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   2013| July-September  | Volume 29 | Issue 3  
    Online since August 27, 2013

 
 
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REVIEW ARTICLES
Neuraxial opioid-induced pruritus: An update
Kamal Kumar, Sudha Indu Singh
July-September 2013, 29(3):303-307
DOI:10.4103/0970-9185.117045  PMID:24106351
Pruritus is a troublesome side-effect of neuraxial (epidural and intrathecal) opioids. Sometimes it may be more unpleasant than pain itself. The prevention and treatment still remains a challenge. A variety of medications with different mechanisms of action have been used for the prevention and treatment of opioid-induced pruritus, with mixed results. The aim of this article is to review the current body of literature and summarize the current understanding of the mechanisms and the pharmacological therapies available to manage opioid-induced pruritus. The literature source of this review was obtained via PubMed, Medline and Cochrane Database of Systematic Reviews until 2012. The search results were limited to the randomized controlled trials, systemic reviews and non-systemic reviews.
  30 22,197 3,129
CASE REPORTS
Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature
Achuthan Nair Venugopal, Rachel Cherian Koshy, Sumod M Koshy
July-September 2013, 29(3):397-400
DOI:10.4103/0970-9185.117114  PMID:24106371
Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.
  9 20,273 996
ORIGINAL ARTICLES
Internal jugular vein cannulation: A comparison of three techniques
Bikash R Ray, Virender K Mohan, Lokesh Kashyap, Dilip Shende, Vanlal M Darlong, Ravindra K Pandey
July-September 2013, 29(3):367-371
DOI:10.4103/0970-9185.117115  PMID:24106363
Context: Ultrasound-guided internal jugular vein (IJV) cannulation is known for increasing success rate and decreasing rate of complications. The ultrasound image can be used as a real time image during cannulation or to prelocate the IJV before attempting cannulation. Aims: This study compares both the ultrasound-guided technique with the classical anatomical landmark technique (central approach) for right IJV cannulation in terms of success rate, complications, and time for cannulation. Settings and Design: A prospective, randomized, observational study was conducted at a tertiary care hospital. Material and Methods: One hundred twenty patients requiring IJV cannulation were included in this study and were randomly allocated in three groups. Number of attempts, success rate, venous access time, catheterization time, and complications were observed in each group. Statistical Analysis Used: Statistical analysis was performed using STATA-9 software. Demographic data were compared using one-way analysis of variance (ANOVA). Nonparametric data were compared using the Kruskall-Wallis test, and multiple comparisons were done applying The Mann-Whitney test for individual pairs of groups. Nominal data were compared by applying the Chi-square test and Fisher exact test. Results: Successful cannulation (≤3 attempt) was achieved in 90.83% of patients without any statistical significant difference between the groups. Venous access time and catheterization time was found to be significantly less in both the ultrasound groups than the anatomical land mark group. Number of attempts and success in first attempt was similar between the groups. Conclusions: Both the ultrasound techniques are found to be better than the anatomical landmark technique. Further, ultrasound-guided prelocation was found to be as effective as ultrasound guided real-time imaging technique for right IJV cannulation.
  9 4,420 846
CASE REPORTS
Epidermolysis bullosa: Careful monitoring and no touch principle for anesthesia management
Sujit V Saraf, Nishigandha J Mandawade, Sandeep K Gore, Usha D Padhye, Charissa S Pereira
July-September 2013, 29(3):390-393
DOI:10.4103/0970-9185.117112  PMID:24106369
Epidermolysis bullosa (EB) is a rare genetic mechanobullous disorder, with excessive fragility of the skin and mucous membranes. Avoiding mechanical injury to the skin and mucous membranes is essential in the anesthetic management. Shearing forces applied to the skin result in bullae formation, while compressive forces to the skin are tolerated. The challenge is to use monitoring technology without damaging the epithelial surface. Difficult airway, positioning issues, nutritional deficiencies, poor immunity, and carcinogenic potential add to the comorbidities. We managed a child with EB undergoing syndactyly release. Ensuring maximal skin and mucous membrane protection, anesthesia in children with EB can be conducted with few sequelae.
