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EDITORIAL |
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Case for local infiltration analgesia: Is all the evidence in black and white? |
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S Bala Bhaskar DOI:10.4103/0019-5049.149437 PMID:25684806 |
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PRESIDENT’S MESSAGE |
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From the desk of the New President |
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SS Harsoor DOI:10.4103/0019-5049.149439 |
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PAST PRESIDENT’S MESSAGE |
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The President's inaugural address during ISACON 2014, on 28 th December 2014 at Madurai |
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SSC Chakra Rao DOI:10.4103/0019-5049.149440 |
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SPECIAL ARTICLE |
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Targeted temperature management in brain protection: An evidence-based review  |
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Swagata Tripathy, Ashok Kumar Mahapatra DOI:10.4103/0019-5049.149442 PMID:25684807Targeted temperature management (TTM) for neuroprotection involves maintaining the temperature of the brain at predetermined levels by various techniques. It is aimed at avoiding the harmful effects of hyperthermia on the brain and at exploiting the protective effects of lower tissue temperature. There has been an explosion in the use of TTM for neuroprotection in a variety of clinical scenarios apart from the commonly accepted fields of resuscitation and ischaemic, hypoxic encephalopathy. This review briefly discusses the evidence base for TTM. The focus is on various areas of application for neuroprotection, the practical issues pertaining to TTM implementation, the recent data that support it and the present areas of controversy. |
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CLINICAL INVESTIGATIONS |
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Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy |
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Nirmala Jonnavithula, Harsh Khandelia, Padmaja Durga, Gopinath Ramachandran DOI:10.4103/0019-5049.149443 PMID:25684808Background and Aims: Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000). The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects. |
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Evaluation of continuous non-invasive arterial pressure monitoring during induction of general anaesthesia in patients undergoing cardiac surgery |
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G Anil Kumar, AM Jagadeesh, Naveen G Singh, SR Prasad DOI:10.4103/0019-5049.149444 PMID:25684809Background and Aims: Continuous arterial pressure monitoring is essential in cardiac surgical patients during induction of general anaesthesia (GA). Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring. Recently, a new continuous non-invasive arterial pressure device (CNAP™) has been validated perioperatively in non-cardiac surgeries. The aim of our study is to compare and assess the performance of CNAP during GA with invasive arterial pressure (IAP) in patients undergoing cardiac surgeries. Methods: Sixty patients undergoing cardiac surgery were included. Systolic, diastolic, and mean arterial pressure (MAP) data were recorded every minute for 20 min simultaneously for both IAP and CNAP™. Statistical analysis was performed using mountain plot and Bland Altman plots for assessing limits of agreement and bias (accuracy) calculation. Totally 1200 pairs of data were analysed. Results: The CNAP™ systolic, diastolic and MAP bias was 5.98 mm Hg, −3.72 mm Hg, and − 0.02 mm Hg respectively. Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP. The mountain plot showed similar results as the Bland Altman plots. Conclusion: We conclude CNAP™ provides real-time estimates of arterial pressure comparable to IAP during induction of GA for cardiac surgery. We recommend CNAP can be used as an alternative to IAP in situations such as cardiac patients coming for non-cardiac surgeries, cardiac catheterization procedures, positive Allen's test, inability to cannulate radial artery and vascular diseases, where continuous blood pressure monitoring is required. |
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Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field: A prospective study |
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Kumkum Gupta, Manoranjan Bansal, Prashant K Gupta, MN Pandey, Salony Agarwal DOI:10.4103/0019-5049.149445 PMID:25684810Background and Aims: Middle ear surgery requires bloodless surgical field for better operating conditions, deep level of anaesthesia and rapid emergence. Recent studies suggest that α2 agonists could provide desired surgical field, sedation and analgesia. The present study was aimed to evaluate the clinical effects of dexmedetomidine infusion as anaesthetic adjuvant during middle ear surgery using operating microscope. Methods: Sixty four adult patients aged 18-58 years, American Society of Anaesthesiologists Grades I and II, of both gender were randomised into two comparable equal groups of 32 patients each for middle ear surgery under general anaesthesia with standard anaesthetic technique. After induction of general anaesthesia, patients of Group I were given dexmedetomidine infusion of 0.5 μg/kg/h and patients of Group II were given placebo infusion of normal saline. Isoflurane concentration was titrated to achieve a systolic blood pressure 30% below the baseline value. All patients were assessed intra-operatively for bleeding at surgical field, haemodynamic changes, awakening time and post-operative recovery. Results: Statistically significant reduction was observed in the required percentage of isoflurane (0.8 ± 0.6%) to maintain the systolic blood pressure 30% below the baseline values in patients receiving dexmedetomidine infusion when compared to those receiving placebo infusion (1.6 ± 0.7%). Patients receiving dexmedetomidine infusion had statistically significant lesser bleeding at surgical field (P < 0.05). The mean awakening time and recovery from anaesthesia did not show any significant difference between the groups. Conclusion: Dexmedetomidine infusion can be safely used to provide oligaemic surgical field for better visualization using operating microscope for middle ear surgery. |
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A prospective study to determine the circumstances, incidence and outcome of cardiopulmonary resuscitation in a referral hospital in India, in relation to various factors |
