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EDITORIAL |
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Alpha 2 agonists in regional anaesthesia practice: Efficient yet safe?  |
p. 681 |
Kundra Pankaj, P Sakthi Rajan DOI:10.4103/0019-5049.147127 PMID:25624529 |
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SPECIAL ARTICLE |
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Neurological deterioration during intubation in cervical spine disorders |
p. 684 |
Padmaja Durga, Barada Prasad Sahu DOI:10.4103/0019-5049.147132 PMID:25624530Anaesthesiologists are often involved in the management of patients with cervical spine disorders. Airway management is often implicated in the deterioration of spinal cord function. Most evidence on neurological deterioration resulting from intubation is from case reports which suggest only association, but not causation. Most anaesthesiologists and surgeons probably believe that the risk of spinal cord injury (SCI) during intubation is largely due to mechanical compression produced by movement of the cervical spine. But it is questionable that the small and brief deformations produced during intubation can produce SCI. Difficult intubation, more frequently encountered in patients with cervical spine disorders, is likely to produce greater movement of spine. Several alternative intubation techniques are shown to improve ease and success, and reduce cervical spine movement but their role in limiting SCI is not studied. The current opinion is that most neurological injuries during anaesthesia are the result of prolonged deformation, impaired perfusion of the cord, or both. To prevent further neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and positioning for surgery are essential. The features that diagnose laryngoscopy induced SCI are myelopathy present on recovery, short period of unconsciousness, autonomic disturbances following laryngoscopy, cranio-cervical junction disease or gross instability below C3. It is difficult to accept or refute the claim that neurological deterioration was induced by intubation. Hence, a record of adequate care at laryngoscopy and also perioperative period are important in the event of later medico-legal proceedings. |
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CLINICAL INVESTIGATIONS |
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Premedication with gabapentin, alprazolam or a placebo for abdominal hysterectomy: Effect on pre-operative anxiety, post-operative pain and morphine consumption |
p. 693 |
Tim Thomas Joseph, Handattu Mahabaleswara Krishna, Shyamsunder Kamath DOI:10.4103/0019-5049.147134 PMID:25624531Background and Aims : Utility of gabapentin for pre-operative anxiolysis as compared to commonly administered alprazolam is not evident. The aim of the present study was to compare the effects of pre-operative oral gabapentin 600 mg, alprazolam 0.5 mg or a placebo on pre-operative anxiety along with post-operative pain and morphine consumption. Methods: Seventy five patients scheduled for abdominal hysterectomy under general anaesthesia were included. Groups gabapentin, alprazolam and placebo, received oral gabapentin 600 mg, alprazolam 0.5 mg and one capsule of oral B-complex forte with Vitamin C respectively, on the night prior to surgery and 2 h prior to surgery. Visual analogue scale (VAS) was used to measure the anxiety and post-operative pain. All patients received patient-controlled analgesia. Statistical tests used were Kruskal-Wallis test, Wilcoxon signed rank test and one-way ANOVA. Results: Alprazolam provided significant anxiolysis (median [interquartile range] baseline VAS score 35 [15.5, 52] to 20 [6.5, 34.5] after drug administration; P = 0.007). Gabapentin did not provide significant decrease in anxiety (median [interquartile range] VAS score 21 [7.5, 41] to 20 [6.5, 34.5]; P = 0.782). First analgesic request time (median [interquartile range in minutes]) was longer in group gabapentin (17.5 [10, 41.25]) compared to group placebo (10 [5, 15]) (P = 0.019) but comparable to that in group alprazolam (15 [10, 30]). Cumulative morphine consumption at different time periods and total morphine consumption (mean [standard deviation]) at the end of study period (38.65 [18.04], 39.91 [15.73], 44.29 [16.02] mg in group gabapentin, alprazolam and placebo respectively) were comparable. Conclusion: Gabapentin 600 mg does not have significant anxiolytic effect compared to alprazolam 0.5 mg. Alprazolam 0.5 mg was found to be an effective anxiolytic in the pre-operative period. Neither alprazolam nor gabapentin, when compared to placebo showed any opioid sparing effects post-operatively. |
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Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique |
p. 700 |
