Reader Login
| Users Online: 4786
Home
|
About us
|
Editorial board
|
Ahead of print
|
Search
|
Current Issue
|
Archives
|
Submit article
|
Instructions
|
Copyright form
|
Subscribe
|
Advertise
|
Contacts
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
Access statistics : Table of Contents
2015| January-April | Volume 9 | Issue 1
Online since
February 11, 2015
Archives
Previous Issue
Next Issue
Most popular articles
Most cited articles
Show all abstracts
Show selected abstracts
Export selected to
Viewed
PDF
Cited
CASE REPORTS
Uncommon drug abuse: An anesthetist dilemma
Kewal Krishan Gupta, Amanjot Singh, Gurpreet Singh, Shobha Aggarwal
January-April 2015, 9(1):116-117
DOI
:10.4103/0259-1162.150191
PMID
:25886435
Although mephentermine (Termin) and ephedrine are commonly used drugs for the treatment of hypotension during anesthesia but their abuse have markedly increased, especially in the young population due to its stimulant properties. Here, we report a case of 23-year-old man with a history of chronic mephentermine abuse, posted for Achilles tendon repair under spinal anesthesia. During intraoperative period, spinal induced hypotension showed unusual resistance to ephedrine boluses and was managed by using directly acting vasoconstrictor, that is, phenylephrine.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
15,055
168
-
REVIEW ARTICLE
Comparative analysis of efficacy of lignocaine 1.5 mg/kg and two different doses of dexmedetomidine (0.5 μg/kg and 1 μg/kg) in attenuating the hemodynamic pressure response to laryngoscopy and intubation
Michell Gulabani, Pavan Gurha, Prashant Dass, Nishi Kulshreshtha
January-April 2015, 9(1):5-14
DOI
:10.4103/0259-1162.150167
PMID
:25886414
Context:
Laryngoscopy and intubation cause an intense reflex increase in heart rate, blood pressure, due to an increased sympathoadrenal pressor response. Lignoocaine has shown blunting of pressor response to intubation. Dexmedetomidine has sympatholytic effects.
Aims:
To the best of our knowledge there is no study comparing the efficacy of lignocaine with two different doses of dexmedetomidine for attenuating the pressor response. With this idea, we planned to conduct the present study.
Materials and Methods:
After approval by the Hospital Ethics committee, 90 consenting adults aged 18-65 years of age of either sex of non-hypertensive ASA Grade I or II were randomly allocated into three groups. Group D1- IV Dexmedetomidine 0.5μg/kg over 10 minutes Group D2- IV Dexmedetomidine 1μg/kg over 10 minutes Group X- IV Lignocaine 1.5mg/kg in 10 ml normal saline
Statistical Analysis Used:
ANOVA and Student's t test used for analysis. Results: Dexmedetomidine 1μg/kg was more effective than 0.5μg/kg and lignocaine 1.5mg/kg in attenuating the pressor response.
Conclusions:
We conclude that dexmedetomidine 1μg/kg adequately attenuates the hemodynamic response to laryngoscopy and endotracheal intubation when compared with dexmedetomidine 0.5μg/kg and lignocaine 1.5mg/kg.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
5,246
413
7
ORIGINAL ARTICLES
Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia
Hossam Ibrahim Eldesuky Ali Hassan
January-April 2015, 9(1):21-27
DOI
:10.4103/0259-1162.150157
PMID
:25886416
Background:
There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges.
Aim of the Study:
The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness.
Patients
and
Methods:
Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA.
Results:
Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group
P
< 0.001 and
P
< 0.01 respectively. The upper dermatomal height of sensory block reached was T9 and T8 in groups B and L respectively. Group B showed more intense motor block than group L. There was no significant difference between both groups as regards postoperative side effects
P
> 0.05. Group L patients did not stay in PACU, and all patients bypassed it
P
< 0.001. Bupivacaine group patients showed significantly longer time to ambulate and time to home-readiness than lidocaine group
P
< 0.001 and
P
< 0.01 respectively.
Conclusion:
Both techniques of SSA were clinically efficient as subarachnoid block, and they had less postoperative side effects. Lidocaine spinal was more eligible for fast-tracking anesthesia than bupivacaine spinal with shorter time to ambulate and home-readiness time.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
5,072
251
4
A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections
Ayesha Goyal, P Shankaranarayan, P Ganapathi
January-April 2015, 9(1):57-62
DOI
:10.4103/0259-1162.150169
PMID
:25886422
Background:
To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases.
