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Citation statistics : Table of Contents
2011| March-April | Volume 55 | Issue 2
Online since
April 22, 2011
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REVIEW ARTICLES
American Society of Anaesthesiologists physical status classification
Mohamed Daabiss
March-April 2011, 55(2):111-115
DOI
:10.4103/0019-5049.79879
PMID
:21712864
Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.
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110
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5,276
Ropivacaine: A review of its pharmacology and clinical use
Gaurav Kuthiala, Geeta Chaudhary
March-April 2011, 55(2):104-110
DOI
:10.4103/0019-5049.79875
PMID
:21712863
Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. It produces effects similar to other local anaesthetics via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor sensory differentiation, which could be useful when motor blockade is undesirable. The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity. The drug displays linear and dose proportional pharmacokinetics (up to 80 mg administered intravenously). It is metabolised extensively in the liver and excreted in urine. The present article details the clinical applications of ropivacaine and its current place as a local anaesthetic in the group.
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44
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5,352
CLINICAL INVESTIGATIONS
Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Jasbir Kaur, Gurpreet Singh, Vikramjit Arora, Sachin Gupta, Ashish Kulshrestha, Amarjit Singh, SS Parmar, Anita Singh, SPS Goraya
March-April 2011, 55(2):116-121
DOI
:10.4103/0019-5049.79883
PMID
:21712865
Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of
P
< 0.05 was considered significant and
P
< 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically non-significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (
P
< 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (
P
> 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.
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Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit
Sunanda Gupta, Udita Naithani, Vimla Doshi, Vaibhav Bhargava, Bhavani S Vijay
March-April 2011, 55(2):146-153
DOI
:10.4103/0019-5049.79895
PMID
:21712871
A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed.During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20,
P
<0.05) with more patients presenting with obstetric complications (91.66%, n=22,
P
<0.01) as compared to medical complications (8.32% n=2). Obstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (
P
=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (
P
=0.01,
P
=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%,
P
=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.
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The comparison of Proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia
Namita Saraswat, Aditya Kumar, Abhijeet Mishra, Amrita Gupta, Gyan Saurabh, Uma Srivastava
March-April 2011, 55(2):129-134
DOI
:10.4103/0019-5049.79891
PMID
:21712868
Aims to compare the efficacy of Proseal laryngeal mask airway(PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic surgeries under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and vecuronium. PLMA or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N
2
O, O
2
, halothane and vecuronium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. There was no failed insertion of devices. Time taken for successful passage of NGT was 9.77 s (6-16 s) and 11.5 s (8-17 s) for groups P and E, respectively. There were no statistically significant differences in oxygen saturation (SpO
2
) or end-tidal carbon dioxide (EtCO
2
) between the two groups before or during peritoneal insufflation. Median (range) airway pressure at which oropharyngeal leak occurred during the leak test with PLMA was 35 (24-40) cm of H
2
O. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. No significant difference in laryngopharyngeal morbidity was noted. A properly positionedPLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic surgeries. It provided equally effective pulmonary ventilation despite high airway pressures without gastric distention, regurgitation, and aspiration.
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EDITORIAL
Emerging concepts in post-operative pain management
SS Harsoor
March-April 2011, 55(2):101-103
DOI
:10.4103/0019-5049.79872
PMID
:21712862
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4
6,465
2,528
CASE REPORTS
Metformin poisoning: A complex presentation
Manish Jagia, Salah Taqi, Mahmud Hanafi
March-April 2011, 55(2):190-192
DOI
:10.4103/0019-5049.79890
PMID
:21712882
The objective of this case report is to highlight presentation, complications and treatment of metformin poisoning. Patient after ingestion of 45gms of metformin developed colicky abdominal pain, severe tachypnea and vomiting. He developed severe lactic acidosis, cardiac arrest, pancreatitis and hemolytic anemia which was treated with charcoal, sodium bicarbonate, early initiation of high volume continuous veno-venous hemofiltration and supportive therapy. Metformin poisoning is a rare presentation and we discuss course of events in the management of metformin poisoning and its associated complications.
