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EDITORIAL |
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Scientific misconduct and unethical practices in anaesthesiology: Stumbling blocks to quality research and publications |
p. 397 |
S Bala Bhaskar, Sukhminder Jit Singh Bajwa DOI:10.4103/0019-5049.160914 PMID:26257410 |
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SPECIAL ARTICLE |
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Scientific misconducts and authorship conflicts: Indian perspective |
p. 400 |
Mohanchandra Mandal, Dipanjan Bagchi, Sekhar Ranjan Basu DOI:10.4103/0019-5049.160918 PMID:26257411This article is a narrative review about how appropriate authorship can be achieved, a brief mention about various scientific misconducts, the reason and consequences of such misconducts and finally, the policies to be adopted by the aspiring authors to avert these problems. The literature search was performed in the Google and PubMed using 'scientific misconduct', 'honorary/ghost authorship', 'publish-or-perish', 'plagiarism' and other related key words and phrases. More than 300 free full-text articles published from 1990 to 2015 were retrieved and studied. Many consensus views have been presented regarding what constitutes authorship, the authorship order and different scientific misconducts. The conflicts about authorship issues related to publication of dissertation, the area of the grey zone have been discussed. Suggestions from different authorities about improving the existing inappropriate authorship issues have been included. |
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CLINICAL INVESTIGATIONS |
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Comparative study of Episure™ AutoDetect™ syringe versus glass syringe for identification of epidural space in lower thoracic epidural |
p. 406 |
Edward Johnson Joseph, Elango Pachaimuthu, Vasukinathan Arokyamuthu, Muthushenbagam Muthukrishnan, Dinesh Kumar Kannan, B Dhanalakshmi DOI:10.4103/0019-5049.160933 PMID:26257412Background and Aims: Episure™ AutoDetect™ syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals. Methods: A total of 120 American Society of Anesthesiolgists I-II patients aged 18-60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm), number of attempts, time to locate epidural space (s), inadvertent dural puncture and failed epidural analgesia were the parameters noted. Results: There were no differences in patient demographics or depth to the epidural space between the two groups. There were five failed blocks in the GS group and none in the EAS group (P = 0.0287). Similarly, there were five inadvertent dural punctures in the GS group and none in the EAS group (P = 0.0287). When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS (P = 0.0012). Conclusion: Using EAS allowed reliable and quick identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe. There was no incidence of inadvertent dural puncture or failed blocks with the EAS. |
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Comparison of analgesic efficacy of flupirtine maleate and ibuprofen in gynaecological ambulatory surgeries: A randomized controlled trial  |
p. 411 |
Vanita Ahuja, Sukanya Mitra, Sunita Kazal, Anju Huria DOI:10.4103/0019-5049.160937 PMID:26257413Background and Aims: Flupirtine maleate is a centrally acting, non-opioid analgesic with unique muscle relaxant properties as compared to common analgesics. The aim of this study was to compare post-operative analgesic efficacy of flupirtine maleate and ibuprofen in patients undergoing gynaecological ambulatory surgeries. Methods: This prospective, randomised controlled study was conducted in 60 women of American Society of Anesthesiologists physical status I/II, 18-70 years of age and scheduled to undergo gynaecological ambulatory surgeries. The participants were randomised to receive either 100 mg oral flupirtine maleate (group flupirtine, n = 30) or 800 mg oral ibuprofen (group ibuprofen, n = 30), 1 h prior to surgery and then every 8 h for 48 h. Verbal Numerical Rating Scale (VNRS) on movement was assessed at 0, 2, 4, 6 and 8 h following surgery. Following discharge from hospital, the patients were interviewed telephonically at 12, 24 and 48 h post-operatively. VNRS was statistically analysed using Mann-Whitney test. Results: VNRS on movement was statistically reduced at 2 h after surgery (P = 0.04) in group flupirtine as compared to group ibuprofen. The analgesic efficacy was similar in both the groups at 4, 6, 8, 12, 24 and 48 h after surgery. The satisfaction scores at 24 and 48 h post-operatively were superior in group flupirtine as compared to group ibuprofen (P < 0.001). Conclusion: Analgesic efficacy of flupirtine maleate was comparable with ibuprofen in patients in ambulatory gynaecological patients up to 48 h postoperatively with superior satisfaction scores. |
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Effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients following major head and neck surgeries |
p. 416 |