  7 2,014 380
ORIGINAL ARTICLES
Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia: A randomized double-blind study
Velayudha Sidda Reddy, Nawaz Ahmed Shaik, Balaji Donthu, Venkata Krishna Reddy Sannala, Venkatsiva Jangam
July-September 2013, 29(3):342-347
DOI:10.4103/0970-9185.117101  PMID:24106359
Background: Alpha 2 -adrenergic agonists have synergistic action with local anesthetics and may prolong the duration of sensory, motor blockade and postoperative analgesia obtained with spinal anesthesia. Aim: The objectives of this study are to compare and evaluate the efficacy of intravenous dexmedetomidine premedication with clonidine and placebo on spinal blockade duration, postoperative analgesia and sedation in patients undergoing surgery under bupivacaine intrathecal block. Materials and Methods: In this prospective, randomized, double-blind placebo-controlled study, 75 patients of the American Society of Anesthesiologists status I or II, scheduled for orthopedic lower limb surgery under spinal anesthesia, were randomly allocated into three groups of 25 each. Group DE received dexmedetomidine 0.5 μgkg−1 , group CL received clonidine 1.0 μgkg−1 and placebo group PL received 10 ml of normal saline intravenously before subarachnoid anesthesia with 15 mg of 0.5% hyperbaric bupivacaine. Onset time and regression times of sensory and motor blockade, the maximum upper level of sensory blockade were recorded. Duration of postoperative analgesia and sedation scores along with side effects were also recorded. Data was analyzed using analysis of variance or Chi-square test, and the value of P < 0.05 was considered statistically significant. Results: The sensory block level was higher with dexmedetomidine (T4 ± 1) than clonidine (T6 ± 1) or placebo (T6 ± 2). Dexmedetomidine also increased the time (243.35 ± 56.82 min) to first postoperative analgesic request compared with clonidine (190.93 ± 42.38 min, P < 0.0001) and placebo (140.75 ± 28.52 min, P < 0.0001). The maximum Ramsay sedation score was greater in the dexmedetomidine group than other two groups (P < 0.0001). Conclusion: Premedication with intravenous dexmedetomidine is better than intravenous clonidine to provide intraoperative sedation and postoperative analgesia during bupivacaine spinal anesthesia.
  7 4,252 987
Profile of infective microorganisms causing ventilator-associated pneumonia: A clinical study from resource limited intensive care unit
Bhaskar Thakuria, Preetinder Singh, Sanjay Agrawal, Veena Asthana
July-September 2013, 29(3):361-366
DOI:10.4103/0970-9185.117111  PMID:24106362
Background: Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times. Aim: The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome. Materials and Methods: This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase. Results: Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%) Conclusion: High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals.
  7 3,186 764
Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study
Aziza M Hussain, Fauzia A Khan, Aliya Ahmed, Tabish Chawla, Syed I Azam
July-September 2013, 29(3):337-341
DOI:10.4103/0970-9185.117095  PMID:24106358
Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002), but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.
  5 3,205 461
Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation
Muhammad Irfan Ul Haq, Hameed Ullah
July-September 2013, 29(3):313-317
DOI:10.4103/0970-9185.117059  PMID:24106353
Background: Failure to maintain a patent airway is one of the commonest causes of anesthesia-related morbidity and mortality. Many protocols, algorithms, and different combinations of tested methods for airway assessment have been developed to predict difficult laryngoscopy and intubation. The reported incidence of a difficult intubation varies from 1.5% to 13%. The objective of this study was to compare Mallampati test (MT) with lower jaw protrusion (LJP) maneuver in predicting difficult laryngoscopy and intubation. Materials and Methods: Seven hundred and sixty patients were included in the study. All the patients underwent MT and LJP maneuver for their airway assessment. After a standardized technique of induction of anesthesia, primary anesthetist performed laryngoscopy and graded it according to the grades described by Cormack and Lehane. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both these tests with 95% confidence interval (CI) using conventional laryngoscopy as gold standard. Area under curve was also calculated for both, MT and LJP maneuver. A P < 0.05 was taken as significant. Results: LJP maneuver had higher sensitivity (95.9% vs. 27.1%), NPV (98.7% vs. 82.0%), and accuracy (90.1% vs. 80.3%) when compared to MT in predicting difficult laryngoscopy and intubation. Both tests, however, had similar specificity and PPV. There was marked difference in the positive and negative likelihood ratio between LJP and MT. Similarly, the area under the curve favored LJP maneuver over MT. Conclusion: The results of this study show that LJP maneuver is a better test to predict difficult laryngoscopy and tracheal intubation. We recommend the addition of this maneuver to the routine preoperative evaluation of airway.
