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   2012| October-December  | Volume 28 | Issue 4  
    Online since October 4, 2012

 
 
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ORIGINAL ARTICLES
Efficacy of intravenous dexamethasone to reduce incidence of postoperative sore throat: A prospective randomized controlled trial
Dipanjan Bagchi, Mohan Chandra Mandal, Sabyasachi Das, Tirtha Sahoo, Sekhar Ranjan Basu, Sanhita Sarkar
October-December 2012, 28(4):477-480
DOI:10.4103/0970-9185.101920  PMID:23225928
Background: Sore throat and hoarseness are common complications of endotracheal intubation. It may be very distressing for the patient and may lead to sleep disturbances and unpleasant memories. Materials and Methods: This prospective double-blinded randomized control trial was aimed to determine the efficacy of prophylactic intravenous dexamethasone to reduce the incidence of postoperative sore throat at 1 hour after tracheal extubation. Ninety six patients of either sex aged between 18 to 60 years scheduled for elective surgeries needing general anesthesia with endotracheal intubation, were randomly allocated into two groups A and B. The patients received either intravenous 0.2 mg/kg dexamethasone (group A, n = 48) or normal saline (group B, n = 47) just before induction. Trachea was intubated with appropriate size disposable endotracheal tubes for securing the airway. Follow up for the incidence of sore throat, cough and hoarseness was done at 1, 6 and 24 hours post-extubation. Results: At 1 hour post-extubation, the incidence of sore throat in the control group was 48.9% compared with 18.8% in the dexamethasone group (P<0.002). Conclusions: Prophylactic intravenous dexamethasone in a dose of 0.2 mg/kg can reduce the incidence of postoperative sore throat at 1 hour post-extubation by around 30%, with the efficacy being around 60%.
  21 4,877 1,012
Incidence and predictors of difficult mask ventilation and intubation
Prerana N Shah, Vimal Sundaram
October-December 2012, 28(4):451-455
DOI:10.4103/0970-9185.101901  PMID:23225922
Background: This study is aimed to determine the incidence and predictors of difficult and impossible mask ventilation. Materials and Methods: Information like age, snoring history, obstructive sleep apnea, dental and mandibular abnormalities, macroglossia, grading like SLUX, Mallampatti, Cormack Lehanne, atlantooccipital extension, presence of beard or moustache, mouth opening were collected. During mask ventilation, the information related to the ventilation and intubation was collected. All variables found to be significant in univariate analysis were subjected to the multivariate logistic regression model to identify independent predictors of measured outcome. Results: Difficult mask ventilation (DMV) was observed in 30 male patients and 9 female patients. Of the 40 patients who had difficult intubation (DI), 7 patients had both DMV and intubation and 1 patient was of impossible mask ventilation/ intubation. Snoring was the lone significant risk factor for DMV. The risk factors identified for DI were snoring, retrognathia, micrognathia, macroglossia, short thick neck, Mallampatti grade [III/IV], abnormal SLUX grade, Cormack Lehanne grade [II,III/IV], abnormal atlantooccipital extension grading, flexion/extension deformity of neck, protuberant teeth, cervical spine abnormality, mouth opening < 3 cm, and BMI > 26 kg/m 2 . BMI > 26 kg/m 2 and atlantooccipital extension grade > 3 were independent risk factors for DI and the presence of two of the variables made the sensitivity and specificity of 43% and 99% respectively with a positive predictive value of 74%. Conclusions: The predictive score may lead to a better anticipation of difficult airway management, potentially deceasing the morbidity and mortality resulting from hypoxia or anoxia with failed ventilation.
  17 5,465 1,088
Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis
Serbülent Gökhan Beyaz
October-December 2012, 28(4):496-500
DOI:10.4103/0970-9185.101940  PMID:23225932
Introduction: Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. Materials and Methods: Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. Results: After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. Conclusion: Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.
