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   2015| April-June  | Volume 31 | Issue 2  
    Online since April 16, 2015

 
 
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REVIEW ARTICLES
Perioperative chlorhexidine allergy: Is it serious?
Claude Abdallah
April-June 2015, 31(2):152-154
DOI:10.4103/0970-9185.155140  PMID:25948892
Chlorhexidine is an antiseptic agent, commonly used, in many different preparations, and for multiple purposes. Despite its superior antimicrobial properties, chlorhexidine is a potentially allergenic substance. The following is a review of the current evidence-based knowledge of allergic reactions to chlorhexidine associated with surgical and interventional procedures.
  6,056 807 14
ORIGINAL ARTICLES
I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures
Poonam A Jadhav, Naina P Dalvi, Bharati A Tendolkar
April-June 2015, 31(2):221-225
DOI:10.4103/0970-9185.155153  PMID:25948905
Background and Aims: Supraglottic airway devices have been established in clinical anesthesia practice and have been previously shown to be safe and efficient. The objective of this prospective, randomized trial was to compare I-Gel with LMA-Proseal in anesthetized spontaneously breathing patients. Material and Methods: Sixty patients undergoing short surgical procedures were randomly assigned to I-gel (Group I) or LMA- Proseal (Group P). Anesthesia was induced with standard doses of propofol and the supraglottic airway device was inserted. We compared the ease and time required for insertion, airway sealing pressure and adverse events. Results: There were no significant differences in demographic and hemodynamic data. I-gel was significantly easier to insert than LMA-Proseal (P < 0.05) (Chi-square test). The mean time for insertion was more with Group P (41 + 09.41 secs) than with Group I (29.53 + 08.23 secs) (P < 0.05). Although the airway sealing pressure was significantly higher with Group P (25.73 + 02.21 cm of H 2 O), the airway sealing pressure of Group I (20.07 + 02.94 cm of H 2 O) was very well within normal limit (Student's t test). The success rate of first attempt insertion was more with Group I (P < 0.05). There was no evidence of airway trauma, regurgitation and aspiration. Sore throat was significantly more evident in Group P. Conclusion: I-Gel is a innovative supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence I-Gel can be a good alternative to LMA-Proseal.
  5,965 865 6
Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study
Sudeshna Mondal, Sarmila Ghosh, Susmita Bhattacharya, Brojen Choudhury, Suchismita Mallick, Anu Prasad
April-June 2015, 31(2):212-216
DOI:10.4103/0970-9185.155151  PMID:25948903
Background and Aims: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia.The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI. Material and Methods: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups. Results: Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B. Conclusion: Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI.
  3,939 1,094 6
Comparison of hemodynamic effects of intravenous etomidate versus propofol during induction and intubation using entropy guided hypnosis levels
Shagun Bhatia Shah, Itee Chowdhury, Ajay Kumar Bhargava, Bhawnish Sabbharwal
April-June 2015, 31(2):180-185
DOI:10.4103/0970-9185.155145  PMID:25948897
Background and Aims: This study aimed to compare the hemodynamic responses during induction and intubation between propofol and etomidate using entropy guided hypnosis. Material and Methods: Sixty ASA I & II patients in the age group 20-60 yrs, scheduled for modified radical mastectomy were randomly allocated in two groups based on induction agent Etomidate or Propofol. Both groups received intravenous midazolam 0.03 mg kg -1 and fentanyl 2 μg kg -1 as premedication. After induction with the desired agent titrated to entropy 40, vecuronium 0.1 mg kg -1 was administered for neuromuscular blockade. Heart rate, systolic, diastolic and mean arterial pressures, response entropy [RE] and state entropy [SE] were recorded at baseline, induction and upto three minutes post intubation. Data was subject to statistical analysis SPSS (version 12.0) the paired and the unpaired Student's T-tests for equality of means. Results: Etomidate provided hemodynamic stability without the requirement of any rescue drug in 96.6% patients whereas rescue drug ephedrine was required in 36.6% patients in propofol group. Reduced induction doses 0.15mg kg -1 for etomidate and 0.98 mg kg -1 for propofol, sufficed to give an adequate anaesthetic depth based on entropy. Conclusion: Etomidate provides more hemodynamic stability than propofol during induction and intubation. Reduced induction doses of etomidate and propofol titrated to entropy translated into increased hemodynamic stability for both drugs and sufficed to give an adequate anaesthetic depth.