Materials and Methods:
After approval of College Ethical Committee, 30 parturient with American Society of Anesthesiologists I-II undergoing elective cesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 10 mg (2 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 10 mg (2 ml) isobaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by APGAR score at 1 and 5 min and umbilical cord blood gas analysis.
Results:
Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO
2
was slightly higher, and pO
2
was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups.
Conclusion:
Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
4,417
344
4
A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief
Wasim Mohammad, Shafat A Mir, Khairaat Mohammad, Khalid Sofi
January-April 2015, 9(1):15-20
DOI
:10.4103/0259-1162.150141
PMID
:25886415
Background:
The aim of the study was to compare postoperative pain relief in patients undergoing an elective thoracotomy with thoracic epidural analgesia using single shot magnesium and clonidine as adjuvants to bupivacaine.
Methods:
In a randomized prospective study, 60 patients of American Society of Anesthesiologists physical status I-III of either sex, between 20 and 60 years undergoing elective unilateral thoracotomy, were allocated to three equal groups of 20 patients. Each patient received thoracic epidural analgesia using bupivacaine alone (Group A) or with magnesium (Group B) or clonidine (Group C) at the end of surgery during skin closure. Postoperatively, pain was measured using a visual analog scale (VAS). Rescue analgesia (50 mg tramadol intravenous) was given at a VAS score of ≥4. Duration of analgesia and total dose of rescue analgesic during 24 h was calculated. Postoperative sedation and other side effects if any were recorded.
Results:
All the groups were homogeneous with respect to their demographics. The 24 h cumulative mean VAS score in Groups A, B, and C was 3.12 ± 0.97, 2.86 ± 0.43, and 1.83 ± 0.59, respectively. The duration of analgesia was prolonged in Group C (165 ± 49.15 min), followed by Group B (138 ± 24.6 min), and Group A (118.5 ± 52.8 min). The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (
P
= 0.001). The number of rescue analgesia doses were more in Group A (3.3 ± 1.65) followed by Group B (2.35 ± 0.98) and Group C (1.75 ± 0.71). The sedation scores were significantly higher in Group C. However, shivering was seen in Group A (40%) and Group C (20%) and absent in Group B (
P
= 0.003).
Conclusion:
Thoracic epidural analgesia using bupivacaine with clonidine is an efficient therapeutic modality for postthoracotomy pain. Magnesium as an adjuvant provided quality postoperative analgesia decreasing the need for postoperative rescue analgesia and incidence of postoperative shivering without causing sedation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
4,157
210
-
Facing the airway challenges in maxillofacial trauma: A retrospective review of 288 cases at a level i trauma center
Babita Gupta, Arunima Prasad, Sarita Ramchandani, Maneesh Singhal, Purva Mathur
January-April 2015, 9(1):44-50
DOI
:10.4103/0259-1162.150142
PMID
:25886420
Background:
Maxillofacial trauma is an apt example of a difficult airway. The anesthesiologist faces challenges in their management at every step from airway access to maintenance of anesthesia and extubation and postoperative care.
Methods:
A retrospective study was done of 288 patients undergoing surgery for maxillofacial trauma over a period of five years. Demographic data, detailed airway assessment and the method of airway access were noted. Trauma scores, mechanism of injury, duration of hospital stay, requirement of ventilator support were also recorded. Complications encountered during perioperative anaesthetic management were noted.
Results:
259 (89.93%) of the patients were male and 188 (62.85%) were in the 21-40 year range. 97.57% of the cases were operated electively. 206 (71.53%) patients were injured in motor vehicular accidents. 175 (60.76%) had other associated injuries. Mean Glasgow coma scale score (GCS), injury severity score (ISS) and revised trauma score (RTS) were 14.18, 14.8 and 12, respectively. Surgery was performed almost nine days following injury. The mean duration of hospitalization was 16 days. ICU admission was required in 22 patients with mean duration of ICU stay being two days. Majority of patients had difficult airway. 240 (83.33%) patients were intubated in the operating room and fibreoptic guided intubation was done in 159 (55.21%) patients. Submental intubation was done in 45 (14.93%) cases.