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3
3,456
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CLINICAL INVESTIGATIONS
Prevention and management of ventilator-associated pneumonia: A survey on current practices by intensivists practicing in the Indian subcontinent
Deven Juneja, Omender Singh, Yash Javeri, Vikas Arora, Rohit Dang, Anjali Kaushal
March-April 2011, 55(2):122-128
DOI
:10.4103/0019-5049.79889
PMID
:21712867
Implementation of evidence-based guidelines to prevent and manage ventilator-associated pneumonia (VAP) in the clinical setting may not be adequate. We aimed to assess the implementation of selected VAP prevention strategies, and to learn how VAP is managed by the intensivists practicing in the Indian Subcontinent. Three hundred 10-point questionnaires were distributed during an International Critical Care Conferenceheld at New Delhi in 2009. A total of 126 (42%) questionnaires distributed among delegates from India, Nepal and Sri Lanka were analyzed. Majority (96.8%) reported using VAP bundles with a high proportion including head elevation (98.4%), chlorhexidine mouthcare (83.3%), stress ulcer prophylaxis (96.8%), heat and moisture exchangers (HME, 92.9%), early weaning (94.4%), and hand washing (97.6%) as part of their VAP bundle. Use of subglottic secretion drainage (SSD, 45.2%) and closed suction systems (CSS, 74.6%) was also reported by many intensivists, whereas use of selective gut decontamination was reported by only 22.2%. Commonest method for sampling was endotracheal suction by 68.3%. Gram negative organisms were reported to be the most commonly isolated. Majority (39.7%) reported using proton pump inhibitors for stress ulcer prophylaxis and 84.1% believed that VAP contributed to increased mortality. De-escalating therapy was considered in patients responding to treatment by 57.9% and 65.9% considered adding empirical methicillin resistant
Staphylococcus aureus
(MRSA)coverage, while 63.5% considered adding nebulized antibiotics in certain high-risk patients. There was good concordance regarding VAP prophylaxis among the intensivists with a majority adhering to evidence-based guidelines. We could identify certain issues like the choice of agent for stress ulcer prophylaxis, use of HME filters, SSD and CSS, where there still exists some practice variability and opportunities for improvement.
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Role of epidural ketamine for postoperative analgesia after upper abdominal surgery
Mamta Sethi, Nitin Sethi, Pradeep Jain, Jayashree Sood
March-April 2011, 55(2):141-145
DOI
:10.4103/0019-5049.79894
PMID
:21712870
Ketamine, a
N
-methyl-D-aspartate receptor antagonist inhibits central sensitization due to peripheral nociception thus potentiating the analgesic effect of morphine. The purpose of our study was to evaluate the effect of adding small-dose ketamine in a multimodal regimen of postoperative patient-controlled epidural analgesia (PCEA). One hundred patients of American Society of Anesthesiologists physical status I-II, undergoing major upper abdominal surgery were randomly allocated to two groups. Group I received PCEA device containing bupivacaine hydrochloride 0.0625% and morphine sulphate (preservative free) 0.05mg/ml. Group II received PCEA device containing bupivacaine hydrochloride 0.0625%, morphine sulphate (preservative free) 0.05 mg/ml and ketamine hydrochloride (preservative free) 0.2 mg/ml. The mean morphine consumption in group I after 1
st
and 2
nd
postoperative day was 8.38±2.85 and 7.64±1.95 mg, respectively, compared to 6.81±1.35 and 6.25±1.22 mg (
P
<0.05) in group II. Although group II consumed significantly less morphine, pain relief at rest and at movement after 6, 12, 24 and 48 hours, postoperatively was significantly better in group II (
P
<0.05) than in group I. These findings suggest that adding small-dose ketamine to a multimodal PCEA regimen provides better postoperative analgesia and reduces morphine consumption.