Alok Kumar, DK Sharma, E Sibi, Barun Datta, Biraj Gogoi DOI:10.4103/0019-5049.147138 PMID:25624532Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range) number of skin punctures were 2 (2-4) in group US and 3 (2-5) in group NS (P < 0.001). No differences were observed in the onset of sensory block in group NS (6.17 ± 1.22 min) and in group US (6.33 ± 0.48 min) (P = 0.16), and in onset of motor block (23.33 ± 1.26 min) in group US and (23.17 ± 1.79 min) in group NS; P > =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine. |
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Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture |
p. 705 |
Ashok Jadon, Sunil Kumar Kedia, Shreya Dixit, Swastika Chakraborty DOI:10.4103/0019-5049.147146 PMID:25624533Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB) and intra- venous (IV) fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB) and Intravenous fentanyl group (FENT). In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG) 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000) was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020). Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049). Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027). Patient acceptance was less in group FENT (P = 0.000031). Conclusion: Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anaesthesia in patients of fracture femur. |
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Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study  |
p. 709 |
Qazi Ehsan Ali, L Manjunatha, Syed Hussain Amir, Shaista Jamil, Abdul Quadir DOI:10.4103/0019-5049.147150 PMID:25624534Background and Aims: Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator. Methods: Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 μg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications. Results: There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted. Conclusion: The addition of 75 μg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects. |
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Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial |
p. 714 |
Mohan Chandra Mandal, Sujata Dolai, Santanu Ghosh, Pallab Kumar Mistri, Rajiv Roy, Sekhar Ranjan Basu, Sabyasachi Das DOI:10.4103/0019-5049.147157 PMID:25624535Background and Aims: Insertion of nasogastric tubes (NGTs) in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events. Methods: In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54), Group W (ureteral guide wire group, n = 54), Group F (neck flexion with lateral pressure, n = 54) and Group R (reverse Sellick's manoeuvre, n = 54). The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted. Results: All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick's method. However, on intergroup analysis, neck flexion and reverse Sellick's methods were comparable but significantly faster than the other two methods with respect to time taken for insertion. Conclusion: Reverse Sellick's manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques. |
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Effect of caudal clonidine on emergence agitation and postoperative analgesia after sevoflurane anaesthesia in children: Randomised comparison of two doses |
p. 719 |
Anudeep Saxena, Ashish Sethi, Vikesh Agarwal, Rajan B Godwin DOI:10.4103/0019-5049.147163 PMID:25624536Background and Aims: Sevoflurane, a popular inhalational anaesthetic for children, has been associated with significant emergence agitation in the recovery phase. This study was intended to compare two doses of caudal clonidine added to ropivacaine 0.2% in order to decide on the optimal dose for prevention of sevoflurane induced emergence agitation (EA) and to get a meaningful prolongation of postoperative analgesia with minimal side effects. Methods: Sixty-one children aged 1-7 years (American Society of Anaesthesiologists physical status I-II) received standardized general anaesthesia with inhaled sevoflurane and caudal epidural block with 0.2% ropivacaine 1 ml/kg for sub-umbilical surgeries. They were assigned randomly to two groups: (I) clonidine 1 μg/kg added to caudal ropivacaine; (II) clonidine 2 μg/kg added to caudal ropivacaine. EA and postoperative analgesia were assessed using pain/discomfort scale score and face, legs, activity, cry, consolability (FLACC) score respectively. Results: EA was observed in 8 children (26.6%) in group I when compared to only 2 children (6.4%) in group II after first 15 min postoperatively. Incidences of EA at 15 min, as well as total incidence of agitation, were both significantly lower in group II when compared to group I with P < 0.05. Duration of analgesia in group I (12 [8-20] h) and group II (16 [8-20] h) was statistically comparable (P > 0.05). There was no difference in the incidence of sedation or complications. Conclusion: Caudal clonidine 2 μg/kg added to 0.2% ropivacaine 1 ml/kg is suggested to be the optimal dose, for prevention of EA and meaningful prolongation of postoperative analgesia with minimal side-effects. |
