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   Table of Contents - Current issue
March 2021
Volume 65 | Issue Suppl 1 (March)
Page Nos. 1-57

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Dexmedetomidine and Ketamine – Comrades on an eternal journey! p. 1
Sukhminder Jit Singh Bajwa
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Comparative evaluation of oral tramadol and gabapentin for prophylaxis of post-spinal shivering p. 5
Poonam Nain, Sandeep Kundra, Tanveer Singh, Mirley R Singh, Richa Kapoor, Arshdeep Singh
Background and Aims: Shivering in the peri-operative period is a common problem which is associated with various complications. Prophylaxis of shivering can thus help in reducing the cost and risk of complications. The present study was designed to compare prophylactic oral gabapentin, tramadol and placebo for prevention of post-spinal shivering. Methods: A total of 150 adult patients of either sex belonging to American Society of Anesthesiologists physical status I–III scheduled for elective orthopaedic surgeries were randomised to receive tramadol 100 mg (group A), gabapentin 600 mg (group B) or placebo (group C) orally 30 min before administration of spinal anaesthesia. The primary outcome was to study the incidence and severity of shivering, whereas the secondary outcome was to evaluate the incidence of adverse effects. Data were analysed by analysis of variance test, Student t-test, Mann–Whitney U test and Chi-square tests. Results: Incidence of shivering was comparable among groups A and B (P = 0.8) whereas it was significantly less than in group C (P = 0.00). Severity of shivering (grade 1 and 2) was comparable in all the groups (P = 0.6 and 0.36), whereas shivering grade 3 and grade 4 was significantly lesser in groups A and B as compared to group C (P = 0.01 and 0.01). The incidence of nausea and vomiting was more in group A (26%) as compared to group B (20%) (P = 0.48) but was significantly lesser than group C (48%) (P = 0.01). Incidence of sedation (sedation score ≥2) was significantly more in group B (22%) as compared to group A (4%) and group C (0%). Conclusion: Prophylactic oral gabapentin 600 mg and tramadol 100 mg are equally effective for prevention of post-spinal shivering.
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Effects of ventilation mode type on intra-abdominal pressure and intra-operative blood loss in patients undergoing lumbar spine surgery: A randomised clinical study p. 12
Sandeep Kundra, Rekha Gupta, Neeru Luthra, Mehak Dureja, Sunil Katyal
Background and Aims: The aim of the study was to evaluate the effect of mode of mechanical ventilation; pressure-controlled ventilation (PCV) vs. volume-controlled ventilation (VCV) on airway pressures, intra-abdominal pressure (IAP) and intra-operative surgical bleeding in patients undergoing lumbar spine surgery. Methods: This was a prospective, randomised study that included 50 American Society of Anesthesiologists class I and II patients undergoing lumbar spine surgery who were mechanically ventilated using PCV or VCV mode. The respiratory parameters (peak and plateau pressures) and IAP were measured after anaesthesia induction in supine position, 10 min after the patients were changed from supine to prone position, at the end of the surgery in prone position, and after the patients were changed from prone to supine position. The amount of intraoperative surgical bleeding was measured by objective and subjective methods. Results: The primary outcome was the amount of intraoperative surgical bleeding. It was significantly less in the PCV group than in the VCV group (137 ± 24.37 mL vs. 311 ± 66.98 mL) (P = 0.000). Similarly, on comparing other parameters like peak inspiratory pressures, plateau pressures and IAP, the patients in PCV group had significantly lower parameters than those in VCV group (P < 0.05). No harmful events were recorded. Conclusion: In patie,nts undergoing lumbar spine surgery, use of PCV mode decreased intraoperative surgical bleeding, which may be related to lower intraoperative respiratory pressures and IAP.