  3,852 645 4
REVIEW ARTICLES
Interdisciplinary position statement on management of hyperglycemia in peri-operative and intensive care
Sukhminder Jit Singh Bajwa, Manash P Baruah, Sanjay Kalra, Mukul Chandra Kapoor
April-June 2015, 31(2):155-164
DOI:10.4103/0970-9185.155141  PMID:25948893
Hospitalized patients with diabetes pose numerous clinical challenges, including hyperglycemia, which may often be difficult to control. The therapeutic challenges are further accentuated by the difficulty in practical application of existing guidelines among Indian and South Asian patients. The present review highlights the various clinical challenges encountered during management of different diabetic hospitalized populations, and attempts to collate a set of practical, patient and physician friendly recommendations to manage hyperglycemia in such patients.
  3,385 756 1
EDITORIAL
Animal testing in the history of anesthesia: Now and then, some stories, some facts
Rakhee Goyal
April-June 2015, 31(2):149-151
DOI:10.4103/0970-9185.155139  PMID:25948891
  3,630 497 1
ORIGINAL ARTICLES
A comparison of continuous infusion and intermittent bolus administration of 0.1% ropivacaine with 0.0002% fentanyl for epidural labor analgesia
Chinmayi Surendra Patkar, Kalpana Vora, Harshal Patel, Veena Shah, Manisha Pranjal Modi, Geeta Parikh
April-June 2015, 31(2):234-238
DOI:10.4103/0970-9185.155155  PMID:25948908
Background and Aims: Minimal consumption of local anesthetic and opioid for epidural labor analgesia has been advocated for safe obstetric outcome and superior maternal satisfaction. The primary objective of this study was to evaluate and compare the analgesic efficacy of mode of administration of epidural 0.1% ropivacaine with 0.0002% fentanyl via continuous infusion or intermittent boluses during labor. Material and Methods: Sixty term primi or second gravida healthy parturients in labor requesting epidural analgesia were recruited in this study. Lumbar epidural catheter was inserted, and analgesia initiated with 0.2% ropivacaine. Patients were randomized to receive ropivacaine 0.1% with fentanyl 0.0002% via either continuous infusion (Group A) or intermittent boluses (Group B) on an hourly basis. If the parturient complained of pain and visual analog scale (VAS) score was >3, an additional bolus of the study drug was given. VAS score, motor blockade, maternal hemodynamics and fetal heart sounds were frequently monitored . Side effects, mode of delivery and neonatal outcome were noted. Results: To achieve similar VAS, the mean total dose of ropivacaine was 18.78 ± 3.88 mg in Group A and 16.86 ± 4.3 mg in Group B, the difference being statistically significant (P = 0.04). Seventeen out of 30 patients in Group A that is, 56.6% and nine patients in Group B that is, 30% required additional top-ups, and this was significantly higher (P = 0.037). Side effects, mode of delivery and neonatal outcome were comparable in both groups. Conclusion: Intermittent bolus administration provides a more efficacious route of drug delivery when compared to continuous infusion by significantly decreasing the total amount of local anesthetic plus opioid without adversely affecting patient safety or maternal satisfaction.
  3,484 607 9
Comparative evaluation of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in neurosurgical patients
Vinit Kumar Srivastava, Sanjay Agrawal, Sujeet Kumar Singh Gautam, Mukadder Ahmed, Sunil Sharma, Raj Kumar
April-June 2015, 31(2):186-190
DOI:10.4103/0970-9185.155146  PMID:25948898
Background and Aims: The present study compared the efficacy of esmolol and dexmedetomidine for attenuation of the sympathomimetic response to laryngoscopy and intubation in elective neurosurgical patients. Material and Methods: A total of 90 patients aged 20-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective neurosurgical procedures were included in this study. Patients were randomly allocated to three equal groups of 30 each comprising of Control group (group C) 20 ml 0.9% saline intravenous (IV), group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 20 ml IV and group esmolol (group E) 1.5 mg/kg diluted with 0.9% saline to 20 ml IV. All the drugs were infused over a period of 10 min and after 2 min induction of anesthesia done.Heart rate (HR), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded baseline, after study drug administration, after induction and 1, 2, 3, 5, 10, and 15 min after orotracheal intubation. Results: In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, whereas in group E, there was a statistical significant increase in blood pressure after intubation at 1, 2, and 3 min only and HR up to 5 min. Conclusion: Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective neurosurgical patients.