Sunil Rajan, Soumya Srikumar, Jerry Paul, Lakshmi Kumar DOI:10.4103/0019-5049.160943 PMID:26257414Background and Aims: Conivaptan, a vasopressin receptor antagonist, is commonly used for the treatment of euvolaemic, hypervolaemic hyponatraemia. Usually, an intravenous (IV) bolus followed by infusion is administered for many days. We decided to assess the effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients. Methods: This was a prospective, randomised trial conducted in 40 symptomatic post-operative Intensive Care Unit (ICU) patients with a serum sodium level of ≤130 mEq/L. Group A patients received IV conivaptan 20 mg over 30 min, whereas in group B infusion of 3% hypertonic saline was started as an infusion at the rate of 20-30 ml/h. Serum sodium levels were measured at 12, 24, 48 and 72 h and the daily fluid balance was measured for 3 days. The Chi-square test, Wilcoxon signed rank test and Mann-Whitney tests were used as applicable. Results: The serum sodium levels before initiating treatment were comparable between groups. However, subsequent sodium levels at 12, 24 and 48 h showed significantly high values in group A. Though at 72 h the mean sodium value was high in group A, it was not statistically significant. Group A showed a significantly high fluid loss on day 1, 2 and 3. The mean volume of hypertonic saline required in group B showed a steady decline from day 1 to 3 and only 13 patients required hypertonic saline on the 3 rd day. Conclusion: Single dose conivaptan is effective in increasing serum sodium levels in post-operative ICU patients up to 72 h associated with a significant negative fluid balance. |
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A prospective, randomised, clinical study to compare the use of McGrath ® , Truview ® and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists |
p. 421 |
Sumitra G Bakshi, Vinayak S Vanjari, Jigeeshu V Divatia DOI:10.4103/0019-5049.160946 PMID:26257415Background and Aims: Video laryngoscopy has been recommended as an alternative during difficult conventional direct laryngoscopy using the Macintosh blade (MAC). However, successful visualisation of the larynx and tracheal intubation using some of the indirect laryngoscopes or video laryngoscopes (VL) requires hand-eye coordination. We conducted this study to determine whether non-channel VLs are easy to use for novices and whether there is any association between expertise with MAC and ease of tracheal intubation with VLs. Methods: Anaesthesiologists participating in the study were divided into three groups: Group novice to intubation (NTI), Group novice to videoscope (NVL)- experienced with MAC, novice to VLs and Group expert (EXP) experienced in all. Group NTI, NVL received prior mannequin training. VLs- Truview ® and McGrath series 5 (MGR) were compared with MAC. One hundred and twenty six adult patients with normal airway were randomised to both, the intubating anaesthesiologist and laryngoscope. The time taken to intubate (TTI) and participants' rating of the ease of use was recorded on a scale of 1-10 (10-most difficult). Results: In Group NTI, there was no difference in mean TTI with the three scopes (P = 0.938). In Group NVL, TTI was longer with the VLs than MAC (P < 0.001). In Group EXP, TTI with VL took 20 s more (P < 0.001). There was significant difference in participants' rating of ease of use of laryngoscope in Group NVL (P = 0.001) but not in the NTI (P = 0.205), EXP (P = 0.529) groups. A high failure was seen with MGR in Group NTI and NVL. Conclusion: In Group NTI, TTI and the ease of use were similar for all scopes. Expertise with standard direct laryngoscopy does not translate to expertise with VLs. Separate training and experience with VLs is required. |
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Comparison of ketorolac and low-dose ketamine in preventing tourniquet-induced increase in arterial pressure |
p. 428 |
Raza Zaidi, Aliya Ahmed DOI:10.4103/0019-5049.160949 PMID:26257416Background and Aims: Application of tourniquet during orthopaedic procedures causes pain and increase in blood pressure despite adequate anaesthesia and analgesia. In this study, we compared ketorolac with ketamine in patients undergoing elective lower limb surgery with tourniquet in order to discover if ketorolac was equally effective or better than ketamine in preventing tourniquet-induced hypertension. Methods: Approval was granted by the Institutional Ethics Review Committee and informed consent was obtained from all participants. A randomised double-blinded controlled trial with 38 patients each in the ketamine and ketorolac groups undergoing elective knee surgery for anterior cruciate ligament repair or reconstruction was conducted. Induction and maintenance of anaesthesia were standardised in all patients, and the minimum alveolar concentration of isoflurane was maintained at 1.2 throughout the study period. One group received ketamine in a dose of 0.25 mg/kg and the other group received 30 mg ketorolac 10 min before tourniquet inflation. Blood pressure was recorded before induction of anaesthesia (baseline) and at 0, 10, 20, 30, 40, 50, and 60 min after tourniquet inflation. Results: The demographic and anaesthetic characteristics were similar in the two groups. At 0 and 10 min, tourniquet-induced rise in blood pressure was not observed in both groups. From 20 min onward, both systolic and diastolic blood pressures were significantly higher in ketorolac group compared to ketamine group. Conclusion: We conclude that ketamine is superior to ketorolac in preventing tourniquet-induced increases in blood pressure. |