  5 3,294 693
Communication skills of anesthesiologists: An Indian perspective
Mritunjay Kumar, Hari Har Dash, Rajiv Chawla
July-September 2013, 29(3):372-376
DOI:10.4103/0970-9185.117116  PMID:24106364
Background: Communication failure is a risk factor for mishaps and complaints, which can be reduced by effective communication between operating room team members and patients. Aim: To conduct a survey among anesthesiologists regarding communications skills and related issues like stress in case of communication failure, need for training, music in operation theater, and language barrier at their work place. Materials and Methods: We conducted a survey among anesthesiologists coming for a neuroanesthesia conference in India (n = 110) in February 2011 by questionnaire sent by e-mail to them. Results: The response rate was 61.8% (68/110). Majority (95.5%) of the respondents agreed that good verbal communication leads to better patient outcome, better handling of crisis and is important between surgeons and anesthesiologists (98.5%). A total of 86% of the anesthesiologists felt that failure of communication caused stress to them. The idea of communication by e-mail or phone text messages instead of verbal communications was discouraged by 65.2%. A total of 82% of respondents felt that training of communication skills should be mandatory for all medical personnel and 77.6% were interested in participating in such course. Language barrier at work place was seen as hurdle by 62.7% of the respondents. A total of 80% of respondents felt that playing music in operating theater is appropriate. Conclusion: Results of the survey highlight the need for effective communication in the operating room between team members and need for formal training to improve it.
  5 2,189 464
REVIEW ARTICLES
Role of colloids in traumatic brain injury: Use or not to be used?
Tumul Chowdhury, Ronald B Cappellani, Bernhard Schaller, Jayesh Daya
July-September 2013, 29(3):299-302
DOI:10.4103/0970-9185.117043  PMID:24106350
Trauma is a leading cause of death worldwide and traumatic brain injury is one of the commonest injuries associated with it. The need for urgent resuscitation is warranted for prevention of secondary insult to brain. However, the choice of fluid in such cases is still a matter of conflict. The literature does not provide enough data pertaining to role of colloids in head injury patients.In this article, we have tried to explore the present role of colloid resuscitation in patient with head injury.
  5 3,447 949
ORIGINAL ARTICLES
The effect of dexmedetomidine continuous infusion as an adjuvant to general anesthesia on sevoflurane requirements: A study based on entropy analysis
Chirag Ramanlal Patel, Smita R Engineer, Bharat J Shah, S Madhu
July-September 2013, 29(3):318-322
DOI:10.4103/0970-9185.117066  PMID:24106354
Background: Dexmedetomidine, a α2 agonist as an adjuvant in general anesthesia, has anesthetic and analgesic-sparing property. Aims: To evaluate the effect of continuous infusion of dexmedetomidine alone, without use of opioids, on requirement of sevoflurane during general anesthesia with continuous monitoring of depth of anesthesia by entropy analysis. Materials and Methods: Sixty patients were randomly divided into 2 groups of 30 each. In group A, fentanyl 2 mcg/kg was given while in group B, dexmedetomidine was given intravenously as loading dose of 1 mcg/kg over 10 min prior to induction. After induction with thiopentone in group B, dexmedetomidine was given as infusion at a dose of 0.2-0.8 mcg/kg. Sevoflurane was used as inhalation agent in both groups. Hemodynamic variables, sevoflurane inspired fraction (FI sevo ), sevoflurane expired fraction (ET sevo ), and entropy (Response entropy and state entropy) were continuously recorded. Statistical analysis was done by unpaired student's t-test and Chi-square test for continuous and categorical variables, respectively. A P-value < 0.05 was considered significant. Results: The use of dexmedetomidine with sevoflurane was associated with a statistical significant decrease in ET sevo at 5 minutes post-intubation (1.49 ± 0.11) and 60 minutes post-intubation (1.11 ±0.28) as compared to the group A [1.73 ±0.30 (5 minutes); 1.68 ±0.50 (60 minutes)]. There was an average 21.5% decrease in ET sevo in group B as compared to group A. Conclusions: Dexmedetomidine, as an adjuvant in general anesthesia, decreases requirement of sevoflurane for maintaining adequate depth of anesthesia.