  2,924 746 4
Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section
Darshana Maheshwari, Samina Ismail
April-June 2015, 31(2):196-200
DOI:10.4103/0970-9185.155148  PMID:25948900
Background and Aims: We aimed to measure the frequency of preoperative anxiety in patients undergoing elective cesarean section (CS) and its impact on patients decision regarding the choice of anesthesia. Material and Methods: This cross-sectional study included 154 consecutive patients, who were scheduled for elective CS. Visual analog scale (VAS) for anxiety was the study tool, and VAS ≥50 was considered as significant anxiety. Enrolled patients were interviewed by the primary investigator the day before the surgery and their VAS score and choice of anesthesia technique either general anesthesia (GA) or regional anesthesia (RA) were recorded. Additional data included demographics, parity, educational status, previous anesthesia experience and source of information. Results: Preoperative anxiety (VAS ≥ 50) was seen in 72.7% of patients, which was significantly higher (P < 0.005) in patients selecting GA (97.18%, n = 71/154) as compared to those selecting RA (51.81%, n = 83/154) for elective CS. Statistically significant association of anxiety (P < 0.005) was seen with age <25 years, nulli and primiparous, higher education status, previous anesthesia experience and source of information from nonanesthetist. Conclusion: Patients scheduled for elective CS were found to have high frequency of anxiety (72.7%), and GA was observed to be the choice of anesthesia technique in anxious patients.
  2,973 561 5
Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway
Ashwini Halebid Ramaswamy, Safiya I Shaikh
April-June 2015, 31(2):217-220
DOI:10.4103/0970-9185.155152  PMID:25948904
Background and aims: Laryngeal mask airway (LMA) insertion requires anesthesia and suppression of airway reflexes. In search of an optimal drug, we compared dexmedetomidine and fentanyl, in combination with propofol for insertion of LMA. Material and Methods: This study was a prospective double blind randomized study. Eighty patients of ASA class 1&2 were randomly divided into two groups of 40 each. Group D received dexmedetomidine 1 mcg/kg and group F received fentanyl 1 mcg/kg intravenously (IV) over 2 minutes. For induction, propofol 2mg/kg was given IV and 90 seconds later LMA was inserted. We observed apnea time, heart rate, respiratory rate, non invasive blood pressure and oxygen saturation before induction, 30 seconds after induction, 1, 3, 5, 10 and 15 minutes after insertion of LMA. Patient's response to LMA insertion like coughing, gagging or any movement were noted and scored. Statistical analysis of data was done using student t test for parametric data, Chi-square test for non parametric data and SPSS 15.0 for windows software. Results: 37 (92.5%) patients of group D and 35 (87.5%) patients of group F had LMA insertion score of <2 and 5 (12.5%) patients of group F had score >2. Adverse events to insertion of LMA and hemodynamic variables were comparable in both the groups. Number of patients developing apnoea was larger and apnoea times were longer in group F compared to group D. When compared to group F, group D showed an increased respiratory rate. Conclusion: Dexmedetomidine can be a comparable alternative to fentanyl as an adjuvant to propofol for providing optimum insertion conditions for LMA and preservation of respiration.
  2,896 583 5
CASE REPORTS
Anesthetic management of post-burn contracture chest with microstomia: Regional nerve blocks to aid in intubation
Kalavala Lakshminarayana Subramanyam
April-June 2015, 31(2):250-252
DOI:10.4103/0970-9185.155160  PMID:25948913
This case report exemplifies the anesthetic technique of blocking bilateral infraorbital and mental nerves for release of contractures of mouth. A 30 year old female patient of post-acid burn contractures of chest wall and mouth was scheduled for contracture release and skin grafting. Airway assessment revealed severe restriction of mouth opening with limited restriction of neck movements. Contracture release of mouth conducted by blocking bilateral infraorbital and mental nerves, which facilitated intubation easily. This case report highlights the practical advantage of nerve blocks for release of contracture mouth, in case of anticipated difficult airway, over other conventional methods.
  2,914 443 -
ORIGINAL ARTICLES
Comparison of margin of safety following two different techniques of preoxygenation
Sunil Rajan, Prasanth Mohan, Jerry Paul, Abraham Cherian
April-June 2015, 31(2):165-168
DOI:10.4103/0970-9185.155142  PMID:25948894
Background and Aims: Shortening the duration of efficacious preoxygenation would provide benefit in emergency situations like fetal distress etc. This study aims to compare the margin of safety following preoxygenation using 8 vital capacity breaths (VCB) in 1 min and tidal volume breathing (TVB) for 3 min, by assessing changes in PaO 2 and apnea induced desaturation time. Material and Methods: Patients were randomly divided into Group A and B. In Group A, 3 min of TVB using O 2 flow of 5 l/min and in Group B, 8 VCB in 60 s using O 2 flow of 10 l/min were used. Anesthesia was induced in all patients with propofol followed by succinylcholine 2 mg/kg intravenously. Mask ventilation was not done and following intubation endotracheal tube was kept open to atmosphere. The time taken for the patients to desaturate to 90% was noted and immediately ventilation was resumed. Arterial blood gas samples were taken while patients were breathing room air, immediately after preoxygenation and at 90% desaturation. Results: Baseline PaO 2 of both the groups were comparable. After preoxygenation Group B had a significantly high PaO 2 value than Group A (439.05 ± 62.20 vs. 345.16 ± 20.80). At 90% desaturation there was no significant difference between groups. Group B showed a significantly high apnea induced desaturation time when compared to Group A (6.87 ± 1.78 vs. 3.47 ± 0.38 min). Conclusions: Preoxygenation by 8 VCB in 1 min provides a greater margin of safety, as it results in a significantly high PaO 2 with an almost doubled apnea induced desaturation time, in comparison with TVB for 3 min.
