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2007| September-October | Volume 51 | Issue 5
March 20, 2010
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Postoperative Analgesia with Local Anaesthetic and Opioid Combinations, Using Double Space CSE Technique
Rajib Bhattacharyya, Bhaskar Dutta
September-October 2007, 51(5):409-409
Double space combined spinal epidural anaesthesia (CSEA) is one of the techniques of anaesthetic armamentarium, which can be used as the sole technique of anaesthesia and continued for relief of postoperative pain. A prospective, randomized, and controlled study was conducted involving 90 patients of ASA physical status I& II coming for elective lower limb orthopaedic surgeries, carried under spinal anaesthesia with 2.5 ml bupivacaine heavy(0.5%) given intrathecally. Epidurally,0.125% bupivacaine alone, or along with morphine 2.5 mg or tramadol 75 mg was administered postoperatively, at two segment sensory regression. The duration of analgesia or the time to first top-up dose in the study groups were 206.8 ± 97.5minutes, 507.3 ± 228.6 minutes and 399.3 ± 152.1 minutes respectively, in bupivacaine group, morphine-bupivacaine group and tramadol-bupivacaine group. None of the patients in the study groups demonstrated motor block after 2 hours of observation period. None of the patients in the study groups had respiratory depression. The double space technique is also economical to the patients, which is a major advantage in our country.
Anaesthetic Management of A Case of Parkinson's Disease for Emergency Laparotomy Using Enteral Levo-dopa Intraoperatively
Navdeep Goyal, Homay Wajifdar, Aruna Jain
September-October 2007, 51(5):427-427
Parkinson's disease is a relatively common neurological disorder. Few case reports are available regarding optimal anaesthetic management of patients with Parkinson's disease. Here we present successful anaesthetic management of a case of suspected ileal perforation with Parkinson's disease for emergency laparotomy. Enteral route of levo-dopa administration was used throughout general anaesthesia.
Rapid Onset Acute Epiglottitis Leading to Negative Pressure Pulmonary Edema
V Saraswat, PV Madhu, Suresh S Kumar
September-October 2007, 51(5):429-429
Pulmonary edema is a potentially life-threatening complication of acute airway obstruction. It develops rapidly, without warning, in young healthy individuals. Two forms of post-obstructive pulmonary edema (POPE) (also known as negative pressure pulmonary edema, NPPE) have been identified. POPE I follows sudden, severe upper airway obstruction. POPE II occurs following surgical relief of chronic upper airway obstruction. Treatment for both is supportive. Full and rapid recovery can be expected with appropriate management. A case report of a middle aged man with acute onset epiglottitis who developed negative pressure pulmonary edema after intubation is presented. The report includes a brief discussion on etiology, clinical features and management dilemma of acute upper airway obstruction.
Ventilatory Obstruction with Spiral Embedded Tube - Are They as Safe?
Dinesh Malhotra, Mahmood Rafiq, Shagufta Qazi, Satya Dev Gupta
September-October 2007, 51(5):432-432
Spiral embedded tubes are routinely being used in anaesthetic practice these days as a preventive measure in cases where kinking of the endotracheal tube is anticipated. In spite of this advantage spiral embedded tubes can at times lead to disaster since any deformity in these tubes is permanent and leads to occlusion of a patent airway. We present a 40-year-male, who underwent popliteal artery anastomosis for a tear after fire arm injury, under general anaesthesia with spiral embedded tube in prone position. Surgical procedure and anaesthesia was uneventful but before extubation, patient bite on the tube created permanent deformity resulting in occlusion, leading to hypoxia and desaturation. The deformed tube was removed and replaced with an LMA, thereafter the patient was managed without any complications or sequelae and a lesson was learnt.
Epidural Catheter Breakage: A Dilemma
Deepanjali Pant, Pradeep Jain, Pravesh Kanthed, Jayashree Sood
September-October 2007, 51(5):434-434
Placement of an epidural catheter in epidural space is a routine practice for providing anaesthesia/analgesia in a myriad of surgical procedures and various painful conditions. Breakage of an epidural catheter, though rare, is a well-known complication. We present a case report of such an event and a comprehensive review of do's and don'ts in this setting.
Thoracic epidural analgesia as an adjunct to general anaesthesia in a case of lung cyst removal in an infant
Mamta Aggarwal, Riju Bansal
September-October 2007, 51(5):438-438
Paediatric thoracic and lumbar epidural analgesia is an integral part in the management of pain in neonates and children. We present a case of left lower lobe lung cyst in a 2 months old infant. The infant underwent excision of the lung cyst under general anaesthesia combined with thoracic epidural analgesia using an epidural catheter inserted via the caudal route. Analgesia was provided using 0.25% bupivacaine with 10mcg of fentanyl. No muscle relaxant was used throughout the surgery. The result showed a marked decrease in the requirement of anaesthetic drugs along with epidural analgesia, reduced surgical stress, and smooth recovery.