  4 3,421 725
Evaluation of analgesic effect of local administration of morphine after iliac crest bone graft harvesting: A double blind study
Devinder Singh, KK Gombar, Nidhi Bhatia, Satinder Gombar, Sudhir Garg
July-September 2013, 29(3):356-360
DOI:10.4103/0970-9185.117109  PMID:24106361
Background and Objective: Pain is a complex process influenced by both physiological and psychological factors. In spite of an armamentarium of analgesic drugs and techniques available to combat post-operative pain, appropriate selection, and effective management for relief of post-operative pain still poses unique challenges. The discovery of peripheral opioid receptors has led to growing interest in the use of locally applied opioids (intra-articular, intra-pleural, intra-peritoneal, and perineural) for managing acute pain. As bone graft harvesting is associated with significant post-operative pain and there is a paucity of literature on the use of peripheral opioids at the iliac crest bone harvesting site, the present study was planned to evaluate the analgesic efficacy of local administration of morphine after iliac crest bone graft harvesting. Materials and Methods: A total of 60 patients, 20-50 years of age scheduled to undergo elective surgery for delayed and non-union fracture both bone leg with bone grafting under general anaesthesia (GA) were randomly assigned to one of the four groups of 15 patients each: group 1: 2.5 ml normal saline (NS) +2.5 ml NS infiltrated into the harvest site at 2 sites + 1 ml NS intramuscularly (i/m); Group 2: 2.5 ml NS + 2.5 ml NS infiltrated into the harvest site at 2 sites + 5 mg morphine in 1 ml i/m.; Group 3: 2.5 mg (2.5 ml) morphine + 2.5 mg (2.5 ml) morphine infiltrated into the harvest site at 2 sites + 1 ml NS i/m; Group 4: 0.5 mg naloxone (2.5 ml) +5 mg (2.5 ml) morphine infiltrated into the harvest site at 2 sites + 1 ml NS i/m. Pain from the bone graft site and operative site was assessed for 24 h post-operatively. Results: The patients who had received morphine infiltration (Group 3) had significantly less pain scores at the graft site at 4, 6, and 10 post-operative hours. They also had significantly less morphine consumption and overall better pain relief as compared to the other groups. Conclusions: Morphine administered peripherally provided better analgesia as compared to that given systemically and this effect was noticeable after 4 h post-operatively.
  4 1,713 317
CASE REPORTS
Accidental intravenous infusion of a large dose of magnesium sulphate during labor: A case report
Kamal Kumar, Arif Al Arebi, Indu Singh
July-September 2013, 29(3):377-379
DOI:10.4103/0970-9185.117105  PMID:24106365
During labor and child delivery, a wide range of drugs are administered. Most of these medications are high-alert medications, which can cause significant harm to the patient due to its inadvertent use. Errors could be caused due to unfamiliarity with safe dosage ranges, confusion between similar looking drugs, mislabeling of drugs, equipment misuse, or malfunction and communication errors. We report a case of inadvertent infusion of a large dose of magnesium sulphate in a pregnant woman.
  3 3,772 472
Anesthesia for opioid addict: Challenges for perioperative physician
Rohit Goyal, Gurjeet Khurana, Parul Jindal, JP Sharma
July-September 2013, 29(3):394-396
DOI:10.4103/0970-9185.117113  PMID:24106370
Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine) who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period.
