Reader Login
| Users Online: 4724
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
2013| September-December | Volume 7 | Issue 3
Online since
December 18, 2013
Archives
Previous Issue
Next Issue
Most popular articles
Most cited articles
Show all abstracts
Show selected abstracts
Export selected to
Cited
Viewed
PDF
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.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
24
7,732
814
ORIGINAL ARTICLES
Effect of wound infiltration with bupivacaine or lower dose bupivacaine/magnesium versus placebo for postoperative analgesia after cesarean section
Ahmad A Eldaba, Yasser M Amr, Reda A Sobhy
September-December 2013, 7(3):336-340
DOI
:10.4103/0259-1162.123227
Aim:
The authors examined the analgesic effect of wound infiltration with bupivacaine or lower dose bupivacaine and magnesium versus normal saline for postoperative analgesia after cesarean section.
Materials and Methods:
A total of 120 patients, American Society of Anesthesiologists (ASA) I-II were prepared for elective cesarean section. At the end of the surgery, the wound was continuously infiltrated at a rate of 5 ml/h for 24 h post-operatively by one of the following solutions: 0.25% bupivacaine, a mixture of 0.125% bupivacaine and 5% magnesium sulphate or normal saline (0.9%). Total opioid consumption, Visual Analogue Scale (VAS) at rest and movement, incidence of opioid side-effects and signs of wound inflammation were assessed during the period of the study (24 h post-operatively). Three months later, residual pain, surgical wound infection, need for extra-antibiotic therapy and wound healing impairment were assessed.
Results:
Post-operative pain scores at rest were statistically significant higher in the control group than those in the both wound infiltration groups from 4
th
h and onwards (
P
0 < 0.0001). Meanwhile, post-operative pain was higher in bupivacaine group versus magnesium group (
P
< 0.0001,
P
< 0.0001, 0.0012, respectively). There was statistically significant increase in VAS during movement in the control group versus others at 2, 4, 12, 24 h post-operatively (
P
< 0.0001). However, patients received magnesium plus bupivacaine wound infiltration showed a significant decrease in post-operative pain scores than whom received bupivacaine from 4
th
h and onward (
P
< 0.0001, 0.0054, 0.0001, respectively). Morphine consumption was significantly reduced in the magnesium group, (
P
< 0.0001). Incidence of residual pain was comparable in the three groups. The incidence of sedation and urine retention were noted to be significantly higher in the control group in comparison to other groups, (
P
<0.0001). The incidence of post-operative nausea and vomiting was reduced in patients received magnesium plus bupivacaine block versus others (
P
< 0.0001).
Conclusion:
Continuous wound infiltration with a mixture of bupivacaine and magnesium sulphate after cesarean section showed an effective analgesia and reduced post-operative Patient Controlled Analgesia (PCA) requirements as compared to continuous wound infiltration with local anesthetic only or placebo with fewer incidences of opioid adverse effects.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
14
3,031
202
Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients
Shilpi Awasthi, Raka Rani, Deepak Malviya
September-December 2013, 7(3):355-358
DOI
:10.4103/0259-1162.123234
Arterial blood gas (ABG) analysis is the gold standard method for assessment of oxygenation and acid base analysis, yielding valuable information about a variety of disease process. This study is aimed to determine the extent of correlation between arterial and peripheral venous samples for blood gases and acid base status in critically ill and emergency department patients and to evaluate if venous sample may be a better alternative for initial assessment and resuscitation. The prospective study was conducted on 45 patients of either sex in the age group of 15-80 years of intensive care unit and emergency ward. Relevant history, presenting complaints, vital signs, and indication for testing were recorded. Arterial and peripheral venous samples were drawn simultaneously in a pre-heparinized syringe and analyzed immediately for blood gases and acid base status. Mean difference and Pearson's product moment correlation coefficient was used to compare the result. After statistical evaluation, the present study shows minimal mean difference and good correlation (
r
> 0.9) between arterial and peripheral venous sample for blood gases and acid base status. Correlation in PO
2
measurement was poor (
r
< 0.3). Thus, venous blood may be a useful alternative to arterial blood during blood gas analysis obviating the need for arterial puncture in difficult clinical situation especially trauma patients, for initial emergency department assessment and early stages of resuscitation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
10
4,140
329
A comparative study of nerve stimulator versus ultrasound-guided supraclavicular brachial plexus block
Mithun Duncan, Akshaya N Shetti, Debendra Kumar Tripathy, D Roshansingh, N Krishnaveni
September-December 2013, 7(3):359-364
DOI
:10.4103/0259-1162.123235
Introduction:
With the advent of ultrasound (US) guidance, this technique saw resurgence in the late 1990s. As US guidance provides real-time view of the block needle, the brachial plexus, and its spatial relationship to the surrounding vital structures; it not only increased the success rates, but also brought down the complication rates. Most of the studies show use of US guidance for performing brachial plexus block, results in near 100% success with or without complications. This study has been designed to examine the technique and usefulness of state-of-the-art US technology-guided supraclavicular brachial plexus block and compare it with routine nerve stimulator (NS)-guided technique.
