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REVIEW ARTICLES
Ketamine: Current applications in anesthesia, pain, and critical care
Madhuri S Kurdi, Kaushic A Theerth, Radhika S Deva
September-December 2014, 8(3):283-290
DOI
:10.4103/0259-1162.143110
Ketamine was introduced commercially in 1970 with the manufacturer's description as a "rapidly acting, nonbarbiturate general anesthetic" and a suggestion that it would be useful for short procedures. With the help of its old unique pharmacological properties and newly found beneficial clinical properties, ketamine has survived the strong winds of time, and it currently has a wide variety of clinical applications. It's newly found neuroprotective, antiinflammatory and antitumor effects, and the finding of the usefulness of low dose ketamine regimens have helped to widen the clinical application profile of ketamine. The present article attempts to review the current useful applications of ketamine in anesthesia, pain and critical care. It is based on scientific evidence gathered from textbooks, journals, and electronic databases.
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149
15,983
1,673
REVIEW ARTICLE
Current role of dexmedetomidine in clinical anesthesia and intensive care
Manpreet Kaur, PM Singh
July-December 2011, 5(2):128-133
DOI
:10.4103/0259-1162.94750
Dexmedetomidine is a new generation highly selective α 2-adrenergic receptor (α 2-AR) agonist that is associated with sedative and analgesic sparing effects, reduced delirium and agitation, perioperative sympatholysis, cardiovascular stabilizing effects, and preservation of respiratory function. The aim of this review is to present the most recent topics regarding the advantages in using dexmedetomidine in clinical anesthesia and intensive care, while discussing the controversial issues of its harmful effects.
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83
34,236
2,727
REVIEW ARTICLES
Postoperative nausea and vomiting: A simple yet complex problem
Safiya Imtiaz Shaikh, D Nagarekha, Ganapati Hegade, M Marutheesh
September-December 2016, 10(3):388-396
DOI
:10.4103/0259-1162.179310
PMID
:27746521
Postoperative nausea and vomiting (PONV) is one of the complex and significant problems in anesthesia practice, with growing trend toward ambulatory and day care surgeries. This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for PONV. We searched the Medline and PubMed database for articles published in English from 1991 to 2014 while writing this review using “postoperative nausea and vomiting, PONV, nausea-vomiting, PONV prophylaxis, and rescue” as keywords. PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors. PONV prophylaxis is administered to patients with medium and high risks based on this scoring system. Newer drugs such as neurokinin-1 receptor antagonist (aprepitant) are used along with serotonin (5-hydroxytryptamine subtype 3) receptor antagonist, corticosteroids, anticholinergics, antihistaminics, and butyrophenones for PONV prophylaxis. Combination of drugs from different classes with different mechanism of action are administered for optimized efficacy in adults with moderate risk for PONV. Multimodal approach with combination of pharmacological and nonpharmacological prophylaxis along with interventions that reduce baseline risk is employed in patients with high PONV risk.
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62
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2,247
Delayed recovery from anesthesia: A postgraduate educational review
Ullhas Sudhakarrao Misal, Suchita Annasaheb Joshi, Mudassir Mohd Shaikh
May-August 2016, 10(2):164-172
DOI
:10.4103/0259-1162.165506
PMID
:27212741
Delayed awakening from anesthesia remains one of the biggest challenges that involve an anesthesiologist. With the general use of fast-acting anesthetic agents, patients usually awaken quickly in the postoperative period. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. The principal factors responsible for delayed awakening following anesthesia are anesthetic agents and medications used in the perioperative period. Nonpharmacological causes may have a serious sequel, hence recognizing these organic conditions is important. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uremia, and severe hypothyroidism may also be responsible for delayed recovery following anesthesia. Unexpected delayed emergence after general anesthesia may also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or thrombosis. Accurate diagnosis of the underlying cause is the key for the institution of appropriate therapy, but primary management is to maintain airway, breathing, and circulation. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology.
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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.
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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.
