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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient. Prevention of this spinal anaesthesia induced hypotension is of utmost importance especially in pregnant population as the life of mother as well as fetus is at risk. Several techniques and methodologies have been adopted for the prevention of this neuraxial hypotension with varying degree of success. The administration of intravenous fluids to optimize the blood volume during sympathectomy has been the most popular and widely used as the first line of therapy among these techniques. The intravenous fluids can be used both before and during the administration of spinal anaesthesia, the techniques appropriately named as pre-loading and co-loading respectively. Numerous research studies and available literary evidence suggests that both of these techniques can be equally effective in prevention of hypotension. The use of colloids has been observed to be more effective for pre-loading due to their longer half-life in the intravascular compartment. However, it has also been suggested that no technique is efficient in preventing the hypotension alone and has to be coupled with judicious use of vasopressors.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: In spite of being the preferred induction agent for LMA insertion, propofol has many undesirable side effects including dose-related cardiorespiratory depression and local pain at injection site. Ketofol as a novel induction agent has been introduced recently with comparable efficacy and improved hemodynamic control . Objective: To investigate ketofol as a suitable induction agent alternative to propofol for insertion of LMA in children considering insertion conditions, hemodynamic stability, local pain at injection site, and recovery. Materials and Methods: In this randomized, double-blind study, 100 children were randomly assigned into two groups of 50 patients each in which induction was performed with either propofol or ketofol. Providers were given one 20 ml syringe [represent either 2 mg/kg of propofol (P group) or 0.75 mg/kg of ketamine and 1.5 mg/kg of propofol (KP group)] and one 10 ml syringe for rescue if needed [represent 1 mg/kg of propofol (P group) or 0.25 mg/kg of ketamine and 0.5 mg/kg of propofol (KP group)]. After monitoring with bispectral index (BIS), general anesthesia was induced by infusion with a syringe perfuser at a constant rate of 250 ml/h with either of the two agents till the BIS values decreased to 40. Mean arterial pressure (MAP), heart rate (HR) were measured every 30 seconds up to 5 minutes after LMA placement. The time till BIS values decreased to 40 was measured. All children were evaluated for incidence of apnea, pain on injection, jaw relaxation, conditions for LMA insertion, and complications such as muscle rigidity, hallucinations, and excessive secretions. Results: Induction time (time to reach BIS of 40) was faster in the KP group (150 ΁ 23.5 seconds) than in the P group (205 ΁ 37.4 seconds). The incidence of injection pain was significantly lower in the KP group (10%) than in the P group (80%). Excellent jaw relaxation and full mouth opening were higher in the KP group [45 patients (90%)] than in the P group [38 patients (76%)]. Excellent LMA insertion conditions were observed in 45 patients (90%) in the KP group and 38 patients (76%) in the P group. The KP group showed preserved hemodynamic stability (mean blood pressure, heart rate) with less incidence and duration of apnea compared to the P group. Conclusion: ketofol is a safe and effective alternative induction agent for LMA insertion in children with rapid onset of action and lower incidence of injection pain. It provided better LMA insertion conditions, improved hemodynamic stability with less prolonged apnea when compared with propofol.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Nanotechnology is a multidisciplinary field that covers a vast and diverse array of devices derived from physics, biology, engineering, and chemistry. Applications of nanotechnology to medicine and physiology imply materials and devices designed to interact with the body at subcellular (i.e., molecular) scales with a high degree of specificity. There is considerable useful information about nanotechnology available and already in use. However, at present, it is very incomplete and scattered. We realized many doctors are unaware of nanotechnology used during surgery and its future prospects in patients. Though most medical products that use nanotechnology are still in the research and development stage, there are a few which are commercially available. Nanotechnology has grown by leaps and bounds over the last few years; applications of this technology in the field of medicine and surgery have been an important spin-off. Many biological structures are at nanometer scale used by surgeons in orthopedic, dental, and neurosurgeries. This article starts with the basics of the nanotechnology and how it is utilized through most medical products. This important article, which is felt to offer high educational value for the doctors, have been selected from an extensive search on the internet, and elaborately discussed. In this review, the scientific and technical aspects of nanotechnology are introduced, and some of its potential clinical applications are