  2,557 706 3
A comparison of the Mallampati test in supine and upright positions with and without phonation in predicting difficult laryngoscopy and intubation: A prospective study
Zahid Hussain Khan, Shahram Eskandari, Mir Saeed Yekaninejad
April-June 2015, 31(2):207-211
DOI:10.4103/0970-9185.155150  PMID:25948902
Background and Aims: Difficult ventilation and intubation have been recognized as the forerunners of hypoxic brain damage during anesthesia. To overcome catastrophic events during anesthesia, an assessment of the airway before induction is of paramount importance. We designed this study to compare the effect of phonation on the Mallampati test in supine and upright positions as against the traditionally employed test without phonation in serving to predict difficult laryngoscopy and intubation. Material and Methods: In this cross-sectional study, 661 patients aged 16-60 years were recruited during the years 2011 to 2012. The Mallampati test was conducted on patients with and without phonation in both the sitting and supine positions. A blinded observer then performed laryngoscopy and intubation. Difficult intubation was assessed according to the Cormack-Lehane Grading scale.Statistical Analysis Used: Diagnostic statistical measures for each of the four situations - sensitivity, specificity, positive and negative predictive values and accuracy - were calculated. Results: In this study, 28 patients (4.2%) had difficult laryngoscopy and nine patients (1.4%) had difficult intubation. There was no difference in the sensitivity of the Mallampati test as regards prediction of laryngoscopy and intubation in the four different positions, but the upright position along with phonation had the highest specificity. The negative predictive value was above 95% in all the positions; however, the positive predictive value was the highest in the supine position along with phonation. Conclusion: Based on our results, the supine position along with phonation had the best correlation in the prediction of difficult laryngoscopy and intubation. We further conclude that phonation significantly improved the Mallampati class in the supine position compared with the upright position.
  2,564 536 6
Influence of hemodynamics and intra-operative hydration on biochemical outcome of renal transplant recipients
Navpreet Kaur Aulakh, Kamakshi Garg, Abhishek Bose, Baldev Singh Aulakh, Harmandeep Singh Chahal, Gurmehar Singh Aulakh
April-June 2015, 31(2):174-179
DOI:10.4103/0970-9185.155144  PMID:25948896
Background and Aims: Early graft function is crucial for successful kidney transplantation. The aim of our study was to evaluate the effect of intra-operative central venous pressure (CVP) and mean arterial pressure (MAP) on early graft function and biochemical outcome. Material and Methods: This was a retrospective study carried out on patients undergoing renal transplant only from live-related donors between March 2011 and May 2013. We mainly divided the patients into two groups based on CVP and mean MAP. One group had CVP more than 12 and other with CVP <12 mmHg at the time of declamping. Further one group was with mean MAP >100 mmHg and other with mean MAP of <100 mmHg. The graft outcome of genetically related and genetically unrelated donors was also evaluated in early postoperative period. The trend in fall of serum creatinine was studied during the first five post-operative days. The effect of age, dry weight, sex, relation with donor and intraoperative factors like MAP and CVP on early graft function were analysed. Correlation analysis, analysis of variance test (ANOVA) and multivariate analysis technique were used in this study for statistical computation. Results: The mean CVP at the time of declamping was 13.91 mmHg. The minimum CVP was 6 mmHg in one patient who had ischemic heart disease with low ejection fraction. All 5 days mean serum creatinine values were comparable in two groups on 1 st , 2 nd , 3 rd and 4 th postoperative days. The mean MAP at the time of declamping was 111.22 mmHg. Mean MAP varied from a minimum of 95 mmHg to maximum of 131 mmHg. There was no significant difference in two groups on 1 st , 2 nd , 3 rd , 4 th and 5 th postoperative days. Conclusion: A CVP around 12 mmHg and mean MAP >95 mmHg with good perioperative fluid hydration is associated with good early graft function.
