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   2014| January-March  | Volume 30 | Issue 1  
    Online since January 24, 2014

 
 
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ORIGINAL ARTICLES
Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block
Sandhya Agarwal, Ritu Aggarwal, Praveen Gupta
January-March 2014, 30(1):36-40
DOI:10.4103/0970-9185.125701  PMID:24574591
Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25), 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25), 30 ml of 0.325% bupivacaine + 1 ml (100 μg) dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR), systolic arterial blood pressure (SBP), and diastolic arterial blood pressure (DBP) were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001), while the duration of blocks was significantly longer (P < 0.001) in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min), heart rate levels in group SD were significantly lower (P < 0.001). SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001). In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001) in group SD. The duration of analgesia (DOA) was significantly longer in SD group than S group (P < 0.001). Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion: Dexmedetomidine added as an adjuvant to bupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia. Patients in group SD were adequately sedated (modified Ramsay Sedation Score, RSS = 2/6 or 3/6) with no adverse effects except bradycardia in one patient of group SD.
  28 9,195 1,646
Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect
Basavana Gouda Goudra, Preet Mohinder Singh, Lakshmi C Penugonda, Rebecca M Speck, Ashish C Sinha
January-March 2014, 30(1):71-77
DOI:10.4103/0970-9185.125707  PMID:24574597
Background: Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m 2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.
  17 4,478 779
REVIEW ARTICLES
Spinal anesthesia in children: A review
Anju Gupta, Usha Usha
January-March 2014, 30(1):10-18
DOI:10.4103/0970-9185.125687  PMID:24574586
Even after a vast safety record, the role of spinal anesthesia (SA) as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception) to reduce the incidence of post-operative apnea when compared to general anesthesia (GA). However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.
  12 13,263 5,174
ORIGINAL ARTICLES
Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia
SS Harsoor, D Devika Rani, S Lathashree, SS Nethra, K Sudheesh
January-March 2014, 30(1):25-30
DOI:10.4103/0970-9185.125693  PMID:24574589
Background: Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for abdominal surgeries on blood glucose levels and on Sevoflurane requirements during anesthesia. Materials and Methods: Forty patients scheduled for abdominal surgery under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 20 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable. Results: During the first postoperative hour, Dexmedetomidine group showed blood glucose levels of 118.2 ± 16.24 mg/dL, compared to placebo group which was 136.95 ± 19.76 mg/dL and it was statistically significant (P < 0.01). Mean hourly Sevoflurane requirement in Group D was 11.10 ± 2.17 mL, compared to 15.45 ± 3.97 mL in placebo group. In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P. Conclusion: IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.
  11 2,846 747
REVIEW ARTICLES
Cricoid pressure: Where do we stand?
Nidhi Bhatia, Hemant Bhagat, Indu Sen
January-March 2014, 30(1):3-6
DOI:10.4103/0970-9185.125683  PMID:24574584
In 1961, Sellick popularized the technique of cricoid pressure (CP) to prevent regurgitation of gastric contents during anesthesia induction. In the last two decades, clinicians have begun to question the efficacy of CP and therefore the necessity of this maneuver. Some have suggested abandoning it on the grounds that this maneuver is unreliable in producing midline esophageal compression. Moreover, it has been found that application of CP makes tracheal intubation and mask ventilation difficult and induces relaxation of the lower esophageal sphincter. There have also been reports of regurgitation of gastric contents and aspiration despite CP. Further, its effectiveness has been demonstrated only in cadavers; therefore, its efficacy lacks scientific validation. These concerns with the use of CP in modern anesthesia practice have been briefly reviewed in this article.
  11 8,320 2,117
ORIGINAL ARTICLES
Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease
Tarek Shams, Hamed Al Wadani, Ragaa El-Masry, Ossama Zakaria
January-March 2014, 30(1):20-24
DOI:10.4103/0970-9185.125692  PMID:24574588
Background: Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision. Materials and Methods: A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA. Results: There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications. Conclusion: The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.
  7 2,108 421
REVIEW ARTICLES
Considerations in perioperative assessment of valproic acid coagulopathy
Claude Abdallah
January-March 2014, 30(1):7-9
DOI:10.4103/0970-9185.125685  PMID:24574585
Valproic acid (VPA) is one of the widely prescribed antiepileptic drugs in children with multiple indications. VPA-induced coagulopathy may occur and constitute a pharmacological and practical challenge affecting pre-operative evaluation and management of patients receiving VPA therapy. This review summarizes the different studies documenting the incidence, severity and available recommendations related to this adverse effect.