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Muralidhar Joshi DOI:10.4103/0019-5049.149446 PMID:25684811Background and Aims: Cardiac arrest has multifactorial aetiology and the outcome depends on timely and correct interventions. We decided to investigate the circumstances, incidence and outcome of cardiopulmonary resuscitation (CPR) at a tertiary hospital in India, in relation to various factors, including extensive basic life support and advanced cardiac life support training programme for all nurses and doctors. Methods: It has been over a decade and a half with periodical updates and implementation of newer guidelines prepared by various societies across the world about CPR for both in-hospital and out-of hospital cardiac arrests (IHCA and OHCA). We conducted a prospective study wherein all cardiac arrests reported in the hospital consecutively for 12 months were registered for the study and followed their survival up to 1-year. Statistical analysis was performed by using Chi-square test for significant differences in proportions applied to various parameters of the study. Results: The main outcome measures were; (following CPR) return of spontaneous circulation, survival for 24 h, survival from 24 h to 6 weeks or discharge, alive at 1-year. For survivors, an assessment was made about their cerebral performance and overall performance and accordingly graded. All these data were tabulated. Totally 419 arrests were reported in the hospital, out of which 413 were in-hospital arrests. Out of this 260 patients were considered for resuscitation, we had about 27 survivors at the end of 1-year follow-up (10.38%). Conclusion: We conclude by saying there are many factors involved in good clinical outcomes following IHCAs and these variable factors need to be researched further. |
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Nebulized ketamine decreases incidence and severity of post-operative sore throat |
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Vanita Ahuja, Sukanya Mitra, Rashi Sarna DOI:10.4103/0019-5049.149448 PMID:25684812Background and Aims: Post-operative sore throat (POST) occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. Methods: We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA) were enrolled. Patients were randomised into two groups; group saline (S) received saline nebulisation 5.0 ml and group ketamine (K) received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). Results: The overall incidence of POST was 33%; 23 patients (46%) in saline and 10 patients (20%) in ketamine group experienced POST (Fisher's exact P = 0.01). The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P < 0.05). The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03) experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02). Conclusion: Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects. |
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CASE REPORTS |
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Anaesthetic management of a child with panthothenate kinase-associated neurodegeneration |
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Renu Sinha, Ghansham Biyani, Sulagna Bhattacharjee DOI:10.4103/0019-5049.149449 PMID:25684813Panthothenate kinase-associated neurodegeneration (PKAN) (Hallervorden-Spatz disease) is a rare autosomal recessive chromosomal disorder characterised by progressive neuroaxonal dystrophy. The characteristic features include involuntary movements, rigidity, mental retardation, seizures, emaciation. The anaesthetic concerns include difficult airway, aspiration pneumonia, dehydration, and post-operative respiratory, and renal insufficiency. We report successful anaesthetic management of a 9-year-old intellectually disabled male child with PKAN, scheduled for ophthalmic surgery under general anaesthesia. |
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Uncontrolled seizures and unusual rise in leucocyte counts: transfluthrin, liquid mosquito repellent suicidal poisoning |
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Kiran Lata Shringi, SC Dulara, RK Aseri, Usha Daria DOI:10.4103/0019-5049.149451 PMID:25684814Transfluthrin is being used as fast acting insecticide and liquid mosquito repellent. This is a case report of poisoning with transfluthrin (90 ml liquid containing 792 mg of transfluthrin) by a 25-year-old female. Tonic-clonic convulsions were not controlled with conventional drugs. In intensive care unit, patient was managed with muscle paralysis by neuromuscular blocking drug vecuronium and elective mechanical ventilation for more than 48 h under care of the anaesthesiologist with uneventful recovery. |
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BRIEF COMMUNICATIONS |
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Successful management of difficult airway in children with the use of adult fibreoptic bronchoscope |
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Latha Rao, Haji Jumana, Madhusudhan Gururajrao, Keshavan H Venkatesh DOI:10.4103/0019-5049.149453 PMID:25684815 |
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Intramyometrial vasopressin as a haemostatic agent: Is it really safe? |
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M Muthukumar, L Mathews, NS Vasantha, S Anoop DOI:10.4103/0019-5049.149456 PMID:25684816 |
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Effects of intravenous clonidine on haemodynamics and on plasma cortisol level during laparoscopic cholecystectomies |
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Hiremathada Sahajananda, Sudheer Rao DOI:10.4103/0019-5049.149458 PMID:25684817 |
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LETTERS TO EDITOR |
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Anaesthetic management for laparoscopic cholecystectomy in patient with situs inversus totalis |
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S Eapen, CS Ahluwalia, V Chopra, S Kiran DOI:10.4103/0019-5049.149459 PMID:25684818 |
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Anaesthetic management of intraoperative airway obstruction by ruptured hydatid cyst of right lung and barotrauma induced pneumothorax of the contralateral lung |
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Depinder Kaur, Saurabh Anand, Prakash Sharma, Ashwini Kumar DOI:10.4103/0019-5049.149461 PMID:25684819 |
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Innovative way of making intubating laryngeal mask airway stabilizer rod |
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M Hanumantha Rao, A Muralidhar, AV Subbarao, PM Vasudevan DOI:10.4103/0019-5049.149463 PMID:25684820 |
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The big "little problem'' with postoperative nausea and vomiting prophylaxis |
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G Chilkoti, M Mohta, R Wadhwa, M Kumar DOI:10.4103/0019-5049.149464 PMID:25684821 |
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Peripheral nerve block needle defect |
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Uday S Ambi, Joselo Delute Macachor, Khalil Shibli DOI:10.4103/0019-5049.149466 PMID:25684822 |
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ERRATUM |
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Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study: Erratum |
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DOI:10.4103/0019-5049.149468 PMID:25687794 |
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