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   2012| April-June  | Volume 28 | Issue 2  
    Online since April 11, 2012

 
 
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REVIEW ARTICLES
Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1)
Santosh Patel, Jan M Lutz, Umakanth Panchagnula, Sujesh Bansal
April-June 2012, 28(2):162-171
DOI:10.4103/0970-9185.94831  PMID:22557737
Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.
  50,788 6,158 6
CASE REPORTS
Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass
Kapil Chaudhary, Anshu Gupta, Sonia Wadhawan, Divya Jain, Poonam Bhadoria
April-June 2012, 28(2):242-246
DOI:10.4103/0970-9185.94910  PMID:22557753
Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.
  15,953 1,869 9
CLINICAL PHARMACOLOGY
Flupirtine : Clinical pharmacology
S Harish, K Bhuvana, Girish M Bengalorkar, TN Kumar
April-June 2012, 28(2):172-177
DOI:10.4103/0970-9185.94833  PMID:22557738
Flupirtine is neither an opioid nor a non steroidal anti-inflammatory drug (NSAID) producing its analgesic action through blockade of glutamate N-methyl-D-aspartate receptor. It is devoid of adverse effects of routinely used analgesic drugs, but is equally efficacious in reducing pain sensation. It has a distinctive mechanism of action, exerting a dual therapeutic effect with both analgesic and muscle relaxant properties that has utility in the treatment of pain, including that associated with muscle tension.
  13,063 1,849 37
CASE REPORTS
Tracheal granulation as a cause of unrecognized airway narrowing
Gaurav Bhatia, Valsamma Abraham, Linjo Louis
April-June 2012, 28(2):235-238
DOI:10.4103/0970-9185.94907  PMID:22557751
Tracheostomy is one of the most common elective surgical procedures performed in critically ill patients. The most frequent late complication after tracheostomy is the development of granulation tissue, a complication that may cause airway occlusion or result in airway stenosis. We report the successful management of a patient with tracheal granulation presenting as an unrecognised cause of difficulty breathing.
  8,572 529 6
ORIGINAL ARTICLES
A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain
Hitesh Mishra, Farhan Ahmad Khan
April-June 2012, 28(2):221-225
DOI:10.4103/0970-9185.94892  PMID:22557747
Objective : To compare the analgesic efficacy and safety of single-dose oral ketorolac and tramadol administered pre and postoperatively for dental extraction pain. Materials and Methods: 74 patients undergoing third molar extraction (impacted or other causes) were recruited into the study, over a period of 1 year. The patients were divided into six groups and they were given ketorolac (20 mg), tramadol (100 mg), or placebo either preoperatively or postoperatively (half an hour before or half an hour after the procedure). Placebo was glucose powder filled in empty capsule. Pain assessment was done using a modified Verbal Rating Scale (VRS) at 30 min, 2, 4, and 6 h after the procedure. A record of whether rescue analgesic (ibuprofen 400 mg) was taken during the 6 h study period, along with the time it was taken, was made. Record of any adverse effects experienced by the patient was also kept. Maximum pain scores for each of the six study groups, over the 6 h study period, were noted. Results: Ketorolac and tramadol were significantly better than placebo in relieving molar tooth extraction pain. Postoperative administration of tramadol was found to be more efficacious than preoperative administration in relieving the pain, whereas the preoperative administration of ketorolac was better than its postoperative administration. Conclusion: This study demonstrated that tramadol is equally effective to ketorolac in relieving pain in the first 6 h after molar extraction and therefore can be tried in patients who are intolerant to nonsteroidal anti-inflammatory drugs.