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4,291
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EVIDENCE BASED REPORT
Evaluation of stressors and coping strategies for stress in Indian anaesthesiologists
RV Shidhaye, DS Divekar, VK Dhulkhed, Gaurav Goel, Arunkumar Gupta, Rahul Shidhaye
March-April 2011, 55(2):193-198
DOI
:10.4103/0019-5049.79871
PMID
:21713218
Several studies have been done to assess job satisfaction and quantify effects of stressors on anaesthesiologists in different regions and countries.Studies related to stress in Indian anaesthesiologists are very limited, which prompted us to design this study not only to identify the stressors but also to find out how anaesthesiologists react to stress and devise means to minimize it to increase their job satisfaction levels. A set of questions was handed over personally to 200 anaesthesiologists at the national- and state-level anaesthesiology conferences and continuing medical educations with a request to return them duly filled in, with an assurance that confidentiality and anonymity would bemaintained.Main outcome measures were demographics, factors causing stress, how the responding anaesthesiologists and their colleagues react to it and methods they adopt to reduce stress at their workplace. Response rate was 96%. The total number of respondents was 192 (54% males and 46% females; juniors, 76%; and seniors, 24%). Identified stressors were as follows: time constraints (34%), medicolegal concerns (24%), interference with home life (22%), clinical problems (20%) and communication problems (9%). Different strategies for coping with stress were identified. This survey is just a beginning. Indian Society of Anaesthesiologists is requested to look into the matter and take it further on a larger scale by multicentric studies to lay down standards related to number of working hours, number of night-call duties per week, proper assistance, medicolegal protection, etc., which would not only reduce occupational stress but also improve efficiency and job satisfaction among anaesthesiologists.
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BRIEF COMMUNICATION
Comparison of oscillometric blood pressure measurement by two clinical monitors: Datex Ohmeda GE S/5 and Criticare 8100E nGenuity
Harihar V Hegde, Rajashekar R Mudaraddi, Vijay G Yaliwal, P Raghavendra Rao
March-April 2011, 55(2):199-200
DOI
:10.4103/0019-5049.79873
PMID
:21712883
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2,414
380
CASE REPORTS
Anaesthetic management of a patient with Eisenmenger syndrome and β-thalassemia major for splenectomy
Nishkarsh Gupta, Sarbjot Kaur, Ajay Goila, Mridula Pawar
March-April 2011, 55(2):187-189
DOI
:10.4103/0019-5049.79892
PMID
:21712881
We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
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2
4,499
640
Hydatidiform mole: A sour encounter with a grapy case
Madhuri S Kurdi
March-April 2011, 55(2):171-173
DOI
:10.4103/0019-5049.79900
PMID
:21712876
Hydatidiform mole cases are usually uncomplicated. However, few cases can be associated with perioperative complications of a critical nature, which can lead to substantial mortality and morbidity. Here is a report of one such case, which, in spite of extensive perioperative management, led to mortality.
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2
4,556
536
CLINICAL INVESTIGATIONS
Comparative evaluation of atenolol and clonidine premedication on cardiovascular response to nasal speculum insertion during trans-sphenoid surgery for resection of pituitary adenoma: A prospective, randomised, double-blind, controlled study
Devendra Gupta, Shashi Srivastava, Rajeev K Dubey, Prabhakar S Prakash, Prabhat K Singh, Uttam Singh
March-April 2011, 55(2):135-140
DOI
:10.4103/0019-5049.79893
PMID
:21712869
Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 μg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (
P
<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (
P
<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.