  3 22,246 1,553
ORIGINAL ARTICLES
Colloid cohydration and variable rate phenylephrine infusion effectively prevents postspinal hypotension in elective Cesarean deliveries
Indu Sen, Rozeeta Hirachan, Neerja Bhardwaj, Kajal Jain, Vanita Suri, Praveen Kumar
July-September 2013, 29(3):348-355
DOI:10.4103/0970-9185.117106  PMID:24106360
Background: Prevention of post-spinal hypotension in obstetric patients can be accomplished using intravenous fluid expansion and prophylactic use of sympathomimetic drugs. The affect of combination of colloids and phenylephrine infusion on maternal hemodynamics has not been widely studied and there is no consensus about the dosage required and time of starting its administration. Materials and Methods: This prospective, randomized, double-blind study enrolled 90 healthy term parturients undergoing elective Cesarean delivery under lumbar subarachnoid block (0.5% hyperbaric bupivacaine 10 mg with fentanyl 25 μg). Patients in Group A received prophylactic intravenous phenylephrine infusion (60 μg/minute) along with hydroxyl-ethyl-starch cohydration (6% HES 130/0.42;15 ml/kg) immediately after subarachnoid block. In Group B, patients received 6% HES cohydration and intermittent intravenous 50 μg boluses of phenylephrine. The efficacy of these in maintaining maternal SBP at 90-110% of baseline and neonatal well-being was evaluated. Results: In Group B, 75.5% of patients required rescue phenylephrine boluses to maintain SBP while maternal hemodynamics were well maintained in Group A and rescue drug was not needed. Reactive hypertension occurred in one patient (2.2%) and bradycardia in two patients (4.4%) in Group A. Six patients complained of nausea in Group B (13.3%) compared to one in Group A. All the newborns had normal Apgar scores and Umbilical arterial pH > 7.2. Conclusion: A combination of colloid cohydration and prophylactic phenylephrine infusion initiated at 60 μg/minute maintained maternal hemodynamics and neonatal well-being during Cesarean deliveries requiring minimum interventions by the anesthesiologist.
  3 2,440 707
Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes
Neerja Bhardwaj, Kajal Jain, Madhusudan Rao, Arup Kumar Mandal
July-September 2013, 29(3):308-312
DOI:10.4103/0970-9185.117053  PMID:24106352
Background: Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope. Materials and Methods: A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was performed twice in each patient using in turn both the Macintosh and Truview laryngoscopes. A baseline radiograph with the head and neck in a neutral position was followed by a second radiograph taken during each laryngoscopy. An experienced radiologist analyzed and measured the cervical movement. Results: Significant cervical spine movement occurred at all segments when compared to the baseline with both the Macintosh and Truview laryngoscopes (P < 0.001). However, the movement was significantly less with Truview compared to the Macintosh laryngoscope at C 0 -C 1 (21%; P = 0.005) and C 1 -C 2 levels (32%; P = 0.009). The atlantooccipital distance (AOD) traversed while using Truview laryngoscope was significantly less than with Macintosh blade (26%; P = 0.001). Truview blade produced a better laryngoscopic view (P = 0.005) than Macintosh blade, but had a longer time to laryngoscopy (P = 0.04). Conclusion: Truview laryngoscope produced a better laryngoscopic view of glottis as compared with Macintosh laryngoscopy. It also produced significantly less cervical spine movement at C 0 -C 1 and C 1 -C 2 levels than with Macintosh laryngoscope in patients without cervical spine injury and without manual in-line stabilization (MILS). Further studies are warranted with Truview laryngoscope using MILS.
  3 2,807 1,036
CASE REPORTS
Giant oral tumor in a child with malnutrition and sickle cell trait: Anesthetic challenges
Preet Mohinder Singh, Anuradha Borle, Anjan Trikha
July-September 2013, 29(3):380-383
DOI:10.4103/0970-9185.117107  PMID:24106366
Pediatric oral tumors have always been challenging for the even most skilled anesthesiologists. The conventional method of awake intubation is not realistic in this age group. The management is to chart out a plan to intubate the child post induction. We describe successful management of a case of giant of ossifying fibroma in a child with sickle cell trait where non-conventional innovate approach helped us to secure the airway pre-operatively and avoid possible medical complications.
  2 2,020 336
LETTERS TO EDITOR
The neural integrity monitor electromyogram tracheal tube: Anesthetic considerations
Glen Atlas, Marshall Lee
July-September 2013, 29(3):403-404
DOI:10.4103/0970-9185.117052  PMID:24106374
  2 1,244 216
Can Klebsiella sepsis lead to hyperammonemic encephalopathy with normal liver function?
