sarita Ramchandani, Ira Balakrishnan, Atin Kumar
January-April 2014, 8(1):93-95
DOI
:10.4103/0259-1162.128921
Subarachnoid block with local anaesthetic agent and opiod as an adjuvant is a well-known technique with a good record of safety. However, some rare neurological complications like aphonia, dysphagia and tingling sensation have been reported following their administration in pregnant females posted for labour analgesia or caesarean section. We report a case of transient aphonia, aphagia and facial tingling following intrathecal administration of bupivacaine along with fentanyl for lower limb wound debridement in a male patient.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,830
72
General anesthesia in tetanus patient undergoing emergency surgery: A challenge for anesthesiologist
Reena Mahajan, Amit Kumar, Shiv Kumar Singh
January-April 2014, 8(1):96-98
DOI
:10.4103/0259-1162.128922
Tetanus is an acute often fatal disease produced by gram positive obligate anaerobic bacterium
Clostridium tetani
. Tetanolysin damages local tissue and provides optimal conditions for bacterial multiplication. It is therefore important to perform a wide debridement of any wound suspected of being a portal of entry for the bacteria. Little evidence exists to recommend specific anesthetic protocols. We encountered a child scheduled for fracture both bone forearm with developing tetanus. Initial management done with intravenous (i.v) diazepam, phenobarbitone, and metronidazole. After premedication with midazolam and fentanyl, induction was done by propofol 60 mg, vecuronium 2.5 mg, ventilated with O
2
+ N
2
O 50:50 with sevoflurane 2% and tracheal intubation was done with 5.5 ID cuffed PVC endotracheal tube. Anesthesia was maintained with sevoflurane 2% and vecuronium intermittently when required. Intraop vitals were stable. On completion of surgery, reversal given and patient was extubated uneventfully and shifted to recovery room. Little evidence exists to recommend specific anesthetic technique for tetanus patient posted for surgery. When present, obvious wounds should be surgically debrided. Ideally patients considered for surgery should undergo anesthesia and surgery before severe autonomic dysfunction develops. Most anesthetic managements are based on limited evidence. However, we used sevoflurane and vecuronium successfully, further study is needed to establish their efficacy and safety. Major challenges lie in the control of muscle rigidity and spasm, autonomic disturbances and prevention of complications.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,779
141
Unsafe abortion: Addressing the anaesthetic confronts
Gaurav Jain, Rohit Varshney, Rina Sharma, Jayati Nath
January-April 2014, 8(1):108-110
DOI
:10.4103/0259-1162.128926
Unsafe abortion has a global incidence of about 20 million cases annually, out of which 97% cases are reported from developing nations. There are many reports showing the occurrence of bowel or uterine perforation in such instances, but most of them have concentrated upon surgical or obstetric complications. We report a case of unsafe abortion with ruptured uterus, intra-abdominal foetus, and bowel infarction that developed intraoperative cardiac arrest during the emergency laparotomy. This case highlights anaesthetic challenges in managing such critically ill-patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,762
93
Scar contracture of anterior tonsillar pillar leading to difficult intubation
Hemlata Kapoor, Suhas Mokashi
January-April 2014, 8(1):111-113
DOI
:10.4103/0259-1162.128927
Unanticipated difficult intubations on the operation table have often tested all the anesthetists' intubation skill. The understanding of the causative factor and accordingly using the correct instrument from the difficult intubation kit requires experience and thorough knowledge on the part of the anesthetist. We describe a case of difficult intubation due to scar contracture of anterior tonsillar pillar formed after a previous surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,142
70
EDITORIAL
Innovations, improvisations, challenges and constraints: The untold story of anesthesia in developing nations
Sukhminder Jit Singh Bajwa, Mohamad Said Maani Takrouri
January-April 2014, 8(1):1-2
DOI
:10.4103/0259-1162.128890
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,304
169
LETTERS TO EDITOR
Portex EpiFuse
TM
epidural connector: Is an improvisation required?
Mayank Gupta, Rama Wason, Anoop R Gogia, Priyanka Gupta
January-April 2014, 8(1):121-121
DOI
:10.4103/0259-1162.128935
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,300
57
Shetti's maneuver
Akshaya N Shetti, Dewan Roshan Singh, Kusha Nag
January-April 2014, 8(1):122-122
DOI
:10.4103/0259-1162.128937
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,254
105
Technological advancements in anesthesia practice: Role of decision support system
Sukhminder Jit Singh Bajwa
January-April 2014, 8(1):117-118
DOI
:10.4103/0259-1162.128930
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,064
65
ORIGINAL ARTICLES
A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial
Luiz Eduardo Imbelloni, Marildo A Gouveia
January-April 2014, 8(1):26-31
DOI
:10.4103/0259-1162.128900
Background:
The thoracic spinal anesthesia was first described in 1909 and recently revised for various surgical procedures. This is a prospective study aims to evaluate the parameters of the thoracic spinal anesthesia (latency, motor block and paresthesia), the incidence of cardiovascular changes and complications comparing low doses of isobaric and hyperbaric bupivacaine.
Materials and Methods:
A total of 200 orthopedic patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T9-T10, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with 0.5% bupivacaine isobaric or hyperbaric. Patients remained in cephalad or head down position 10-20° for 10 minutes. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications.
Results:
All patients developed spinal and there was no failure. The solution did not affect the onset of the blockade. The duration of motor block was greater than the sensitive with isobaric. The duration of sensory block was greater than the motor block with hyperbaric solution. The incidence of paresthesia was 4%, with no difference between the needles. The incidence of hypotension was 12.5% with no difference between the solutions. There was no neurological damage in all patients.