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Fast-track surgery: Toward comprehensive peri-operative care
Aditya J. Nanavati, S. Prabhakar
May-August 2014, 8(2):127-133
DOI
:10.4103/0259-1162.134474
Fast-track surgery is a multimodal approach to patient care using a combination of several evidence-based peri-operative interventions to expedite recovery after surgery. It is an extension of the critical pathway that integrates modalities in surgery, anesthesia, and nutrition, enforces early mobilization and feeding, and emphasizes reduction of the surgical stress response. It entails a great partnership between a surgeon and an anesthesiologist with several other specialists to form a multi-disciplinary team, which may then engage in patient care. The practice of fast-track surgery has yielded excellent results and there has been a significant reduction in hospital stay without a rise in complications or re-admissions. The effective implementation begins with the formulation of a protocol, carrying out each intervention and gathering outcome data. The care of a patient is divided into three phases: Before, during, and after surgery. Each stage needs active participation of few or all the members of the multi-disciplinary team. Other than surgical technique, anesthetic drugs, and techniques form the cornerstone in the ability of the surgeon to carry out a fast-track surgery safely. It is also the role of this team to keep abreast with the latest development in fast-track methodology and make appropriate changes to policy. In the Indian healthcare system, there is a huge benefit that may be achieved by the successful implementation of a fast-track surgery program at an institutional level. The lack of awareness regarding this concept, fear and apprehension regarding its implementation are the main barriers that need to be overcome.
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ORIGINAL ARTICLES
Quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy: A randomized prospective controlled trial
Naglaa Khalil Yousef
July-September 2018, 12(3):742-747
DOI
:10.4103/aer.AER_108_18
PMID
:30283187
Background
: Abdominal hysterectomy is associated with sever postoperative pain. Quadratus lumborum (QL) block is a regional analgesic technique which has an evolving role in postoperative analgesia.
Aims
: we aimed to compare ultrasound guided bilateral transverse abdominis plane (TAP) block versus bilateral QL block in patients undergoing total abdominal hysterectomy.
Settings and Design
: This is a prospective randomized controlled double blinded study.
Patients and Methods
: Sixty adult female patients (ASA I-II), scheduled for total abdominal hysterectomy were randomized into two equal groups (TAP group and QL group). Each patient received general anesthesia plus bilateral TAP block or bilateral QL block. We recorded postoperative total dose of morphine used / 24 hours, Visual Analuge Scales (VAS) for pain (at 30 min, 2, 4, 6, 12, and 24 hours postoperative), duration of postoperative analgesia, total dose of fentanyl use intraoperative, number of patients needed rescue analgesia and any side effects.
Statistical Analysis
: Independent sample T test and Chi-Square (X2) test were used as appropriate.
Results
: Patients in QL group consumed significantly less fentanyl and morphine than patients in TAP group, VAS for pain was significant higher in TAP group than in QL group at all times, the duration of postoperative analgesia was shorter in TAP group than in QL group, the number of patients requested analgesia was significantly higher in TAP group than in QL group.
Conclusions
: Bilateral QL block provided better intraoperative and postoperative analgesia with less opioids consumption compared with bilateral TAP block, in patients undergoing total abdominal hysterectomy.
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Ultrasound-guided erector spinae plane block compared to modified pectoral plane block for modified radical mastectomy operations
Mona Gad, Khaled Abdelwahab, Ahmed Abdallah, Mohamed Abdelkhalek, Mahmoud Abdelaziz
April-June 2019, 13(2):334-339
DOI
:10.4103/aer.AER_77_19
PMID
:31198256
Background:
Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the opioids and general anesthetics' needs. This study compared the erector spinae plane (ESP) block and the pectoral plane (PECS) block effects on the opioid consumption postoperatively, stress response, fentanyl needs intraoperatively, pain scores, and incidence of complications in female patients subjected to MRM surgery.
Patients and Methods:
Fifty patients were allocated randomly and divided into two groups. Forty-seven patients were included in the final analysis after exclusion. ESP block group (E group,
n
= 24) received 20 mL of 0.25% levobupivacaine plus 0.5 μ/kg dexmedetomidine that was injected in-between erector spinae muscle and transverse process. PECS block group (P group,
n
= 23) received 30 mL of 0.25% levobupivacaine plus 0.5 μg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the interfascial plane and the other was 20 mL injected between the serratus anterior and the pectoralis minor.