discussed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Midazolam is the most commonly used premedication in children. It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an a2 agonist, has been suggested as an alternative. Dexmedetomidine is a more a2 selective drug with more favorable pharmacokinetic properties than clonidine. Aims: To compare i.v. Dexmedetomidine and Midazolam as premedication in pediatric patients. Settings and Design: Open label single blind study. Material and Methods: 60 patients were randomly allocated to group D(n=30) and group M(n=30) and given Inj Dexmedetomidine 0.4 μg/kg diluted in 10 ml slowly i.v. and Inj Midazolam 0.05mg/kg i.v. accordingly. Level of sedation, parent separation, response to induction, blood pressure, pulse, oxygen saturation, post operative agitation and shivering was noted. Statistical Analysis Used: Unpaired student's t-test and chi square test used in this study. P value <0.05 was considered significant. Results: There were significant differences in parental separation acceptance,Response to induction and wake-up behavior score. When compared with group M, patients in groupD were significantly more sedated % minutes after premedication (P<0.001). Post operative agitation and shivering was low in group D in comparision with group M. Though blood pressure and pulse were on lower side in group D than in group M, oxyden saturation remained same in both the groups having no statistical significance. Conclusions: Dexmedetomidine is superior than Midazolam as premedication in pediatric patients with more intense sedation, excellent parent separation, favourable induction conditions, lower incidence of postoperative agitation and shivering along with hemodynamic stability and no respiratory depression.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq^® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Materials and Methods: Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups. Results: We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001. Conclusion: Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Context: Preoperative anxiety and uncooperativeness experienced by pediatric patients are commonly associated with postoperative behavioral problems. Aims: We aimed to evaluate the efficacy and safety of intranasal Midazolam as a sedative in a pediatric age group for radiological imaging procedures and to note onset of sedation, level of sedation, condition of patient during separation from parents and effect on the cardio-respiratory system. Settings and Design: Randomized double-blinded study. Subjects and Methods: Fifty patients of the pediatric age group of American Society of Anesthesiologist grade 2 and 3 who came for any radiological imaging procedures were studied. Patients were randomly allocated to receive, intranasally, either Midazolam 0.5 mg/kg (group A N0 = 25) or normal saline (group B N = 25) in both nostrils (0.25 mg/kg in each) 15 min before the procedure. Time for onset of sedation and satisfactory sedation, sedation score, separation score, hemodynamic changes and side-effects were recorded. Statistical Analysis Used: Student's t-test. Results: Intranasal Midazolam group had a significantly shorter time for onset of sedation and satisfactory sedation. Mean sedation score and mean separation score at 10 min and 15 min intervals were significant in intranasal Midazolam as compared with normal saline (P < 0.001). Conclusions: Intranasal Midazolam 0.5 mg/kg is safe and effective and provides adequate sedation for easy separation from the parents and reduced requirement of intravenous supplementation during radiological imaging procedures without any untoward side-effects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Limited evidence supports the efficacy of peripheral route fentanyl and local anesthetic combination for postoperative analgesia. Our study was therefore designed to demonstrate the analgesic efficacy of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in patients undergoing modified radical mastoidectomy (MRM). Materials and Methods: 60 patients undergoing MRM under general anesthesia were randomly allocated into two groups, first group receiving 0.5% bupivacaine at a dose of 2 mg/kg body weight with 50 μg fentanyl and second group receiving bupivacaine 0.5% at a dose of 2 mg/kg body weight with 100 μg fentanyl as infiltration of operative field in and around the incision site, after the incision and just before completion of surgery. In postoperative period pain, nausea-vomiting and sedation was recorded at 0 hr, 2, 4, 6, 12 and 24 hrs. Results: Both the combinations of bupivacaine and fentanyl (Group I and Group II) were effective for postoperative analgesia. In both the groups the Visual Analogue Scale (VAS) score was less than 3 at each time interval. None of the patients required rescue analgesia. The comparison of VAS scores at different intervals showed that group II had lower VAS scores at all time points. Conclusions: Fentanyl and bupivacaine combinations in doses of 50 and 100 μg along with 0.5% bupivacaine at a fixed dose of 2 mg/kg body weight are effective in the management of postoperative pain. Patients who received 100 μg fentanyl (Group II) had lower VAS scores as compared to the patients who received 50 μg fentanyl (Group I) with similar side effects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Context: Preoperative anxiety is synonymous with pediatric surgery. Anxiolysis is of crucial importance and poses a significant challenge to the pediatric anesthesiologist. Orally administered midazolam and ketamine can be used as anxiolytic premedication in children. Aim: To compare the efficacy of orally administered midazolam and ketamine for preoperative sedation and anxiolysis in children and determine the minimum interval required between premedication and parental separation. Setting and Design: Prospective, randomized, double-blind study. Materials and Methods: A total of 70 children aged 2-8 years, belonging to ASA grade 1 and 2, scheduled to undergo elective infraumbilical and peripheral surgeries were randomized into two groups of 35 each to receive either midazolam (0.5 mg/kg) or ketamine (5 mg/kg) orally. They were assessed at an interval of 5 minutes up to 40 minutes, at the time of parental separation, intravenous cannulation, and application of face mask for ventilation. Sedation was noted according to Ramsay Sedation Scale and anxiolysis was noted according to Anxiolysis Scores used in previous published studies. Statistical Analysis Used: Skewed data between groups were analyzed by Mann Whitney U Test. Data within a group were analyzed using Friedman's Analysis of variance and a post hoc test. Results: No statistically significant difference in sedation and anxiolysis scores were obtained between the groups at any point of time. Maximum sedation score was achieved at 20 minutes in both the groups, with no statistically significant difference with scores obtained thereafter. Statistically significant difference occurred in anxiolysis score at study points in group receiving midazolam. Conclusion: The study documents the rapid achievement of preoperative sedation and anxiolysis in children with orally administered midazolam or ketamine, with the latter producing a superior quality of anxiolysis. An interval of 20 minutes is sufficient between premedication and parental separation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Context: Ropivacaine, s-enantiomer of amide local anaesthetic produces differential neural blockade with less motor blockade, cardiovascular and neurological toxicity makes it suitable for day case surgery in children. Aims: To compare the effectiveness of Inj. Ropivacaine (0.2 or 0.25%) or Inj. Bupivacaine (0.25%) with fentanyl in caudal block for intra and postoperative analgesia. Settings and Design: Double blind retrospective randomized study. Materials and Methods: All the patients (n=112) varying from age group 3.02 ± 3.29 years belonging to ASA I-IV were randomly allocated to receive caudal analgesia Group BF inj. Bupivacaine (0.25%, 2 mg/kg) + Inj. Fentany1 μg/kg (n=70) and group RF: Inj. Ropivacaine (0.25% or 0.2%, 2 mg/kg) + inj. Fentanyl 1 μg/kg (n=42).We monitored vitals and requirement of inhalational gases inraoperatively and also observed pain by pain score ( Visual Analogue Score in verbal group and Objective Pain Scale in nonverbal group) and vitals postoperatively . We used rescue analgesics (inj. Paracetamol 5 mg/kg iv) when VAS score ≥4. Statistical Analysis: Student's t-test. Results: Duration of analgesia was prolonged in both group RF and BF. Time for first rescue analgesic for group RF (6.1 ± 1.1 hr) compared to group BF (5.6 ± 0.9 hr). Haemodynamic stability and less requirement of inhalation agent intraoperatively with group RF than others. Conclusions: Ropivacaine with Fentanyl found to be better combination for pediatric surgeries for below umbilical surgeries as an adjuvant to general anaesthesia or sole technique with chances of less complication with high success rate.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires (1) expertise with neuroanesthesia and obstetric anesthesia care, (2) accurate physical examination of the neurological system preoperatively, (3) safe choice and conductance of the anesthesia technique (mostly regional anesthesia), (4) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother, and (5) intraoperative neuromonitoring together with the control of the fetal heart rate. The most important message is that in the ideal case, any woman with a known, preexisting neurological disorder should discuss her plans to become pregnant with her physician before she becomes pregnant. Neurological diseases in pregnancy can be classified into three categories: (a) Pre-existent chronic neurological diseases such as epilepsy and multiple sclerosis (MS). (b) Diseases with onset predominantly in pregnancy such as some brain tumors or cerebrovascular events. (c) Pregnancy-induced conditions such as eclampsia and Hemolysis elevated liver enzymes and low platelets syndrome. This article addresses specific issues surrounding neurologic disease in pregnant women including MS parturient, spinal cord injury, parturient with increased intracranial pressure and shunts, parturient with brain tumors, Guillain-Barrι syndrome and epilepsy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Context: Blind insertion of central venous catheter has many implications. Better options should be sought to perform this procedure. Aim: To evaluate various options for positioning central venous catheter tip. Settings and Design: This is institutional based randomized prospective controlled study. Materials and Methods: In this prospective study depth and