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Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy  |
p. 726 |
Gourishankar Reddy Manne, Mahendra R Upadhyay, VN Swadia DOI:10.4103/0019-5049.147164 PMID:25624537Background and Aim: Dexmedetomidine is a α2 agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful adjuvant in anaesthesia as stress response buster, sedative and analgesic. We aimed primarily to evaluate the effects of low dose dexmedetomidine infusion on haemodynamic response to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecystectomy. The secondary aims were to observe the effects on extubation time, sedation levels, post-operative analgesia requirements and occurrence of adverse effects. Methods: Sixty patients of American Society of Anaesthesiologists(ASA) physical grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into three groups of 20 patients each. Group NS patients received normal saline, Group Dex 0.2 and Group Dex 0.4 patients received dexmedetomidine infusion at 0.2 mcg/kg/h and 0.4 mcg/kg/h respectively, starting 15 min before induction and continued till end of surgery. Parameters noted were pulse rate, mean arterial pressure, oxygen saturation, post-operative sedation and analgesia requirements. SPSS 15.0 version software was used for statistical analysis. ANOVA test for continuous variables, post-hoc test for intergroup comparison, and Chi-square test for discrete values were applied. Results: In Group NS significant haemodynamic stress response was seen following laryngoscopy, tracheal intubation, creation of pneumoperitoneum and extubation. In dexmedetomidine groups, the haemodynamic response was significantly attenuated. The results, however, were statistically better in Dex 0.4 group compared with Dex 0.2 group. Post-operative 24 hour analgesic requirements were much less in dexmedetomidine groups. No significant side effects were noted. Conclusion: Low dose dexmedetomidine infusion in the dose of 0.4 mcg/kg/h effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in post-operative analgesic requirements. |
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Effect of site selection on pain of intravenous cannula insertion: A prospective randomised study |
p. 732 |
Basavana Gouda Goudra, Eilish Galvin, Preet Mohinder Singh, Jimme Lions DOI:10.4103/0019-5049.147166 PMID:25624538Background and Aim: Pain on intravenous (IV) cannulation continues to cause considerable anxiety among the patients visiting the hospital for elective surgery. Often, it is the only unpleasant experience, especially in ambulatory surgical settings. Although, anecdotal evidence suggests that antecubital fossa (ACF) might be less painful site for venous cannulation, no scientific study exists to validate the same. Methods: In this prospective randomised study, effect of site selection on pain of venous cannulation was studied. Fifty-five consecutive adults, scheduled to undergo elective surgery, were randomly allocated to get IV cannulation first on ACF (28 patients) or on dorsum of hand (DOH) (27 patients) followed by cannulation on the contralateral arm on the alternative site (DOH or ACF). Five patients were excluded due to multiple cannulation attempts. Pain scores on cannulation related to both sites were recorded and compared. Results: Non-parametric data and frequency data analysis, using the Wilcoxon signed rank test or the Chi-square test as appropriate, showed that ACF approach was significantly less painful in comparison to the DOH when using a 20-gauge cannula for venous cannulation (P < 0.05). Conclusion: We recommend that in the absence of any contraindications, ACF should be the cannulation site of choice. However, considerations like increased chance of kinking and obstruction might preclude such practice. |
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CASE REPORTS |
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Anaesthetic management of a patient with Allgrove syndrome |
p. 736 |
BG Arun, BS Deepak, Murali R Chakravarthy DOI:10.4103/0019-5049.147168 PMID:25624539Allgrove syndrome is a rare autosomal recessive disorder, which manifests with adrenal insufficiency, achalasia cardia and alacrimia. Autonomic neuropathy can also be associated with it. Adrenal crisis can be precipitated by surgery, infection or trauma. This disorder poses a challenge to anaesthesiologists during anaesthesia for various surgeries. We report the anaesthetic management of a child with Allgrove syndrome. |
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Anaesthetic management of a pregnant patient with intracranial space occupying lesion for craniotomy |
p. 739 |