  13 5,054 761
REVIEW ARTICLES
Efficacy of sacral neuromodulation in treating chronic pain related to painful bladder syndrome/interstitial cystitis in adults
Devjit Srivastava
October-December 2012, 28(4):428-435
DOI:10.4103/0970-9185.101890  PMID:23225919
Objective: The objective of this review is to evaluate the efficacy and safety of sacral neuromodulation in treating chronic pelvic pain related to Painful bladder syndrome/Interstitial-cystitis. Design: The databases searched were MEDLINE and EMBASE [1950- Nov 2011]. Additional searches were performed on the Cochrane Database of Systematic reviews (CDSR), Scopus, CINAHL, BIOSIS, The Cochrane controlled trials register, the science citation index, TRIP DATABASE. Results: Overall 70.8% or 170/244 patients were successful at the trial stage. The only randomized controlled trial reported a decrease in Visual analogue pain scores of 49% (7.9 to 4.0) for sacral nerve stimulation [SNS] and 29%(4.5 to 3.2) for pudendal nerve stimulation [PNS] at 6 months follow up. Nine observational studies reported a decrease in pain scores/decrease in pain medications at long term follow up following permanent sacral neuromodulation. One study showed an 80% improvement in Global response assessment score. Conclusion: The results from the randomised controlled trial and case series/case reports demonstrate a reduction of pain symptoms of Painful bladder syndrome following sacral neuromodulation
  12 5,835 1,063
CASE REPORTS
Neuroleptic malignant syndrome: A diagnostic challenge
Reshma P Ambulkar, Vijaya P Patil, Aliasgar V Moiyadi
October-December 2012, 28(4):517-519
DOI:10.4103/0970-9185.101946  PMID:23225938
We report the case of a 7-year-old girl operated for craniopharyngioma who developed hyperkalemic cardiac arrest in the post-operative period. She was diagnosed as Neuroleptic malignant syndrome (NMS) and the causative drug was carbamazepine. It was essentially a diagnosis of exclusion, and treatment was mainly supportive in form of withdrawal of the neuroleptic medication (carbamazepine) and administration of dantrolene and bromocriptine. Although, relatively uncommon, NMS can be fatal. NMS presents a clinical challenge as the patient outcome depends on its prompt recognition and treatment.
  7 3,213 593
Pulmonary hemorrhage in an outpatient ophthalmic anesthesia setting− it's never "just a cataract"
Ashish K Khanna, Kenneth C Cummings
October-December 2012, 28(4):520-523
DOI:10.4103/0970-9185.101947  PMID:23225939
A 48-year-old man, with end stage renal disease and a history of recreational drug abuse, presented for elective cataract surgery. Patient underwent the procedure with a general endotracheal anesthesia with a balanced anesthetic. After an uneventful intra-operative period, he had a sudden onset large volume hemoptysis just prior to extubation. Poor oxygenation and hemodynamic instability necessitated emergent reintubation in the immediate post-extubation period. Emergent bronchoscopy did not show active airway bleeding or obstructive mucous plugs, and a diagnosis of diffuse alveolar hemorrhage was made. The patient was gradually weaned off the ventilator and made a slow recovery over a one - week period.
  7 1,830 303
ORIGINAL ARTICLES
Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery
Ranju Gandhi, Rani Sunder
October-December 2012, 28(4):460-464
DOI:10.4103/0970-9185.101906  PMID:23225924
Background: Analgesic efficacy of rectal acetaminophen is variable in different surgical procedures. Little data is available on its efficacy in ophthalmic surgeries. We conducted this prospective, randomized, double blind study to evaluate and compare the efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery over a 24 hour period. Materials and Methods: 135 children scheduled for elective ophthalmic surgery were randomly allocated to one of the three groups, high, low, or control (H, L, or N) and received rectal acetaminophen 40 mg/kg, 20 mg/kg or no rectal drug respectively after induction of general anesthesia. Postoperative observations included recovery score, hourly observational pain score (OPS) up to 8 hours, time to first analgesic demand, and requirement of rescue analgesics and antiemetics over a 24 hour period. Results: Nineteen of 30 (63%) of children in group N required postoperative rescue analgesic versus 5/48 (10%) of group H (P <0.0001) and 10/47 (23%) of group L (P =0.0005) during 24 hour period. Mean time to requirement of first analgesic was 206±185 min in group H, 189±203min in group L, and 196 ±170 min in group N (P=0.985). OPS was significantly lower in group H and L compared to group N during first 8 hours. Requirement of rescue antiemetic was 18.7% in group H as compared to 23% each in group L and group N (P >0.5). Conclusions: Single dose rectal acetaminophen can provide effective postoperative analgesia for pediatric ophthalmic surgery at both high dose (40 mg/kg) and low dose (20 mg/kg) both in early postoperative and over a 24 hour period.
