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EDITORIAL |
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Indian Society of Anaesthesiologists cardiopulmonary resuscitation guidelines: Ushering in a new initiative |
p. 865 |
Mukul Chandra Kapoor, SSC Chakra Rao, Bibhuti Bhushan Mishra DOI:10.4103/ija.IJA_650_17 PMID:29217850 |
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SPECIAL ARTICLES |
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Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital  |
p. 867 |
Syed Moied Ahmed, Rakesh Garg, Jigeeshu Vasishtha Divatia, SSC Chakra Rao, Bibhuti Bhusan Mishra, M Venkatagiri Kalandoor, Mukul Chandra Kapoor, Baljit Singh DOI:10.4103/ija.IJA_636_17 PMID:29217851The cardiopulmonary resuscitation (CPR) guidelines of compression-only life support (COLS) for management of the victim with cardiopulmonary arrest in adults provide a stepwise algorithmic approach for optimal outcome of the victim outside the hospital by untrained laypersons. These guidelines have been developed to recommend practical, uniform and acceptable resuscitation algorithms across India. As resuscitation data of the Indian population are inadequate, these guidelines have been based on international literature. The guidelines have been recommended after discussion among Indian experts and the recommendations modified to ensure its practical applicability across the country. The COLS emphasises on early recognition of cardiac arrest and activation, early chest compression and early transfer to medical facility. The guidelines emphasise avoidance of any interruption of chest compression, and thus relies primarily on chest compression-only CPR by laypersons. |
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Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital  |
p. 874 |
Rakesh Garg, Syed Moied Ahmed, Mukul Chandra Kapoor, Bibhuti Bhusan Mishra, SSC Chakra Rao, M Venkatagiri Kalandoor, Jigeeshu Vasishtha Divatia, Baljit Singh DOI:10.4103/ija.IJA_637_17 PMID:29217852The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS) for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation. |
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Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital  |
p. 883 |
Rakesh Garg, Syed Moied Ahmed, Mukul Chandra Kapoor, SSC Chakra Rao, Bibhuti Bhusan Mishra, M Venkatagiri Kalandoor, Baljit Singh, Jigeeshu Vasishtha Divatia DOI:10.4103/ija.IJA_664_17 PMID:29217853The cardiopulmonary resuscitation (CPR) guideline of comprehensive cardiopulmonary life support (CCLS) for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care. |
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COMMENTARY |
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Need for resuscitation registry in India based on Indian Society of Anaesthesiologists cardiopulmonary resuscitation guidelines |
p. 895 |
Ramakrishnan V Trichur DOI:10.4103/ija.IJA_680_17 PMID:29217854 |
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ORIGINAL ARTICLES |
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Effect of nasal oxygen supplementation during apnoea of intubation on arterial oxygen levels: A prospective randomised controlled trial |
p. 897 |
Nishant Sahay, Shalini Sharma, Umesh K Bhadani, Chandni Sinha, Amarjeet Kumar, Alok Ranjan DOI:10.4103/ija.IJA_232_17 PMID:29217855Background and Aims: Apnoeic oxygenation during laryngoscopy has been emphasised in recent recommendations for airway management. We aimed to compare the effect of nasal oxygen supplementation on time for pulse oximeter oxygen saturation (SpO2) to fall from 100% to 92% (desaturation safety time), to assess the arterial oxygen partial pressures (PaO2) with and without nasal oxygen supplementation and the time for SpO2 to recover from 92% to 100% after initiation of ventilation. Methods: This is a prospective randomised placebo-controlled trial involving sixty patients, where nasal oxygen supplementation given at 10 L/min during apnoea of laryngoscopy in one group of patients (Group O2) was compared to no oxygen supplementation in other group (Group NoO2). Desaturation safety period and the PaO2just after intubation were compared. Time for SpO2 to increase to 100% after initiation of ventilation was also assessed. Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Desaturation safety period at 415.46 ± 97.23 seconds in group O2versus 378.69 ± 89.31 seconds in group NoO2(P = 0.213) and PaO2(P = 0.952) and time to recovery of SpO2 (P = 0.058) were similar in both groups. Rise in arterial carbon dioxide secondary to apnoea was slower in oxygen supplementation group (P = 0.032). Conclusion: Apnoeic oxygen supplementation at 10 L/min flow by nasal prong did not significantly prolong the apnoea desaturation safety periods or the PaO2in our study. |
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Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine |
p. 903 |