Efficacy of Analgesic Effects of Low Dose Intrathecal Clonidine as Adjuvant to Bupivacaine
BS Sethi, Mary Samuel, Deepak Sreevastava
September-October 2007, 51(5):415-415
Clonidine (α-2-adrenergic agonist) has analgesic effect at spinal level mediated by postsynaptically situated α-2-adrenoreceptors in dorsal horn of spinal cord. Previous studies have used this drug intrathecally in higher dosages. Sixty adult patients belonging to ASA grade I and II, scheduled for gynaecological surgery under spinal anaesthesia were randomly divided into two groups. Clonidine group received clonidine 1 μg.kg
with 12.5 mg 0.5% bupivacaine and the Control group received an identical volume of saline mixed with 12.5mg0.5% bupivacaine. The maximum dose of clonidine used was70 μg. The meantime from injection to regression of the level of sensory analgesia by two segments was longer in the Clonidine group than in Control group (
<0.001). The duration of motor blockade was longer in Clonidine group than in Control group (
<0.05). There was also a significant difference in the duration of analgesia between the two groups (
<0.001). The rescue analgesia was required earlier in the Control group(mean 223 min) compared to the Clonidine group(mean614 min). The number of injections of diclofenacin24 hours was higher for Control group (mean2.66) than Clonidine group (mean 1.16) (
<0.05). The patients in the Clonidine group had a significant fall in mean arterial pressure and heart rate and were more sedated than those in Control group, however, no therapeutic interventions needed. We concluded that addition of clonidine to bupivacaine in the dose of 1μg.kg
significantly increases the duration of spinal analgesia as compared to bupivacaine alone with clinically insignificant influence on haemodynamic parameters and level of sedation.
Public Awareness About Anaesthesia and Anaesthesiologist: A Survey
Udita Naithani, Dharam Purohit, Pramila Bajaj
September-October 2007, 51(5):420-420
Though the role of anaesthesiologist is crucial, the public knowledge of anaesthetic practice is limited. It is thus important for us to think that why the importance of this speciality is not known and how to make people aware about the vital role played by an anaesthesiologist in medical set up. The present study was conducted in a tertiary care teaching hospital, on 150 adult surgical patients posted for elective surgery to assess patient's knowledge about the role of anaesthesiologist, their preoperative concerns related to anaesthesia, post operative complaints and level of satisfaction regarding anaesthesia services. A majority (92.67%) of patients felt that anaesthesia was necessary for surgery, only 42.67% knew that it was given by an anaesthesiologist. Only 27.33% of the patients knew that besides anaesthetizing, anaesthesiologists monitors & takes care of vital signs throughout surgery. Patients were not much aware of their role in ICU (7.33%), painless labour (12.67%) & pain clinic (4.67%). Only 15.33% patients had knowledge about anaesthesia risks given in consent form. Though people with higher literacy levels had greater knowledge about anaesthesia compared with the lower literacy group (
<0.001), even their mean scores fell in average range. The statistical association between past exposure to anaesthesia and knowledge about anaesthesia was not significant (
>0.1). Contribution of anaesthesiologists in patients knowledge was the least (1.33%). The number of patients having preoperative fears was much more (61.33%) than the actual number of patients having discomfort during surgery(16.67%). Large majority of patients were satisfied with the quality of anaesthesia services (99.33%), and showed willingness to know about their anaesthesiologist in case of any future surgery (70%). We concluded that there is a widespread misconception amongst the public about the role of anaesthesiologists inside and outside the operating room, however services provided were considered satisfactory. Therefore, sufficient time should be given to educate the patients about anaesthesia and the various role an anaesthesiologist plays. Meeting during the preanaesthetic examination should be used to fulfill this purpose.
Comparison of Bispectral Index Values Produced by Isoflurane and Halothane at Equal End-tidal MAC Concentrations
Neerja Bharti, Jagan Devrajan
September-October 2007, 51(5):401-401
The bispectral index (BIS) has been validated as a measure of hypnotic effect for various anaesthetic agents. There are limited data correlating the BIS with minimum alveolar concentration (MAC) of different volatile anaesthetics. We compared the BIS values using halothane and isoflurane at equal end-tidal MAC multiples. Forty adult patients of ASAI-II undergoing elective abdominal surgeries were randomly assigned into two groups. After a standardized induction, anaesthesia was maintained with either halothane (Group H) or isoflurane (Group I) in combination with nitrous oxide 66% in oxygen and fentanyl.BIS values were measured before induction, during anaesthesia at 0.5 MAC, 1 MAC, 1.5 MAC concentration of the volatile anaesthetics and then at awakening of the patient. BIS measurements were made after meeting steady state concentrations of volatile anaesthetic agents. BIS values at 0.5 MAC, 1.0 MAC and 1.5 MAC for patients receiving halothane exceeded those for patients receiving isoflurane. BIS value at awakening did not differ between the halothane and isoflurane groups. We concluded that at equal MAC concentrations of halothane and isoflurane BIS values were significantly lower with isoflurane.