Conclusions:
Maxillofacial injuries present a complex challenge to the anaesthesiologist. The fibreoptic bronchoscope is the main weapon available in our arsenal. The submental technique scores over the time-honored tracheostomy. Communication between the anaesthesiologist and the surgeon must be given paramount importance.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
4,081
149
1
Comparative study between epidural morphine and bupivacaine with epidural clonidine and bupivacaine for postoperative pain relief in abdominal surgeries
Tapan J Parikh, Vishal Divecha, Divyang Dalwadi
January-April 2015, 9(1):28-33
DOI
:10.4103/0259-1162.150159
PMID
:25886417
Background:
Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia.
Aims:
The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 μg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries.
Settings and Design:
Double-blind retrospective randomized study.
Methodology:
All the patients (
n
= 60) varying from age group belonging to American Society of Anesthesiologists I-II were randomly allocated to receive epidural analgesia Group A - Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (
n
= 30), Group B - Clonidine (2 μ/kg) + Bupivacaine (0.125%) (
n
= 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1
st
dose.
Statistical Analysis Used:
Continuous data are analyzed by Student's
t
-test (paired '
t
'- test for intragroup variations and unpaired '
t
'- test for intergroup variations). Chi-square test was used for categorical data. A
P
≤ 0.05 was considered to be statistically significant.
Results:
Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (
P
< 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients.
Conclusions:
Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
4,031
193
-
CASE REPORTS
Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature
RV Ranjan, TR Ramachandran, S Manikandan, Roshan John
January-April 2015, 9(1):127-129
DOI
:10.4103/0259-1162.150184
PMID
:25886439
Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
4,011
92
-
ORIGINAL ARTICLES
Efficacy of spinal additives neostigmine and magnesium sulfate on characteristics of subarachnoid block, hemodynamic stability and postoperative pain relief: A randomized clinical trial
Suchita Joshi-Khadke, VV Khadke, SJ Patel, YM Borse, KV Kelkar, JP Dighe, RD Subhedar
January-April 2015, 9(1):63-71
DOI
:10.4103/0259-1162.150168
PMID
:25886423
Background:
Intrathecal neostigmine and magnesium sulfate (MgSO
4
) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity.
Aims:
The aim was to investigate the effect of neostigmine and MgSO
4
on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA.
Subjects and Methods:
In this prospective, randomized, double-blind study 75 American Society of Anesthesiologist status I and II adult females posted for major gynecological surgery were assigned to one of the three groups (
n
= 25). Group N received Neostigmine 25 μg, Group M received MgSO
4
50 mg, Group C received 0.5 ml saline as an adjuvant to 17.5 mg hyperbaric bupivacaine. Onset, duration of block, heart rate, mean arterial pressure, postoperative analgesia, analgesic requirement, and adverse effects were recorded. Data expressed as mean (standard deviation) or number (%).
P
<0.05 were statistically significant.
Results:
The three groups were comparable in characteristics of SA. The mean duration of analgesia was significantly longer in Group N (5.1 h) followed by Group M (4.2 h) and Group C (3.8 h) (
P
= 0.0134). Analgesic requirement was significantly less in Group N followed by Group M and Group C (
P
= 0.00232). The pain score was significantly less in Group M (
P
< 0.05). The incidence of hypotension and vasopressor requirement was lowest (48%) in Group N than in Group M (64%) and Group C 84% (
P
= 0.0276). The incidence of bradycardia and atropine requirement was the lowest in Group M (
P
= 0.0354). Sedation was observed in 56% patients in Group M compared to 20% in Group N and 8% in Group C (
P
= 0.0004).
Conclusion:
Intrathecal Neostigmine and MgSo
4
does not affect characteristics of SA. Postoperative analgesia of neostigmine was better than MgSO
4
. Neostigmine provides some protection against hypotension of SA whereas MgSO
4
protects against bradycardia.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
3,882
214
1
Comparison of equipotent doses of rocuronium and vecuronium
Mrunalini Parasa, Nagendra Nath Vemuri, Mastan Saheb Shaik
January-April 2015, 9(1):88-91
DOI
:10.4103/0259-1162.150676
PMID
:25886427
Background:
Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED
95
) of R and V.