  7 3,543 465
Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study
Alok Kumar, DK Sharma, Barun Datta
October-December 2012, 28(4):501-504
DOI:10.4103/0970-9185.101941  PMID:23225933
Introduction: Ketamine and dexmedetomidine decrease anesthetic requirement and provide analgesia to patients. We designed this study to compare the effect of dexmedetomidine and ketamine when added to lignocaine in intravenous regional anesthesia (IVRA). Materials and Methods: Seventy two patients undergoing hand surgery were randomly assigned to three groups to receive IVRA. They received 20 ml of 1% lignocaine and either 1 ml of isotonic saline (Group L, n = 24); or 0.5 mg/kg body weight ketamine (Group LK, n = 24) or 1 mcg/kg body weight dexmedetomidine (Group LD, n = 24). Sensory and motor block onset and recovery time were noted. After the tourniquet deflation, pain and sedation values, time to first analgesic requirement and any side effects were noted. Results: Shortened sensory and motor block onset times (69.17 min and 7.83 min respectively, P < 0.0001) and improved quality of anesthesia (satisfaction score = 3, P < 0.05) were found in ketamine group. Visual analog scale scores (3.21 ± 0.41) were comparable while time to first analgesic requirement (166.25 ± 25.89 min, P < 0.0001) was significantly longer in dexmedetomidine group after tourniquet release. Conclusion: We conclude that the addition of 1 mcg/kg of body weight dexmedetomidine or 0.5 mg/kg of body weight ketamine to lignocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. We considered ketamine reduced the time for onset of block, delayed the onset of tourniquet pain, and reduced postoperative analgesic requirement and had a better patient satisfaction than placebo or dexmedetomidine.
  7 3,694 679
Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients
Handattu M Krishna, Shyamsunder Kamath, Laxmi Shenoy
October-December 2012, 28(4):481-485
DOI:10.4103/0970-9185.101923  PMID:23225929
Background: The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique. Materials and Methods: This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed. Results: Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group). Conclusions: LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.
  7 2,291 375
CLINICAL PHARMACOLOGY
Use of Articaine in loco-regional anesthesia for day care surgical procedures
Sukhminder Jit Singh Bajwa, Ravi Jindal
October-December 2012, 28(4):444-450
DOI:10.4103/0970-9185.101898  PMID:23225921
The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.
  6 4,174 880
LETTERS TO EDITOR
Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene
Guruprasad P Bhosale, Veena R Shah
October-December 2012, 28(4):534-535
DOI:10.4103/0970-9185.101954  PMID:23225946
  5 8,388 584
Mannitol-induced intraoperative hyperkalemia, a little-known clinical entity
JP Sharma, Rashmi Salhotra
October-December 2012, 28(4):546-547
DOI:10.4103/0970-9185.101965  PMID:23225957
  5 1,940 391
ORIGINAL ARTICLES
Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination
Kalpana S Vora, Veena R Shah, Bhadresh Patel, Geeta P Parikh, Bina P Butala
October-December 2012, 28(4):491-495
DOI:10.4103/0970-9185.101935  PMID:23225931
Background: Epidural analgesia with opioid provides good control of postoperative pain in cesarean section, thereby improving the mother's ability to mobilize and interact with her newborn infant. Aim: The aim of this study is to evaluate and compare the analgesic actions and side effects of epidural analgesia with sufentanil, morphine or combination of the two after cesarean section. Materials and Methods: 60 women undergoing elective cesarean section were allocated into three groups of 20 each in a randomized blinded fashion. Epidural analgesia was administered with sufentanil 50 mcg in Group S; morphine 4 mg in Group M; and, a combination of sufentanil 25 mcg and morphine 2 mg was used in Group SM. Analgesic efficacy in terms of onset of action and duration of analgesia was assessed by using the Visual Analog Scale (0 to 10 cm) for 24 hours. Number of opioid doses needed in 24 hours was noted. Side effects like respiratory depression /excessive sedation, pruritus and nausea were recorded. Results: Onset of action were at 7.6 ± 1.5 minutes in group S, 67.6 ± 1.5 minutes in group M and 12.2 ± 2.6 minutes in group SM. Duration of analgesia was longer in group M 17.5 ± 1.9 hours and SM 13.8 ± 1.6 hours than in group S 5.2 ± 1.2 hours. More doses of analgesia were required in group S compared to group M and SM. Side effects were comparable in the three groups. Conclusion: Epidural administration of a combination of sufentanil and morphine offered the advantage of faster onset of action and longer duration of analgesia as compared to the two drugs administered alone.