  2,448 515 4
EDITORIAL
Chlorhexidine: Hypersensitivity and anaphylactic reactions in the perioperative setting
Eleni Moka, Eriphili Argyra, Ioanna Siafaka, Athina Vadalouca
April-June 2015, 31(2):145-148
DOI:10.4103/0970-9185.155138  PMID:25948890
  2,437 493 10
ORIGINAL ARTICLES
Comparison of Macintosh laryngoscope and C-MAC video laryngoscope for intubation in lateral position
Ravi Bhat, Channabasavaraj S Sanickop, Manjunath C Patil, Vijay S Umrani, Mallikarjun G Dhorigol
April-June 2015, 31(2):226-229
DOI:10.4103/0970-9185.155221  PMID:25948906
Background and Aims: Endotracheal intubation is conventionally performed when the patient is in supine position. It may be required to secure airway in laterally positioned patient. Tracheal intubation in lateral position seems to be difficult because the laryngeal view is compromised. Hence, C-MAC video laryngoscope (Karl Storz, Germany), a newer device using a modified macintosh blade may be useful for intubation in lateral position. Material and Methods: A total of 100 American Society of Anesthesiologists Grade I and II patients, randomly allotted to C-MAC or direct laryngoscopy group. Patients with difficult airway were excluded. After induction of anesthesia, patient was put in right-lateral position and intubation was carried out by consultant who is well-versed in using C-MAC laryngoscope. Time for intubation, number of attempts, Modified Cormack - Lehane grade, mucosal injury, and external laryngeal manipulation applied were noted. Statistical Analysis: Demographics and baseline airway assessments were analyzed using summary statistics. Unpaired t-test was used to assess intubation time. Number of attempts, esophageal intubation, dental injury, mucosal injury, use of stylet, and application of external laryngeal manipulation were analyzed using Chi-square test. Results: Overall intubation success rate was 100%. The time taken in C-MAC group was 24.8 ± 8.5 s and in direct group was 33.8 ± 9.12 s. The number of intubation attempts was not significant. Cormack - Lehane grade was better with C-MAC laryngoscope. Mucosal injury and use of external laryngeal manipulation was more in direct group. Conclusion: C-MAC is better than Macintosh laryngoscope for intubation in lateral position.
  2,353 450 5
The dexmedetomidine "augmented" sedato analgesic cocktail: An effective approach for sedation in prolonged endoscopic retrograde cholangio-pancreatography
Sandip Mukhopadhyay, Mausumi Niyogi, Joydip Sarkar, Basabdatta Samanta Mukhopadhyay, Swapan Kumar Halder
April-June 2015, 31(2):201-206
DOI:10.4103/0970-9185.155149  PMID:25948901
Background and Aims: In absence of any published standard guideline for sedation or anesthesia practice for prolonged therapeutic "endoscopic retrograde cholangio-pancreatography (ERCP)," safe and cost-effective sedation protocol is the need of the hour. Our study aims to evaluate the efficacy of a dexmedetomidine as an add-on for prolonged deep sedation for ERCP and to compare three deep sedation regimens regarding safety and efficacy. Material and Methods: Forty-five consecutively enrolled patients planned for therapeutic ERCP and assumed to have prolonged procedural duration (>50 min) were divided into three groups in a randomized assessor blinded fashion. Group 1 received propofol and midazolam, Group 2 received the sedato-analgesic cocktail containing ketamine-propofol-midazolam-pentazocine, and the Group 3 received sedate-analgesic cocktail plus dexmedetomidine infusion under monitoring of vital parameters and according to the judgment of the concerned anesthesiologist. Total propofol requirement, episodes of gagging, oxygen desaturation, changes in mean blood pressure (MBP), recovery and satisfaction score of endoscopist, anesthetist and patient were noted and analyzed statistically using one way ANOVA with Bonferroni correction and Chi-square test. Results: Mean propofol requirement, incidences of gagging and oxygen desaturation was significantly less in Group 2 and 3 compared to Group 1. MBP was more stable and recovery was faster in Group 3. Anesthetist's satisfaction was more with Group 2 and even more with Group 3. Conclusions: The sedato-analgesic cocktail was superior to the conventional propofol-midazolam regimen, dexmedetomidine as add-on increased the efficacy and safety of sedate-analgesic cocktail. It reduces propofol requirement, helps to maintain the patient in a safe and more stable level of sedation and increases satisfaction of the anesthetist.