Materials and Methods:
The study was carried out in 60 adult American Society of Anesthesiologists physical status 1-2 patients of age 20-60 years. The patients were divided into two groups of 30 each and received either 0.9 mg/kg of R (Group R) or 0.168 mg/kg of V (Group V) to facilitate endotracheal intubation. Neuromuscular blockade was assessed at corrugator supercilii and adductor pollicis muscles to evaluate onset time and duration of neuromuscular block, respectively.
Results:
The mean onset time was significantly rapid in Group R as compared to Group V (
P
-0.011). Overall intubating conditions were excellent in 100% of patients in Group R as compared to 70% in Group V. The mean duration of action did not show a significant variation between the groups.
Conclusion:
At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
3,816
154
1
Comparative evaluation of oral flupirtine and oral diclofenac sodium for analgesia and adverse effects in elective abdominal surgeries
Joginder Pal Attri, Gagandeep Kaur Sandhu, Sudhir Khichy, Harsimrat Singh, Kulwinder Singh, Radhe Sharan
January-April 2015, 9(1):72-78
DOI
:10.4103/0259-1162.150681
PMID
:25886424
Background:
Flupirtine is a centrally-acting, nonopioid analgesic that interacts with N-methyl-D-aspartate receptors.
Aim:
The present study was designed to compare analgesic efficacy and adverse effects of orally administered flupirtine and diclofenac sodium for postoperative pain relief.
Settings
and
Design:
In a prospective, randomized double-blind study, 100 patients of American Society of Anesthesiologist grade I and II in the age group of 18-65 years of either sex undergoing elective abdominal surgeries were included after taking informed consent.
Materials and Methods:
The present study started after 12 h of surgery and patients were randomly divided into two groups of 50 each. For postoperative analgesia, group A received flupirtine 100 mg orally and group B received diclofenac sodium 50 mg orally and study drugs were repeated every 6 hourly for 5 days postoperatively. Vital parameters and visual analogue scale (VAS) scores for pain were recorded at 0, 1, 2, 4, 6, 8, 12, 16 and 24 h, and adverse effects were noted for 48 h of the study period.
Statistical
Analysis:
Data were compiled and analyzed statistically using Chi-square test and two-tailed Student's
t
-test.
Results:
Visual analogue scores decreased more rapidly in diclofenac group during 1
st
h, hence there was rapid onset of analgesia in this group as compared to flupirtine group but later on VAS was comparable in both groups at all measured intervals (
P
> 0.05). Patients in diclofenac group experienced significantly more heartburn (
P
= 0.00), impaired taste sensation (
P
< 0.001) and dizziness (
P
= 0.004) as compared to flupirtine group.
Conclusion:
Oral flupirtine and diclofenac sodium were equally effective for postoperative analgesia. There was faster onset of analgesia with diclofenac sodium, but flupirtine was better tolerated by the patients because of its minimal adverse effects.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,594
144
-
Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy
M Upadya, SH Pushpavathi, Kaushik Rao Seetharam
January-April 2015, 9(1):39-43
DOI
:10.4103/0259-1162.150154
PMID
:25886419
Background:
Nonsteroidal anti-inflammatory drugs used for postoperative analgesia have considerable adverse effects, with paracetamol having a different mechanism of action, superior side effect profile and availability in intravenous (IV) form, this study was conducted to compare intra-peritoneal bupivacaine with IV paracetamol for postoperative analgesia following laparoscopic cholecystectomy.
Aim:
The aim was to compare the efficacy of intra-peritoneal administration of bupivacaine 0.5% and IV acetaminophen for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
Settings and Design:
Randomized, prospective trial.
Materials and Methods:
A total of 60 patients of American Society of Anesthesiologists physical Status I and II scheduled for laparoscopic cholecystectomy were enrolled for this study. Group I received 2 mg/kg of 0.5% bupivacaine as local intra-peritoneal application and Group II patients received IV 1 g paracetamol 6
th
hourly. Postoperatively, the patients were assessed for pain utilizing Visual Analog Scale (VAS), Visual Rating Prince Henry Scale (VRS), shoulder pain. The total number of patients requiring rescue analgesia and any side-effects were noted.
Statistical Analysis:
Data analysis was performed using Students unpaired
t
-test. SPSS version 11.5 was used.