  5,320 899 10
Pain during venous cannulation: Double-blind, randomized clinical trial of analgesic effect between topical amethocaine and eutectic mixture of local anesthetic
CN Yeoh, CY Lee
April-June 2012, 28(2):205-209
DOI:10.4103/0970-9185.94869  PMID:22557744
Background : Venous cannulation is often a painful procedure for the patient. Eutectic mixture of local anesthetic (EMLA) is the commonest topical analgesic used but suffers from disadvantages such as slow onset and skin blanching, which may interfere with venous cannulation. Amethocaine is a newer topical analgesic which seems to be devoid of such problems. Materials and Methods: This prospective randomized double-blind study compared the analgesic efficacy of EMLA with amethocaine during venous cannulation in adults. Eighty ASA I-II patients, aged 18-65 years, were recruited. The test drug was applied on the designated site of venous cannulation and covered with an occlusive dressing for at least 60 min prior to the procedure. Data collected included visual analogue score (VAS) during first attempt at venous cannulation, the ease and success rate at cannulation, and cutaneous changes at the application site. Results: Mean and median VAS for the EMLA group were 27.9 ± 9.8 and 30 mm, respectively; while for the Amethocaine group were 19.1 ± 14.1 and 20 mm, respectively. Differences in VAS did not reach statistical significance. No statistically significant differences were observed in the ease and success rate at cannulation. Cutaneous changes in the form of local induration and erythema (three patients in the Amethocaine group) and blanching (eight patients in the EMLA group) were mild, localized, and required no further treatment. No patient developed severe allergic reactions. Conclusion: Topical EMLA and amethocaine were comparable in terms of analgesic efficacy and ease of venous cannulation in adult patients.
  4,615 615 7
CASE REPORTS
An alternative treatment in hypertriglyceridemia-induced acute pancreatitis in pregnancy: Plasmapheresis
Dilek Altun, Gulay Eren, Zafer Cukurova, Oya HergŁnsel, Levent Yasar
April-June 2012, 28(2):252-254
DOI:10.4103/0970-9185.94913  PMID:22557756
Hormonal influences during pregnancy can compromise otherwise controlled lipid levels in women with familial hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity in both mother and fetus. Both cholesterol and triglyceride levels in serum increase progressively during pregnancy. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications. Experiences with plasmapheresis are limited. We report two cases of hypertriglyceridemia-induced acute pancreatitis during pregnancy, which were successfully treated by plasmapheresis.
  4,080 682 21
ORIGINAL ARTICLES
Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache
Md Rabiul Alam, Md Aminur Rahman, Reza Ershad
April-June 2012, 28(2):190-193
DOI:10.4103/0970-9185.94840  PMID:22557741
Objective: Headache is not an uncommon complication of spinal anesthesia. The efficacy of intravenous (IV) hydrocortisone in treating the patients with postdural puncture headache was observed in this study. Materials and Methods: Sixty patients with headache following spinal anesthesia were randomly allocated into two groups. Thirty patients received only conventional therapy (recumbent positioning, IV or oral hydration, analgesics with caffeine, stool softeners, and soft diet) plus 2 ml of normal saline IV (placebo) 8 hourly for 48 h. Thirty other patients received conventional therapy plus hydrocortisone IV (100 mg in 2 ml 8 hourly for 48 h). Headache intensity was measured using visual analogue scale. Results: No significant difference was observed in baseline headache intensity between the two groups (P = 0.6642) before beginning of treatment. After 6 h, the mean headache intensity in patients treated conventionally was 6.02 ± 2.46, while it was 2.06 ± 1.98 in other patients who received additional hydrocortisone IV (P < 0.0001). After 24 h, headache intensity was 3.77 ± 1.85 in conventionally treated group versus 0.94 ± 2.67 in hydrocortisone group (P < 0.0001), while it was 1.95 ± 1.12 in conventionally treated group versus 0.69 ± 1.64 in hydrocortisone group (P = 0.001) after 48 h. Conclusions: Very short-term use of IV hydrocortisone was found effective in reducing headache following spinal anesthesia. However, its clear mechanism of action is yet to be determined. Large-scale studies are recommended to consider the steroid therapy as a standard treatment for postdural puncture headache.
  3,950 783 15
REVIEW ARTICLES
Anesthesia for bone replacement surgery
Sunil Singh, Shri Prakash Singh, Jitendra K Agarwal
April-June 2012, 28(2):154-161
DOI:10.4103/0970-9185.94827  PMID:22557736
Advances in clinical medicine, improved understanding of pathophysiology, and the extensive application of medical technology have projected hitherto high risk and poor outcome surgical procedures into the category of routine and relatively good outcome surgeries. Bone replacement surgery is one amongst these and is wrought with a multitude of perioperative complexities. An understanding of these goes a long way in assisting in the final outcome for the patient. Here we present a review of the literature covering various issues involved during the different stages of the perioperative period.