Tanmoy Ghatak, Afzal Azim, Sameer Mahindra, Armin Ahmed
July-September 2013, 29(3):415-416
DOI:10.4103/0970-9185.117079  PMID:24106385
  2 1,145 225
Epidural lipomatosis: A dilemma in interventional pain management for the use of epidural Steroids
David H Rustom, Deepak Gupta, Shushovan Chakrabortty
July-September 2013, 29(3):410-411
DOI:10.4103/0970-9185.117070  PMID:24106381
  2 15,398 601
Data acquisition from S/5 GE Datex anesthesia monitor using VSCapture: An open source.NET/Mono tool
John George Karippacheril, Tam Yuk Ho
July-September 2013, 29(3):423-424
DOI:10.4103/0970-9185.117096  PMID:24106390
  2 2,033 389
Intra-lingual succinylcholine for the treatment of adult laryngospasm in the absence of IV access
Basavana Gouda Goudra, Lakshmi C Penugonda, Ashish C Sinha
July-September 2013, 29(3):426-427
DOI:10.4103/0970-9185.117102  PMID:24106393
  2 1,415 299
ORIGINAL ARTICLES
Composite auditory evoked potentials index is not a good indicator of depth of anesthesia in propofol-fentanyl anesthesia: Randomized comparative study
Tomoki Nishiyama
July-September 2013, 29(3):333-336
DOI:10.4103/0970-9185.117087  PMID:24106357
Background: The composite auditory evoked potentials index (cAAI) was considered a measure of overall balance between noxious stimulation, analgesia, and hypnosis; while bispectral index (BIS) shows only hypnosis, and auditory evoked potentials index (AAI) shows response to stimuli. The present study compared the performance of cAAI, BIS, and AAI in propofol-fentanyl anesthesia. Materials and Methods: Forty-five patients for abdominal surgery aged 30-65 years with ASA physical status I or II were randomly divided into three groups by an envelope method. Anesthesia was induced with midazolam, propofol, and fentanyl alongwith an epidural block. When hemodynamics were stable during surgery, propofol infusion rate was fixed at 4 mg/kg/h for 10 min, then increased to 6 mg/kg/h and kept it for 10 min. AAI (AEP version 1.4), cAAI (AEP version 1.6), or BIS (A-2000) was monitored in each 15 patients, and the performance of three indices was compared. Results: All three indices decreased significantly before intubation. Only the AAI increased significantly by intubation. During anesthesia except for at propofol 6 mg/kg/h, the cAAI was significantly higher than the AAI. Only the AAI was significantly lower at propofol 6 mg/kg/h than at 4 mg/kg/h. The cAAI had the largest and AAI had the smallest inter-individual variations. The cAAI was higher than the manufacturer's recommended range of general anesthesia. Conclusion: In propofol-fentanyl anesthesia, AAI might be better to discriminate anesthetic depth than cAAI and BIS.
  2 1,170 241
EDITORIALS
Minimizing medication errors: Moving attention from individual to system
Parshotam Lal Gautam
July-September 2013, 29(3):293-294
DOI:10.4103/0970-9185.117037  PMID:24106347
  1 1,326 332
LETTERS TO EDITOR
Is fibreoptic bronchoscopy a must prior to one lung ventilation in a situs inversus patient?
S Eapen, Soumita Kar, S Kiran, RK Singh
July-September 2013, 29(3):404-405
DOI:10.4103/0970-9185.117055  PMID:24106375
  1 1,120 193
Intensive care unit psychosis a well known fact but rarely thought early
Vanita Ahuja, Nitika Goel, Subhash Das, Pritam Singh
July-September 2013, 29(3):413-414
DOI:10.4103/0970-9185.117075  PMID:24106384
  1 3,554 362
Mapping the antiplatelet effects of clopidogrel and aspirin by modified thromboelastography
Hemlata , Anupam Verma, Priti Elhence
July-September 2013, 29(3):421-423
DOI:10.4103/0970-9185.117094  PMID:24106389
  1 2,777 447
CASE REPORTS
Anesthetists approach in a neonate with nesidioblastoma undergoing pancreatectomy
Kiran Patel, Mukta Shikare, Dilip Chavan, Pradnya Sawant
July-September 2013, 29(3):384-386
DOI:10.4103/0970-9185.117108  PMID:24106367
Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is rare, but an important cause of hypoglycemia in infants, associated with a number of structural abnormalities of the endocrine pancreas is collectively termed as "Islet cell dysmaturation syndrome." We present the anesthetic management in a clinically diagnosed case of PHHI in a 22 days old full term child, undergoing Subtotal Pancreatectomy. We have discussed the challenges faced in the intra-operative period in managing this neonate for pancreatic resection surgery with focus on intra-operative management of blood glucose levels.