Results:
The VAS was significantly higher in Group I compared with Group II at 8
th
, 12
th
and 24
th
postoperative hour. At 1
st
and 4
th
postoperative hours, VAS was comparable between the two groups. Although the VRS was higher in Group I compared with Group II at 12
th
and 24
th
postoperative hour; the difference was statistically significant only at 24
th
postoperative hour. None of the patients in either of the groups had shoulder pain up to 8 h postoperative. The total number of patients requiring analgesics was higher in Group II than Group I at 1
st
postoperative hour.
Conclusion:
Although local anesthetic infiltration and intra-peritoneal administration of 0.5% bupivacaine decreases the severity of incisional, visceral and shoulder pain in the early postoperative period, IV paracetamol provides sustained pain relief for 24 postoperative hours after elective laparoscopic cholecystectomy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,457
196
-
Comparative analgesic efficacy of different doses of dexamethasone during infraumbilical surgery: A Randomized controlled trial
Ragi Jain, CK Dua
January-April 2015, 9(1):34-38
DOI
:10.4103/0259-1162.150153
PMID
:25886418
Background:
Postoperative pain is a common complaint and despite the availability of various drugs, is still not managed well. Analgesic effects of glucocorticoids are still to be substantially established. Hence, we designed randomized, double-blind, placebo-controlled trial to compare the effect of two different doses of dexamethasone on postoperative pain in patients undergoing infra-umbilical surgeries under spinal anesthesia.
Methods:
Ninety American Society of Anesthesiologists Grade I and II patients were randomized to receive injection dexamethasone 8 mg (Group DI), dexamethasone 16 mg (Group DII) or placebo (Group C) prior to performance of intrathecal block. Outcome studied was postoperative pain on the rest and motion and nausea and vomiting.
Result:
There was no difference in Visual Analog Scale (VAS) scores during rest in all the three groups. However, VAS scores on motion showed a significant decrease in Group DII at 24 and 36 h when compared to Group C (95% confidence interval [CI] of mean at 24 h for Group C = 5.6093-7.1049 and Group DII = 4.8709-5.9567,
P
= 0.04; 95% CI of mean at 36 h for Group C = 4.5868-5.8418 and Group DII = 3.5388-4.7378,
P
= 0.01). There was no significant difference in the incidence of postoperative nausea and vomiting or additional analgesic requirements.
Conclusion:
Dexamethasone 16 mg reduces postoperative pain on motion at 24 and 36 h. It has no effect on postoperative pain at rest or on nausea and vomiting.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
3,504
120
1
EDITORIALS
In memory of departed editor of AER Burhan Adeen Alabed (1922-2014)
Mohamad Said Maani Takrouri, Muna Abass
January-April 2015, 9(1):3-4
DOI
:10.4103/0259-1162.150678
PMID
:25886413
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,522
99
-
ORIGINAL ARTICLES
Effect of a trial pharmaceutical solution on reversing sensations after using lidocain: An animal study
Abbas Haghighat, Amin Davoudi, Mohsen Minaiyan, Meghdad Molai, Abdolreza Afshar, Keyvan Basiri
January-April 2015, 9(1):79-82
DOI
:10.4103/0259-1162.150182
PMID
:25886425
Introduction:
Local anesthesia has a paramount role in any branches of medical sciences specially dentistry. Soft tissue irritations and lips biting are adverse side-effects in some cases. This study tried out to represent a new pharmaceutical solution in returning sensations faster.
Materials and Methods:
Five New Zealand laboratory rabbits were anesthetized with 1 cc Ketamine and Xilosine intramuscularly in thigh site. Electrodes were attached to the palms and wrists. Then, 0.2 cc lidocain 2% was injected in forearm origin in order to block median proximal nerve in both forelegs. The nerves conduction study (NCS) was recorded before and after lidocain injection, plus 30 min and once again 1 h after calcium gloconate 10%, dextrose 50%, citric acid solution injection. The recorded data were analyzed using Wilcoxon test and using SPSS software (version 11.5) at significant level of 0.05.
Results:
The NCS of left and right forearms was 1.4 ± 1.35 mV and 0.48 ± 0.45 mV. According to the statistical test, there was no significant difference between two groups (
P
> 0.05).