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Comparative evaluation of Air-Q blocker and Proseal laryngeal mask airway in patients undergoing elective surgery under general anaesthesia: A randomised controlled trial p. 20
Swati Jindal, Ankita Mittal, Lakesh K Anand, Manpreet Singh, Dheeraj Kapoor
Background and Aims: The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic airway device (SAD) with capability to serve as a conduit for intubation. As there is limited data on Air-Q blocker, the present study was performed to compare the efficacy of Air-Q blocker and Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. Methods: A total of 90 American Society of Anesthesiologists (ASA) physical status I and II patients were randomly allocated to Air-Q blocker or PLMA group. Oropharyngeal leak pressure (OLP), insertion success, insertion time, ease of orogastric tube (OGT) insertion, fibreoptic visualisation of the glottis, haemodynamic and ventilation parameters, and complications at emergence and postoperatively were investigated. Results: OLPs were higher in PLMA group as compared to Air-Q blocker group (P = 0.002). Still, the OLP (27.5 ± 5.8 cm H2O) was clinically effective in Air-Q blocker group.The mean time for successful insertion was significantly shorter for Air-Q blocker than PLMA (P = 0.019). The number of attempts to insert both the devices was comparable (P ≥ 0.05). Air-Q blocker provided a significantly better fibreoptic score than PLMA (P = 0.038). The two groups were comparable in terms of ease of OGT insertion, haemodynamics and ventilation parameters, and complications at emergence and postoperatively. Conclusions: Air-Q blocker provides a clinically effective OLP though PLMA provides a slightly better sealing function in patients undergoing laparoscopic and non-laparoscopic surgeries under general anaesthesia requiring neuromuscular blockade. Air-Q blocker has shorter insertion time and a better fibreoptic view of glottis as compared to PLMA.
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Efficacy of dexmedetomidine as an adjunct to ropivacaine in transversus abdominis plane block for paediatric laparoscopic surgeries: A double-blinded randomised trial p. 27
Kashish Garg, Neerja Bhardwaj, Sandhya Yaddanapudi, Indu M Sen, Preethy J Mathew, Ravi P Kanojia
Background and Aims: α2 agonists have been utilised in regional blocks, but very little data is available for their use in transversus abdominis plane (TAP) block in paediatric laparoscopic (LAP) surgeries. This study investigated the analgesic effect of ropivacaine alone versus its combination with dexmedetomidine for TAP block in children undergoing LAP surgery. Methods: A randomised, double-blind trial was conducted in 50 American Society of Anesthesiologists (ASA) 1 and 2 children of 2–8 years undergoing LAP abdominal surgery. Children were randomised to receive a total volume of 0.5 ml/kg of 0.2% ropivacaine (LA group) or 0.2% ropivacaine with 1 μg/kg dexmedetomidine (LAD group) for performing ultrasound-guided bilateral TAP block postoperatively (PO). Patients were monitored PO for vital signs, pain, sedation, time to first rescue analgesic and total analgesic consumption for 24 h. Time to first rescue analgesic was expressed as mean ± standard deviation (SD) and analysed using Kaplan–Meier survival analysis. Pain and sedation scores were expressed as median [interquartile range (IQR)] and analysed using Mann–Whitney U test. Results: First rescue analgesic demand was significantly longer (P = 0.001) in LAD (474.8 min) versus LA group (240.9 min) but total analgesics consumption in first 24 h was comparable. Pain scores were significantly lower (P < 0.05) in LAD compared to LA group at all times PO. Each group had comparable but significantly lower sedation scores up to 24 h PO. Conclusion: Addition of dexmedetomidine to ropivacaine in TAP block prolongs the time to first analgesic requirement without a difference in the total analgesic consumption.