  5 7,036 884
CASE REPORTS
Anesthetic challenges in managing a case of type III laryngo-tracheo-esophageal cleft
Nisha Rajmohan, Hassy Prakasam, Johny V Francis
October-December 2012, 28(4):514-516
DOI:10.4103/0970-9185.101945  PMID:23225937
Laryngo-tracheo-esophageal cleft (LTEC) is a rare congenital anomaly characterized by failure of fusion of the cricoid cartilage posteriorly and incomplete development of the tracheo-esophageal septum. Securing the airway during anesthesia in patients with LTEC, especially in the severe forms is a challenge. We describe the anesthetic management and the airway challenges in a neonate with type III LTEC who underwent bronchoscopy and repair of LTEC.
  4 3,031 336
ORIGINAL ARTICLES
A randomized double-blind placebo-controlled clinical study on the effects of gabapentin premedication on hemodynamic stability during laparoscopic cholecystectomy
Mausumi Neogi, Santanu Basak, Debasis Ghosh, Sandip Mukherjee, Satrajit Dawn, Dhurjoti P Bhattacharjee
October-December 2012, 28(4):456-459
DOI:10.4103/0970-9185.101903  PMID:23225923
Background: Carbon dioxide pneumoperitoneum for laparoscopic surgery increases arterial pressures, heart rate, and systemic vascular resistance. In this randomized double-blind placebo-controlled clinical study, we investigated the efficacy of gabapentin premedication to provide perioperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Sixty patients, of either sex (18-65 years of age) undergoing elective laparoscopic cholecystectomy were randomly allocated to two groups of 30 patients each. Patients of group G received oral gabapentin 900 mg 2 h before induction of anesthesia, while patients in group P received placebo at the same time. Results: Mean arterial pressure in patients of group G were significantly lower (P < 0.05) after tracheal intubation and pneumoperitoneum and remained lower, as compared to group P, throughout the pneumoperitoneum. Similarly, heart rate in group G was significantly lower (P < 0.05) after tracheal intubation and pneumoperitoneum and remained lower, in comparison to group P, throughout the peumoperitoneum. Intravenous labetalol was required, to control intraoperative hypertension, in 33.3% (10 out of 30) patients in group P. There was no significant difference in the incidence of adverse effects between the two groups. Conclusion: Gabapentin premedication provided perioperative hemodynamic stability during laparoscopic surgery.
  4 2,750 604
Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery
Amit Jain, Kajal Jain, Neerja Bhardawaj
October-December 2012, 28(4):486-490
DOI:10.4103/0970-9185.101927  PMID:23225930
Background and Aim: Intrathecal (IT) neostigmine has been used as an adjunct to spinal anesthesia. The purpose of this study was to determine whether a combination of low-dose neostigmine IT would enhance analgesia of a fixed dose of fentanyl IT, in patients undergoing unilateral total knee replacement (TKR) surgery with spinal anesthesia. Settings and Design: Forty-five patients scheduled for unilateral TKR were randomized to one of the three groups (n = 15) and prospectively studied using placebo-controlled, double-blinded design. Materials and Methods: A 19-G epidural catheter was introduced through the L3-L4 interspace with patient in the sitting position, followed by spinal anesthesia administration through the L3-L4 interspace. Fifteen milligrams of hyperbaric bupivacaine (3 ml) plus the test drug (0.5 ml) was administered IT. The test drug was normal saline (0.5 ml) in group I; fentanyl 20 mcg (0.4 ml) and normal saline (0.1 ml) in group II; and fentanyl 20 mcg (0.4 ml) and neostigmine 1 mcg (0.1 ml) in group III. Characteristics of sensory and motor block, heart rate, and blood pressure were recorded intraoperatively. Postoperatively, pain scores, postoperative nausea and vomiting (PONV) scores, and sedation scores, and postoperative analgesic dose were recorded. Results: Forty-five patients were enrolled in this study and 43 patients were subjected to statistical analysis. Overall 24-h visual analog score in group III was significantly less than in those who received fentanyl alone (P = 0.00). The durations of complete analgesia and effective analgesia were longer for all patients in group III compared with group II (P < 0.05) and group I (P < 0.005) patients. The total number of epidural top ups (rescue analgesia) required was less in group II (P < 0.05) and group III (P < 0.005) patients, compared with the control group. The incidence of nausea and vomiting was not increased in group III patients. Conclusions: The addition of 1 mcg neostigmine IT increased the duration of analgesia and decreased the analgesic consumption in 24 h in TKR. There was no increase in the incidence of adverse effects.