Aim:
To note block execution time, time of onset of sensory and motor block, quality of block and success rates.
Settings and Design:
Randomized controlled trial.
Materials and Methods:
A total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and NS (Group NS). Both groups received 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with 1:200000 adrenaline. The amount of local anaesthetic injected calculated according to the body weight and not crossing the toxic dosage (Inj. bupivacaine 2 mg/kg, Inj. lignocaine with adrenaline 7 mg/kg). The parameters compared between the two groups are block execution time, time of onset of sensory and motor block, quality of sensory and motor block, success rates are noted. The failed blocks are supplemented with general anesthesia.
Statistical Analysis:
The data were analyzed using the SPSS (version 19) software. The parametric data were analyzed with student "
t"
test and the nonparametric data were analyzed with Chi-square test A
P
< 0.05 was considered significant.
Results:
There was no significant difference between patient groups with regard to demographic data, the time of onset of sensory and motor block. Comparing the two groups, we found that the difference in the block execution time and success rates is not statistically significant. A failure rate of 10% in US and 20% in NS group observed and is statistically insignificant (
P
= 0.278). No complication observed in either group.
Conclusions:
US and NS group guidance for performing supraclavicular brachial plexus blocks ensures a high success rate and a decreased incidence of complications that are associated with the blind technique. However, our study did not prove the superiority of one technique over the other. The US-guided technique seemed to have an edge over the NS-guided technique. A larger study may be required to analyze the advantages of using US in performing supraclavicular brachial plexus blocks, which could help justify the cost of purchase of the US machine.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
8
2,414
278
A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery
Nitu Puthenveettil, Sunil Rajan, Lakshmi Kumar, Suresh Gangadharan Nair
September-December 2013, 7(3):371-375
DOI
:10.4103/0259-1162.123244
Context:
Establishing a near perfect surgical field during functional endoscopic sinus surgery (FESS) is essential and even a minor bleeding can severely compromise an already restricted view. So, if controlled hypotension can be provided without compromising the safety of patient by a relatively effortless method, surgical field can be improved greatly.
Aims:
The aim of this study was to compare the hemodynamic changes and surgical conditions during FESS following oral premedication with clonidine and metoprolol.
Settings and Design:
A total of 40 patients undergoing FESS were included in this prospective, randomized controlled study.
Subjects and Methods:
Patients were divided into two equal groups. Group A patients were premedicated with oral clonidine 300 mcg and Group B with oral metoprolol 50 mg, 2 h before surgery. All patients received fentanyl 2 mcg/kg and induced with propofol 2 mg/kg. Intubation was done following vecuronium 1 mg/kg. Anesthesia was maintained with 66% N
2
O, 33% O
2
and 1% isoflurane. The heart rate (HR) and blood pressure (BP) were measured before induction and thereafter every 15 min up to 2 h. The surgeons were asked to estimate the quality of the operative field using a pre-defined category scale with scores 1-5.
Statistical
Analysis:
Difference within the groups was analyzed using analysis of variance and
post-hoc
test was used to test the difference between individual groups. Chi-square test was used to find out the association between categorical variables.
Results:
Comparison of category scale revealed a lower score in Group A up to 60 min. Group B patients showed a statistically lower HR from pre-induction up to 90 min while systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure did not show a significant difference.
Conclusions:
Oral premedication with 300 mcg of clonidine produced a better operative field than oral metoprolol 50 mg during FESS.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
7
2,550
166
A comparative study of the efficacy of intravenous Paracetamol and Dexmedetomidine on peri-operative hemodynamics and post-operative analgesia for patients undergoing laparoscopic cholecystectomy
Sarbari Swaika, Nilakshi Parta, Surajit Chattopadhyay, Bikash Bisui, Sumantra Sarathi Banarjee, Somjit Chattarjee
September-December 2013, 7(3):331-335
DOI
:10.4103/0259-1162.123225
Background:
Unrelieved post-operative pain may result in the physical suffering as well as multiple physiological and the psychological consequences, which may adversely affect the peri-operative outcome and contribute to increase the length of stay in hospital.
Objectives:
We designed this study to evaluate the effect of IV Paracetamol and Dexmedetomidine as multimodal analgesic technique on post-operative analgesia and to reduce the consumption of the systemic opioid and its adverse effects in cases of laparoscopic cholecystectomy.