Conclusion:
The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,620
119
Study of quality and extent of intrathecal bupivacaine block by extradural injectio n of bupivacaine or normal saline in combined spinal epidural technique
Sarmila Guha (Banerjee), Ujjwal Bandyopadhyay, Pradyut Kumar Pan, Arijit Sinha
January-April 2014, 8(1):54-58
DOI
:10.4103/0259-1162.128909
Aims:
The aim of the present study is to substantiate and compare the quality and extent of nerve block by using intrathecal bupivacaine or extradural bupivacaine alone and in combined spinal-epidural (CSE) technique using smaller dose of intrathecal bupivacaine and extradural injection of a smaller dose of bupivacaine or normal saline.
Setting
and
Design:
A prospective study design was set up with 60 adult patients scheduled for vaginal and lower abdominal operation under CSE technique and single spinal or epidural technique.
Materials and Methods:
60 patients undergoing infra-umbilical surgery were divided into three groups (Group). Group A1 (control) 10 patients received 3 ml of intrathecal heavy bupivacaine. A2-10 patients received 16 ml isobaric bupivacaine extradurally Group B (
n
= 20) patients received 2 ml intrathecal heavy bupivacaine and 10 ml normal saline extradurally. Group C patients (
n
= 20) received 2 ml heavy bupivacaine intrathecally and 10 ml isobaric bupivacaine extradurally. A total duration of this study was 18 months. Duration of motor block, sensory block, analgesia, onset of sensory block and cephaloid extent of sensory block and side-effects noted among patients. Visual analog scale in the post-operative period was recorded.
Statistical
Analysis:
The results were analyzed statistically by applying analysis of variable, odds ratio and Chi-square test.
Results:
Patients were comparable regarding the onset time and height and duration of sensory block with a significant difference, though there was no difference in duration of motor block and analgesia. The side-effects in the control group are higher than the other two groups.
Conclusion:
Quality of nerve block in combined technique using bupivacaine both intrathecally and extradurally is better and associated with lower side-effect compared with intrathecal heavy bupivacaine or extradural isobaric bupivacaine alone.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,459
106
Comparison of different doses of intranasal nitroglycerine in attenuation of pressor response to laryngoscopy and intubation
Atul B Vyas, Indu A Chadha, Prajeesh M Nambiar, Vijeth T. G. Bhat, Dharmendrasinh D Chavada, Prashant Chhaganbhai Sorathiya
January-April 2014, 8(1):59-62
DOI
:10.4103/0259-1162.128910
Aims:
To observe the various pressor responses to laryngoscopy and intubation in normotensive patient undergoing elective surgery under general anesthesia and use of three different attenuating doses (400, 800, 1200 mcg) of intranasal nitroglycerine administered five minutes before laryngoscopy and intubation, to observe the efficacy and safety.
Settings and Design:
Randomized study.
Materials and Methods:
The study was carried out in a total of 60 patients. ASA grade 1 and II patients posted for elective surgeries under general anesthesia were included. Patients received different doses of intranasal nitroglycerine five minutes before induction as given below Group 1-received 400 micrograms-20 patients Group 2-received 800 micrograms-20 patients Group 3-received 1200 micrograms-20 patients. Statistical Analysis: Student's
t
test.
Results and Summary:
Results were statistically analyzed. All three groups effectively attenuated the pressor response to laryngoscopy and intubation. Maximum rise in heart rate was seen in group III (23.86%). Maximum fall in systolic (19.6%), diastolic (30.76%), and mean arterial blood pressure (25.53%) was observed in group III at 10
th
minute of laryngoscopy and intubation.
Conclusion:
Best results of attenuation of pressor response were seen with 400 and 800 micrograms of intranasal nitroglycerine. One thousand and two hundred micrograms dose caused maximum increase in heart rate and caused maximum fall in blood pressure, hence it is advisable to use increased dose with caution in attenuation of pressor response to laryngoscopy and intubation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,456
126
Operative blood transfusion quality improvement audit
Mazen Al Sohaibani, Assaf Al Malki, Venumadhav Pogaku, Saad Al Dossary, Hanan Al Bernawi
January-April 2014, 8(1):68-71
DOI
:10.4103/0259-1162.128912
Context:
To determine how current anesthesia team handless the identification of surgical anaesthetized patient (right patient). And the check of blood unit before collecting and immediately before blood administration (right blood) in operating rooms where nurses have minimal duties and responsibility to handle blood for transfusion in anaesthetized patients.
Aims:
To elicit the degree of anesthesia staff compliance with new policies and procedures for anaesthetized surgical patient the blood transfusion administration.
Settings and Design:
Setting: A large tertiary care reference and teaching hospital. Design: A prospective quality improvement. Elaboration on steps for administration of transfusion from policies and procedures to anaesthetized patients; and analysis of the audit forms for conducted transfusions.
Subjects and Methods:
An audit form was used to get key performance indicators (KPIs) observed in all procedures involve blood transfusion and was ticked as item was met, partially met, not met or not applicable.
Statistical Analysis Used:
Descriptive statistics as number and percentage Microsoft excel 2003. Central quality improvement committee presented the results in number percentage and graphs.
Results:
The degree of compliance in performing the phases of blood transfusion by anesthesia staff reached high percentage which let us feel certain that the quality is assured that the internal policy and procedures (IPP) are followed in the great majority of all types of red cells and other blood products transfusion from the start of requesting the blood or blood product to the prescript of checking the patient in the immediate post-transfusion period.
Conclusions:
Specific problem area of giving blood transfusion to anaesthetized patient was checking KPI concerning the phases of blood transfusion was audited and assured the investigators of high quality performance in procedures of transfusion.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
5,051
165
Feedback
Subscribe
Sitemap
|
What's New
|
Feedback
|
Disclaimer
© Anesthesia: Essays and Researches | Published by Wolters Kluwer -
Medknow
Online since 1
st
June, 2010