Results:
Postoperative morphine consumption and stress hormone level in P group were significantly lower than E group. The pain scores and number of patients requested analgesic postoperatively showed significantly higher values in E group. Hemodynamic parameters, fentanyl needed intraoperatively and the incidence of postoperative complications recorded no significant difference between the two groups.
Conclusion:
The current study demonstrated that PECS block provides better quality of analgesia than ESP block in patients subjected to MRM operations.
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Comparative study between effect of pre- versus post-incisional transversus abdominis plane block on acute and chronic post-abdominal hysterectomy pain
Yasser Mohamed Amr, Sabry M Amin
January-June 2011, 5(1):77-82
DOI
:10.4103/0259-1162.84199
Background:
The prevalence of persistent chronic pain after abdominal hysterectomy is 5-32%. Our objectives were to determine the influence of transversus abdominis plane (TAP) block on the incidence of acute and chronic post-hysterectomy pain and to examine potential associations between time of block administration, either before surgical incision (preemptive) or after end of surgical procedure and its effect.
Materials and Methods:
Seventy-five patients undergoing elective total abdominal hysterectomy under general anesthesia were allocated randomly to receive TAP block either pre-incisional, or before emergence from anesthesia or sham block (just a needle puncture, control group). Pain was evaluated postoperatively at rest and movement by visual analogue scale. Peri-operative analgesic requirements, sedation, postoperative nausea and vomiting scores were recorded. Patients were questioned at three, and six months after surgery for type and severity of chronic pain.
Results:
Pain scores were significantly higher in Group II versus Group I (
P
<0.05), but both demonstrated significantly lower pain scores than control Group. Analgesic requirements decreased significantly in patients received TAP block (
P
<0.0001) with more significant decrease in the pre-incisional group. The incidence of chronic pain was significantly reduced in the pre-incisional group than others. The incidence of sedation was noted to be higher in the control group (61%) versus other groups (18% and 32% respectively), at time point 12 h postoperatively but was comparable between 12, 48 h (awake and alert). Incidence of postoperative nausea and vomiting (PONV) was reduced in patients who received TAP block (16% and 29%) in Group I and II respectively versus 66.5% in Group III. There were no complications attributed to the TAP block.
Conclusions:
TAP block seems to be an acceptable choice for postoperative analgesia; pre-incisional TAP block appeared to reduce the severity of acute pain, analgesic requirements with its undesirable side-effects and incidence of chronic pain in comparison with blockade before emergence from anesthesia.
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REVIEW ARTICLES
Sugammadex: A revolutionary drug in neuromuscular pharmacology
Kusha Nag, Dewan Roshan Singh, Akshaya N Shetti, Hemanth Kumar, T Sivashanmugam, S Parthasarathy
September-December 2013, 7(3):302-306
DOI
:10.4103/0259-1162.123211
Sugammadex (ORG 25969) is a unique neuromuscular reversal drug; a novel cyclodextrin, the first in a new class of selective relaxant binding agents, which reverse neuromuscular blockade (NMB) with the aminosteroid non-depolarizing muscle relaxants rocuronium and vecuronium. Sugammadex can reverse moderate or deep NMB. The clinical use of sugammadex promises to eliminate many of the shortcomings in current anesthetic practice with regard to antagonism of rocuronium and other aminosteroid muscle relaxants.
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Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy?
Sarbari Swaika, Anirban Pal, Surojit Chatterjee, Debashish Saha, Nidhi Dawar
July-December 2011, 5(2):182-186
DOI
:10.4103/0259-1162.94761
Background:
Postoperative nausea and vomiting (PONV) is a serious concern in patients undergoing laparoscopic cholecystectomy (LC), with an incidence of 46 to 72%. The purpose of this study was to compare the antiemetic efficacy of intravenous (iv) ondansetron 8 mg, ramosetron 0.3 mg, and palonosetron 0.075 mg for prophylaxis of PONV in high-risk patients undergoing LC.