position of central venous catheter were evaluated in 150 patients in intensive care unit. Three different methods: Pere's, landmark, and endocavitory (atrial) ECG control were used. Statistical Analysis: Twoway ANOVA test was applied on SPSS version 16 to test the significant difference between the three groups. Results: Patient characteristic and demographic data were similar in the three groups. The average depth of central venous catheter by Pere's, landmark, and endocavitory (ECG) technique were 14.20 ± 0.69 cm, 12.08 ± 0.98 cm, and 8.18 ± 0.74 cm, respectively. Conclusion: The correct position of central venous catheter by endocavitory (atrial) ECG appears not only to reduce the procedure related complications but also post procedure manipulation of catheter tip detected by post procedure chest X-ray.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Carbon dioxide pneumoperitoneum (PP) for laparoscopic surgery increases arterial pressure, heart rate, and systemic vascular resistance. In this randomized, double blind, prospective clinical study; we investigated the efficacy of magnesium sulfate to prevent adverse hemodynamic response associated with PP in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Sixty patients, of either sex (18-65 years of age), undergoing elective laparoscopic cholecystectomy were randomly allocated in one of the two groups containing 30 patients each. Group M received magnesium sulfate 30 mg/kg intravenously as a bolus before PP. Group C received same volume of 0.9% saline. Results: Mean arterial pressure and heart rate were significantly less throughout the period of pneumoperitoneum in patients of group M. Intravenous labetalol was required in 40% (12 out of 30) of the patients in group C to control intraoperative hypertension and it was clinically significant in comparison to group M. Conclusion: Magnesium sulfate administered before PP attenuates adverse hemodynamic response and provides hemodynamic stability during PP created for laparoscopic surgery.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Wolff-Parkinson-White syndrome is an electrophysiological disorder of heart. Patients with such disorder may be asymptomatic or present with cardiac symptoms like palpitation and dyspnea. These patients may present with serious cardiac complication like atrial fibrillation and PSVT intraoperatively. We report a case of a 30-year-old female with WPW syndrome posted for laparoscopic cholecystectomy under general anesthesia. We took all the precautions necessary to avoid tachycardia and arranged drugs necessary to treat any complications together with stringent monitoring which is very important for favorable outcome in these patients. Management of the case offers an opportunity to relearn the important considerations on WPW syndrome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Peripartum cardiomyopathy (PPCM) is a disease of unknown etiology which affects pregnant females during late pregnancy or during the first 5 months post-partum. The clinical presentation of these patients is similar to that of patients with dilated cardiomyopathy. Anesthetic management of such cases poses a challenge; due to the increased risk of various perioperative complications. We report the successful anesthetic management of lower segment caesarean section in a patient with PPCM.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Acute renal failure is not common in pregnancy. However, the incidence rises when pregnancy is complicated with Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP) syndrome, which itself is a rare occurrence. We had an unusual case of HELLP syndrome in twin pregnancy with deranged renal profile for emergency cesarean section. We report the case, its anesthetic management for emergency cesarean section, and perioperative supportive treatment for acute renal failure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: It has been contended the general anesthetic agents also may affect the psycho-social behavior of the patients, especially during the emergence from GA. This assumes much significance in day cases where, patients have to be roadworthy and mentally stable before discharge. Aims: We compared the psycho-behavioral effects of propofol, sevoflurane and their combination, while emerging from anesthesia. Settings and Design: The patients coming for short duration day care anesthesia were studied in a prospective randomized controlled comparison. Materials and Methods: The psycho-behavioral changes in early, intermediate and late recovery period were studied in 60 consenting patients undergoing Total Intra Venous Anesthesia (TIVA) using Propofol, Volatile Induction and Maintenance Anesthesia (VIMA) using Sevoflurane and the combination of these two agents. Statistical Analysis: Statistical Analysis of the data and application of various statistical tests was carried out with help of Statistical Package for Social Services (SPSS version 18). Data were compiled, analyzed and presented as frequency, proportions, mean and standard deviation. The tests of significance , like Chi-square test, percentages, independent sample t test, paired t test, and P value were used in the study. Results and Conclusions: Both the modalities of GA, viz; TIVA and VIMA, do produce significant psycho-behavioral changes in the patients after GA, though transiently. So it is imperative for the Clinicians to anticipate the entire aspect of Psycho-behavioral patterns before discharging the day cases from the Post anesthesia Care Unit (PACU).

