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   Table of Contents - Current issue
July 2021
Volume 65 | Issue 7
Page Nos. 499-565

Online since Friday, July 23, 2021

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Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement Highly accessed article p. 499
Naveen Malhotra, Sukhminder Jit Singh Bajwa, Muralidhar Joshi, Lalit Mehdiratta, Indrani Hemantkumar, R Amutha Rani, TS Shamshad Beegum, Surekha Shinde, Madhuri Kurdi, Amit Kohli, Nishant Sahay, N Pratheeba, Madhavi Julakanti, Devyani Desai, Heena Chhanwal, Geeta Ahlawat, N Basker
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Research and COVID-19: Losing momentum every now and then p. 508
Sukhminder Jit Singh Bajwa, Lalit Mehdiratta
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Comparison of analgesic efficacy of the conventional approach and mid-transverse process to pleura approach of the paravertebral block in video-assisted thoracoscopy surgeries: A randomised controlled trial p. 512
KB Swathi, Manoj Kamal, Mritunjay Kumar, Rakesh Kumar, Swati Chhabr, Pradeep Bhatia
Background and Aims: The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB. Methods: Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO2), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23. Results: Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours (P = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups. Conclusion: The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries.
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Comparison of dexmedetomidine in two different doses on emergence agitation in children under sevoflurane anaesthesia: A double-blind randomised controlled trial p. 519
Abinaya Ramachandran, Nagalakshmi Palanisamy, MV Vidya, Mamie Zacharia, Sagiev K George, RV Ranjan
Background and Aims: Emergence agitation (EA) in children is one of the most common postoperative problems encountered in the recovery room. Sevoflurane has been strongly associated with EA owing to its lower solubility and rapid recovery. Dexmedetomidine has been found to reduce the incidence of EA. This study was designed to evaluate the effectiveness of dexmedetomidine in two doses in reducing EA in children. Methods: This was a prospective double-blinded randomised study done on eighty children aged 5–14 years undergoing adenotonsillectomy/tonsillectomy under sevoflurane anaesthesia. Patients in Group A (n = 40) received 0.3 μg/kg/h and patients in group B (n = 40) received 0.5 μg/kg/h infusion after a bolus dose of 0.5 μg/kg of dexmedetomidine. The primary objective was to compare two different doses of dexmedetomidine on EA in the postoperative period. The secondary objectives were to assess the pain and perioperative haemodynamics in the recovery room. The anaesthesiologist blinded to the study charted the paediatric anaesthesia emergence delirium score (PAED), perioperative haemodynamic parameters, objective pain score and rescue medications if given. The data were analysed using Student's unpaired t-test, Chi-square test, repeated measures Analysis of Variance (ANOVA) and Mann-Whitney U test wherever appropriate. Results: The incidence of EA was comparable between both groups (P = 0.960). The haemodynamic parameters (P > 0.05) and the objective pain score (P = 0.810) also did not show a statistically significant difference. Conclusion: A lower dose of dexmedetomidine (0.3 μg/kg/h) is equally effective as a higher dose (0.5 μg/kg/h) after a bolus dose of 0.5 μg/kg in decreasing EA.
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Is hypotensive anaesthesia guided by invasive intraarterial monitoring required for orthognathic surgery? – A retrospective review of anaesthetic practice and intraoperative blood loss in orthognathic surgery in a tertiary hospital p. 525
Yi Lin Lee, Suhitharan Thangavelautham, Sudha Harikrishnan, Ranjith Karthekeyan, Harikrishnan Kothandan
Background and Aims: Orthognathic surgeries for maxillofacial deformities are commonly performed globally and are associated with significant blood loss. This can distort the surgical field and necessitate blood transfusion with its concomitant risks. We aimed to review if invasive intraarterial (IA) line monitoring and/or hypotensive anaesthesia is required for orthognathic surgeries, and their effects on intraoperative blood loss and transfusion requirements. Methods: This was a retrospective observational study conducted in patients admitted for orthognathic surgeries in a public tertiary hospital. Anaesthetic techniques and intraoperative haemodynamics were studied for their effects on intraoperative blood loss. Results: The data from 269 patients who underwent orthognathic–bimaxillary surgeries was analysed. Inhalational anaesthetic combined with remifentanil was administered for 86.6%, total intravenous anesthesia to 11.2% patients, while the rest received inhalational anaesthesia. Hypotensive anaesthesia was achieved in 48 subjects (17.8%) and associated with shorter duration of surgery (349 vs 378 min, P = 0.02) and a trend towards lower blood loss (874 mL vs 1000 mL, P = 0.058) but higher transfusion requirement (81.3% vs 58.8%, P = 0.004). An IA line was used in 119 patients (44.2%) and was not associated with a higher probability of achieving hypotensive anaesthesia (19.3% vs 16.7%, P = 0.06). However, less blood loss (911 vs 1029 mL, P = 0.05) occurred compared to noninvasive blood pressure monitoring. Conclusion: Invasive blood pressure monitoring is as effective as noninvasive methods to achieve hypotensive anaesthesia. It does not aid in achieving lower target blood pressure. There is a lack of association between a reduction in blood loss and higher blood transfusion during hypotensive anaesthesia and this will require further evaluation.