  3 4,540 821
CASE REPORTS
Quinine-induced bronchiolitis obliterans and organizing pneumonia
Masoodur Rahman, Rayhan Hashmey, Said Abuhasna
October-December 2012, 28(4):505-507
DOI:10.4103/0970-9185.101942  PMID:23225934
Quinine is a vital anti-malarial drug used in the management of resistant Falciparum malaria. There are previous reports of quinine-induced pulmonary edema and infiltrates. We report the first case of biopsy-proven bronchiolitis obliterans organizing pneumonia (BOOP), confirmed by the Naranjo Adverse Drug Reaction Probability Scale (NADRS) of 5 and a severity scale of 5, secondary to intravenous quinine, in a 15-year-old girl with Plasmodium falciparum infection after a visit to Kenya. Clinical course of the patient followed by review of the literature and appropriate medical interventions for quinine-induced BOOP are suggested.
  2 1,955 294
Anesthesia for parturient with renal transplantation
Beena K Parikh, Veena R Shah, Guruprasad Bhosale
October-December 2012, 28(4):524-527
DOI:10.4103/0970-9185.101948  PMID:23225940
Management of successful pregnancy after renal transplantation is a unique challenge to nephrologist, obstetrician, and anesthesiologist, as these patients have altered physiology and are immune-compromised. We present the anesthetic management of three postrenal transplant patients scheduled for cesarean section. While conducting such cases, cardiovascular status, hematological status, and function of transplanted kidney should be assessed thoroughly. Side effects of immunosuppressant drugs and their interaction with anesthetic agents should be taken into consideration. Main goal of anesthetic management is to maintain optimum perfusion pressure of renal allograft to preserve its function.
  2 2,955 623
EDITORIALS
Low and minimal flow anesthesia: Angels dancing on the point of a needle
George Mychaskiw
October-December 2012, 28(4):423-425
DOI:10.4103/0970-9185.101883  PMID:23225917
  2 2,930 6,118
LETTERS TO EDITOR
Pneumothorax following ultrasound guided supraclavicular brachial plexus block
Kapil Gupta, Shyam Bhandari, Deepak Singhal, Parminder S Bhatia
October-December 2012, 28(4):543-544
DOI:10.4103/0970-9185.101962  PMID:23225954
  2 1,667 313
Metoclopramide-induced akathisia
Gaurav Chauhan, Pavan Nayar, Chandni Kashyap
October-December 2012, 28(4):548-549
DOI:10.4103/0970-9185.101967  PMID:23225959
  2 2,655 398
REVIEW ARTICLES
Anesthetic considerations of parturients with obesity and obstructive sleep apnea
Saravanan P Ankichetty, Pam Angle, Anita Shirley Joselyn, Vinod Chinnappa, Stephen Halpern
October-December 2012, 28(4):436-443
DOI:10.4103/0970-9185.101895  PMID:23225920
Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However, very few parturients are diagnosed during pregnancy. These undiagnosed parturients pose great challenge to the attending anaesthesiologist during the perioperative period. Parturients at risk should be screened for OSA, and if diagnosed, treated. This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit.