  - 1,482 224
Lower segment cesarean section in a patient with severe thrombocytopenia and pregnancy induced hypertension
Minal Harde, Sona Dave, Rahul Ramji Vasave, Pinakin Gujjar, Rakesh Bhadade
July-September 2013, 29(3):387-389
DOI:10.4103/0970-9185.117110  PMID:24106368
Thrombocytopenia in pregnancy carries a major risk of feto-maternal morbidity and mortality. We present a case of hypocellular bone marrow with severe thrombocytopenia with pregnancy induced hypertension (PIH) for emergency lower segment cesarean section (LSCS). This disease is characterized by pancytopenia and hypocellular bone marrow with impaired morphology and maturation. Causes of death due to this disease include hemorrhage and infection secondary to thrombocytopenia and neutropenia especially following surgery. We report successful management of emergency LSCS with severe thrombocytopenia with severe PIH.
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COMMENTARY
Surgeons and anesthesiologists: Need to communicate?
Rakhee Goyal
July-September 2013, 29(3):297-298
DOI:10.4103/0970-9185.117040  PMID:24106349
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EDITORIALS
Anesthesiology research and practice in developing nations: Economic and evidence-based patient-centered approach
Sukhminder Jit Singh Bajwa
July-September 2013, 29(3):295-296
DOI:10.4103/0970-9185.117039  PMID:24106348
  - 1,067 291
LETTERS TO EDITOR
Difficulty in proseal laryngeal mask airway insertion: An unusual cause
Renu Sinha, Bikash Ranjan Ray
July-September 2013, 29(3):401-402
DOI:10.4103/0970-9185.117049  PMID:24106372
  - 1,251 207
Sudden sustained asystole during a cerebellopontine angle surgery
M C B Santhosh, Rohini Bhat Pai, Raghavendra P Rao, Varun Byrappa
July-September 2013, 29(3):402-403
DOI:10.4103/0970-9185.117050  PMID:24106373
  - 864 183
Anesthetic management of T tube: A simple approach
Aparna A Nerurkar, Vandana V Laheri, Smita S Lele, Manish Kotwani, Bharati A Tendolkar
July-September 2013, 29(3):405-406
DOI:10.4103/0970-9185.117057  PMID:24106376
  - 770 173
Authors' reply: Anesthetic management of a patient with montgomery t-tube in-situ for direct laryngoscopy
Sukhyanti Kerai, Richa Gupta, Sonia Wadhawan, Poonam Bhadoria
July-September 2013, 29(3):406-407
PMID:24106377
  - 679 168
Acute shoulder pain for holding the face mask: A complication of mask ventilation
Arun Kumar, Mihir P Pandia, Hari H Dash
July-September 2013, 29(3):407-408
DOI:10.4103/0970-9185.117061  PMID:24106378
  - 733 177
Kinking of a patent flexometallic tube due to dislodgement of reinforcing spirals
Surya Kumar Dube, Mihir Prakash Pandia, Varun Jain
July-September 2013, 29(3):408-409
DOI:10.4103/0970-9185.117064  PMID:24106379
  - 848 164
Spinal accesory nerve blockade by local infiltration for central venous catheter insertion: An unusual occurrence
Rudrashish Haldar, Sukhen Samanta, Prakhar Gyanesh
July-September 2013, 29(3):409-410
DOI:10.4103/0970-9185.117068  PMID:24106380
  - 833 165
Septic pulmonary embolism following necrotizing fasciitis of the upper limb
Parul Mullick, Harish C Sachdeva, Pankaj Bundela, Smita Prakash, Anoop Raj Gogia
July-September 2013, 29(3):416-418
DOI:10.4103/0970-9185.117080  PMID:24106386
  - 1,518 213
An indigenous minitracheostomy/cricothyroidotomy set developed from unused items from intra-aortic balloon pump kit
Murali Chakravarthy
July-September 2013, 29(3):418-420
DOI:10.4103/0970-9185.117089  PMID:24106387
  - 2,003 193
Amitraz: An unfamiliar poisoning with familiar pesticide
Sweta , Uma Srivastava, Archana Agarwal
July-September 2013, 29(3):420-421
DOI:10.4103/0970-9185.117092  PMID:24106388
  - 901 211
Pneumothorax following ultrasound guided supraclavicular brachial plexus block
Harsimran Singh
July-September 2013, 29(3):411-412
DOI:10.4103/0970-9185.117071  PMID:24106382
  - 962 217
Authors' reply: Pneumothorax following ultrasound guided supraclavicular brachial plexus block
Kapil Gupta, Shyam Bhandari, Deepak Singhal, Parminder Singh Bhatia
July-September 2013, 29(3):412-413
PMID:24106383
  - 668 146
Dental guards: An alternative solution for loose tooth
Bikash Ranjan Ray, Puneet Khanna, Rahul Kumar Anand, Dalim Kumar Baidya
July-September 2013, 29(3):424-425
DOI:10.4103/0970-9185.117098  PMID:24106391
  - 1,133 202
Is MOUTHS better than MOUTH?