  3,675 755 -
ORIGINAL ARTICLES
Efficacy of clonidine as an adjuvant to ropivacaine for caudal analgesia in children undergoing subumbilical surgery
Akilandeswari Manickam, Mahesh Vakamudi, Aruna Parameswari, Chetana Chetan
April-June 2012, 28(2):185-189
DOI:10.4103/0970-9185.94839  PMID:22557740
Context: The use of clonidine as an adjuvant to ropivacaine in different concentrations through the caudal space has been shown to improve the analgesic efficacy of local anesthetics. Aims: The purpose of our study was to compare the efficacy of ropivacaine 0.1% with clonidine 1 mcg/kg to that of plain 0.1% and 0.2% ropivacaine for caudal analgesia in children. Settings and Design: Prospective, double blind, randomized controlled trial. Materials and Methods: Sixty children in the age group of 1-6 years undergoing subumbilical surgeries were included in the study. Group A received 1 ml/kg of 0.1% ropivacaine, group B received 1 ml/kg of 0.1% ropivacaine with clonidine 1 mcg/kg, and group C received 1 ml/kg of 0.2% ropivacaine. Results: The mean duration of analgesia was 243.7 ± 99.29 min in group A, 590.25 ± 83.93 min in group B, and 388.25 ± 82.35 min in group C. The duration of analgesia was significantly prolonged in group B compared to groups A and C with the P value of 0.001. At 8 h, all the 20 children in group A had received the first rescue analgesic compared to 18 children in group C and 3 children in group B. The duration of motor blockade after extubation was 30.6 ± 7.8 min and was noted only in group C. Only 1 child in group B received two rescue medications compared to 15 (75%) children in group A and 8 (40%) children in group C. None of the groups were treated for bradycardia or hypotension and no significant sedation was noted. Conclusions: Clonidine 1 mcg/kg with ropivacaine 0.1% prolongs the duration and quality of analgesia compared to plain ropivacaine 0.1% and 0.2% without any significant sedation.
  3,749 641 4
LETTERS TO EDITOR
Undetected hypothyroidism and unexpected anesthetic complications
P Sudha, Rachel Cherian Koshy, Viji S Pillai
April-June 2012, 28(2):276-277
DOI:10.4103/0970-9185.94932  PMID:22557772
  3,377 496 1
ORIGINAL ARTICLES
Induction for classic laryngeal mask airway insertion: Does low-dose fentanyl work?
Akanksha Dutt, Anjum Khan Joad, Mamta Sharma
April-June 2012, 28(2):210-213
DOI:10.4103/0970-9185.94877  PMID:22557745
Background : Laryngeal mask airway (LMA) insertion requires an optimal balance of anesthesia. Propofol with different opioids is a preferred combination. Two doses of fentanyl were compared for the efficacy and side effects. Materials and Methods: 96 patients were randomly distributed into F 1 (fentanyl 1 mcg/kg) and F 2 (fentanyl 2 mcg/kg) groups. The conditions for LMA insertion, hemodynamic profile, bronchoscopic view, and incidence of sore throat were compared. Result: There was no statistically significant difference in any parameter in the two groups except for a significant fall in systolic and mean arterial pressure in F 2 group. Conclusion: Both doses of fentanyl (1 and 2 mcg/kg) provide comparable insertion conditions for LMA. Fentanyl in the lower dose provides a more stable hemodynamic profile.
  3,364 504 3
CASE REPORTS
An unanticipated difficult airway in Lesch-Nyhan syndrome
Rashmi Salhotra, Chhavi Sharma, Asha Tyagi, Surendra Kumar, AK Sethi, Shuchi Bhatt
April-June 2012, 28(2):239-241
DOI:10.4103/0970-9185.94909  PMID:22557752
An 11-year-old boy with Lesch-Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.
  3,454 373 3
Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?
Souvik Chaudhuri, MD Gopalkrishna, Cherish Paul, Ratul Kundu
April-June 2012, 28(2):249-251
DOI:10.4103/0970-9185.94912  PMID:22557755
Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.