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CASE REPORTS |
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Hot charcoal vomitus in aluminum phosphide poisoning - A case report of internal thermal reaction in aluminum phosphide poisoning and review of literature |
p. 433 |
Seyed Mostafa Mirakbari DOI:10.4103/0019-5049.160952 PMID:26257417Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed 'ignition'. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient's face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event. |
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BRIEF COMMUNICATIONS |
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Oral midazolam is a safe and effective premedication in adult outpatients undergoing brachytherapy for cancer cervix under general anaesthesia: A prospective randomised, double blind placebo-controlled study |
p. 437 |
Rakhi Bansal, Anjum S Khan Joad, Meenakshi Saxena, Manisha Hemrajani DOI:10.4103/0019-5049.160955 PMID:26257418 |
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Anaesthetic management of a rare case of single ventricle heterotaxy syndrome for emergency caesarean section |
p. 439 |
Pushpa Ture, Safiya Shaikh, Shanta Hungund, S Roopa DOI:10.4103/0019-5049.160956 PMID:26257419 |
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Post-operative airway obstruction in Noonan syndrome: An unusual presentation |
p. 442 |
Sheetal R Jagtap, Hemalata R Iyer, Rochana G Bakhshi, Hemant N Lahoti DOI:10.4103/0019-5049.160961 PMID:26257420 |
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Use of ProSeal ® LMA and thoracic epidural in myasthenia patients for trans-sternal thymectomy: A case series |
p. 444 |
Binu Puthur Simon, Salil G Nair, Gauravjit Singh Paik, Khin Lay Nyi DOI:10.4103/0019-5049.160962 PMID:26257421 |
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Oral ketamine for phantom limb pain: An option for challenging cases |
p. 446 |
Sukanya Mitra, Sunita Kazal DOI:10.4103/0019-5049.160963 PMID:26257422 |
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LETTERS TO EDITOR |
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Management of airway in intratracheal tumour surgery |
p. 449 |
Upadhyayula Srinivas, Anand Kumar Sathpathy, Niharika Reddy Atla, Syed Yaseen DOI:10.4103/0019-5049.160964 PMID:26257423 |
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Good vagal tone, a tourniquet and dexmedetomidine: Recipe for disaster |
p. 450 |
CN Jaideep, DV Bhargava DOI:10.4103/0019-5049.160965 PMID:26257424 |
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Unilateral pulmonary oedema: Rare manifestation of scorpion sting |
p. 452 |
K Venugopal, DP Kushal, G Shyamala, N Kiran Chand DOI:10.4103/0019-5049.160966 PMID:26257425 |
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Spinal cord surgery in left lateral position with tilt in a pregnant patient with intradural extramedullary Schwannoma |
p. 453 |
Sathish Babu, Arul Murugan, Thamarai DOI:10.4103/0019-5049.160967 PMID:26257426 |
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Radiation hazards in operation theatre: Anaesthesiologist's concerns and preventive strategies |
p. 455 |
Gurpreet Kaur, Sukhminder Jit Singh Bajwa, Gurkaran Kaur DOI:10.4103/0019-5049.160970 PMID:26257427 |
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Minimising intraoperative exposure of ionising radiation to the anaesthesiologist |
p. 456 |
Moiz Kurban Alibhai, Sergey Rastopyrov DOI:10.4103/0019-5049.160972 PMID:26257428 |
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Commentary: Minimising intraoperative exposure of ionising radiation to anaesthesiologists |
p. 458 |
RS Raghavendra Rao DOI:10.4103/0019-5049.160974 PMID:26257429 |
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Delayed presentation of post tuberculous broncho oesophageal fistula in an adult: Perioperative anaesthetic management |
p. 459 |
Prakash Sharma, Ashvini Kumar DOI:10.4103/0019-5049.160976 PMID:26257430 |
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Perioperative management of a patient with severe Haemophilia B for abdominal pseudotumour Surgery |
p. 461 |
Lakshmi Kumar, Rekha Varghese, Ramachandran Narayana Menon, Neeraj Siddharthan DOI:10.4103/0019-5049.160978 PMID:26257431 |
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COMMENTS ON PUBLISHED ARTICLE |
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Opioids induced serotonin toxicity? Think again |
p. 463 |
Vandana Sharma, Ghansham Biyani, Pradeep Kumar Bhatia DOI:10.4103/0019-5049.160979 PMID:26257432 |
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RESPONSE TO COMMENTS |
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Cardiac arrest from tramadol and fentanyl combination |
p. 464 |
Shalini Nair, Tony Thomson Chandy DOI:10.4103/0019-5049.160982 PMID:26257433 |
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