  7 4,687 718
CASE REPORTS
Dapsone-induced methemoglobinemia: "Saturation gap"-The key to diagnosis
Shivinder Singh, Navdeep Sethi, Sushmitha Pandith, Gouri Shankar Ramesh
January-March 2014, 30(1):86-88
DOI:10.4103/0970-9185.125710  PMID:24574600
Two cases of Acquired Methemoglobinemia are presented. The significance of a high index of suspicion for diagnosisis emphasized, especially in the presence of a "saturation gap". The various causes of acquired methemoglobinemia are enumerated and the management reviewed.
  6 4,297 513
ORIGINAL ARTICLES
Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital
Afzal Azim, Parikshit Singh, Parmeet Bhatia, Arvind K Baronia, Mohan Gurjar, Banani Poddar, Ratender K Singh
January-March 2014, 30(1):78-81
DOI:10.4103/0970-9185.125708  PMID:24574598
Background: A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU). Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates. Materials and Methods: Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention) over a period of 18 months. Fisher's exact test was applied to statistically analyze the data. Results: There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001), competing causes (88.0 vs. 13.3%, P < 0.001), and improper sequencing (89.3 vs. 36.0%, P < 0.001). There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001) and no time intervals (100.0 vs. 22.6%, P < 0.001). Conclusion: Authors conclude that death certification errors can be significantly reduced by educational interventional programs.
  6 1,525 287
Comparison of the effects of dexmedetomidine-ketamine and sevoflurane-sufentanil anesthesia in children with obstructive sleep apnea after uvulopalatopharyngoplasty: An observational study
Xinqi Cheng, Yue Huang, Qing Zhao, Erwei Gu
January-March 2014, 30(1):31-35
DOI:10.4103/0970-9185.125699  PMID:24574590
Background: Children with obstructive sleep apnea (OSA) are particularly at risk under anesthesia after uvulopalatopharyngoplasty (UPPP). This prospective randomized double-blind study focused on the comparison of dexmedetomidine-ketamine and sevoflurane-sufentanil anesthesia on children with respect to safety, feasibility, and clinical effects. Materials and Methods: A total of 60 children, aged 2-10 years, classified as American Society of Anesthesiologists (ASA) status I and II scheduled for UPPP were prospectively studied. Patients were randomly allocated to receive either dexmedetomidine-ketamine-based anesthesia (group DK, n = 30) or sevoflurane-sufentanil-based anesthesia (group SS, n = 3 0). Heart rate (HR) and systolic blood pressure during the first 60 min of the procedure, Ramsay sedation score, the Pediatric Anesthesia Emergence Delirium (PAED) scale and a 5-point scale used to evaluate emergence agitation (EA) in postanesthesia care unit (PACU) and postoperative outcomes data were recorded. Results: During the first 60 min of anesthesia, mean HR, and mean diastolic noninvasive arterial blood pressure (NIBP) were not statistically different in the two groups (P > 0.05) Compared with group SS, the patients in group DK had lower rescue tramadol requirement and lower pain score, PAED score, and EA score at 5, 10, 15, and 30 min in PACU; but had a higher Ramsay scale at 10, 15, 30, 45, and 60 min in PACU and the incidence of SpO 2 below 95%, also the time of first bowel movement and ambulation in group DK was shorter. Conclusions: The dexmedetomidine-ketamine combination was not superior to a sevoflurane-sufentanil combination because of late awake time and a high potential for adverse respiratory events in PACU, the benefit of dexmedetomidine administration being a decreased incidence of EA and a lower recovery time of bowel movement and ambulation.