Conclusion:
Calcium gloconate 10%, dextrose 50%, citric acid solution did not reverse the effect of anesthetic drugs. Possible reasons were pressure to the nerves, which were caused by drug volume, and low sample size.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
3,460
82
2
EDITORIALS
Endocrine disruption: Battle ground for anesthesia
Sukhminder Jit Singh Bajwa, Sanjay Kalra
January-April 2015, 9(1):1-2
DOI
:10.4103/0259-1162.150135
PMID
:25886412
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,326
114
-
CASE REPORTS
Continuous posterior lumbar plexus and continuous parasacral and intubation with lighted stylet for ankylosing spondylitis
Luiz Eduardo Imbelloni, Neli Lucena
January-April 2015, 9(1):98-100
DOI
:10.4103/0259-1162.150146
PMID
:25886430
Ankylosing spondylitis is characterized by progressive ossification of the spinal column with resultant stiffness. Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway and performing neuraxial blockade. We describe a case of intubation with lighted stylet, and use of the continuous lumbosacral plexus for THA and postoperative analgesia with an elastomeric pump.Key words: Airways difficult anticipated, anesthesia, ankoylosing spondylitis, arthroplasty, conduction, continuous lumbosacral plexus, hip, infusion pumps, intubation awake, replacement
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,248
103
-
Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice
PL Narendra, Harihar V Hegde, TK Vijaykumar, Samson Nallamilli
January-April 2015, 9(1):105-108
DOI
:10.4103/0259-1162.150163
PMID
:25886432
Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,234
105
-
Out of the blue! Thyroid crisis
Mrunalini Parasa, Bala Kusuma Kumari Chinthakunta, Nagendra Nath Vemuri, Mastan Saheb Shaik
January-April 2015, 9(1):130-132
DOI
:10.4103/0259-1162.150179
PMID
:25886440
A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,196
132
-
ORIGINAL ARTICLES
Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy?
Ali Mohamed Ali Elnabtity, Mohamed M Tawfeek, Amr Ali Keera, Yasser Ali Badran
January-April 2015, 9(1):51-56
DOI
:10.4103/0259-1162.150177
PMID
:25886421
Background:
Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL).
Aim:
This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL.
Settings and Design:
Prospective randomized comparative study
. Materials and Methods:
Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg).
Statistical
Analysis:
Statistical analysis was performed using SPSS program version 19 and EP16 program.
Results:
The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (
P
< 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (
P
< 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (
P
< 0.001), but only significant at 10 min (
P
= 0.03) and 30 min (
P
= 0.007) during the PACU time. There was also highly significant decrease (
P
< 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (
P
= 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (
P
= 0.01 and 0.022, respectively).
Conclusion:
Ultrasound-guided unilateral TAP block is an effective alternative analgesic technique during ureteric SWL.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,225
101
-
CASE REPORTS
Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
Vinod Bala Dhir, Anupama Gill Sharma, Mohandeep Kaur, Michell Gulabani
January-April 2015, 9(1):109-111
DOI
:10.4103/0259-1162.150165
PMID
:25886433
Here we present a case of high spinal blockade in a patient belonging to ASA Grade I which lead to need for endotracheal intubation. A 35 year old healthy male, weighing 59 kg, of height 165 cms presented with a post traumatic raw area over the left lower limb. A reverse sural graft along with skin grafting (from the thigh) was planned. In OR, the patient was placed in sitting position and the extradural space was identified by 'loss of resistance to air' technique at the L2-L3 intervertebral space. The catheter could not be threaded into the extradural space, hence 5ml of 0.9% saline was injected. However, still the catheter could not be negotiated. Further attempts to identify the extradural space at the L1-L2 and L3-L4 interspace levels were made. During these attempts a total of 18 ml of 0.9% saline was injected into the extradural space. Within 2 minutes blood pressure fell to 90/60 mmHg. Injection mephenteramine (3 mg) was given intravenously and a slight head up tilt was applied. After 2 more minutes the patient started complaining of tingling in his hands and difficulty in breathing. Oxygen 100% was administered via a face mask attached to the anesthesia circle system. In view of onset of respiratory failure, general anesthesia was induced. Thiopentone (200 mg) and Suxamethonium (75 mg) were given intravenously, the patient's trachea was intubated and his lungs ventilated with 40% oxygen, 60% nitrous oxide and 0.2-0.4% Isoflurane, without additional neuromuscular blockade. The arterial saturation promptly returned to 97% and, immediately after intubation, the heart rate was found to be 103 beats/min and the arterial BP 162/102 mmHg. At the end of surgery, spontaneous ventilation returned and the patient was allowed to breathe 100% oxygen via the tracheal tube until he awoke, when his trachea was extubated.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,229