Materials and Methods:
Eighty consenting, American society of Anesthesiologist-physical status-I (ASA-PS-I), female patients, aged 19-60 year was randomly assigned to one of the following two groups: Group P (
n
= 40) received IV 1 g Paracetamol infusion over 10 min pre-operatively and 6 hourly thereafter and Group D (
n
= 40) received IV Dexmedetomidine 1 ΅g/kg bolus over 10 min pre-operatively and 0.2-0.4 ΅g/kg/h thereafter for 24 h. Peri-operative hemodynamic variables, post-operative pain scores, and the need for rescue analgesics were recorded and compared.
Results:
Profiles of intra-operative hemodynamic changes were similar in both groups in respect to heart rate (HR), diastolic blood pressure, mean arterial pressure except in the systolic blood pressure where Dexmedetomidine significantly reduced it in compare to Paracetamol (
P
= 0.014). Post-operatively 4
th
h and 24
th
h changes in mean HR between two groups was a statistically significant (
P
< 0.05). Visual analog scale scores were significantly lower in the Group P compared with Group D at 8
th
, 16
th
, and 24
th
h (
P
< 0.001). Sedation score were statistically higher in the Group D compared with the Group P at post-operative 4
th
, 8
th
, 16
th
, and 24
th
h (
P
< 0.006).
Conclusion:
Adjunctive use of both Paracetamol and Dexmedetomidine infusion reduced opioid use. However, Paracetamol peri-operatively provides adequate analgesia with the less sedation whereas Dexmedetomidine provides analgesia and co-operative sedation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
6
2,497
259
A retrospective analysis of anesthetic experience in 2917 patients posted for cleft lip and palate repair
Parul Jindal, Gurjeet Khurana, Deepali Gupta, JP Sharma
September-December 2013, 7(3):350-354
DOI
:10.4103/0259-1162.123233
Context:
Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children.
Aim:
to study the perioperative anesthetic complications in poor children with cleft abnormalities.
Settings and Design:
Retrospective analysis.
Materials and Methods:
This retrospective audit was conducted on 2917 patients of smile train project under going general anesthesia for cleft lip and palate from January 2007 to December 2010. Demographic, pre-anesthetic status, anesthetic management and anesthesia complications were recorded. Chi-square test was used to assess the relation between patient factors and occurrence of complications.
Results:
Of the 3044, we were able to procure complete data of 2917 patients. Most of children presented with anemia 251 (35%), 202 (29%) had eosinophilia while 184 (26%) had upper respiratory tract infection. The incidence of perioperative complications was 8.19% of which 33.7% critical incidents occurred during the induction time. The most common complication was laryngospasm 77 (40.9%) followed by difficult intubation 64 (30.9%). There was no mortality.
Conclusion:
Since these procedures do not characterize an emergency, most of the perioperative complications can be prevented by following the routine installed by the institute and smile train protocols.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
6
2,530
139
Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery
Mohamed Hamdy Elakany, Sherif Ahmed Abdelhamid
September-December 2013, 7(3):390-395
DOI
:10.4103/0259-1162.123263
Background:
Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries.
Materials and Methods:
Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (
n
= 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (
n
= 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded.
Results:
Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups.
Conclusions:
Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
6
3,052
207
EDITORIAL
Post-operative anesthesia rounds: Need of the hour
Sukhminder Jit Singh Bajwa, Mohamad Said Maani Takrouri
September-December 2013, 7(3):291-293
DOI
:10.4103/0259-1162.123205
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
5
2,760
208
ORIGINAL ARTICLES
Comparison of colloid preload versus coload under low dose spinal anesthesia for cesarean delivery
Rohit Varshney, Gaurav Jain
September-December 2013, 7(3):376-380
DOI
:10.4103/0259-1162.123248
Background:
Although fluid bolus is considered as a conventional prophylactic measure to prevent spinal-induced hypotension; vasopressors are nevertheless required. Low dose spinal anesthetics could markedly reduce such episodes of hypotension, by minimizing sympathetic blockade.
Aims:
We chose to compare the relative efficacy of colloid preload versus coload under low dose spinal anesthesia, for elective cesarean delivery.
Settings and Design:
A prospective, randomized, double-blinded study.
Materials and Methods:
In total, 42 parturients were randomized to receive a preload (Group P) of hydroxyl ethyl starch (10 ml/kg) over 20 min before initiation of low dose spinal anesthesia (hyperbaric bupivacaine 5.5 mg with fentanyl 25 μg) or coload (Group C) of an identical fluid over 5 min, starting at the time of identification of cerebrospinal fluid. Our primary outcome included hemodynamic parameters and the incidence of hypotension. The neonatal outcome and side-effects were also monitored.
Statistical Analysis:
Mann-Whitney
U
test and Fisher's exact/Chi-square test, whichever appropriate. A
P
< 0.05 was considered to be significant.
Results:
The incidence of hypotension was lower in Group P (10%) when compared with Group C (25%), though insignificant statistically. The hemodynamic parameters were better in Group P, though intergroup statistical differences were not observed. The time to the first episode of hypotension was longer in the Group P (17 min) as compared with Group C (14 min). No notable side-effects or adverse neonatal outcome was noted.