  6 2,525 662
A survey of undergraduate anesthesia rotation in medical colleges of Pakistan
Fauzia Minai, M Irfan Ul Haq, Gauhar Afshan
January-March 2014, 30(1):82-85
DOI:10.4103/0970-9185.125709  PMID:24574599
Background: Student perceptions of specialties influence career choice decisions. It is important to expose undergraduates to the scope of rewarding careers in specialties like anesthesia by ensuring a good quality educational experience during anesthesia rotation. Our objective was to survey the curriculum structure and placement of the anesthesia undergraduate rotation in all the medical colleges of Pakistan recognized by the Pakistan Medical and Dental Council. Materials and Methods: A standardized survey questionnaire was distributed by direct contact, postal mail or e mail to one identified anesthetist in all recognized medical colleges with enrolment of 100 or more students. The response rate was 75%. We received responses by hand, email and postal mail. Results: We received responses from 15 out of 20 anesthetists contacted. 11 reported undergraduate anesthesia rotation while 4 reported absence of this rotation in their undergraduate curriculum. The rotation placement, duration and curriculum showed a wide variation and lack of standardization. Conclusion: Our survey indicates that the inclusion of anesthesia rotation in undergraduate medical education is not mandatory and standardized. The rotation duration, placement and curriculum need to be standardized to enhance the quality of the experience and promote the scope of the specialty for rewarding careers.
  5 1,424 275
High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience
Herbert Spapen, Marianne Borremans, Marc Diltoer, Viola Van Gorp, Duc Nam Nguyen, Patrick M Honoré
January-March 2014, 30(1):65-70
DOI:10.4103/0970-9185.125706  PMID:24574596
Background: Few studies have investigated high-frequency percussive ventilation (HFPV) in adult patients with acute respiratory distress syndrome (ARDS). Materials and Methods: We retrospectively analyzed data from critically ill-patients with moderate and severe ARDS who received HFPV. Ventilation and oxygenation were governed according to a predefined protocol. HFPV was continued until patients could be switched to conventional ventilation. Results: A total of 42 patients (20 with pneumonia-related ARDS and 22 non-septic ARDS cases) were evaluable. Baseline demographic characteristics, severity of illness, lung injury score; pH and respiratory variables were comparable between pneumonia and non-sepsis-related ARDS. Within 24 h, HFPV restored normal pH and PaCO 2 and considerably improved oxygenation. Oxygenation improved more in non-septic than in pneumonia-related ARDS. Patients with pneumonia-induced ARDS also remained longer HFPV-dependent (7.0 vs. 4.9 days; P < 0.05). Mortality at 30 days was significantly higher in pneumonia-related than in non-sepsis-related ARDS (50% vs. 18%; P = 0.01). Conclusions: HFPV caused rapid and sustained improvement of oxygenation and ventilation in patients with moderate to severe ARDS. Less improved oxygenation, longer ventilator dependency and worse survival were observed in pneumonia-related ARDS.
  5 2,573 469
Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy
Sandeep Kundra, Vishnu Gupta, Hanish Bansal, Anju Grewal, Sunil Katyal, Ashwini Kumar Choudhary
January-March 2014, 30(1):46-52
DOI:10.4103/0970-9185.125703  PMID:24574593
Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml) was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml) was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU) and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests. Results: Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg) as compared to group II (24.80 ± 6.009 mg). Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P < 0.001). Group I patients were discharged earlier from PACU as compared to group II (P < 0.001) though time of discharge from hospital was similar in both the groups. There were no major adverse effects except pruritis, which was observed in 30.6% patients in group I and 37.3% in group II (statistically insignificant (P > 0.01)). Conclusion: Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.
  5 2,277 432
Is midazolam superior to triclofos and hydroxyzine as premedicant in children?
Sujata Chaudhary, Reena Jindal, Gautam Girotra, Rashmi Salhotra, Rajesh Singh Rautela, Ashok Kumar Sethi
January-March 2014, 30(1):53-58
DOI:10.4103/0970-9185.125704  PMID:24574594
Background: Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries. Materials and Methods: Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed. Results: The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed. Conclusion: Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.
  5 5,660 517
CASE REPORTS
Bronchoscopic topical steroid instillation in prevention of tracheal stenosis
Ankit Agarwal, DK Singh
January-March 2014, 30(1):91-93
DOI:10.4103/0970-9185.125712  PMID:24574602
Corrosive acid poisoning commonly results in chemical injuries to respiratory and upper gastrointestinal tract. Corrosive mucosal erosion of the larynx and trachea may occur if the patient aspirates acid. We successfully used local anti-inflammatory action of dexamethasone instilled through a fiber-optic bronchoscope for regression of mucosal edema and prevention of subsequent development of stricture in a young female.