  3,355 393 2
ORIGINAL ARTICLES
Complications of three deep sedation methods for magnetic resonance imaging
Solina Tith, Kirk Lalwani, Rongwei Fu
April-June 2012, 28(2):178-184
DOI:10.4103/0970-9185.94837  PMID:22557739
Background : Propofol and pentobarbital are commonly used to sedate children undergoing magnetic resonance imaging (MRI). Aim/Objective: To compare the safety of three types of sedation: intravenous propofol (PROP), mixed pentobarbital/propofol (PENT), and mixed pentobarbital group requiring supplemental sedation (PENT SUPP) regimens in pediatric patients following deep sedation (DS) for noncardiac MRI. Materials and Methods: We conducted a case-control study matching 619 cases with complications with 619 controls using data from our institution's sedation database for children deeply sedated for noncardiac MRI. Cases were defined as patients with any complication and we characterized complications from cases, and used a conditional logistic regression model to assess the association between three DS methods and occurrence of complications after adjusting for confounding variables. Results: We found that complications occurred in association with 794 (10.1%) of the 7,839 DSs performed for MRI between 1998 and 2008. Of the 794 cases, 619 cases met inclusion criteria for the study. Among the 619 cases that met inclusion criteria, 24 (0.3% of 7,839 DSs total) were associated with major complications. Type of sedation was significantly associated with the occurrence of complications, and the PENT group was associated with decreased odds of complications when compared to the PROP regimen (OR 0.68; 95% CI 0.46, 0.98; P=0.040) and compared to the PENT SUPP group (OR 0.60; 95% CI 0.31, 0.89; P<0.0001). Conclusions: DS with a pentobarbital technique was associated with decreased odds for complications when compared to a propofol-based technique or a pentobarbital technique requiring supplemental sedation.
  3,126 516 3
CASE REPORTS
Perioperative concerns in transoral robotic surgery: Initial experience of four cases
Suryakumar Narayanasamy, Puneet Khanna, AP Bhalla, Anil Kumar Singh
April-June 2012, 28(2):226-229
DOI:10.4103/0970-9185.94895  PMID:22557748
US Food and Drug Administration has recently approved transoral robotic surgery for the treatment of some benign tumors and selected malignant tumors of the head and neck. Robotically-assistance in ear, nose and throat surgery is established and will play an increasingly large role in the future of surgical practice. Anesthesiologists need to modify their management and familiarize themselves with the upcoming robotic procedures to ensure better patient outcomes and improve patient safety.
  2,776 463 2
ORIGINAL ARTICLES
Toxicity of topical lidocaine applied to the breasts to reduce discomfort during screening mammography
Colleen K Lambertz, Christopher J Johnson, Paul G Montgomery, James R Maxwell, Stefanie J Fry
April-June 2012, 28(2):200-204
DOI:10.4103/0970-9185.94859  PMID:22557743
Background : We measured the effect of 30 milliliters (mL) of 4% lidocaine gel on the breasts and chest wall of healthy women covered for 1 h on plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide (MEGX), electrocardiogram (EKG) results, and adverse events. Materials and Methods: This institutional review board-approved, prospective, open-label study complied with the Health Insurance Portability and Accountability Act (HIPAA). The study evaluated 10 healthy women aged 42-75 years with 30 mL of 4% lidocaine gel on the skin of the breasts and chest wall covered for 1 h. Cardiac and neurological assessments were performed and blood was drawn for lidocaine and MEGX levels at baseline and 1/2, 1, 2, 3, 4, 6, and 8 h after application. EKGs were performed before application and at 3 h. Subjects provided informed written consent. Primary and secondary outcomes were plasma concentrations of lidocaine and MEGX and frequency of adverse events, respectively. Statistical analysis included paired t-tests for EKGs and repeated measures regression for vital signs. Results: No lidocaine was detected in the blood of 9 of 10 subjects. One subject had low plasma concentrations of lidocaine just above the level of detection the first 4 h after application only. No MEGX was detected. Mean decrease in heart rate was likely multifactorial. Conclusion: Thirty mL of 4% lidocaine gel on the breasts and chest wall covered for 1 h in healthy women resulted in plasma concentrations of lidocaine and MEGX well below therapeutic or toxic levels and no clinically significant adverse events.