Materials and Methods:
In this prospective, randomized, double-blinded study, 87 female patients, 18 to 70 years of age (ASA I and II) and undergoing elective LC under general anesthesia were randomly allocated into three equal groups, the ondansetron group (8 mg iv;
n
=29), the ramosetron group (0.3 mg iv;
n
=29), and the palonosetron group (0.075 mg iv;
n
=29), and the treatments were given just after completion of surgery before extubation. The incidence of complete response (patients who had no PONV and needed no other rescue antiemetic medication), nausea, vomiting, retching, and need for rescue antiemetics over 24 hours after surgery were evaluated.
Results:
The number of complete responders were 19 (65.5%) for ramosetron, 11 (37.9%) for palonosetron, and 10 (34.5%) for ondansetron, representing a significant difference overall (
P
=0.034) as well as between ramosetron and ondansetron (
P
=0.035). Comparison between ramosetron and palonosetron also showed a clear trend favoring the former (
P
=0.065).
Conclusion:
Ramosetron 0.3 mg iv was more effective than palonosetron 0.075 mg and ondansetron 8 mg in the early postoperative period, but there was no significant difference in the overall incidence of nausea suffered.
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Evaluation of ultrasound-guided erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Randomized, controlled, prospective study
Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer
January-March 2019, 13(1):50-56
DOI
:10.4103/aer.AER_194_18
PMID
:31031480
Background:
Oblique subcostal transversus abdominis plane block (OSTAP) is a recently described regional anesthetic technique used in upper abdominal surgeries such as laparoscopic cholecystectomy (LC). Erector spinae plane block (ESPB) has also been reported for postoperative analgesia in LC.
Aim:
We aimed to compare the effectiveness of OSTAP and ESPB in providing postoperative analgesia in patients undergoing these surgeries.
Setting and Design:
This study was designed as a double-blinded, prospective, randomized, efficiency study in a tertiary university hospital, postoperative recovery room, and ward.
Materials and Methods:
A total of 72 patients were recruited and 60 patients were randomized into three equal groups (ESPB, OSTAP, and control group). Pain intensity between groups was compared using Numeric Rating Scale (NRS) scores. In addition, consumption of paracetamol and tramadol and additional rescue analgesic requirement were measured. Standard multimodal analgesia was performed in all groups, while ESPB block was also performed in Group ESPB and OSTAP block was also performed in group OSTAP.
Statistical Analysis Used:
Descriptive statistics were expressed as mean ± standard deviation. Independent
t
-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, Shapiro–Wilk test, one-way ANOVA, and
post hoc
Tukey's analysis were used for statistical analysis.
Results:
NRS was lower in block groups during the first 3 h. There was no difference in NRS scores at other hours. Analgesic consumption and rescue analgesic requirement were lower in groups ESPB and OSTAP when compared to those of control group. Block groups were similar.
Conclusion:
Bilateral ultrasound-guided ESPB and OSTAP performed at the end of LC lead to akin analgesia requirement and improve the quality of multimodal analgesia.
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423
REVIEW ARTICLES
Anaesthetic challenges and management during pregnancy: Strategies revisited
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa
May-August 2013, 7(2):160-167
DOI
:10.4103/0259-1162.118945
During pregnancy, an obstetrician can encounter various complications and sometimes require surgery or operative intervention for delivery. However, the role of anaesthesiologists during such clinical scenario is grossly under-estimated. Without any close coordination and team work among obstetricians, neonatologists and an anaesthesiologist, morbidity and mortality can increase during these surgical interventions. The clinical scenario can become more challenging if the parturient suffers from any comorbid diseases. The present article reviews some of the common challenging scenarios during pregnancy that an anaesthesiologist frequently encounters during routine practice. Anaesthetic management has been discussed briefly and separately for each trimester and post-partum period. The article also aims at gaining in-depth knowledge of these obstetrical and surgical emergencies so as to ensure close-knit team work among obstetricians, anaesthesiologists, intensivists and a neonatologist.