  3 1,610 278
Peri-operative dexamethasone therapy and post-operative psychosis in patients undergoing major oral and maxillofacial surgery
Chethan Manohara Koteswara, Pritish Patnaik
January-March 2014, 30(1):94-96
DOI:10.4103/0970-9185.125713  PMID:24574603
A broad array of behavioral symptoms, including psychosis, can transpire post-operatively following a variety of surgeries. It is difficult to diagnose the exact cause of post-operative psychosis. We report three cases, which developed psychosis post-operatively after undergoing major oral and maxillofacial surgeries. All the three patients were administered dexamethasone peri-operatively. Dexamethasone is used to prevent or reduce post-operative edema. The exact dose of dexamethasone, which can cause psychosis, is unknown. It is important to raise awareness about this potential complication so that measures for management can be put in place in anticipation of such an event.
  3 3,469 394
LETTERS TO EDITOR
Transient compressive lumbar radiculopathy following post-epidural blood patch
Deepak Gupta, Hassan Amhaz, Ashish Mazumdar, Vitaly Soskin
January-March 2014, 30(1):112-114
DOI:10.4103/0970-9185.125723  PMID:24574611
  3 7,700 357
ORIGINAL ARTICLES
Oral bisoprolol improves surgical field during functional endoscopic sinus surgery
Sumitha Mary Jacob, Tony Thomson Chandy, Verghese T Cherian
January-March 2014, 30(1):59-64
DOI:10.4103/0970-9185.125705  PMID:24574595
Background: The success of functional endoscopic sinus surgery (FESS) depends on visual clarity of the surgical field, through the endoscope. The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of bisoprolol (2.5 mg) would reduce the bleeding during FESS and improve the visualization of the operative field. Materials and Methods: Thirty American Society of Anesthesiologists I or II patients, scheduled for FESS were randomized to receive either a placebo (Group A) or 2.5 mg of bisoprolol (Group B) 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP) of 60-70 mmHg, by titrating dose of isoflurane and fentanyl. The concentration of isoflurane used was recorded every 15 min. At the end of the surgery, the volume of blood loss was measured and the surgeon was asked to grade the operative field as per the Fromme-Boezaart Scale. Result: The blood loss was significantly (P < 0.0001) more in the control group (398.67 ± 228.79 ml) as compared with that in the bisoprolol group (110.67 ± 45.35 ml). The surgical field was graded better in those who received bisoprolol as compared with those in the control group ( P − 0.0001). The volume percent of isoflurane and the dose of fentanyl used was significantly lower in those who received bisoprolol. During the operative period, the MAPs were 70.0 ± 2.7 (Group A) and 62.6 ± 3.6 mmHg (Group B) and the heart rate was 99.8 ± 5.0/min (Group A) and 69.2 ± 4.4/min (Group B). These differences were statistically significant ( P − 0.001). Conclusion: This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg) can significantly reduce the blood loss during FESS and improve the visualization of the operating field.
  3 1,933 485
Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia
Srilata Moningi, Padmaja Durga, Gopinath Ramachandran, Pisapati Venkata Lakshmi Narasimha Murthy, Rami Reddy Chilumala
January-March 2014, 30(1):41-45
DOI:10.4103/0970-9185.125702  PMID:24574592
Background: Selective obturator nerve blockade (ONB) is an effective option to prevent adductor spasm during transurethral resection of bladder tumors (TURBT) involving the lateral wall under spinal anesthesia (SA). The classic approach is less popular as the obturator nerve is deep seated and associated with vascular injury. The inguinal approach was described as a safer alternative. This randomized clinical study was undertaken to compare the ease of block, the success rate and complications of the classic pubic and superficial inguinal approach for ONB. Materials and Methods: A total of 30 patients scheduled to undergo TURBT under SA were administered bilateral ONB. Inguinal approach recently described by Choquet was performed on one side and classic approach described by Labat was performed on the other side in random order using a nerve stimulator. The ease of block, success rate (number of attempts to accomplish the block) and complications were noted and compared between both the approaches. Chi-square analysis was performed to compare the ease of approach of the two techniques. Non-parametric analyses using Mann Whitney test was used to compare the number of attempts to accomplish the block in each approach. A value of P < 0.05 was considered statistically significant. Results: The ease of block (P = 0.09) and the median number of attempts to accomplish the block (P = 0.45) were comparable between the two approaches. The incidence of vascular injury was higher in classic approach (P = 0.056). Conclusions: Inguinal approach is a useful alternative to classic approach block for patients undergoing TURBT under SA.