  2 6,580 1,468
LETTERS TO EDITOR
Glidescope® for predicted difficult airway in Klippel-Feil syndrome
Vanita Ahuja, Sunita Kazal, Satinder Gombar, Deepak Thapa, Raj Bahadur
October-December 2012, 28(4):532-534
DOI:10.4103/0970-9185.101953  PMID:23225945
  1 2,222 365
Use of Proseal, as an alternative to conventional facemask, to facilitate ventilation in anticipated difficult mask ventilation
Akansha Atulkar, Richa Gupta, Sonia Wadhawan
October-December 2012, 28(4):540-541
DOI:10.4103/0970-9185.101960  PMID:23225952
  1 1,589 252
Idiopathic facial paralysis following general anesthesia
Lonjaret Laurent, Vuillaume Corine, Fourcade Olivier, Geeraerts Thomas
October-December 2012, 28(4):536-537
DOI:10.4103/0970-9185.101956  PMID:23225948
  1 1,697 278
Venous embolism with oxygen following wound irrigation
Raminder Sehgal, Bimla Sharma, Jayashree Sood
October-December 2012, 28(4):547-548
DOI:10.4103/0970-9185.101966  PMID:23225958
  1 1,129 236
ORIGINAL ARTICLES
A randomized prospective study of desflurane versus isoflurane in minimal flow anesthesia using "equilibration time" as the change-over point to minimal flow
Tanuja Mallik, S Aneja, R Tope, V Muralidhar
October-December 2012, 28(4):470-475
DOI:10.4103/0970-9185.101916  PMID:23225926
Background: In the administration of minimal flow anesthesia, traditionally a fixed time period of high flow has been used before changing over to minimal flow. However, newer studies have used "equilibration time" of a volatile anesthetic agent as the change-over point. Materials and Methods: A randomized prospective study was conducted on 60 patients, who were divided into two groups of 30 patients each. Two volatile inhalational anesthetic agents were compared. Group I received desflurane (n = 30) and group II isoflurane (n = 30). Both the groups received an initial high flow till equilibration between inspired (Fi) and expired (Fe) agent concentration were achieved, which was defined as Fe/Fi = 0.8. The mean (SD) equilibration time was obtained for both the agent. Then, a drift in end-tidal agent concentration during the minimal flow anesthesia and recovery profile was noted. Results: The mean equilibration time obtained for desflurane and isoflurane were 4.96 ± 1.60 and 16.96 ± 9.64 min (P < 0.001). The drift in end-tidal agent concentration over time was minimal in the desflurane group (P = 0.065). Recovery time was 5.70 ± 2.78 min in the desflurane group and 8.06 ± 31 min in the isoflurane group (P = 0.004). Conclusion: Use of equilibration time of the volatile anesthetic agent as a change-over point, from high flow to minimal flow, can help us use minimal flow anesthesia, in a more efficient way.
  1 2,667 570
BOOK REVIEWS
"Code Red" The Disaster Manual
Mukul Chandra Kapoor
October-December 2012, 28(4):550-550
  - 1,147 209
Clinical Practice of Cardiac Anesthesia Third Edition
Mukul Chandra Kapoor
October-December 2012, 28(4):551-551
  - 2,471 531
CASE REPORTS
Is intraoperative endoscopy safe in a child with Kasai procedure?
Vinayak S Pujari, Mathews K Thomas, Yatish Bevinaguddaiah, Tejesh C Anandaswamy
October-December 2012, 28(4):508-509
DOI:10.4103/0970-9185.101943  PMID:23225935
We report a case of venous air embolism which occurred during intraoperative endoscopy in a five-year-old boy who had undergone Kasai procedure in his infancy. The child had a cardiac arrest during the procedure from which he could not be resuscitated. The awareness about this complication would allow rapid diagnosis, which is vital to provide specific treatment and prevent fatal outcome.
  - 1,508 263
Recurrent intraoperative silent ST depression responding to phenylephrine
PM Singh, Dipal Shah, Anjan Trikha
October-December 2012, 28(4):510-513
DOI:10.4103/0970-9185.101944  PMID:23225936
Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae.