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Clonidine provides many desirable effects like sedation, analgesia, anxiolysis, and hemodynamic stability and these properties make it a potentially useful anesthetic premedication in the pediatric settings. The aim of this study was to compare oral midazolam (0.5 mg/kg), which is considered gold standard with oral clonidine (5 mcg/kg) as a premedication in pediatric patients. Materials and Methods: Sixty children classified as American Society of Anesthesiologists physical status I, aged between 2 and 12, who were scheduled to undergo an elective surgery, were enrolled for a prospective, randomized, and double blind controlled trial. They received either oral midazolam (Group M) or oral clonidine (Group C) 60 minutes before induction of anesthesia and were submitted to an evaluation of anxiety and sedation scores. We also evaluated secondary outcomes such as palatability, parental separation, effect on hemodynamic status, co-operation during venipuncture and facemask application, postoperative analgesic requirement, and recovery profile. Results: Oral midazolam had better efficacy in the preoperative period as sedative and anxiolytic (P < 0.001), allowed better cooperation during venipuncture and facemask application (P < 0.001), whereas, oral clonidine provided better palatability (P < 0.001), parental satisfaction (P < 0.001), stable perioperative hemodynamics (P < 0.001), better postoperative analgesia (P < 0.001), and night sleep pattern (P < 0.05) without any noticeable side effects (P > 0.05). Conclusion: We conclude that under the conditions of this study, oral midazolam is a better medication than clonidine in children in preoperative period while clonidine is a better medication postoperatively with added advantage of palatability, hemodynamic stability, and no significant side effects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway. Materials and Methods: The patients were randomly allocated to one of the two groups of 30 each at conclusion of surgery. First group was extubated in prone position and second in supine position at conclusion of surgery. Supine group patients were rolled back and prone group patients were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates (HR), mean arterial pressure (MAP) were noted at various points of time. Coughing, laryngospasm, vomiting, monitor disconnection if any were also noted. Results: During emergence from anesthesia heart rate was significantly more in group S than group P at all intervals ( P < 0.001). Mean arterial pressure was significantly higher in the supine group at 2, 3, and 4 min compared to prone group ( P = 0.003). Compared to supine patients, prone patients had fewer incidences of coughing ( P = 0. 0004), laryngospasm, vomiting and monitor disconnection. Conclusion : In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Ropivacaine has less systemic toxicity and greater differentiation of sensory and motor blockade after subarachnoid block. This study was aimed to evaluate the anesthetic efficacy of intrathecal 0.75% isobaric ropivacaine alone or with fentanyl in elderly patients undergoing transurethral resection of prostrate. Materials and Methods: Fifty four elderly consented patients of ASA grade I-III scheduled for transurethral resection of prostrate under the subarachnoid block were randomized to receive either intrathecal 4 mL of 0.75% isobaric ropivacaine (Group R, n = 27) or 3.5 mL of 0.75% isobaric ropivacaine with 0.5 mL (25 mg) of fentanyl (Group RF, n = 27). The characteristics of sensory and motor blockade, intraoperative hemodynamic changes, and secondary effects were noted for evaluation. Results: There was no significant difference in the demographic profile of patients. The surgical anesthesia was adequate for TURP surgery in all patients. The median time to achieve the sensory blockade at T10 dermatome was 3.2 ± 1.5 min in Group R and 3.5 ± 1.3 min in Group RF. The median duration of sensory blockade at T10 was 130.6 ± 10.2 min in Group R and 175.8 ± 8.6 min in Group RF. The median duration of complete motor block was significantly shorter than the duration of sensory blockade ( P < 0.001). There were fewer episodes of manageable hypotension in 5 patients of Group R and 11 patients of Group RF. No secondary effects have occurred in any patients. Conclusion: The intrathecal 0.75% isobaric ropivacaine alone or with fentanyl has provided effective surgical anesthesia for transurethral resection of prostrate and hemodynamic stability in elderly patients.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The "Tako-Tsubo syndrome" is a rare, transient, reversible hypokinesia of distal part of left ventricle, with normal coronary arteries. It was recently described and frequently associated with an extreme stressful event in postmenopausal women. We report a case of "Tako-Tsubo syndrome" following elective surgery for oesophageal malignancy with septic shock. Our report highlights the electrocardiographic changes with the progression of this syndrome and the challenges we faced in managing the case.