  3 3,465 632
CASE REPORTS
Anaphylaxis from atracurium without skin manifestation
Souvik Maitra, Suvadeep Sen, Sudeshna (Bhar) Kundu, Sugata Pal
January-March 2014, 30(1):104-105
DOI:10.4103/0970-9185.125717  PMID:24574606
Anaphylaxis is an acute, potentially fatal allergic reaction involving multi organ system that is triggered by a wide range of antigens with a subsequent release of chemical mediators from mast cells and basophils. Diagnosis is primarily clinical though laboratory studies are helpful in further confirmation. Anaphylactic reactions during anesthesia are rare, but can be fatal if not promptly recognized and treated. Among all drugs commonly used in anesthesia, muscle relaxants are the most notorious to trigger anaphylactic reactions and benzylisoquinolinium group of drugs are known to be less common an offender than the steroidal compounds. We report severe anaphylactic reaction after administration of atracurium that was promptly diagnosed and managed without any further morbidity.
  2 1,682 372
LETTERS TO EDITOR
Anesthetic management of a child with Bardet-Biedl syndrome undergoing post-auricular dermoid excision
Manjunath T Bhat, Mysore Chandramouli Basappaji Santhosh, Harihar V Hegde, Raghavendra P Rao
January-March 2014, 30(1):117-118
DOI:10.4103/0970-9185.125732  PMID:24574615
  2 2,312 228
Hyoscine-N-butylbromide induced ventricular tachycardia during ERCP
Ersan Ozaslan, Nursen Karakelle, Nihal Gokbulut Ozaslan
January-March 2014, 30(1):118-119
DOI:10.4103/0970-9185.125733  PMID:24574616
  2 1,753 257
CASE REPORTS
Successful living donor kidney transplantation in a patient with prothrombin gene mutation: Case report and literature review
Edward Shen, Tadahiro Uemura, Zakiyah Kadry, Subramanian Sathishkumar
January-March 2014, 30(1):106-108
DOI:10.4103/0970-9185.125718  PMID:24574607
We present a patient with known prothrombin gene mutation and a history of prior vascular events, who underwent living donor kidney transplantation. Given the presumed elevated risk of complication from known prothrombin mutation, clinical management was directed towards optimizing living donor allograft function.
  1 1,411 209
Platelet cold agglutinins and thrombocytopenia: A diagnostic dilemma in the intensive care unit
TV Bharath Kumar, Neerja Bhardwaj
January-March 2014, 30(1):89-90
DOI:10.4103/0970-9185.125711  PMID:24574601
We report a case of pseudo-thrombocytopenia due to cold agglutinins against platelets. These cold agglutinins were the cause for diagnostic confusion and resulted in extensive workup and unnecessary therapeutic precautions. A thirty two year old female with Guillain-Barre syndrome was admitted in the ICU and serial work-up showed markedly low levels of platelets. The patient had no symptoms of bleeding and patient was investigated extensively for deciphering the etiology of low platelet count. In-vitro clumping of platelets was suspected and in-vitro studies showed marked clumping of platelets with ethylene-diamine-tetra-acetic acid, citrate and heparinized samples. The manual platelet count was found to be within normal limits. Thrombocytopenia as a result of platelet cold agglutinins is a rare cause of in-vitro low platelet counts. No clinical problems have been reported due to the same.
  1 2,607 320
Esophageal polyp as a posterior mediastinal mass: Intraoperative dynamic airway obstruction requiring emergency tracheostomy
Suvadeep Sen, Anjolie Chhabra, Arpita Ganguly, Dalim Kumar Baidya
January-March 2014, 30(1):97-100
DOI:10.4103/0970-9185.125715  PMID:24574604
Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures. We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.