  2,148 418 4
Role of flupirtine as a preemptive analgesic in patients undergoing laparoscopic cholecystectomy
Ghanshyam Yadav, Shailaja Shankar Behera, Saurabh Kumar Das, Gaurav Jain, Sujali Choupoo, Janak Raj
April-June 2015, 31(2):169-173
DOI:10.4103/0970-9185.155143  PMID:25948895
Background and Aims: Postsurgical pain is the leading complaint after laparoscopic cholecystectomy that may delay the postoperative recovery and hence we undertook a prospective randomized trial to analyze the role of flupirtine as a preemptive analgesic for postoperative pain relief in patients undergoing above surgery. Material and Methods: A total of 66 cases were randomly assigned to two groups to receive capsule flupirtine (200 mg) or capsule vitamin B complex administered orally, 2 h before the laparoscopic cholecystectomy surgery. Time to first analgesic requirement, assessment of postoperative pain in terms of visual analog score, and analgesic requirement postoperatively were measured as a primary outcome. Results: Time to first analgesic requirement was significantly prolonged in the flupirtine group as compared with the placebo group. There was significant pain reduction in early postoperative period (up to 4 h), but no changes occurred thereafter. Total analgesic requirement (including rescue analgesia) and side-effects were comparable between the groups except for higher sedation in flupirtine group. Conclusions: Flupirtine is effective as a preemptive analgesic in providing adequate pain relief during the immediate postoperative period after laparoscopic cholecystectomy surgery. However, continuation of drug therapy postoperatively could possibly delineate its optimal analgesic profile more profoundly.
  2,162 375 1
LETTERS TO EDITOR
Anesthetic management of a patient with Wilms tumor, aniridia, genital anomalies and mental retardation syndrome undergoing right nephrectomy
Akshaya N Shetti, Vithal K Dhulkhed, ­Amrish D Gujrathi, Swetha G Sangolli
April-June 2015, 31(2):280-281
DOI:10.4103/0970-9185.155216  PMID:25948930
  2,187 266 -
CASE REPORTS
Spinal subdural hematoma with cauda equina syndrome: A complication of combined spinal epidural anesthesia
Neha Singhal, Priyanka Sethi, Jitesh Kumar Jain, Saurabh Agarwal
April-June 2015, 31(2):244-245
DOI:10.4103/0970-9185.155158  PMID:25948911
Combined spinal-epidural anesthesia (CSE) is considered safe in lower limb surgeries. We report a case of sudden neurological deterioration in a stable postoperative patient who was given CSE for total knee replacement and low molecular weight heparin in postoperative period. On the 4 th postoperative day, she developed sudden onset weakness in left lower limb along with bladder incontinence. Magnetic resonance imaging spine revealed a subdural hematoma at L2-L3 level. Immediate laminectomy along with cord decompression was done and patient recovered well except for a persistent foot drop on left side.
  1,897 491 6
ORIGINAL ARTICLES
Comparative study of systemically and perineurally administered tramadol as an adjunct for supraclavicular brachial plexus block
Vishal Nagpal, Shelly Rana, Jai Singh, Sudarshan Kumar Chaudhary
April-June 2015, 31(2):191-195
DOI:10.4103/0970-9185.155147  PMID:25948899
Background and Aims: The study was designed to compare the effects of tramadol administered as an adjunct to bupivacaine in supraclavicular block to that of systemic administration, on postoperative analgesia and rescue analgesic requirement following upper limb surgeries. Material and Methods: A prospective, randomized, controlled, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular block. All the three group patients received either of the following drugs mixtures: Group A - bupivacaine 0.5%-18 ml + normal saline-7 ml for block and normal saline-10 ml intravenously. Group B - bupivacaine 0.5%-18 ml + normal saline-7 ml mixture for block and tramadol (100 mg) diluted to10 ml - intravenously. Group C - bupivacaine 0.5%-18 ml + tramadol (100 mg) + normal saline-5 ml mixture and normal saline 10 ml intravenously. The patients were observed for sensory, motor onset along with the duration of sensory and motor block. Patients were monitored for sedation and hemodynamic parameters during intra-operative and postoperative period. Pain-free period and demand for rescue analgesia was noted in all the patients. Results: The study demonstrates that the mixture of tramadol and bupivacaine injected perineurally for supraclavicular brachial plexus block hastens the onset of sensory block, motor block and provides a longer duration of motor blockade and demand for rescue analgesia as compared to other two groups. Conclusions: In conclusion, the addition of tramadol to bupivacaine mixtures as an adjunct for supraclavicular brachial plexus block provide better postoperative analgesia for orthopedic upper extremity surgery in comparison to control or systemic tramadol group without any side effects.
  1,903 451 2
LETTERS TO EDITOR
Inadvertent pneumothorax caused by intubating bougie
Kanil Ranjith Kumar, Ravinder Kumar Batra, Ritma Dhir, Suresh Chandra Sharma
April-June 2015, 31(2):271-272
DOI:10.4103/0970-9185.155209  PMID:25948923
  2,087 211 1
Acute intermittent porphyria
Kartik Syal, Rashmi Bhatt, Surinder Singh, Anil Ohri
April-June 2015, 31(2):261-263
DOI:10.4103/0970-9185.155204  PMID:25948918
  1,945 252 -
Pregabalin for refractory postdural puncture headache
Anamika Yadav, Aparna S Chatterjee, Raghuveersingh Pritamsingh Gehdoo
April-June 2015, 31(2):258-260
DOI:10.4103/0970-9185.155163  PMID:25948916
  1,756 276 -
CASE REPORTS
Congenital hemihyperplasia with hemipigmentation: A rare presentation
Major Vishal Arora, Major Sanjay Choubey, Mridusmita Saikia, Shivani Fotedar
April-June 2015, 31(2):253-255
DOI:10.4103/0970-9185.155161  PMID:25948914
Hemihyperplasia is a heterogenous group of disorders characterized by asymmetric limb growth. Confusion regarding their classification and ascertainment into various syndromes still exists. Subtle, asymmetric variation of the unilateral structures of the head, face, trunk or extremities may occur in the general population in the absence of any local lesion or condition.