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ORIGINAL ARTICLES
Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia
Santosh Kumar, Urmila Palaria, Ajay K. Sinha, D. C. Punera, Vijita Pandey
May-August 2014, 8(2):202-208
DOI
:10.4103/0259-1162.134506
Background:
Mixing of various adjuvants has been tried with local anesthetics in an attempt to prolong anesthesia from peripheral nerve blocks but have met with inconclusive success. More recent studies indicate that 8 mg dexamethasone added to perineural local anesthetic injections augment the duration of peripheral nerve block analgesia.
Aims:
Evaluating the hypothesis that adding dexamethasone to ropivacaine significantly prolongs the duration of analgesia in supraclavicular brachial plexus block compared with ropivacaine alone.
Patients and Methods:
It was a randomized, prospective, and double-blind clinical trial. Eighty patients of ASA I and II of either sex, aged 16-60 years, undergoing elective upper limb surgeries were equally divided into two groups and given supraclavicular nerve block. Group R patients (
n
= 40) received 30 ml of 0.5% ropivacaine with distilled water (2 ml)-control group whereas Group D patients (
n
= 40) received 30 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml)-study group. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The secondary outcome included maximum visual analogue scale (VAS), total analgesia consumption, surgeon satisfaction, and side effects.
Results:
Group R patients required first rescue analgesia earlier (557 ± 58.99 min) than those of Group D patients (1179.4 ± 108.60 min), which was found statistically significant in Group D (
P
< 0.000). The total dose of rescue analgesia was higher in Group R as compared to Group D, which was statistically significant (
P
< 0.00).
Conclusion:
Addition of dexamethasone (8 mg) to ropivacaine in supraclavicular brachial plexus approach significantly and safely prolongs motor blockade and postoperative analgesia (sensory) that lasted much longer than that produced by local anesthetic alone.
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Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia
Samy Elsayed Hanoura, Rabei Hassanin, Rajvir Singh
May-August 2013, 7(2):168-172
DOI
:10.4103/0259-1162.118947
This study was designed to evaluate the effect of adding dexmedetomidine to regular mixture of epidural drugs for pregnant women undergoing elective cesarean section with special emphasis on their sedative properties, ability to improve quality of intraoperative, postoperative analgesia, and neonatal outcome.
Materials and Methods:
Fifty women of ASA physical status I or II at term pregnancy were enrolled randomly to receive plain bupivacaine plus fentanyl (BF Group) or plain bupivacaine plus mixture of fentanyl and dexmedetomidine (DBF Group). Incidence of hypotension, bradycardia, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores, and side effects were recorded.
Results:
No difference in the times taken for block to reach T4 sensory level, to reach the highest level of sensory block, and interval between first neuraxial injection and onset of surgery between the groups was noted. Onset of postoperative pain was significantly delayed in the DBF group (
P
= 0.001), the need for supplementary fentanyl was significantly less in DBF group (
P
= 0.03), no significant difference was noted between both groups regarding neonatal Apgar scores as well as the incidence of hypotension, bradycardia, nausea, vomiting, and duration of motor blockade. DBF group had significantly less incidence of shivering (
P
= 0.03).
Conclusion:
Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects.
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Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough
Sunil Rajan, George Jacob Malayil, Rekha Varghese, Lakshmi Kumar
April-June 2017, 11(2):287-293
DOI
:10.4103/0259-1162.181427
PMID
:28663608
Context:
Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation.
Aim:
To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough.
Settings and Design:
Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study.
Subjects and Methods:
Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h.
Statistical Analysis Used:
One-way analysis of variance, Chi-square test, Fisher's exact test, paired
t
-tests, and Wilcoxon's signed-rank test as applicable.
Results:
Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control.
Conclusion:
Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice.