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Comparison of effect of intraperitoneal instillation of additional dexmedetomidine or clonidine along with bupivacaine for post-operative analgesia following laparoscopic cholecystectomy p. 533
Thottikat Kaarthika, Sri Devi Radhapuram, Aloka Samantaray, Hemalatha Pasupuleti, Mangu Hanumantha Rao, R Bharatram
Background and Aims: Despite advances in minimally invasive surgery, postoperative pain remains a concern after laparoscopic cholecystectomy. This study aims to compare the effect of intraperitoneal instillation of bupivacaine with alpha-2 agonists (dexmedetomidine and clonidine) for postoperative analgesia. Methods: One hundred and eight patients scheduled for elective laparoscopic cholecystectomy were randomised to receive either 20 mL of 0.5% bupivacaine (Group B), 20 mL of 0.5% bupivacaine with dexmedetomidine 1 μg/kg (Group BD) or 20 mL of 0.5% bupivacaine with clonidine 1 μg/kg (Group BC). Study drug made to equal volume (40 mL) was instilled before the removal of trocar at the end of surgery. Standard general endotracheal anaesthesia with intra-abdominal pressure of 12–14 mm Hg during laparoscopy was followed uniformly. The primary objective of our study was the magnitude of pain. One way analysis of variance (ANOVA) for continuous variables and Chi-square test for categorical variables was used. Results: The Numerical Rating Scale (NRS) scores for pain intensity did not show any statistical significance at any of the pre-defined time points. Time to first request for analgesia was shortest in group BC (64.0 ± 60.6 min) when compared to the other groups (B, 78.8 ± 83.4 min; BD, 112.2 ± 93.4 min; P < 0.05). Total amount of rescue fentanyl given in groups BD (16.8 ± 29.0 μg) and BC (15 ± 26.4 μg) was significantly less than B (35.7 ± 40.0 μg); P < 0.05). Conclusion: The addition of alpha-2 agonists to bupivacaine reduces the post-operative opioid consumption, and dexmedetomidine appears to be superior to clonidine in prolonging time to first analgesic request.
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Comparison of efficacy of gabapentin and memantine premedication in laparoscopic cholecystectomies for postoperative pain relief – A randomised placebo controlled trial p. 539
Sujitha Reddy Karri, Kavitha Jayaram, Annekiran Kumar, Padmaja Durga
Background and Aims: The multiplicity of the mechanisms of the pain in laparoscopic cholecystectomy inclines us to the usage of multimodal analgesia. Gabapentin is known for its analgesic efficacy when given as premedication in many surgeries. N-methyl-D-aspartate (NMDA) antagonists are used for both acute and chronic pain, but the use of memantine in the perioperative period is less studied. The aim of this randomised controlled study was to subjectively and objectively compare postoperative pain relief using gabapentin, memantine and placebo as premedication. Methods: Sixty-six patients posted for laparoscopic cholecystectomy were randomised into three groups. During the preoperative assessment, the baseline threshold and tolerance values of pain were measured using an algesiometer. Patients were pre-medicated with oral gabapentin 600 mg or memantine 20 mg or placebo an hour before surgery. Following extubation, pain scores were reassessed (both subjectively and objectively) along with Ramsay sedation scores at different time intervals for 4 h postoperatively. Results: Gabapentin group had lower Numerical Rating Scale scores at 15 min and 1 h postoperatively when compared to the other two groups. Memantine group had a longer time for the first request for rescue analgesia (50.53 min) compared to gabapentin and placebo. The objective assessment of pain with analgesiometer showed no statistical significance between the three groups for both threshold and tolerance values. Ramsay sedation scores were higher in the gabapentin group compared to the other two. Conclusion: Gabapentin provides better postoperative pain relief compared to memantine when given as single dose premedication for laparoscopic cholecystectomy.
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Anaesthetic considerations for post-COVID-19 mucormycosis surgery- A case report and review of literature p. 545
Kewal K Gupta, Amanjot Singh, Akshay Kalia, Rajvir Kandhola
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The aftermath of COVID-19 pandemic: Rhino-orbital mucormycosis p. 548
Suhas Ashok Hooli, Vaijayanti Nitin Gadre, Sunita Bage, Manoj Dnyanba Gilvarkar
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Impact of aerosol box on anxiety of the anaesthesiologist for intubation during COVID-19 pandemic: A single-blinded observational study p. 554
Rishi Katiyar, Sarika Katiyar, Gaurav Acharya, Anurag Yadava
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Bilateral tension pneumothorax: An unusual complication in a COVID-19 recovered patient p. 556
Vidhi Chandra, Pooja Singh, H Santoshkumar Huligeri, Maitree Pandey
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Perioperative short-term positive airway pressure therapy in combating COVID-19 related oxygen crisis p. 558
Arun Muthukumar
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Non-operating room anaesthesia for a child with Beckwith Wiedemann syndrome with a history of congenital laryngomalacia p. 559
Vijetha Nagendra, Ranganatha Praveen, Ajay Prasad Hrishi, Manikandan Sethuraman
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Anaesthetic implications in patient with Charcot-Marie-Tooth disease p. 561
Hemlata Kapoor, Milin Shah, Suhani Desai
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PENG block: Advantages of out-of-plane approach p. 563
David Lopez-Lopez, Pablo Casas Reza, Maria Gestal Vazquez, Paula Dieguez Garcia
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In response to, PENG block: Advantages of out-of-plane approach p. 565
Ashok Jadon, Neelam Sinha, Swastika Chakraborty, Bhupendra Singh
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