Conclusion:
Colloid preload has a clinical advantage over the coload strategy, in reducing hypotensive episodes under low dose spinal anesthesia. Preload is better under large hemodynamic fluctuations while coload is preferable for emergency scenarios.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
5
2,217
208
Comparison of efficacy and safety of ropivacaine with bupivacaine for intrathecal anesthesia for lower abdominal and lower limb surgeries
Sonal N Bhat, Himaldev , Madhusudan Upadya
September-December 2013, 7(3):381-385
DOI
:10.4103/0259-1162.123252
Background:
A prospective randomized clinical study was conducted to study the efficacy and safety of ropivacaine with bupivacaine intrathecally for lower abdominal and lower limb surgeries.
Material and Methods:
70 patients aged between 18 to 65 years were randomized into two groups,
n
= 35 in each group. Group A received 3 ml of (0.5%) isobaric bupivacaine (15 mg) and Group B 3 ml of (0.75%) isobaric ropivacaine (22.5 mg). Spinal anesthesia procedure was standardized. Haemodynamic parameters, onset and duration of sensory and motor blockade, level achieved, regression and side effects were compared between the two groups.
Results:
Onset and regression of sensory blockade in ropivacaine group was faster with a
P
< 0.001 which was statistically significant. Onset of motor blockade was rapid in both the groups but duration of motor blockade was significantly shorter in ropivacaine group. Excellent analgesia, with no side effects and stable haemodynamics was noted in ropivacaine group.
Conclusion:
Hence ropivacaine was safe and equally effective as bupivacaine for lower abdominal and lower limb surgeries with early motor recovery, providing early ambulation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
5
2,241
220
CASE REPORTS
Case of difficult tracheostomy tube insertion: A novel yet simple solution to the dilemma
Hemani Ahuja, Ashu S Mathai, Reetika Chander, Amy E Mathew
September-December 2013, 7(3):402-404
DOI
:10.4103/0259-1162.123272
Difficulties arising during tracheostomy tube insertion can be rapidly fatal if the airway is not adequately controlled. We report a case of difficult tracheostomy in a gentleman with severe subcutaneous emphysema following a previously failed tracheostomy attempt. Tracheostomy tube insertion through the pre-existing stoma failed repeatedly due to rapidly increasing distance of trachea from the skin and unexpected false passages; however, the trachea was eventually cannulated using a regular endotracheal tube.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
4
2,353
120
ORIGINAL ARTICLES
Paravertebral block is a proper alternative anesthesia for outpatient lithotripsy
Samy Hanoura, Mahmoud Elsayed, Magdy Eldegwy, Ahmed Elsayed, Tamer Ewieda, Mohammad Shehab
September-December 2013, 7(3):365-370
DOI
:10.4103/0259-1162.123238
Context:
This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for extracorporeal shock wave lithotripsy (ESWL) procedure. A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5 mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm
2
area after localizing the stones site, 10 min before the session. A total of 10 mm visual analogue scale (VAS) was used to evaluate pain every 10 min during the session. At the end of the procedure, total doses of rescue analgesia, the number of shockwaves, their power, and the total duration of shockwave treatment were recorded. After completion of the procedure, the patient was assessed for pain and nausea in the postanesthesia care unit (PACU) using the VAS. Patient's satisfaction and time needed to discharge patients to home also were recorded. Time to do the anesthetic technique was significantly higher (
P
< 0.001) in group-P than group-L, it was 12.7 ± 2.3 min versus 6.9 ± 1.9 min, respectively; intraoperative rescue analgesia by fentanyl was lesser (
P
< 0.001) in group-P than group-L, 26.7 ± 6.32 mcg versus 78.6 ± 5.41 mcg, respectively, also time interval between ends of the procedure till discharge to home was significantly higher (
P
< 0.001) in group-P than group-L, it was 99 ± 17 min versus 133 ± 31 min, respectively. VAS was not significant difference between both groups either intraoperative or postoperative in first hour. Patient's satisfaction was significantly higher (
P
< 0.05) in group-P than group-L, it was 8.8 ± 1.1 versus 6.1 ± 0.6, respectively. Adverse events were lesser, but not significant in group-P than in group-L. Two patients (8%) in group-L and one patient (4%) in the group-P experienced episodes of postoperative nausea and vomiting (PONV). Paravertebral block is an effective alternative anesthesia for outpatient lithotripsy; multiple level paravertebral blocks provide an optimal anesthetic condition, with acceptable adverse events for ESWL. And, providing proper analgesia during the procedure and in first hour after finishing of the procedure, early discharge to home and providing better patient's satisfactions.
Aims:
This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for ESWL procedure.
Settings and Design:
Prospective open label study.