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464
REVIEW ARTICLES
A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures
Amin Davoudi, Mansour Rismanchian, Ali Akhavan, Saeid Nosouhian, Farshad Bajoghli, Abbas Haghighat, Farahnaz Arbabzadeh, Pouran Samimi, Atiyeh Fiez, Elham Shadmehr, Kasra Tabari, Sanaz Jahadi
January-April 2016, 10(1):13-16
DOI
:10.4103/0259-1162.167846
PMID
:26957683
Dental anxiety and fear of needle injection is one of the most common problems encountered by dental practitioners, especially in the pediatric patient. In consequences, it might affect the patient's quality of life. Several methods are suggested to lower the discomfort of local anesthesia injection during dental procedures. Desensitization of injection site is one of the recommended strategies. Among chemical anesthetic topical agents that are effective but might have allergic side effects, using some nonpharmacological and safe techniques might be useful. This study aimed to overview the efficacy of using cooling techniques, mostly by ice or popsicles, warming or pH buffering of drug, and using modern devices to diminish the discomfort of local anesthesia injection during dental procedures.
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601
ORIGINAL ARTICLES
Comparison of oral clonidine, oral dexmedetomidine, and oral midazolam for premedication in pediatric patients undergoing elective surgery
Sarika Kumari, Nidhi Agrawal, G Usha, Vandana Talwar, Poonam Gupta
January-March 2017, 11(1):185-191
DOI
:10.4103/0259-1162.194586
PMID
:28298782
Background:
Midazolam has been commonly used orally for premedication in children. A search for a better alternative continues to overcome its side effects. Recently alpha-2 agonists, clonidine, and dexmedetomidine have been used for premedication in children.
Aim:
To study and compare the efficacy of oral clonidine, oral dexmedetomidine, and oral midazolam for premedication in pediatric surgical patients.
Settings and Design:
This prospective, randomized, double blind study was conducted in a tertiary care hospital.
Materials and Methods:
The study was conducted in ninety children of either sex, in the age group of 4–12 years and the American Society of Anesthesiologists Physical status I, posted for ophthalmic surgery. Patients were randomly allocated to one of the three groups of thirty patients each: Group M: Oral midazolam 0.5 mg/kg body weight, Group D: Oral dexmedetomidine 4 μg/kg body weight, and Group C: Oral clonidine 4 μg/kg body weight. Patients were assessed for sedation, anxiolysis, and change in heart rate and blood pressure in the preoperative area. Behavior of children at separation from parents, mask acceptance, and side effects if any were noted.
Statistical Analysis:
Data analysis was performed by unpaired Student's
t
-test and Chi-square test.
Results:
Children in oral midazolam group achieved faster onset of sedation, higher sedation score, and lower anxiety score as compared to other two groups. The Group D and Group M were comparable as regards behavior at separation from parents (
P
= 0.236), but Group D was significantly better than Group C (
P
= 0.031). The three groups were comparable as regards providing satisfactory mask acceptance (
P
= 0.163). A number of children with easy separation from parents and excellent mask acceptance were significantly more in Group M as compared to Groups C and D (
P
= 0.028 and
P
= 0.012, respectively). Group C and Group D showed a lower mean arterial pressure at 45 min (
P
< 0.001) and 60 min after premedication (
P
< 0.001) as compared to Group M.
Conclusion:
Oral midazolam is superior to the oral clonidine, and oral dexmedetomidine with faster onset of sedation, higher sedation score, lower anxiety score, and greater number of children with easy separation and excellent mask acceptance.
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4,310
310
Intrathecal nalbuphine as an adjuvant to subarachnoid block: What is the most effective dose?
Arghya Mukherjee, Anirban Pal, Jitendra Agrawal, Amrita Mehrotra, Nidhi Dawar
July-December 2011, 5(2):171-175
DOI
:10.4103/0259-1162.94759
Background:
Nalbuphine has been used intrathecally as an adjuvant in previous studies, but none clearly state the most effective dose of nalbuphine. The purpose of our study was to establish the effectiveness of intrathecal nalbuphine as an adjuvant, compare three different doses and determine the optimum dose with prolonged analgesic effect and minimal side-effects.
Materials and Methods:
In this prospective, randomized, double-blinded, controlled study, 100 ASA I and II patients undergoing lower limb orthopedic surgery under subarachnoid block (SAB), were randomly allocated to four groups: A, B, C and D, to receive 0.5 ml normal saline (NS) or 0.2, 0.4 and 0.8 mg nalbuphine made up to 0.5 ml with NS added to 0.5% hyperbaric bupivacaine 12.5 mg (total volume 3 ml), respectively. The onset of sensory and motor blockade, two-segment regression time of sensory blockade, duration of motor blockade and analgesia, visual analogue scale (VAS) pain score and side-effects were compared between the groups.