Rakhee Goyal, Gaurav Mittal, Arun Kumar Yadav, Rishab Sethi, Animesh Chattopadhyay DOI:10.4103/ija.IJA_277_17 PMID:29217856Background and Aims: Knee replacement surgery causes tremendous post-operative pain and adductor canal block (ACB) is used for post-operative analgesia. This is a randomised, controlled, three-arm parallel group study using different doses of dexmedetomidine added to ropiavcaine for ACB. Methods: A total of 150 patients aged 18–75 years, scheduled for simultaneous bilateral total knee replacement, received ultrasound-guided ACB. They were randomised into three groups -Group A received ACB with plain ropivacaine; Groups B and C received ACB with ropivacaine and addition of dexmedetomidine 0.25 μg/kg and 0.50 μg/kg, respectively, on each side of ACB. The primary outcome was the duration of analgesia. Total opioid consumption, success of early ambulation, and level of patient satisfaction were also assessed. Results: The patient characteristics and block success rates were comparable in all groups. Group C patients had longer duration of analgesia (Group C 18.4 h ± 7.4; Group B 14.6 ± 7.1; Group A 10.8 ± 7; P < 0.001); lesser tramadol consumption (Group C 43.8 mg ± 53.2; Group B 76.4 ± 49.6; Group A 93.9 mg ± 58.3; P < 0.001) and lesser pain on movement (P < 0.001). The patients in Group B and C walked more steps than in Group A (P < 0.002). The level of patient satisfaction was highest in Group C (P < 0.001). Conclusions: The addition of dexmedetomidine to ropivacaine resulted in longer duration of analgesia after adductor canal block for simultaneous bilateral total knee replacement surgery. |
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A comparison of haemodynamic responses between clinical assessment-guided tracheal intubation and neuromuscular block monitoring-guided tracheal intubation: A prospective, randomised study |
p. 910 |
Rudranil Nandi, Shekhar Ranjan Basu, Susanta Sarkar, Rakesh Garg DOI:10.4103/ija.IJA_93_17 PMID:29217857Background and Aims: Haemodynamic responses to laryngoscopy and endotracheal intubation and their hazards are well documented. The purpose of the study was to compare the effects of laryngoscopy and intubation on cardiovascular responses when the appropriate moment for intubation was directed by either clinical judgment or train-of-four assessment. Methods: A total of 68 patients, posted for laparoscopic cholecystectomy, were randomised into two groups. In Group M patients, the trachea was intubated after train of four counts became zero in adductor pollicis muscle, whereas in Group C patients, the trachea was intubated after the clinical judgment of jaw muscle relaxation. Changes in heart rate (HR) and mean arterial pressure, intubating conditions and the time between the administration of a neuromuscular blocking agent and endotracheal intubation were recorded. Results were analysed by the Analysis of variance and chi-square tests. Results: HR and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and tracheal intubation (P < 0.05). The mean time required for intubation was significantly shorter in Group C compared to Group M (175 ± 7 s vs. 385 ± 101 s). Excellent and good intubation conditions were observed in all Group M patients, whereas 24 out of 34 patients (70%) in Group C showed excellent and good intubation conditions. Conclusion: Haemodynamic responses to laryngoscopy and tracheal intubation can be significantly attenuated if tracheal intubation is performed following complete paralysis of laryngeal muscles, detected by neuromuscular monitoring of adductor pollicis muscle. |
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Effect of co-administration of different doses of phenylephrine with oxytocin on the prevention of oxytocin-induced hypotension in caesarean section under spinal anaesthesia: A randomised comparative study |
p. 916 |
Ranjitha Gangadharaiah, Devika Rani Duggappa, Sudheesh Kannan, SB Lokesh, Karuna Harsoor, KM Sunanda, SS Nethra DOI:10.4103/ija.IJA_256_17 PMID:29217858Introduction: Co-administration of phenylephrine prevents oxytocin-induced hypotension during caesarean section under spinal anaesthesia (SA), but higher doses cause reflex bradycardia. This study compares the effects of co-administration of two different doses of phenylephrine on oxytocin-induced hypotension during caesarean section under SA. Methods: In this prospective, double-blind study, 90 parturients belonging to the American Society of Anesthesiologists' physical status 1 or 2, undergoing caesarean section under SA were randomised into Group A: oxytocin 3U and phenylephrine 50 μg, Group B: oxytocin 3U and phenylephrine 75 μg, Group C: oxytocin 3U and normal saline, administered intravenously over 5 min after baby extraction. The incidence of hypotension (the primary outcome), rescue vasopressor requirement and side effects were recorded. Statistical analyses were with analysis of variance, Kruskal-Wallis, chi-square and Fisher's exact tests. Results: Demographic parameters such as age, height, weight, level of sensory block at 20 min and duration of surgery were comparable in all the groups. The incidence of hypotension (Group A – 90%, Group B – 10%, Group C – 98%, P = 0.001), magnitude of fall in mean arterial pressure (Group A-15.03 ± 6.12 mm of Hg, Group B – 6.63 ± 4.49 mm of Hg and Group C-13.03 ± 3.39 mm of Hg, P < 0.001) and rescue vasopressor requirement (Group A-45 ± 15.25 mg, Group B-5 ± 15.25, Group C-91.66 ± 26.53, P < 0.001) were significantly lower in Group B compared to A and C. Conclusion: Co-administration of phenylephrine 75 μg with oxytocin 3U reduces the incidence of oxytocin-induced hypotension compared to phenylephrine 50 μg with oxytocin 3U during caesarean section under spinal anaesthesia. |