  1,807 171 -
LETTERS TO EDITOR
Surgical partial removal of papillomatosis for endotracheal intubation as an alternative to tracheostomy for an "almost completely" occluded airway
Yiru Tong, Xiying Zhang, Zhen Du, Ting Xiao, Yun Li, Henry Liu
April-June 2015, 31(2):285-287
DOI:10.4103/0970-9185.155220  PMID:25948934
  1,751 160 -
Internal jugular vein thrombosis: a complication of temporary hemodialysis catheter
Bina P Butala, Veena R Shah, Bhavesh Solanki, Jasmita Kalo
April-June 2015, 31(2):276-278
DOI:10.4103/0970-9185.155213  PMID:25948927
  1,693 193 1
Truview PCD-video laryngoscope aided nasotracheal intubation in case series of orofacial malignancy with limited mouth opening
Archita Rajaram Patil, Kalpana Rajendra Kulkarni, Rajaram Shankar Patil, Samrat Sukumar Madanaik
April-June 2015, 31(2):256-258
DOI:10.4103/0970-9185.155162  PMID:25948915
  1,671 202 1
FORUM
Nasotracheal intubation with MacGrath videolaryngoscope using Schroeder directional stylet: Case series
Bikramjit Das, Syed Moied Ahmed, Nadeem Raza
April-June 2015, 31(2):239-241
DOI:10.4103/0970-9185.155156  PMID:25948909
Background and Aims: MacGrath videolaryngoscope is one of the recent videolaryngoscopes, which can be used to facilitate nasotracheal intubations using Scroeder directional stylet. Material and Methods: 15 patients, American Society of Anesthesiologists Grades I-II, undergoing tonsillectomy, requiring nasotracheal intubation were included. All patients were intubated with MacGrath videolaryngoscope and Schroeder stylet. Primary outcome measures were duration and ease of intubation. Overall success rate, number of attempts, modified Cormack-Lehane (C-L) grading, and complications were also recorded. Results: All 15 intubations were successful during first laryngoscopy attempt. C-L Grade I views were obtained in 14 patients (93%) and Grade II view in one patient (7%). The time required to obtain the best C-L view was 9.4 ± 1.5 s. The time taken to complete tracheal intubation was 34.27 ± 3.38 s. Average numerical rating scale for tracheal intubation was 8.7 ± 0.9. Minor complications occurred in four patients (26.7%). Conclusions: MacGrath videolaryngoscope produces excellent laryngoscopic views in patients with normal airways. Impaction of tracheal tube on posterior nasopharyngeal wall can be overcome by Schroeder stylet.
  1,648 216 -
ORIGINAL ARTICLES
Efficacy of contrasting background on a drug label: A prospective, randomized study
Babita Gupta, Surender Kumar Gupta, Saurabh Suri, Kamran Farooque, Naveen Yadav, Mahesh Misra
April-June 2015, 31(2):230-233
DOI:10.4103/0970-9185.155154  PMID:25948907
Background and Aims: Medication error can occur due to fault at any level starting from manufacturing until the administration to the patient. It can be difficult to read the drug name and other information from an ampoule, if there is poor contrast between the font color and background of the ampoule. Primary aim of this study was to evaluate the efficacy of the contrast color on the ampoule's label. Material and Methods: The study was conducted in a randomized blinded manner at a tertiary level trauma center. One hundred and eight resident doctors participated in the study. All the participants were divided into two groups after randomization. Group A was given the original drug ampoule while the modified ampoule with contrast was given to Group B. Total time in reading the ampoule and difficulty in reading (DR) scoring were noted for each participant. Another scoring regarding correct reading of ampoule was also noted and compared. Statistical Analysis: Student's t-test and Mann-Whitney test were used accordingly and P < 0.05 was considered as significant. Results: It was found that mean time taken in reading the original ampoule was more compared to modified ampoule (11.64 ± 1.48 vs. 9.48 ± 1.62 seconds P < 0.05). DR score was also higher in Group A (P < 0.05) and correct reading score was more in Group B (P < 0.05). Conclusion: The labels on drug ampoules or vials should always have a contrasting background. This may reduce medication error and improve patient safety.