Results:
Two-segment regression time of sensory blockade and duration of effective analgesia was prolonged in groups C (0.4 mg nalbuphine) and D (0.8 mg nalbuphine) (
P
<0.05), and the incidence of side-effects was significantly higher in group D (
P
<0.05) compared with the other groups.
Conclusion:
Nalbuphine used intrathecally is a useful adjuvant in SAB and, in a dose of 0.4 mg, prolongs postoperative analgesia without increased side-effects.
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18
5,436
580
Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery: A prospective randomized feasibility study
Serkan Tulgar, Halil Cihan Kose, Onur Selvi, Ozgur Senturk, David Terence Thomas, Mehmet Nurullah Ermis, Zeliha Ozer
October-December 2018, 12(4):825-831
DOI
:10.4103/aer.AER_142_18
PMID
:30662115
Study Objective:
Lumbar Erector spinae Plane block (L-ESPB) is a modification of a recently described block. Both L-ESPB and Transmuscular Quadratus Lumborum block (QLB-T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L-ESPB and QLB-T in providing postoperative analgesia in patients undergoing hip and femur operations.
Design:
Double-blinded, prospective, randomized, feasibility study.
Setting:
Tertiary university hospital, postoperative recovery room and ward.
Methodology:
A total of 72 patients (American Society of Anesthesiology physical status classification II-III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L-ESB and QLB-t).
Interventions:
Standard multimodal analgesia was performed in the control group while L-ESPB or QLB-T was performed in the block groups.
Measurements:
Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured.
Results:
There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1
st
, 3
rd
and 6
th
h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups.
Conclusion:
While L-ESPB and QLB-T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.
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18
5,029
476
REVIEW ARTICLES
Anesthetic gases and global warming: Potentials, prevention and future of anesthesia
Hina Gadani, Arun Vyas
January-June 2011, 5(1):5-10
DOI
:10.4103/0259-1162.84171
Global warming refers to an average increase in the earth's temperature, which in turn causes changes in climate. A warmer earth may lead to changes in rainfall patterns, a rise in sea level, and a wide range of impacts on plants, wildlife, and humans. Greenhouse gases make the earth warmer by trapping energy inside the atmosphere. Greenhouse gases are any gas that absorbs infrared radiation in the atmosphere and include: water vapor, carbon dioxide (CO
2
), methane (CH
4
), nitrous oxide (N
2
O), halogenated fluorocarbons (HCFCs), ozone (O
3
), perfluorinated carbons (PFCs), and hydrofluorocarbons (HFCs). Hazardous chemicals enter the air we breathe as a result of dozens of activities carried out during a typical day at a healthcare facility like processing lab samples, burning fossil fuels etc. We sometimes forget that anesthetic agents are also greenhouse gases (GHGs). Anesthetic agents used today are volatile halogenated ethers and the common carrier gas nitrous oxide known to be aggressive GHGs. With less than 5% of the total delivered halogenated anesthetic being metabolized by the patient, the vast majority of the anesthetic is routinely vented to the atmosphere through the operating room scavenging system. The global warming potential (GWP) of a halogenated anesthetic is up to 2,000 times greater than CO
2
. Global warming potentials are used to compare the strength of different GHGs to trap heat in the atmosphere relative to that of CO
2
. Here we discuss about the GWP of anesthetic gases, preventive measures to decrease the global warming effects of anesthetic gases and Xenon, a newer anesthetic gas for the future of anesthesia.
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18
8,954
666
ORIGINAL ARTICLES
Management of celphos poisoning with a novel intervention: A ray of hope in the darkest of clouds
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa Kaur, Jasbir Kaur, Kanwalpreet Singh, Aparajita Panda
January-June 2010, 4(1):20-24
DOI
:10.4103/0259-1162.69301
Context:
Celphos poisoning is one the most common and lethal poisonings with no antidote available till now.