Subject and Methods:
A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm
2
area after localizing the stones site, 10 min before the session. A total of 10 mm VAS was used to evaluate pain every 10 min during the session. At the end of the procedure, total doses of rescue analgesia, the number of shockwaves, their power, and the total duration of shockwave treatment were recorded. After completion of the procedure, the patient was assessed for pain and nausea in the PACU using the VAS. Patient's satisfaction and time needed to discharge patients to home also were recorded.
Statistical Analysis:
The findings of the two groups were statistically compared using SPSS version 12 (SPSS Inc., Chicago, IL). Data were expressed as mean ± standard deviation, number, and percentage. Nominal nonparametric data were analyzed using Chi-square test. Parametric data were compared using unpaired t-test. Ordinal nonparametric data were analyzed using Mann-Whitney U-test.
Results:
Time to do the anesthetic technique was significantly higher (
P
< 0.001) in group-P than group-L, it was 12.7 ± 2.3 min versus 6.9 ± 1.9 min, respectively; intraoperative rescue analgesia by fentanyl was lesser (
P
< 0.001) in group-P than group-L, 26.7 ± 6.32 mcg versus 78.6 ± 5.41 mcg, respectively, also time interval between ends of the procedure till discharge to home was significantly higher (
P
< 0.001) in group-P than group-L, it was 99 ± 17 min versus 133 ± 31 min, respectively. VAS was not significant difference between both groups either intraoperative or postoperative in first hour. Patient's satisfaction was significantly higher (
P
< 0.05) in group-P than group-L, it was 8.8 ± 1.1 versus 6.1 ± 0.6, respectively. Adverse events were lesser, but not significant in group-P than in group-L. Two patients (8%) in group-L and one patient (4%) in the group-P experienced episodes of PONV.
Conclusions:
Paravertebral block is an effective alternative anesthesia for outpatient lithotripsy; multiple level paravertebral blocks provide an optimal anesthetic condition, with acceptable adverse events for ESWL. And providing proper analgesia during the procedure and in first hour after finishing of the procedure, early discharge to home and providing better patient's satisfactions.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
4
1,904
140
REVIEW ARTICLES
Advances in neuro-monitoring
Charu Mahajan, Girija Prasad Rath, Parmod Kumar Bithal
September-December 2013, 7(3):312-318
DOI
:10.4103/0259-1162.123216
Neuromonitoring aims to detect harmful physiologic events, early enough to guide the treatment instituted. Evidences encourage us to implement multimodal monitoring, as no single monitor is capable of providing a complete picture of dynamic cerebral state. This review highlights the role of intracranial pressure monitoring, cerebral oxygenation (jugular venous oximetry, brain tissue oxygenation, near infrared oximetry, cerebral microdialysis) and cerebral blood flow monitoring (direct and indirect methods) in the management of neurologically injured patients. In this context, the recent developments of these monitors along with the relevant clinical implications have been discussed. Nevertheless, the diverse range of data obtained from these monitors needs to be integrated and simplified for the clinician. Hence, the future research should focus on identification of a most useful monitor for integration into multimodal system.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
4
3,633
333
CASE REPORTS
Bispectral index as a possible early marker of cerebral hypoperfusion
TV Bharath Kumar, Goverdhan Dutt Puri
September-December 2013, 7(3):405-407
DOI
:10.4103/0259-1162.123274
We report a case of unexplained transient ventricular fibrillation in a child with ventricular septal defect (VSD) scheduled for VSD closure. The bispectral index (BIS) values dropped within 15s of transient cardiac arrest and it showed recovery within 15 s of restoration of circulation. Monitoring BIS during surgery, especially cardiac surgeries may help identify periods of cerebral ischemia early.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
3
3,240
84
LETTERS TO EDITOR
Benzodiazepine overdose associated atrioventricular block
Krithika Anand, Mritunjay Kumar
September-December 2013, 7(3):419-420
DOI
:10.4103/0259-1162.123280
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
3
1,536
88
REVIEW ARTICLES
Anesthetic management of a patient presenting with eclampsia
S Parthasarathy, VR Hemanth Kumar, R Sripriya, M Ravishankar
September-December 2013, 7(3):307-312
DOI
:10.4103/0259-1162.123214
Eclampsia is one of the most common emergencies encountered by anesthesiologists which involve a safe journey of two lives. The definition, etiology, pathophysiology, treatment guidelines along with a special reference to management of labour pain and caesarean section are discussed. Eclampsia is commonly faced challenging case in our day to day anaesthesia practice,but less is discussed in our anaesthesia text books. Lot of controversies with regard to fluid management and monitoring still remain unanswered
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
3
9,739
1,014
CASE REPORTS