Akshaya N Shetti
July-September 2013, 29(3):425-425
DOI:10.4103/0970-9185.117099  PMID:24106392
  - 657 169
ORIGINAL ARTICLES
Perioperative concerns in pediatric patients undergoing different types of scoliosis correction surgery: A retrospective observational study
Anjolie Chhabra, Mahesh Kumar Arora, Dalim Kumar Baidya, Praveen Talawar, Preet Mohinder Singh, Arvind Jayswal
July-September 2013, 29(3):323-327
DOI:10.4103/0970-9185.117072  PMID:24106355
Background: Advances in scoliosis surgery have now made it possible for younger patients to be taken up for scoliosis correction. Objectives: To ascertain the patient profile, perioperative complications and need for intensive care management in children undergoing posterior fusion and instrumentation (PF), anterior release (AR), and growth rod (GR) insertion surgery. Patients and Methods: After taking parental consent, data were collected retrospectively for 33 patients who underwent 37 procedures (four patients had both anterior and posterior procedures) on 2 days of the week mainly from August 2008 to February 2010 at a tertiary care institution. Results: Children undergoing GR surgery were younger (8.1 ± 2.1 years) than patients undergoing AR (12.9 ± 1.7 years) or posterior fusion (14.2 ± 2.2 years). AR children had a significantly higher Cobb's angle and more rigid curves. (P = 0.057) Associated congenital abnormalities especially neurological were commoner in the GR children. Surgical duration and blood loss was significantly more for PF (2207.5 ± 1224.13 ml) than GR (456 ± 337.5 ml), or AR (642.85 ± 304.72 ml), (P = 0.0002). PF patients needed Intensive care unit (ICU) care mainly due to the blood loss and prolonged surgery (35%). AR performed via thoracotomy was associated with the need for mechanical ventilation in 28.6%. The GR patients had major intraoperative hemodynamic events and 20% needed ICU care. Conclusions: Post-operative ventilation may be required in 20-35% patients undergoing procedures for scoliosis correction. Despite GR insertion involving lesser blood loss; younger age, congenital abnormalities, positioning, and surgical manipulation resulted in life threatening events in these patients.
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Pharmaco-economics: Minute-based cost of sevoflurane in pediatric short procedures and its relation to demographic variables
Preet Mohinder Singh, Anjan Trikha, Renu Sinha, Rashmi Ramachandran, Vimi Rewari, Anuradha Borle
July-September 2013, 29(3):328-332
DOI:10.4103/0970-9185.117083  PMID:24106356
Background: Inhalation agents account for significant cost of short daycare procedures. The estimation of this cost to pre-calculate expected expenditure is not available in literature. As for intravenous agents, their relations to weight and other demographic parameters are also not well established. The present study aims to evaluate the above concern. Materials and Methods: A total of 100 pediatric (ASA I, II) patients scheduled for ophthalmological examination under anesthesia (EUA) were included in the study. Following premedication, anesthesia in all children was induced using incremental concentrations of sevoflurane at a flow of 6 l with 1:1 oxygen:nitrous oxide ratio. Upon induction, the flows were reduced to 2 l, keeping sevoflurane at 1 to 2 minimum alveolar concentration (MAC). Using Dion's equation, the costs for induction and maintenance with sevoflurane were calculated for each patient. Results: The cost per minute of sevoflurane was found to be Rs. 13.23. Unlike intravenous agents, no significant correlation was found to exist between sevoflurane consumption with age or weight. The sevoflurane consumption was also not influenced by the gender. The total cost of EUA correlated most strongly with duration of maintenance phase, followed by induction duration.
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