Aims:
To evaluate the effectiveness of new treatment regimens and interventions in reduction of mortality from the fatal effects of celphos poisoning.
Settings and Design:
A profile of 33 patients, who got admitted in Intensive Care Unit (ICU) of our institute with alleged intake of celphos pellets, was studied.
Materials and Methods:
In all the 33 patients with alleged celphos poisoning, extensive gastric lavage was done with a mixture of coconut oil and sodium bicarbonate solution. Strict monitoring, both invasive and non-invasive, was done and symptomatic/supportive treatment was carried out on a patient to patient basis.
Statistical Analysis:
At the end of the study, all the data were compiled systematically and statistical analysis was carried out using the non-parametric tests and value of P<0.05 was considered significant.
Results:
Majority of the patients out of the total 33 were young with mean age of 21.86±4.92 and had good educational level. Most of the patients presented clinically with cardiovascular signs and symptoms (58%), followed by respiratory distress (15%) and little higher incidence of multi-organ symptomatology (18%). The mean stay of the patients in ICU was 5.84±1.86 days and the survival rate was 42%.
Conclusions:
With the treatment regimen we have formulated, we were able to save 42% of our patients and recommend the use of this regimen by all the intensivists and physicians.
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17
38,427
1,166
Assessment of the subglottic region by ultrasonography for estimation of appropriate size endotracheal tube: A clinical prospective study
Kumkum Gupta, Prashant K Gupta, Bhawna Rastogi, Atul Krishan, Manish Jain, Gouri Garg
July-December 2012, 6(2):157-160
DOI
:10.4103/0259-1162.108298
Background:
Endotracheal intubation is important to carry out various surgical procedures. The estimation of endotracheal tube size is governed by narrowest diameter of the upper airway. The objective of the study was to assess the narrowest tracheal diameter by ultrasound for selection of the appropriate size endotracheal tube.
Materials and Methods:
After the approval of institution ethical committee and written informed consent, 112 patients aged 3 to 18 years of both genders with normal airways, scheduled for surgery under general anesthesia and intubation, were enrolled for this prospective clinical observational study. Preanesthetic ultrasonography of the subglottic region was performed by experienced ultrasonologist with a high-resolution linear array transducer in sniffing position for every patient and the subglottic tracheal diameter was estimated to select the appropriate-size endotracheal tube. The endotracheal tube, calculated on the basis of physical indices and by ultrasound, was statistically correlated with the appropriate size endotracheal tube used clinically for intubation.
Results:
The ultrasound guided selection criterion has estimated the appropriate-sized endotracheal tube better than physical indices (age or height)-based formulas. The estimated endotracheal tube size by ultrasound was significantly correlated with the clinically used endotracheal tube.
Conclusion:
Ultrasonography may be used for the assessment of the subglottic diameter of trachea in children to estimate the appropriate size endotracheal tube for intubation.
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17
4,048
361
REVIEW ARTICLES
Risk and safety concerns in anesthesiology practice: The present perspective
Sukhminder Jit Singh Bajwa, Jasbir Kaur
January-June 2012, 6(1):14-20
DOI
:10.4103/0259-1162.103365
Newer developments and advancements in anesthesiology, surgical, and medical fields have widened the functional scope of anesthesiologist thus increasing his professional responsibilities and obligations. While at workplace, anesthesiologist is exposed to a wide array of potential hazards that can be detrimental to his overall health. Numerous risks and safety concerns have been mentioned in the literature, but the magnitude of challenges in anesthesiology practice are far greater than those cited and anticipated. Many times these challenging situations are unavoidable and the attending anesthesiologist has to deal with them on an individual basis. These hazards not only affect the general health but can be extremely threatening in various other ways that can increase the potential risks of morbidity and mortality. This article is an attempt to bring a general awareness among anesthesia fraternity about the various health hazards associated with anesthesia practice. Also, a genuine attempt has been made to enumerate the various preventive methods and precautions that should be adopted to make practice of anesthesiology safe and smooth.
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16
10,692
658
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© Anesthesia: Essays and Researches | Published by Wolters Kluwer -
Medknow
Online since 1
st
June, 2010