  - 2,570 367
COMMENTARY
Low flow anesthesia and volatile anesthetic agents - Concerns
Rakesh Garg
October-December 2012, 28(4):475-476
PMID:23225927
  - 2,340 655
EDITORIALS
Pain or constipation: A difficult choice
Trikha Anjan, PM Singh
October-December 2012, 28(4):426-427
DOI:10.4103/0970-9185.101884  PMID:23225918
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LETTERS TO EDITOR
Removal of knotted dialysis guide wire under monitored anaesthesia care in radiological suite
Rohit Goyal, Sanjay Agrawal, Ritesh Kumar
October-December 2012, 28(4):537-539
DOI:10.4103/0970-9185.101957  PMID:23225949
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Assessment of airway the MOUTH concept
S Parthasarathy, Sourav Kumar Bag, N Krishnaveni
October-December 2012, 28(4):539-539
DOI:10.4103/0970-9185.101958  PMID:23225950
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Anesthesiologist to surgeons' rescue: An off label use of choledochoscope
Shiba Aggarwal, Mritunjay Kumar, Rajeev Uppal, Anirban Hom Choudhuri
October-December 2012, 28(4):540-540
DOI:10.4103/0970-9185.101959  PMID:23225951
  - 1,323 242
Modified Guedel's airway for facilitation of fiberoptic laryngoscopy
Amit Rastogi, Anuj Jain, Surendra Singh, Prakhar Gyanesh
October-December 2012, 28(4):542-543
DOI:10.4103/0970-9185.101961  PMID:23225953
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Regional blocks for pre-emptive anti-emesis
Deepak Gupta
October-December 2012, 28(4):535-536
DOI:10.4103/0970-9185.101955  PMID:23225947
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Location of the upper Murphy's eye in the uncuffed Ring, Adair, and Elwyn tube
Sandeep K Mishra, Niyaz C Ashraf, Hemavathy Balchander, Ashok S Badhe
October-December 2012, 28(4):528-528
DOI:10.4103/0970-9185.101949  PMID:23225941
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An unusual complication of reinforced tube reuse
T Gurumurthy, Kulkarni Rammurthy, Lulu S Mahmood, Radhesh Hegde
October-December 2012, 28(4):528-530
DOI:10.4103/0970-9185.101950  PMID:23225942
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Autoimmune hypophysitis: Anesthetic implications
Rochana G Bakhshi, Sheetal R Jagtap
October-December 2012, 28(4):530-531
DOI:10.4103/0970-9185.101951  PMID:23225943
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Amoxicillin/clavulinic acid-induced anaphylaxis during anesthesia
Maulana M Ansari, Kapil Gupta, Shyam Bhandari, Shahla Haleem
October-December 2012, 28(4):531-532
DOI:10.4103/0970-9185.101952  PMID:23225944
  - 1,629 315
Trachlight-guided intubation with esophageal combitube in situ
Rajesh Mahajan, Daljit Singh Charak, Rishab Bassi, Firdose Shafi
October-December 2012, 28(4):544-545
DOI:10.4103/0970-9185.101963  PMID:23225955
  - 1,387 291
Intubation using dexmedetomidine and ketamine in a child with Pierre Robin sequence
Shirley DSouza, Deepa Barad, Sidhesh Bharne
October-December 2012, 28(4):545-546
DOI:10.4103/0970-9185.101964  PMID:23225956
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ORIGINAL ARTICLES
Analgesic activity of fixed dose combinations of paracetamol with diclofenac sodium and paracetamol with tramadol on different pain models in healthy volunteers - A randomized double blind crossover study
Sachidanand Tripathi, Rima Shah, DC Sharma
October-December 2012, 28(4):465-469
DOI:10.4103/0970-9185.101912  PMID:23225925
Aim: To evaluate and compare the analgesic activity of fixed dose combinations (FDC) of Paracetamol with Diclofenac sodium and Paracetamol with Tramadol on different human pain models in healthy human volunteers. Materials and Methods: A randomized double blind crossover study was carried out in 30 healthy human volunteers using three pain models; cold-water stress test, radiant heat method, and BP cuff inflation method. The subjects were randomized into two groups of 15 each, group A received FDC of Paracetamol 500 mg with Diclofenac sodium 50 mg and group B was given a FDC of Paracetamol 375 mg and Tramadol 50 mg. All the volunteers were tested on three pain models. Observations for pain tolerance were recorded at baseline and at the interval of 30, 60, 120, and 180 minutes after drug administration. Crossover was done after a washout period of 7 days. The results of both the study periods were analyzed using an independent t-test. Results: Mean age of the participants was 23±1 years and the male:female ratio was 2:1. In the radiant heat method, paracetamol with tramadol combination treatment showed a significant increase in pain tolerance at 2 hours and 3 hours (P 0.028 and 0.055 respectively) compared to paracetamol with diclofenac combination. Other two pain models did not show any significant difference in the study groups. Conclusion: Paracetamol with tramadol combination was more effective than paracetamol with diclofenac sodium combination on the radiant heat model. In human pain models, there is an incomplete understanding of mechanisms and activated pathways are not precisely determined that needs further evaluation.
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