Dilated cardiomyopathy in acromegaly: Case report and anesthesia management
Abhijit S Nair, Anand M Nirale, K Sriprakash, T. V. S. Gopal
September-December 2013, 7(3):411-414
DOI
:10.4103/0259-1162.123277
Patients who are diagnosed having acromegaly develop a lot of cardiovascular Complications such as hypertension, arrhythmias, systolic and diastolic dysfunction, valvular dysfunction and heart failure. Dilated cardiomyopathy (DCM) with systolic and diastolic dysfunction is relatively rare but is associated with an increased mortality. We report a case of acromegaly diagnosed at 52 years of age in a known diabetic, non-hypertensive male who had DCM with severe left ventricular dysfunction, global hypokinesia, moderate mitral regurgitation, and grade II diastolic dysfunction who was treated with diuretics, digitalis, and vasodilators. He was diagnosed with a growth hormone secreting pituitary macroadenoma and underwent endoscopic excision of the pituitary tumor under general anesthesia.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
2,295
132
ORIGINAL ARTICLES
A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures
Malti Agrawal, Vijay Dureja, Ananda Prakash Verma, Lakhwinder Singh Kang
September-December 2013, 7(3):319-325
DOI
:10.4103/0259-1162.123221
Aims and Objectives:
Laparoscopic surgery is the choice for gynaecological surgery these days, but pneumoperitoneum (PNO) and trendelenburg position increase the intraocular pressure (IOP) leading to decrease in perfusion of retina and at times the significant risk of ischemic retinopathy. Our present aim is to find out the suitable combination of induction and maintenance agent for combating the increase in IOP by PNO, lithotomy and trendelenburg position, and to study the changes in IOP at different time points and positions in gynaecological laparoscopic procedures.
Patients and methods:
After taking permission from the Ethical Committee 120 female patients of ASA grade 1 and II were divided arbitrarily in four groups each comprising 30 patients. In group A and B induction was done with propofol 2.5 mg/kg given IV and in group C and D induction was done with thiopentone 5 mg/kg given IV. Atracurium 0.5 mg/kg IV was used as neuromuscular blocking agent (NMBA).Laryngeal mask airway (LMA) was inserted in all the cases and patients were ventilated with Bain's circuit. Maintenance of anesthesia was done with total intra venous anesthesia (TIVA) with propofol and100% oxygen in group A and C. In group B and D maintenance was done with 1% isoflurane with oxygen (O
2
) and nitrous oxide (N
2
O) in the ratio of 40:60. Changes in IOP, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were measured. Baseline readings were taken initially and then 2 min after premedication, 1 min after LMA insertion, 1 min after PNO with lithotomy position, 5 min after 20° head down tilt and PNO
in situ
and 2 min after exsufflation of PNO with supine horizontal position.
Results and Conclusion:
To mitigate increase in IOP during gynaecological laparoscopic surgeries, propofol, and propofol TIVA (Group A) proved to be the best option. Propofol and isoflurane (Group B) thiopentone and propofol TIVA (Group C) were not as effective as group A. However, induction with thiopentone and maintenance with isoflurane (Group D) were not effective at all.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
1,973
131
Effect of nalbuphine and pentazocine on attenuation of hemodynamic changes during laryngoscopy and endotracheal intubation: A clinical study
Dilip Kothari, Chetan K Sharma
September-December 2013, 7(3):326-330
DOI
:10.4103/0259-1162.123223
Background:
Narcotic drugs have been used to attenuate laryngoscopy and intubation induced circulatory responses, but are not always available due to tough narcotics laws. Nalbuphine a synthetic opioid, free from restrictions has been in use for post-operative pain relief. Hence, we decided to compare nalbuphine and pentazocine for attenuation of hemodynamic effects during larygoscopy and endotracheal intubation in a randomized, double-blind clinical study.
Materials and Methods:
A total of 60 patients (ASA I and II) of either sex, between 18 years and 50 years were given either nalbuphine 0.2 mg/kg (group N,
n
= 30) or pentazocine 0.5 mg/kg (group P,
n
= 30) 5 min before induction of general anesthesia. After, induction with thiopentone and endotracheal intubation with succinylcholine balanced anesthesia was maintained with O
2
:N
2
O, 0.2% halothane and non-depolarizing relaxants for surgical duration. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic pressure, mean arterial pressure, and rate pressure product calculated by HR × SBP were recorded at various time intervals.
Results:
A non-significant fall (
P
> 0.05) up to 3 min and thereafter a significant rise (
P
< 0.05) in all the parameters were observed throughout the remaining study period with nalbuphine, whereas a continuous and significant (
P
< 0.05) rise in these parameters were observed with pentazocine. Maximum rise in both the group was observed immediately after larygoscopy and intubation and these started to return toward the basal values at the end of the study period, but remained above the initial values. (pentazocine > nalbuphine
P
= <0.01).