  1,638 211 1
LETTERS TO EDITOR
Airway management of a huge thyroid swelling with retrosternal extension by awake intubation using loco-sedative technique
Garima G Ladha, Nidhi D Patel, Neeta Kavishvar
April-June 2015, 31(2):272-274
DOI:10.4103/0970-9185.155210  PMID:25948924
  1,593 230 -
CASE REPORTS
Complex pseudoaneurysm of ascending aorta: Unusual cause of right heart dysfunction-implications to the anesthesiologist
Prachi Kar, Ramachandran Gopinath, Durga Padmaja, RV Kumar
April-June 2015, 31(2):246-249
DOI:10.4103/0970-9185.155159  PMID:25948912
Pseudoaneurysm of ascending aorta (PAA) is a rare complication occurring after cardiac surgery. Because of rarity of the condition, most standard teaching and anesthetic literature do not highlight on these postoperative aortic complications. Right heart dysfunction associated with PAA is scarcely reported. We describe here two cases of PAA with right heart involvement and discuss the possible anesthetic challenges.
  1,643 175 -
LETTERS TO EDITOR
Recurrent laryngeal nerve palsy following interscalene brachial plexus block: How to manage and avoid permanent sequelae?
Seema Thukral, Priyanka Gupta, Mayank Gupta, Archana Lakra
April-June 2015, 31(2):282-283
DOI:10.4103/0970-9185.155217  PMID:25948931
  1,444 229 2
Hyperventilation syndrome after general anesthesia
Shigemasa Tomioka, Nami Enomoto, Yukihiro Momota
April-June 2015, 31(2):284-285
DOI:10.4103/0970-9185.155219  PMID:25948933
  1,430 232 1
A rare case of postpoliomyelitis quadriparetic patient with severe kyphoscoliosis
Vanita Ahuja, Satinder Gombar, Deepak Singla
April-June 2015, 31(2):266-268
DOI:10.4103/0970-9185.155206  PMID:25948920
  1,476 183 -
Noninvasive ventilation in a patient with noncardiogenic pulmonary edema following amlodipine poisoning
Kishan Shetty, Lulu Sherif, Rakesh Babu, Girish Bhatt
April-June 2015, 31(2):264-266
DOI:10.4103/0970-9185.155205  PMID:25948919
  1,437 217 1
A rare and deceptive venous anomaly, sinus pericranii
Mohammed Meesam Rizvi, Raj Bahadur Singh, Arindam Sarkar, Sanjay Choubey
April-June 2015, 31(2):279-280
DOI:10.4103/0970-9185.155215  PMID:25948929
  1,411 243 2
COMMENTARY
Finding the way into the burnt airway!
Anuradha Borle, Preet Mohinder Singh
April-June 2015, 31(2):242-243
DOI:10.4103/0970-9185.155157  PMID:25948910
  1,412 205 -
LETTERS TO EDITOR
Circuit leak with D-vapor
Jeetinder Kaur Makkar, Kajal Jain, Amit Jain
April-June 2015, 31(2):260-261
DOI:10.4103/0970-9185.155164  PMID:25948917
  1,403 143 -
Benign intracranial hypotension: A new indication for epidural blood patch
Muhammad Yasir, Naveed Latif, Naveeda Zakaria, Gauhar Afshan
April-June 2015, 31(2):283-284
DOI:10.4103/0970-9185.155218  PMID:25948932
  1,322 189 -
Is visualization of dilator also important in central venous cannulation?
Kavitha Jayaram, Srilata Moningi, Dilip Kumar Kulkarni, R Gopinath
April-June 2015, 31(2):278-279
DOI:10.4103/0970-9185.155214  PMID:25948928
  1,259 230 -
Alternatives to GlideRite ® for flexometallic endotracheal tube insertion with GlideScope ®
Tony Thomson Chandy, Georgene Singh
April-June 2015, 31(2):274-275
DOI:10.4103/0970-9185.155211  PMID:25948925
  1,339 132 -
Trachlight-guided intubation in small infant with difficult airway
Sameer Sethi, Chitta Ranjan Mohanty
April-June 2015, 31(2):275-276
DOI:10.4103/0970-9185.155212  PMID:25948926
  1,320 151 -
Simulation based learning: Indian perspective
Tejinder Singh Swaran Singh
April-June 2015, 31(2):268-269
DOI:10.4103/0970-9185.155207  PMID:25948921
  1,239 153 -
Simulation for "Evaluation" and teaching "Standard operating procedures"
Pankaj Kundra, Anusha Cherian
April-June 2015, 31(2):270-271
DOI:10.4103/0970-9185.155208  PMID:25948922
  1,225 163 -
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