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Efficacy of transdermal buprenorphine patch on post-operative pain relief after elective spinal instrumentation surgery |
p. 923 |
Saikat Niyogi, Pratibha Bhunia, Jisnu Nayak, Sankari Santra, Amita Acharjee, Indrani Chakraborty DOI:10.4103/ija.IJA_118_17 PMID:29217859Background and Aims: Transdermal buprenorphine patch (TDB) is increasingly used for chronic pain management because of non-invasive dosing, longer duration of action and minimal side effects. However its role in acute post-operative pain management for spinal instrumentation surgery is not well established. The aim of this study was to evaluate the analgesic efficacy of buprenorphine patch for postoperative pain relief in patients undergoing spinal instrumentation surgery. Methods: In this randomised, placebo-controlled, double-blinded, prospective study, 70 adult patients undergoing elective spinal instrumentation surgery were randomly allocated into two groups-TDB Group (buprenorphinepatch) and TDP Group (placebo patch). Time to first rescue analgesic requirement was the primary outcome. All patients also were monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status till 48 h after surgery. Statistical analysis was carried out using student independent t-test if normally distributed or with Mann–Whitney U-test if otherwise. Results: Time to first post-operative rescue analgesic (tramadol) requirement was much delayed in TDB Group than TDP Group (708.0 ± 6.98 min vs 54 ± 0.68 min, P < 0.001) and the total tramadol requirement was higher in TDB Group (490.60 ± 63.09 averagevs. 162.93 ± 63.91 mg, P < 0.001). Intra-and post-operative haemodynamic status was also stable in TDB Group without any adverse event. Conclusion: A TDB patch (10 μg/hour) applied 24 hours before surgery can be used as a postoperative analgesic for lumber fixation surgery without any drug-related adverse effect. |
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CASE REPORT |
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Greater palatine nerve neuropraxia after laryngeal mask insertion: A rare occurrence |
p. 930 |
Jyoti Garg, Geoffrey Haw Chieh Liew, Shariq Ali Khan DOI:10.4103/ija.IJA_364_17 PMID:29217860With the more frequent use of the laryngeal mask airway (LMA) over endotracheal tubes for general anaesthesia, various cranial nerve injuries have been reported recently. We report a rare occurrence of greater palatine nerve (GPN) palsy subsequent to the use of LMA Supreme™ in a young female scheduled for hand surgery. Although the exact mechanism of a nerve injury is still a matter of further research, we postulate pressure neuropraxia of GPN as a causative factor in the development of numbness over the hard palate after the removal of LMA in the post operative period. |
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BRIEF COMMUNICATION |
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Practice and reasons for routine pre-operative investigations among anaesthesiologists and surgeons: An online survey |
p. 933 |
Habib Md Reazaul Karim DOI:10.4103/ija.IJA_92_17 PMID:29217861 |
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LETTERS TO EDITOR |
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Tracheostomal myiasis! A word of caution |
p. 936 |
Rajeev Sharma, K Vino Barathi, Rahul Saini, Sushmita Bairagi, Deepa Rani DOI:10.4103/ija.IJA_461_17 PMID:29217862 |
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Sustained intraoperative bradycardia revealing Sengers syndrome |
p. 937 |
Youssef Zarrouki, Youssef Elouardi, Amra Ziadi, Abdenasser Mohamed Samkaoui DOI:10.4103/ija.IJA_436_17 PMID:29217863 |
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Post-reperfusion bronchospasm in a deceased donor liver transplant recipient: An enigma |
p. 939 |
Kiran Bharath, Amar Nandhakumar, Harendra Singh, Vivekanandan Shanmugam DOI:10.4103/ija.IJA_437_17 PMID:29217864 |
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Jet Insufflator for cannot intubate cannot ventilate situation. An Indian Jugaad |
p. 941 |
Ketan Sakharam Kulkarni, Nandini Malay Dave, Priyanka Pradip Karnik, Madhu Garasia DOI:10.4103/ija.IJA_363_17 PMID:29217865 |
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Airway management of a paediatric patient with temporomandibular joint ankylosis with extra hepatic portal vein obstruction, splenomegaly, hypersplenism, and obstructive sleep apnoea for shunt surgery: A unique challenge |
p. 943 |
Shiv Akshat, Shikha Jain, Puneet Khanna, Ravinder Kumar Batra DOI:10.4103/ija.IJA_336_17 PMID:29217866 |
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