  1 2,116 250
LETTERS TO EDITOR
Subglottic stenosis and acute airway obstruction
Uma Hariharan
January-March 2014, 30(1):122-124
DOI:10.4103/0970-9185.125736  PMID:24574619
  1 1,153 282
Management of anesthesia in biotinidase deficiency
Ugur Goktas, Muhammed Bilal Cegin, Ismail Kati, Onur Palabiyik
January-March 2014, 30(1):126-126
DOI:10.4103/0970-9185.125738  PMID:24574621
  1 925 336
An effective pharmacological management of postburn hypertrophic scar pain
Anuj Jain, Anil Agarwal, Chetna Shamshery
January-March 2014, 30(1):111-112
DOI:10.4103/0970-9185.125721  PMID:24574610
  1 1,510 258
BOOK REVIEW
Anaesthesia and Allied Sciences for Paramedics
Manpreet Singh
January-March 2014, 30(1):127-127
  - 1,430 295
CASE REPORTS
Role of newer imaging modalities for airway assessment in dynamic tracheal compression
Prabha Udayakumar, Madhurima Srikanti, Vinodhadevi Vijayakumar, Gunavathi Kandappan
January-March 2014, 30(1):101-103
DOI:10.4103/0970-9185.125716  PMID:24574605
Anesthetic management of a patient with tracheal stenosis is challenging. Though we have newer imaging modalities like multislice, three-dimensional computerized tomography, virtual bronchoscopy to determine the size and anatomy of the airway, it is difficult to accurately predict the distensibility of the trachea with the available preoperative tests. With our experience in this case, we believe that newer imaging modalities are just an adjunct in the assessment of the compromised airway in case of dynamic compression. Clinical assessment is very important in deciding the plan of management.
  - 1,656 252
COMMENTARY
Vitamin D and anesthesia: Is our present knowledge sufficient?
Basavana G Goudra, Preet Mohinder Singh
January-March 2014, 30(1):19-19
PMID:24574587
  - 1,802 482
EDITORIAL
Cricoid pressure: An enigma wrapped in a mystery or a hand wrapped around a throat? If I can't disprove a lie, does it become the truth?
Ashish C Sinha
January-March 2014, 30(1):1-2
DOI:10.4103/0970-9185.125682  PMID:24574583
  - 3,807 586
LETTERS TO EDITOR
Obtaining airtight seal with plastic infusion bottle using conventional intravenous set
Depinder Kaur, Shiv Kumar Singh, Suresh Kumar Singhal
January-March 2014, 30(1):109-109
DOI:10.4103/0970-9185.125719  PMID:24574608
  - 1,213 210
Airway complication due to retropharyngeal spread of epidural abscess during prone position
Anirban Hom Choudhuri, Mritunjay Kumar
January-March 2014, 30(1):110-111
DOI:10.4103/0970-9185.125720  PMID:24574609
  - 1,062 193
Spontaneous ventilation and not controlled ventilation for removal of foreign body when present in both bronchi in a child
Jyotsna Punj, Gururaj Nagaraj, Divya Sethi
January-March 2014, 30(1):119-121
DOI:10.4103/0970-9185.125734  PMID:24574617
  - 916 227
Move the anesthesia workstation cautiously!
Prakash K Dubey
January-March 2014, 30(1):121-122
DOI:10.4103/0970-9185.125735  PMID:24574618
  - 1,057 217
Reply to: Management of intraoperative hiccups with intravenous promethazine
Serbülent Gökhan Beyaz
January-March 2014, 30(1):114-114
DOI:10.4103/0970-9185.125724  PMID:24574612
  - 971 203
Providing anesthesia in a remote location for radiation oncology in an adult - Problems and solutions
Basavana Gouda Goudra, Preet Mohinder Singh, Ashish Sinha
January-March 2014, 30(1):114-116
DOI:10.4103/0970-9185.125725  PMID:24574613
  - 987 251
Prallethrin poisoning that taxes the brain
Subramanian Senthilkumaran, Ritesh G Menezes, Namasivayam Balamurugan, Ponniah Thirumalaikolundusubramanian
January-March 2014, 30(1):116-117
DOI:10.4103/0970-9185.125726  PMID:24574614
  - 886 184
Life-threatening severe sepsis following stapled hemorrhoidopexy
Apurva Agarwal, Bikram Kumar Gupta, Shaily Agarwal, Ajay Bhagoliwal, Kiran Pandey
January-March 2014, 30(1):124-125
DOI:10.4103/0970-9185.125737  PMID:24574620
  - 1,139 314
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