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Discharge readiness after minor gynaecological surgeries comparing dexmedetomidine and ketamine premedication in bispectral index (BIS) guided propofol-based anaesthesia p. 34
Gaganjot Kaur, Preetveen Kaur, Ruchi Gupta, Keerat Kullar, Gurpreet Singh Bhangu, Sartaj Singh Sandhu
Background and Aims: Dexmedetomidine and ketamine are commonly used pre-medicants to propofol. Previous literature shows a delay in recovery with their use without any clarity on discharge. This study was planned to find out whether adding these premedicants to Bispectral index (BIS) guided propofol anaesthesia led to delayed discharge in minor gynaecological surgeries. Methods: Totally, 120 adult females belonging to American Society of Anesthesiologists (ASA) physical status I and II undergoing minor gynaecological surgeries under general anaesthesia were randomly allocated to receive 1 μg/kg dexmedetomidine (Group D), 0.5 mg/kg ketamine (Group K) and normal saline (Group P) as premedication. Propofol 1% was used for induction and maintenance of anaesthesia keeping BIS between 55 and 70. After the procedure, patients were assessed primarily for discharge readiness using Modified Post Anaesthesia Discharge Scoring System (MPADSS).The secondary outcomes were Modified Aldrete Score (MAS), total dose of propofol used and haemodynamics. Results: The percentage of patients ready for discharge were 22.5%, 30% and 15%at 1 hour in group D, K and P, respectively (p = 0.275). Median MAS was 5, 4 and 6 respectively for group D, K and P immediately post-surgery (p = 0.000). The mean dose of propofol used was 69.75 ± 12.56 mg in group D and 135.25 ± 9.2 mg in group P (p = 0.001). There were significant haemodynamic variations in group D (16.4% fall in heart rate at 5 minutes and 24.18% fall in mean arterial pressure at 15 minutes). Conclusion: Premedication with dexmedetomidine and ketamine in propofol anaesthesia does not delay discharge. However, stable haemodynamics and good analgesia with ketamine make it a better option.
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Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study Highly accessed article p. 41
Lakshmi Mahajan, AP Singh, Gifty
Background and Aims: When the world was frantically searching for a drug effective against the coronavirus disease (COVID)-19, remdesivir, a broad-spectrum anti-viral medication, became a part of the COVID treatment. We planned a study to evaluate improvement in clinical outcomes with remdesivir treatment for five days. Methods: Participants more than 40-years old and with moderate to severe COVID-19 but not on mechanical ventilation were randomly assigned into two groups-remdesivir group (34 cases) to receive the study drug intravenous (IV) remdesivir for five days plus the standard care (SC) and non-remdesivir group (36 cases) to receive the SC but not to receive the study drug. Follow-up was continued for 12 days after the beginning of treatment or until discharge/death. Patient's clinical status was assessed by laboratory investigations and physical examination (from day 1 to day 12 on a 4-point ordinal scale and from day 12 to 24 on a 6-point ordinal scale). Oxygen support requirements and adverse events were recorded.The data were entered and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: High-flow oxygen support and non-invasive ventilation was required at baseline by lesser patients in the remdesivir group. In the end, both groups had similar outcomes after adjustment for baseline clinical status. There was no statistical difference in mortality between the two groups (p = 0.749). Patients in both groups had an equal time to recovery. There was no difference in the occurrence of adverse effects of remdesivir between the two groups. Conclusion: Remdesivir therapy for five days did not produce improvement in clinical outcomes in moderate to severe COVID-19 cases.
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Principles of conducting cardiac anaesthesia services in COVID-19 pandemic p. 47
Yatin Mehta, Naveen Malhotra
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Intraoperative Magnetic Resonance Imaging (iMRI) mishaps – Troubleshooting an unsafe object attached to the scanner p. 50
Vattipalli Sameera, Ashish Bindra, Girija P Rath
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Clinical pearls in anaesthesia for electromyographic tube guided robotic thyroidectomy p. 51
Shagun Bhatia Shah, Jitendra Kumar Dubey, Manoj Bhardwaj, Amit Mittal
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Unanticipated severe pulmonary hypertension in a patient undergoing living donor liver transplant - Role of milrinone and transesophageal echocardiography p. 53
Gaurav Sindwani, Mahesh K Arora, Achal Dhir, Viniyendra Pamecha
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Non-infectious fever in cerebral arteriovenous malformation: Central fever or paroxysmal sympathetic hyperactivity p. 55
Rajeeb K Mishra, Nitin Jain, Keshav Goyal, Shweta Kedia
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