Vinay Marulasiddappa, BS Raghavendra, HN Nethra DOI:10.4103/0019-5049.147170 PMID:25624540Intracranial space occupying lesion [SOL] during pregnancy presents several challenges to the neurosurgeons, obstetricians and anaesthesiologists in not only establishing the diagnosis, but also in the perioperative management as it requires a careful plan to balance both maternal and foetal well-being. It requires modification of neuroanaesthetic and obstetric practices which often have competing clinical goals to achieve the optimal safety of both mother and foetus. Intracranial tuberculoma should be considered in the differential diagnosis of intracranial SOL in pregnant women with signs and symptoms of raised intracranial pressure with or without neurological deficits, especially when they are from high incidence areas. We report a 28-week pregnant patient with intracranial SOL who underwent craniotomy and excision of the lesion, subsequently diagnosed as cranial tuberculoma. |
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Penetrating abdomino-thoracic injury with an iron rod: An anaesthetic challenge |
p. 742 |
Kiranpreet Kaur, Suresh K Singhal, Mamta Bhardwaj, Prashant Kumar DOI:10.4103/0019-5049.147172 PMID:25624541Penetrating abdomino-thoracic injuries are potentially life-threatening due to the associated haemorrhagic shock and visceral injury. The management of these injuries poses specific challenges in pre-hospital care, transport, and management strategies. We report a 35-year-old male having impalement injury of the left thorax and left upper arm with a metallic rod used for construction of the house after a fall from height. One rod penetrated thorax from left shoulder and exit point was present just above the iliac crest and second rod was seen piercing left upper arm. Patient was successfully managed without any intraoperative, post-operative surgical complications, neurological damage or permanent injuries. |
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Unexpected presentation of a type IV laryngo-tracheo-oesophageal cleft: Anaesthetic implications of a rare case |
p. 746 |
Sanjay Dwarakanath, Arundathi Reddy DOI:10.4103/0019-5049.147173 PMID:25624542Laryngo-tracheo-oesophageal cleft (LTEC) is a congenital midline defect of the posterior larynx and trachea and the anterior wall of the oesophagus. Existence of these clefts may not be apparent during pre-operative evaluation. We present a rare case of a neonate initially scheduled for tracheo-oesophageal fistula repair. Unexplained air leak in spite of placement of size 4.0 mm endotracheal tube in a 2.5 kg neonate triggered extensive intra-operative evaluation of the airway anatomy via flexible and rigid bronchoscope. A type IV LTEC with an unusual anatomy was identified that was considered surgically irreparable. This case also highlights the need for a team approach and preparedness of anaesthesiologists for a difficult airway while managing such cases. Maintenance of high degree suspicion is warranted. |
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Cardiac tamponade secondary to perforation of innominate vein following central line insertion in a neonate |
p. 749 |
Ramkumar Dhanasekaran, Ranjith B Karthekeyan, Mahesh Vakamudi DOI:10.4103/0019-5049.147174 PMID:25624543Cardiac tamponade following central line in a neonate is rare and an uncommon situation; however, it is potentially reversible when it is diagnosed in time. We report a case of cardiac tamponade following central line insertion. A 10-day-old 2.2 kg girl operated for obstructed total anomalous pulmonary venous connections had neckline slipped out during extubation. Attempted cannulations of right femoral vein were unsuccessful. At the end of the left internal jugular vein cannulaton, there was a sudden cardiorespiratory arrest. Immediate transthoracic echocardiogram showed left pleural and pericardial collection. Chest was opened and the catheter tip was seen in the thoracic cavity after puncturing the innominate vein. The catheter was removed and the vent was repaired. |
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BRIEF COMMUNICATIONS |
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Awareness of the ultrasound guided regional anaesthesia among anaesthesia residents in India: A questionnaire-based study |
p. 752 |
Naveen Yadav, Rakesh Garg, Santavana Kohli DOI:10.4103/0019-5049.147175 PMID:25624544 |
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Diagnostic value of different screening tests in isolation or combination for predicting difficult intubation: A prospective study |
p. 754 |
Tanu Mehta, J Jayaprakash, Veena Shah DOI:10.4103/0019-5049.147176 PMID:25624545 |
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Anaesthetic management of excision of a functioning pancreatic beta cell tumour |
p. 757 |
Pasupuleti Hemalatha, R Sri Devi, Aloka Samantaray, N Hemanth, Mangu Hanumantha Rao DOI:10.4103/0019-5049.147177 PMID:25624546 |