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Laurence-Moon-Biedl Syndrome is primarily a rare, recessively inherited genetic disorder. The cardinal features are polydactyly, obesity and retinitis pigmentosa, mental retardation, genital hypoplasia and cardiac anomalies. This spectrum may extend and may also involve renal anomalies. Here, we report a rare case of 15-year-old boy who was overweight and suffering from Laurence Moon Biedl syndrome scheduled for closure of atrial septal defect.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Behçet's disease is a multisystem inflammatory disorder of unknown etiology characterized by vasculitis of large and smaller vessels. Most common features are appearance of oral ulcers which later heal by scarring and ocular involvement leading to glaucoma requiring surgical treatment. Here, we report a case of child suffering from Behçet's disease undergoing repeated ocular surgery for uncontrolled glaucoma and found that with the usual risk involved in such patients there are important changes in the airway when the patient is exposed to repeated surgery under general anesthesia.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Context: The study was undertaken to observe the effect of different maintenance-fluid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia. Aims: To know the intraoperative blood glucose levels. Settings and Design: Prospective randomized parallel group study. Subjects and Methods: Two hundred non-diabetic patients (100 in each group) aged between 18 years and 60 years were enrolled for this prospective randomized parallel group study. Group A patients received Ringer's lactate solution and Group B patients received 0.45% sodium chloride with 5% dextrose and 20 mmol/L potassium chloride as maintenance fluid. Capillary blood glucose (CBG) level was measured immediately before initiation of intravenous fluid therapy and thereafter hourly till the end of surgery. If at any time intraoperative CBG was found to be more than or equal to 150 mg/dL calculated dose of human soluble insulin was given as intravenous bolus equal to the amount of CBG/100 units. Statistical Analysis Used: For comparison of normally distributed variables independent sample t test was done. For rest of the data, i.e., CBG_0, CBG_4 and insulin consumption Mann-Whitney U test was employed. Results: 63% patients in group B developed at least one episode of hyperglycemia CBG ≥ 150 mg/dL) but only 29% in the Group A did so. Insulin consumption was significantly higher in Group B than in Group A to maintain normoglycemia. The relative risk of becoming hyperglycemic in Group B patients is 2.172 (95% CI 1.544 to 3.057). Number needed to harm, i.e., hyperglycemia, in Group B is 2.941 (95% CI 2 to 5). Conclusions: We conclude that stress induced-hyperglycemic response in patients undergoing major non-cardiac surgery is common in non-diabetic population. Maintenance-fluid therapy by dextrose containing solution as opposed to Ringer's lactate solution increases the incidence of hyperglycemia. To achieve normoglycemia by intravenous bolus dose of human regular insulin, significantly higher doses are required in patients receiving dextrose containing saline as maintenance fluid.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: This hospital-based, prospective, case-controlled study was carried out to monitor fluid absorption during transurethral resection of the prostrate (TURP) by marking the irrigating fluid with ethanol for signs of TURP syndrome. Addition of ethanol allows early detection and prevention of full blown TURP syndrome as also the volume of fluid absorbed can be measured. Subjects and Methods: Patients were divided into two groups of 50 each, taking males undergoing TURP belonging to ASA (American Society of Anesthesiologists) I and II. Group 1 received irrigation with 1.5% glycine alone and group 2 received irrigation with 1.5% glycine along with ethanol during TURP. The primary outcome measure was the detection of TURP syndrome using end expiratory ethanol levels and comparing with serum electrolytes and clinical manifestations. The secondary outcome measures, the hemodynamic parameters such as heart rate, systolic and diastolic pressures, and oxygen saturation were recorded during the intraoperative period after spinal anesthesia and then postoperatively till the end of the first hour in the recovery room. Statistical Analysis: Chi-square test, Student's t-test and Pearson's correlation coefficient 'r'. Results: Mean resection time in the ethanol positive patients (36.36 min) was significantly higher than that in the ethanol negative patients (22.08 min) ( P < 0.01). The estimated fluid absorbed was statistically significant in 45 minutes of resection in three patients with positive ethanol readings ( P < 0.05).Resection was temporally stopped in 16 patients (32%) and permanently in 1 patient (2%), whose resection time reached 60 min. A positive correlation was found between total fall in serum sodium and maximum expiratory ethanol concentration. There was a significant difference in the heart rate between the two groups in the 40 ^th minute ( P < 0.05). Conclusion: Ethanol is a noninvasive, easy-to-use marker in irrigating fluid for assessing fluid absorption. It forewarns to take corrective measures earlier than both fall in sodium and manifestations of TURP syndrome, allowing successful completion of TURP.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]