92
-
Difficult airway in a pediatric case of pycodysostosis
Maizar M Alkhalaf, Hassan Mohamed Ali, Rashed Al Otaibi
January-April 2015, 9(1):124-126
DOI
:10.4103/0259-1162.150677
PMID
:25886438
Pycodysostosis is a genetic autosomal rare disease with an incidence of 1:1.7 million births; the pathophysiology of the disease is related to mutation of cathepsin K gene. Sleep apnea, respiratory difficulties because of chest and oral abnormalities may cause a challenge to the anesthetist during intubation and/or mechanical ventilation. In this case report we will discuss a case of pycodysostosis with a difficult airway.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,169
81
-
Hyperhomocysteinemia and Evan's syndrome with uncal herniation for emergency splenectomy
Savitha Keelara Shivalingaiah, J Arpana, M Karthik Jain, Vineesh K Varghese
January-April 2015, 9(1):118-120
DOI
:10.4103/0259-1162.150186
PMID
:25886436
Hyperhomocysteinemia is a genetic disorder of metabolism and transport of amino acid, commonly present as a pro-coagulant state. Evan's syndrome is an autoimmune disorder with pancytopenia, a diagnosis of exclusion. The present report highlights the anesthetic management of a rare case, where both these clinical entities coexist. A 26-year-old male, a known case of hyperhomocyteinemia on medication for 4 years, came with a history of severe headache, blurring of vision and bleeding gums. Computerized tomography brain report showed subdural hematoma (SDH) of 16 mm with 9 mm right midline shift and on investigation had thrombocytopenia (5000 cells/cumm). Patient was diagnosed to have Evan's syndrome. Because he was refractory to the medical management, taken up for emergency splenectomy, followed by burr hole evacuation of SDH. Successful anesthetic management of the case is presented in this report.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,136
62
-
Submental intubation with intubating laryngeal mask airway as conduit: An airway option for oral submucous fibrosis release
Aruloli Mohambourame, Mohamed Sameer, VR Hemanth Kumar, Muthukumaran Ramamirtham
January-April 2015, 9(1):95-97
DOI
:10.4103/0259-1162.150137
PMID
:25886429
The main anesthetic concern with oral submucous fibrosis is progressive restriction of mouth opening due to fibrosis producing difficult airway. Securing airway by nasotracheal intubation and tracheostomy are associated with potential complications. Flexible fiberoscope is not available in all the institutes. Submental intubation using intubating laryngeal mask airway is an acceptable alternative technique in such situations. It also provides an unobstructed surgical field.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,078
101
-
Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia
M Thiriloga Sundary
January-April 2015, 9(1):121-123
DOI
:10.4103/0259-1162.150188
PMID
:25886437
Thoracic epidural analgesia is one of the most effective and time-tested modalities of providing postthoracotomy pain relief. It improves postoperative pulmonary outcome. Nevertheless, being a blind procedure several complications have been associated with the technique. Pleural puncture is one rare complication that might occur following thoracic epidural catheterization. We have discussed a patient who underwent a right thoracotomy for excision of emphysematous bulla of lung under general anesthesia with thoracic epidural. The epidural catheter was misplaced in the pleural cavity and was detected intraoperatively after thoracotomy. The catheter was left
in situ
and was successfully utilized to provide postoperative analgesia via the interpleural route.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
3,055
83
-
Critical upper limb ischemia due to thrombus in the right subclavian artery: An uncommon complication of right internal jugular vein cannulation
Nagendra Nath Vemuri, PL Narendra
January-April 2015, 9(1):101-104
DOI
:10.4103/0259-1162.150160
PMID
:25886431