A Survey on Use of Nitrous Oxide in Current Anaesthetic Practice in India
Jayanta Kumar Mitra, Virendra Jain, Deepak Sharma, Hemanshu Prabhakar, HH Dash
September-October 2007, 51(5):405-405
In anaesthetic practice, exposure to a hazardous substance should be eliminated or controlled where practicable. Over the past few years, the use of nitrous oxide has become debatable. To assess the current anaesthetic practice in India on the use of nitrous oxide, a total of 400 questionnaires constituted by 15 questions on three topics- use of nitrous oxide, medical air and TIVA(total intravenous anaesthesia)- were distributed. Anaesthesiologists were selected randomly and requested to fill up the questionnaire. Of the 400 questionnaires, 40 questionnaires were discarded due to incomplete answer, leaving a total of 360 valid returned questionnaires, a 90% response rate. 27.22% respondents stated that the use of nitrous oxide had decreased .When medical air was available, 66.67% felt that they would use it frequently. A total of 214 (59.44%) stated that they used total intravenous anaesthesia occasionally. The results showed that although anaesthesiologists had reduced their use of nitrous oxide, this was due to medical considerations rather than concerns over health and pollution issues arising from the use of nitrous oxide.
What's New in Patient Safety and How It Will Affect Your Practice
September-October 2007, 51(5):363-363
EVIDENCE BASED DATA
Postoperative Pain Management : Organisation and Audits
September-October 2007, 51(5):441-441
Monitoring Devices for Measuring the Depth of Anaesthesia - An Overview
Prabhat Kumar Sinha, Thomas Koshy
September-October 2007, 51(5):365-365
Achieving adequate depth of anaesthesia during surgical procedures is desirable. Therefore, assessment and monitoring/ measurement of the depth of anaesthesia are fundamental to anaesthetic practice. The purpose of this review is to identify the risk factors that may be associated with intraoperative awareness, provide decision tools that may enable the clinician to reduce the frequency of unintended intraoperative awareness, stimulate the pursuit and evaluation of strategies that may prevent or reduce the frequency of intraoperative awareness, different types of tools developed to date to monitor the depth of anaesthesia, provide guidance for the intraoperative use of different monitoring tools as they relate to intraoperative awareness and how to approach a patient when awareness is reported by the patient along with current guidelines in the use of current available monitors.
Parkinson's Disease and Anaesthesia
A Rudra, Pallab Rudra, Suman Chatterjee, T Das, Manjushree Ray, P Kumar
September-October 2007, 51(5):382-382
Parkinson's disease is a debilitating neurodegenerative disorder due to death of dopaminergic neurons of the substantia nigra that leads to resting tremor, muscle rigidity, and bradykinesia. Parkinson's disease is a common disease of elderly patients who present a particular anaesthetic challenge. Good number of patients are newly diagnosed at the time of preanaesthetic examinations. Variety of drugs may be used for symptomatic treatment. Controversies surrounding the use of the newer drugs and possible advances in neurosurgical interventions are discussed. Particular anaesthetic problems in Parkinson's disease include respiratory, cardiovascular, and neurological. Potential drug interactions are described and recommendations are made about suitable anaesthetic technique.
Steroid Therapy - Current Indications in Practice
VK Grover, Ramesh Babu, S.P.S Bedi
September-October 2007, 51(5):389-389
Steroids are a widely used group of drugs in anaesthesia practice, sometimes with definite indication and sometimes without indication. When used judiciously they have proved to be of immense help. There has been a renewed interest in the use of steroids in modern day perioperative medicine. In the following article the recent trends, relevance and consensus issues on the use of steroids as adjunct pharmacological agents in relation to anaesthesia have been discussed, along with emphasis on important clinical aspects of their perioperative usefulness.
Emergency Anaesthetic Management of Extensive Thoracic Trauma
September-October 2007, 51(5):394-394
High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important role in the management of extensive thoracic trauma. Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz. pleura, lungs, heart, great vessels, trachea and oesophagus. It may lead to pneumothorax, cardiac tamponade or life threatening haemorrhage. With aggressive care and management of these factors, majority of patients can survive and return to normal life.
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