  2,756 379 4
A simple thermal pain model for the evaluation of analgesic activity in healthy subjects
Sunil Kumar Reddy Khambam, MUR Naidu, P Usha Rani, T Ramesh Kumar Rao
April-June 2012, 28(2):214-220
DOI:10.4103/0970-9185.94887  PMID:22557746
Objective : Assessment of the analgesic effect of an agent in an experimental pain model permits a level of control not possible in a clinical pain setting and is an ideal approach for evaluation of analgesic drugs. The aim of the present study was to establish a simple and reliable method of producing experimental pain, which can be used for screening of various analgesic agents. Materials and Methods: The standardized method was followed in all cases, by recording thermal pain threshold in seconds in 24 healthy volunteers using hot air source at two different speeds, which is equipped in an acrylic-made chamber adjustable to three different levels. Reproducibility of the test procedure was evaluated by recording the thermal threshold parameter by a single observer on two sessions (interday reproducibility) and second observer on one session (interobserver reproducibility) separately. Validity of model was further tested by evaluating the analgesic effect of tramadol on 12 healthy volunteers. Results: Thermal pain model was found to produce low variability with coefficient of variation (CV) less than 10%. Interobserver and interday reproducibility were very good, as shown by Bland-Altman plot, with most of the values within ± 2SD. There was a significant increase in pain threshold time with use of tramadol as compared to placebo which was statistically significant (P < 0.05). Conclusion: The newly developed pain model offers a stable and sensitive method for the early assessment of analgesic activity.
  2,615 367 2
EDITORIALS
Airway management devices for general anesthesia for magnetic resonance imaging
Kirti N Saxena
April-June 2012, 28(2):153-153
DOI:10.4103/0970-9185.94823  PMID:22557735
  2,138 776 2
LETTERS TO EDITOR
Sciaticofemoral nerve block for varicose vein surgery in the patient with eventration of diaphragm, dextroposition of the heart and bicuspid aortic valve
Shivakumar Shivanna, CA Tejesh, AC Manjunath, K Sandhya
April-June 2012, 28(2):277-279
DOI:10.4103/0970-9185.94933  PMID:22557773
  2,501 326 -
Pulmonary artery hypertension in mitral stenosis: Role of right ventricular stroke volume, atrio-ventricular compliance, and pulmonary venous compliance
Praveen Kumar Neema, Ramesh Chandra Rathod
April-June 2012, 28(2):261-262
DOI:10.4103/0970-9185.94916  PMID:22557759
  2,291 447 5
CASE REPORTS
Anesthetic management of a child with Hunter's syndrome
Jasmeet Kaur, Adarsh C Swami, Amit Kumar, Sneh Lata
April-June 2012, 28(2):255-257
DOI:10.4103/0970-9185.94914  PMID:22557757
Hunter's syndrome is a member of a group of recessively inherited metabolic disorders termed mucopolysaccharidoses, caused by deficiency of lysosomal enzymes required for degradation of mucopolysaccharides or glycosaminoglycans, leading to accumulation of partially degraded glycosaminoglycans in various tissues. This leads to various anatomical abnormalities and systemic involvement, posing a challenge to an anesthetist. We present the anesthetic management of a 4-year old child with Hunter's disease with anticipated difficult airway, who presented for adenotonsillectomy and repair of umbilical and inguinal hernia.