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Critical incident is a possibility with water in flowmeter |
p. 760 |
M Manjuladevi, KS Vasudeva Upadhyaya, PS Sathyanarayana, Rashmi Rani, Viraj Shah DOI:10.4103/0019-5049.147178 PMID:25624547 |
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Posterior reversible encephalopathy syndrome following caesarean section under spinal anaesthesia |
p. 762 |
Sunil Rajan, Nitu Puthenveettil, Jerry Paul, Lakshmi Kumar DOI:10.4103/0019-5049.147179 PMID:25624548 |
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Management of spasticity with severe painful myoclonic jerks in an operated case of spinal astrocytoma |
p. 765 |
Pradeep Jain, Murali Krishna Chava DOI:10.4103/0019-5049.147180 PMID:25624549 |
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Bone cyst: Case report and implications for the anaesthesiologist |
p. 767 |
Chhavi Sawhney, Ghansham Biyani, Sadik Mohammed, Pallavi Shende DOI:10.4103/0019-5049.147181 PMID:25624550 |
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Late-presenting bilateral congenital diaphragmatic hernia: An extremely rare confluence of two rarities |
p. 768 |
Justin P James, Juliana J Josephine, Manickam Ponniah DOI:10.4103/0019-5049.147182 PMID:25624551 |
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LETTERS TO EDITOR |
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Use of cyanoacrylate glue for persistent post-dural puncture cerebrospinal fluid leak |
p. 771 |
Ashish Bangaari, Mirza Anwar Ahmed Baig, Munisamy Ragavan, Rajan Rajendra Kumar DOI:10.4103/0019-5049.147154 PMID:25624552 |
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Bronchotomy for removal of foreign body bronchus in an infant |
p. 772 |
S Kiran, CS Ahluwalia, V Chopra, S Eapen DOI:10.4103/0019-5049.147156 PMID:25624553 |
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A rare complication of tongue laceration following posterior spinal surgery using spinal cord monitoring: A case report |
p. 773 |
Tan Jun Hao, Gabriel Liu, Priscilla Ang DOI:10.4103/0019-5049.147159 PMID:25624554 |
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Klippel Trenaunay syndrome and the anaesthesiologist |
p. 775 |
Smitha Elizabeth George, A Sreevidya, Anil Asokan, V Mahadevan DOI:10.4103/0019-5049.147161 PMID:25624555 |
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An ultra-rapid development of tachyphylaxis to nitroglycerin |
p. 777 |
Harihar V Hegde, N Jagadish, P Raghavendra Rao DOI:10.4103/0019-5049.147183 PMID:25624556 |
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Another circuit block: This time the actual Bain circuit |
p. 778 |
CN Jaideep DOI:10.4103/0019-5049.147184 PMID:25624557 |
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A technique to prevent overfilling of viewing chamber of intravenous infusion kit |
p. 780 |
Lovelesh Kakani, Surinder M Sharma, Rashmi C Mehta, Gurpreet Singh DOI:10.4103/0019-5049.147185 PMID:25624558 |
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Learning from our mistakes: A case of a concealed history and a casual resident |
p. 781 |
Madhuri S Kurdi, Kaushic A Theerth DOI:10.4103/0019-5049.147186 PMID:25624559 |
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Pseudo-pulmonary oedema |
p. 782 |
Bharat Paliwal, Manoj Kamal DOI:10.4103/0019-5049.147187 PMID:25624560 |
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Delayed recovery from anaesthesia due to acute phenytoin therapy |
p. 783 |
Teena Bansal, Sarla Hooda, Rajmala Jaiswal, Manish Bansal DOI:10.4103/0019-5049.147188 PMID:25624561 |
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Fatal drug errors in anaesthesia: Can we override? |
p. 785 |
Amitabh Kumar, Kapil Gupta, Manju Gupta, Shyam Bhandari DOI:10.4103/0019-5049.147189 PMID:25624562 |
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Coiling of guide wire in the internal jugular vein during central venous catheter insertion: A rare complication |
p. 786 |
Richeek Kumar Pal, Baisakhi Laha, Sabyasachi Nandy, Rajasree Biswas DOI:10.4103/0019-5049.147190 PMID:25624563 |
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COMMENTS ON PUBLISHED ARTICLES |
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Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial |
p. 789 |
Nidhi Arun, Rajnish Kumar DOI:10.4103/0019-5049.147191 PMID:25624564 |
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Comparison of supraglottic devices i-gel ® and LMA Fastrach ® as conduit for endotracheal intubation |
p. 790 |
Priyanka Sethi, Tanvir Samra, Neeraj Gupta DOI:10.4103/0019-5049.147192 PMID:25624565 |
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Palm print sign in prediction of difficult laryngoscopy in diabetes |
p. 791 |
Sim Sai Tin, Viroj Wiwanitkit DOI:10.4103/0019-5049.147193 PMID:25624566 |
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