Conclusion
: Nalbuphine effectively reduces the tachycardia, hypertension, and cardiac workload associated with laryngoscopy and endotracheal intubation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
2,195
174
REVIEW ARTICLES
Pregnancy with co-morbidities: Anesthetic aspects during operative intervention
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Gagandeep Singh Ghuman
September-December 2013, 7(3):294-301
DOI
:10.4103/0259-1162.123207
The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
2
3,410
808
CASE REPORTS
Submental orotracheal intubation: A better alternative to tracheostomy in panfacial fractures
Prasant Mohan Chandra, Fareedi Mukram Ali, Anuroop Singhai, Anupama Mudhol, Farheen Ustad
September-December 2013, 7(3):415-417
DOI
:10.4103/0259-1162.123278
Surgical repair of complex maxillofacial trauma presents a challenge to the surgeon and anaesthetist. Submental intubation is an alternative where oral and nasal intubation cannot be used. We present a case where tracheostomy was avoided in a patient with multiple maxillofacial fractures by opting for sub-mental endotracheal intubation technique. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The technique avoids the complications associated with tracheostomy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,735
101
LETTERS TO EDITOR
Damaged expiratory valve: A missed mishap!!
Akshaya N Shetti
September-December 2013, 7(3):421-422
DOI
:10.4103/0259-1162.123281
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,122
54
The potential role of dexmeditomidine during perioperative period in a hypertensive patient with Eagle syndrome
Veenita Sharma, Sukhminder Jit Singh Bajwa
September-December 2013, 7(3):423-424
DOI
:10.4103/0259-1162.123282
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,392
77
ORIGINAL ARTICLES
Comparison of recovery profile for propofol and sevoflurane anesthesia in cases of open cholecystectomy
Shiv Kumar Singh, Amit Kumar, Reena Mahajan, Surabhi Katyal, Sfurti Mann
September-December 2013, 7(3):386-389
DOI
:10.4103/0259-1162.123259
Objective:
Sevoflurane and propofol are considered to be the agents of choice in surgeries of short duration due to their better recovery profile and few post-operative complications. This study was designed to compare the early recovery profile of sevoflurane and propofol anesthesia in patients undergoing open cholecystectomy.
Materials and Methods:
A total of 60 patients of either sex with American Society of Anesthesiologists grade 1 and 2 scheduled for elective cholecystectomy were prospectively randomized into two groups. Group S (30 patients) were maintained with sevoflurane anesthesia (1-2%), while in Group P (30 patients) were maintained with propofol infusion (75-125 μg/kg/min) in both the groups the anesthetic concentration/dose was so adjusted to keep hemodynamic parameter (mean arterial pressure and heart rate) within 15% of their respective baselines values.
Results:
It was observed that there was no significant difference (
P
> 0.05) between there early recovery profile that includes spontaneous eye opening (7.5 ± 1.6 min for sevoflurane group and 6.9 ± 1.7 min for propofol group), following simple verbal command (9.2 ± 2.2 min for sevoflurane group and 8.9 ± 1.9 min for propofol group) and extubation time (10.7 ± 2.3 min for sevoflurane group and 10.3 ± 2.0 min for propofol group) but there was a significant difference (
P
< 0.05) in incidence of post-operative nausea and vomiting (PONV) in both groups.
Conclusion:
Propofol is as good as sevoflurane for maintenance of anesthesia in surgeries like open cholecystectomy with an added advantage of lower incidence of PONV owing to its intrinsic antiemetic properties.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
1
1,914
152
CASE REPORTS
Anesthetic management of Wolff-Parkinson-White syndrome in a pregnant patient posted for emergency caesarean section
Urmila Palaria, Mohd A Rasheed, Geeta Jain, AK Sinha
September-December 2013, 7(3):408-410
DOI
:10.4103/0259-1162.123276
The most common arrhythmia seen during pregnancy is paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome accounts for majority of this in such population. The presence of pre-disposing factors may facilitate the onset of tachyarrhythmias in previously asymptomatic parturients with the WPW syndrome such as increased hemodynamic, hormonal, autonomic, and emotional changes. Therefore, meticulous monitoring is essential perioperatively. Epidural anesthesia providing added advantage of hemodynamic stability and post-operative analgesia is preferred in such pregnant patients undergoing emergency cesarean section.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,646
145
Intraoperative management of atrial fibrillation in a patient with restrictive cardiomyopathy
Arun Kumar, Shaji Mathew, Nataraj Madagondapalli Srinivasan
September-December 2013, 7(3):396-398
DOI
:10.4103/0259-1162.123265
A 65-year-old patient with renal amyloidosis presented for Trans Urethral Resection of Prostate (TURP). There were no symptoms pertaining to the cardiorespiratory system. Preoperative investigations showed only secondary cardiomyopathy. Intraoperatively the patient developed atrial fibrillation with hypotension which was successfully managed by cardioversion.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,708
100
Anesthetic management of emergency laparotomy in a case of ischemic cardiomyopathy with COPD
Saswata Bharati, Dinesh K Singh
September-December 2013, 7(3):399-401
DOI
:10.4103/0259-1162.123267
Anesthesia for non-cardiac surgeries in patients with ischemic cardiomyopathy with other co-morbidities is a challenging situation for anesthetists. The choice of anesthesia and anesthetic agents should be judicious and balanced to maintain optimum cardiac output and to avoid myocardial depression for a successful postoperative outcome. Here, we describe the anesthetic management for emergency exploratory laparotomy in a patient who was suffering from ischemic cardiomyopathy along with chronic obstructive pulmonary disease and was presented to the emergency operation theater for gastrointestinal tract perforation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,100
143
LETTERS TO EDITOR
Defective arterial catheter: Potential for catastrophic complication?