  2,261 448 4
ORIGINAL ARTICLES
The influence of initial target effect-site concentrations of propofol on the similarity of effect-sites concentrations at loss and return of consciousness in elderly female patients with the Diprifusor system
Satoshi Shibuta, Seitetsu Kanemura, Osamu Uchida, Takashi Mashimo
April-June 2012, 28(2):194-199
DOI:10.4103/0970-9185.94851  PMID:22557742
Background : Whether effect-site concentrations of propofol (Cep) at loss of consciousness and return of consciousness (LOC and ROC, respectively) in elderly women using Diprifusor are similar is unclear. We investigated whether differences in initial target Cep (Ctarget) alter similarities between Cep values at LOC and ROC. Materials and Methods: In this study, female patients (n = 58, age = 72.5 ± 1.1 years) undergoing knee arthroplasty were administered propofol with Diprifusor. Cep at LOC and ROC were estimated for different Ctarget values (3.0-4.5 mg/ml). Pearson's correlation coefficient analysis and simple regression were performed to assess the relationship between Cep at LOC and ROC for each Ctarget. Differences in correlation coefficients of regression lines obtained from each Ctarget group were determined using the t-test. Results: The different Ctarget groups did not show significant differences in total propofol levels and in Cep values at LOC or ROC. However, Cep at ROC was significantly higher than Cep at LOC when Ctarget was 4.0 and 4.5 μg/ml, whereas these Cep values were not significantly different in low Ctarget groups. Strong positive correlations were observed between Cep at LOC and ROC for all Ctarget groups. Regression coefficients for the different Ctarget groups were not significantly different. Compared to low (≤3.5 μg/ml) Ctarget groups, high Ctarget groups showed significantly shorter time until LOC. Induction quality was not significantly different among the groups. Conclusions: In elderly women, Cep values at LOC are strong predictors of Cep at ROC when Ctarget is 3.0-4.5 μg/ml. High Ctarget groups (≥4.0 μg/ml) exhibited shorter induction times with normal cardiovascular stability.
  2,313 346 1
CASE REPORTS
Preoperative neurogenic pulmonary edema: A dilemma for decision making
Siva Kumar Reddy Lakkireddigari, Padmaja Durga, Madhukar Nayak, Gopinath Ramchandran
April-June 2012, 28(2):232-234
DOI:10.4103/0970-9185.94905  PMID:22557750
Neurogenic pulmonary edema may be a less-recognized consequence of obstructive hydrocephalus. The authors report a patient with acute obstructive hydrocephalus due to cerebellar metastatic lesion, who presented with neurogenic pulmonary edema. The edema resolved on placement of the ventriculoperitonial shunt. This report addresses the importance of recognition of neurogenic pulmonary edema as a possible perioperative complication resulting from an increase in intracranial pressure and the issues involved with anesthetic management of co-existing neurogenic pulmonary edema and intracranial hypertension.
  2,122 365 4
EDITORIALS
Is that a robot operating in your mouth?
Ashish Sinha
April-June 2012, 28(2):151-152
DOI:10.4103/0970-9185.94821  PMID:22557734
  2,012 464 -
CASE REPORTS
Foreign body esophagus in a neonate: Unusual age and unusual presentation
Ranju Singh, Chittaranjan Pandit, Deepti Gupta, Homay Vajifdar
April-June 2012, 28(2):258-260
DOI:10.4103/0970-9185.94915  PMID:22557758
Foreign body ingestion in neonatal period is an uncommon occurrence, despite foreign ingestion being common among pediatric age group. We report a rare case of foreign body esophagus in a 12-day-old female neonate causing obstructive symptoms after a homicidal attempt. The unusual age and circumstances involving the ingestion of the foreign body prompted us to report this case.
  2,189 266 4
LETTERS TO EDITOR
Mallampatti class 4 to class 1!!
Rohith Krishna, Murugesh Wali, Madagondapalli Srinivasan Nataraj, Thrivikram Shenoy
April-June 2012, 28(2):264-265
DOI:10.4103/0970-9185.94918  PMID:22557761
  2,100 323 2
CASE REPORTS
"Blow-torch phenomenon" during laser assisted excision of a thyroglossal cyst at the base of the tongue
Anitha G Bhat, P Ganapathi
April-June 2012, 28(2):247-248
DOI:10.4103/0970-9185.94911  PMID:22557754
We report a case of blow-torch phenomenon encountered during diode laser assisted excision of a thyroglossal cyst in a child. This is first such case report from India and highlights an unusual complication which anesthesiologists need to be aware of due to the increasing use of operative laser.