Internal jugular catheterization is associated with arterial puncture in 6.3-9.4% of cases and subclavian artery (SCA) injuries are probably under-reported. Several complications like hemothorax, delayed presentation of hemomediastinum due to SCA injury have been reported. We report a case of critical upper limb ischemia due to SCA thrombosis developing a few hours after a difficult right internal jugular vein cannulation without any evidence of initial arterial injury with the finder or introducer needle and which was successfully treated by surgical thrombectomy. Arterial trauma should be kept in mind during subsequent manipulations and at all stages, particularly if a technical difficulty arises during the procedure. Although the ultrasound (US) was not used in this case, US should be used not just to identify the vein, but also to verify guide-wire and catheter insertion. High index of suspicion is necessary for detection of postprocedure thrombosis of SCA. Close monitoring for neurologic and vascular sequelae after the procedure is suggested in all difficult catheter insertions, even without a direct arterial puncture.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
3,046
87
1
Dexmedetomidine with low-dose ketamine for cataract surgery under peribulbar block in a patient with Huntington's chorea
Shraddha Naik, Akshaya N Shetti, AV Nadkarni, Bhuvna Ahuja
January-April 2015, 9(1):92-94
DOI
:10.4103/0259-1162.150140
PMID
:25886428
Huntington's chorea (HC) is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia, and psychiatric disturbances. There are only a few case reports regarding the anesthetic management of a patient with HC and the best anesthetic technique is yet to be established for those patients which are at higher risk of perioperative complications. We report the anesthetic management of a 64-year-old patient with HC admitted for cataract surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,819
151
-
ORIGINAL ARTICLES
0.2% ropivacaine with fentanyl in the management of labor analgesia: A case study of 30 parturients
Seema Shreepad Karhade, Shalini Pravin Sardesai
January-April 2015, 9(1):83-87
DOI
:10.4103/0259-1162.151238
PMID
:25886426
Background:
Epidural infusion of 0.2% ropivacaine is recommended by the manufacturers for labor analgesia.
Aims:
The aim of this study is to evaluate the analgesic efficacy, degree of motor blockade, obstetric outcome in the form of incidence of normal vaginal, assisted vaginal and lower segment cesarean section.
Settings and Design:
Pilot study.
Materials and Methods:
In this pilot study, 30 nulliparous parturients in active labor had epidural analgesia established using 0.2% ropivacaine with 25 mcg fentanyl for initiation when cervical dilatation was 3-4 cm and then analgesia was maintained with 0.2% ropivacaine at 10 ml/h till the delivery of baby.
Statistical Analysis:
It was done by Wilcoxon sign rank test and paired
t
-test as applicable.
Results:
There was a significant difference (
P
< 0.05) between prebolus, postbolus and postinfusion with respect to visual analog score. There was a significant difference (
P
> 0.05) between prebolus, postbolus, and postinfusion with respect to Bromage motor score, (Wilcoxon sign rank test). Six out of 30 paturients complained of tingling and heaviness in lower limbs after continuous infusion of 2-2.5 h.
Conclusion:
We conclude that 0.2% ropivacaine (8 ml) with fentanyl 25 mcg is good for initiation of ambulatory labor analgesia. But for maintenance of labor analgesia lower concentration of ropivacaine may be preferred.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,818
137
-
CASE REPORTS
Perioperative management of poly-trauma in a postmitral valve replacement patient with severe left ventricular systolic dysfunction
RV Ranjan, Manikandan Sivasubramanian, TR Ramachandran, Baranidharan Selvamani
January-April 2015, 9(1):112-115
DOI
:10.4103/0259-1162.150189
PMID
:25886434
The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively. In such situations, the anesthesiologist must have the knowledge hemodynamics, diagnostic evaluations, and treatment modalities, more so regarding various drugs used during anesthesia. We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,842
72
-
BOOK REVIEW
Anesthesia and resuscitation achievements
Mohamad Said Maani Takrouri
January-April 2015, 9(1):135-135
DOI
:10.4103/0259-1162.150173
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
2,516
66
-
LETTER TO EDITOR
Hazard notice: Blocked oxygen humidifier!!
Shivanand L Karigar, Akshaya N Shetti, Rachita G Mustilwar, Dewan Roshan Singh
January-April 2015, 9(1):133-134
DOI
:10.4103/0259-1162.150171
PMID
:25886441
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,508
67
-
OBITUARY
Prof. Burhan Adeen Alabed
Mohamad Said Maani Takrouri
January-April 2015, 9(1):136-136
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
2,103
49
-
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