Bikash Ranjan Ray, Puneet Khanna, Ajisha Aravindan
September-December 2013, 7(3):418-418
DOI
:10.4103/0259-1162.123279
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,353
67
ORIGINAL ARTICLES
Accuracy of estimation of total body weight by legs and head weight measuring and comparison method in the anesthetized patients
Ebrahim Nasiri, Reza Nasiri
September-December 2013, 7(3):341-345
DOI
:10.4103/0259-1162.123229
Context:
Accurate patient weight is an important factor in the emergency and operating room departments.
Aims:
The aim of this study is to determine the accuracy of estimation of total body weight by legs and head weight measuring and comparison method in the anesthetized patients.
Settings and Design:
Education of hospitals, Mazandaran University of Medical Sciences, prospective, observational study.
Subjects and Methods:
This is prospective observational study. Nursing staff were asked to estimated weight that knows about a similar person weight on the operating room and matched together, then told his/her guests. They were measured total body weight before anesthesia and then patient head and legs weight after anesthesia. The main outcome was mean weight of these methods and percent accuracy in weight estimation for each group recorded.
Statistical Analysis:
Descriptive statistically used.
Results:
Overall, 57.3% (243/425) of operating personnel estimations were equal with actual weight. 35.4% (150/425) of the estimations were less 10 kg than the actual weight and only 7.3 (31/425) of the estimations were above 5 kg of actual weight. The accuracy of overall estimations by operating personnel and its comparison to the accuracy of legs weight, head, and sum weight by a similar method is demonstrated.
Conclusions:
Despite having no formula in the critical intensive care and anesthesia region for estimation anesthetized, for comatose patient weight. We can use this formula, but where possible, should be based on measured weight for drug dose calculation and this is not possible, combination of these formulas is suitable.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
2,315
103
Bispectral index monitoring of propofol sedation during ultrasound guided nerve block for inguinal herniorraphy: A randomized prospective study
Kumkum Gupta, Prashant K Gupta, Bhawna Rastogi, Manish Jain, Lokesh Kumar, Ivesh Singh
September-December 2013, 7(3):346-349
DOI
:10.4103/0259-1162.123231
Background:
Patient's awareness can be reduced during ultrasound guided nerve block for inguinal herniorraphy with propofol sedation. The study was aimed to evaluate the clinical efficacy of direct visualization of anatomy of inguinal region by ultrasound and benefits of bispectral index (BIS) monitoring.
Materials
and
Methods:
After approval, 40 adult male consented patients of ASA grade I-III of 18-58 years with body mass index <25 were randomized into two groups of 20 patients each. A high frequency (8-13 MHz) linear transducer was used to perform the ilioinguinal and iliohypogastric nerves (ILHN and ILIN) block between the internal oblique and transversus abdominis muscles with 20 mL of 0.75% ropivacaine. The propofol infusion rate for sedation in patients of group I (non-BIS) was managed clinically and in patients of group II (BIS) was managed with BIS index of 65-75. Any surgical or anesthetic complications were recorded. The two groups were compared by evaluating the propofol consumption during surgery.
Results:
Ultrasonographic visualization of the ILHN and ILIN was possible in all patients and inguinal herniorraphy was performed uneventfully. The mean dose of propofol required for sedation was 5.45 mg/kg/h in patients of group I (non-BIS) while 4.92 mg/kg/h in patients of group II (BIS). The mean propofol consumption was not statistically significant (
P
= 0.12). All patients were hemodynamically stable and there was no respiratory depression during propofol sedation.
Conclusion:
Ultrasonography has facilitated the clinically effective nerve block for inguinal herniorraphy and BIS monitoring has ensured amnesia and faster emergence.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
-
1,841
88
RETRACTION NOTICE
Retraction Notice
September-December 2013, 7(3):293-293
PMID
:25206898
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
-
1,457
65
Feedback
Subscribe
Sitemap
|
What's New
|
Feedback
|
Disclaimer
|
Privacy Notice
© Anesthesia: Essays and Researches | Published by Wolters Kluwer -
Medknow
Online since 1
st
June, 2010