  2,026 293 1
LETTERS TO EDITOR
The i-gel™ - A promising airway device for magnetic resonance imaging suite
Susheela Taxak, Mamta Bhardwaj, Ajith Gopinath
April-June 2012, 28(2):263-264
DOI:10.4103/0970-9185.94917  PMID:22557760
  1,915 386 6
Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy
Ashish Kulshrestha, Suman Arora, Megha Mathur, Sukhminderjit S Bajwa
April-June 2012, 28(2):273-274
DOI:10.4103/0970-9185.94929  PMID:22557770
  1,894 374 2
CASE REPORTS
Complete bacterial filter blockage by a plastic film
Jiapeng Huang, Kishin Dodwani, Paul Simon, Jing Zhou
April-June 2012, 28(2):230-231
DOI:10.4103/0970-9185.94902  PMID:22557749
We describe a case where the expiratory bacterial filter was completely blocked by a plastic membrane. Significantly increased airway pressures and inability to deliver adequate tidal volume to the patient were experienced. The cause of machine failure could not be identified until a complete preanesthesia machine manual check was performed. All machines and circuits should be checked manually, even with the availability of new and advanced self-tests in machines. Backup ventilation equipments and familiarity with signs of expiratory and inspiratory limb obstruction should not be underestimated.
  1,852 235 -
LETTERS TO EDITOR
Diagnosis of pheochromocytoma
Kalpana S Vora, Veena R Shah
April-June 2012, 28(2):274-276
DOI:10.4103/0970-9185.94931  PMID:22557771
  1,616 456 -
Comprehensive eye care : A simple step toward a better outcome
Uma Hariharan
April-June 2012, 28(2):279-279
DOI:10.4103/0970-9185.94934  PMID:22557774
  1,699 339 2
The use of intrathecal dexmedetomidine and magnesium
R Garg, RC Gupta
April-June 2012, 28(2):271-272
DOI:10.4103/0970-9185.94926  PMID:22557768
  1,561 465 -
Failed ventilation due to heat and moisture exchanger filters malfunction
Sukhminder Jit Singh Bajwa, Amarjit Singh
April-June 2012, 28(2):269-270
DOI:10.4103/0970-9185.94923  PMID:22557766
  1,625 300 2
Alternative approach for the anesthetic management of a patient with large pulmonary bulla presenting with an intracranial tumor for surgery
Sriganesh Kamath, Varadarajan Bhadrinarayan, Manish Ranjan, GS Umamaheswara Rao
April-June 2012, 28(2):272-273
DOI:10.4103/0970-9185.94927  PMID:22557769
  1,588 251 -
Obstruction to scavenging system tubing
Lenin Babu Elakkumanan, Arumugam Vasudevan, Sudeep Krishnappa, Ranjan Raj Pandey, Hemavathi Balachander, Ashok S Badhe
April-June 2012, 28(2):270-271
DOI:10.4103/0970-9185.94924  PMID:22557767
  1,560 236 -
Anesthesia mask: A 22-mm connector
Ashish Bangaari
April-June 2012, 28(2):268-268
DOI:10.4103/0970-9185.94922  PMID:22557765
  1,482 240 -
A modified ambu resuscitator which detects and measures spontaneous breathing
J Capelli, N Ferlo, A Foley, V Smith, V Hazelwood, Glen M Atlas
April-June 2012, 28(2):281-281
DOI:10.4103/0970-9185.94936  PMID:22557776
  1,356 240 -
Intraluminal obstruction of epidural catheter due to manufacturing defect
Prasad K Kulkarni, Vittal A Pai, Riddhi P Shah, Sriranga R Joshi
April-June 2012, 28(2):280-280
DOI:10.4103/0970-9185.94935  PMID:22557775
  1,350 230 -
Effect of intraoperative depth of anesthesia on postoperative pain and analgesic requirement: A randomized prospective observer blinded study
Neeru Sahni, Lakesh K Anand, KK Gombar, Satinder Gombar
April-June 2012, 28(2):266-267
DOI:10.4103/0970-9185.94920  PMID:22557763
  1,316 262 2
Effect of intraoperative depth of anesthesia on postoperative pain and analgesic requirement: A possible misidentified role of propofol
Pierre-Yves Lequeux, Emily Bui-QuŰc, Gilbert Bejjani
April-June 2012, 28(2):265-266
DOI:10.4103/0970-9185.94919  PMID:22557762
  1,281 263 -
An unusual defect in the nitrous oxide pipeline
Amit Jain, Jeetinder K Makkar, Neeru Sahni, Sohan Lal Solanki
April-June 2012, 28(2):267-268
DOI:10.4103/0970-9185.94921  PMID:22557764
  1,230 240 -
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