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3,974
618
LETTERS TO EDITOR
Indigenous coated needle for nerve block
Dilip Kothari, Jitendra Agrawal, Amrita Mehrotra
March-April 2011, 55(2):201-202
DOI
:10.4103/0019-5049.79874
PMID
:21712884
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2
2,646
363
Fibreoptic aided retrograde intubation in an oral cancer patient
Sabyasachi Das, Mohan C Mandal, Bidyut B Gharami, Payel Bose
March-April 2011, 55(2):202-203
DOI
:10.4103/0019-5049.79876
PMID
:21712885
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2
5,917
431
Life-threatening haemolysis in a patient with acute copper sulphate poisoning
Nishant Sood, PK Verma
March-April 2011, 55(2):204-205
DOI
:10.4103/0019-5049.79878
PMID
:21712887
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2
2,237
373
CASE REPORTS
Nonconvulsive status epilepticus: An unusual cause of postoperative unresponsiveness following general anaesthesia
P Sudha, Rachel Cherian Koshy
March-April 2011, 55(2):174-176
DOI
:10.4103/0019-5049.79901
PMID
:21712877
Any altered behaviour or sensorium following general anaesthesia is of concern to the anaesthesiologist, as it could be attributed to the anaesthetic itself or to a hypoxic insult, both of which can have medicolegal implications. It is important to be aware of a relatively unfamiliar entity known as nonconvulsive status epilepticus in this context. We report two cases to highlight this condition.
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1
3,411
401
Pleural puncture with thoracic epidural: A rare complication?
Rachna Wadhwa, Sandeep Sharma, Devadatta Poddar, Sujata Sharma
March-April 2011, 55(2):163-166
DOI
:10.4103/0019-5049.79898
PMID
:21712874
Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.
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1
3,235
453
Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery
Rakesh Garg, Renu Sinha, PK Nishad
March-April 2011, 55(2):167-170
DOI
:10.4103/0019-5049.79899
PMID
:21712875
Wolff-Parkinson-White (WPW) syndrome is one of the pre-excitation syndromes in which activation of an accessory atrioventricular (AV) conduction pathway leads to bypass the AV node and cause earlier ventricular activation than the normal pathway. We report a patient with intermittent WPW syndrome who repeatedly manifested pre-excitation after subarachnoid block.
[ABSTRACT]
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1
4,070
472
CLINICAL INVESTIGATIONS
Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator
Umesh Goneppanavar, Akshay Nair, Gurudas Kini
March-April 2011, 55(2):154-159
DOI
:10.4103/0019-5049.79896
PMID
:21712872
Lightwand-guided intubation is a semi-blind technique that takes advantage of the anterior location of the trachea in relation to the oesophagus. Fibreoptic evaluation of lightwand-guided intubation has revealed a possibility of laryngeal interference and epiglottic distortion. Jaw lift, tongue traction or a combination of both have been used to assist in lightwand-guided intubation. This study fibreoptically evaluates lightwand-guided intubation using jaw lift and combined jaw and tongue traction. Eighty four patients with normal airway undergoing general anaesthesia were studied. This randomised, double blinded, cross over study was done in two phases. First phase - after achieving adequate depth of anaesthesia, a fibrescope was advanced nasally, and lightwand-guided intubation was carried out under direct fibreoptic visualisation with the aid of either jaw lift or combined jaw and tongue traction. Second phase - Extubation followed by reintubation using the other manoeuvre. Interference with laryngeal structures during intubation and position of the epiglottis at the end of intubation were noted. Epiglottic distortion (deviated to one side/infolded into trachea) was observed in 6 patients with jaw lift and 17 patients with combined jaw and tongue traction (
P
=0.003). Laryngeal interference was significantly higher (
P
=0.012) with combined manoeuvre (30/78) than with jaw lift alone (9/81). Although lightwand-guided intubation can be performed quickly and easily, interference with laryngeal structures and distortion of the epiglottis can occur. Jaw lift manoeuvre causes less laryngeal interference than combined jaw and tongue traction applied by a single operator.
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ERRATUM
Erratum
March-April 2011, 55(2):121-121
PMID
:21712866
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[PubMed]
1
2,057
329
LETTERS TO EDITOR
Femoral sciatic block: A safe alternative in von Recklinghausen's disease
R Bhagyalakshmi, Rachel Cherian Koshy
March-April 2011, 55(2):210-212
DOI
:10.4103/0019-5049.79885
PMID
:21712892
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1
3,465
440
Paediatric face mask for adult ventilation in presence of nasal tumours
Rajeev Sharma
March-April 2011, 55(2):203-204
DOI
:10.4103/0019-5049.79877
PMID
:21712886
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[PubMed]
1
2,132
398
CASE REPORTS
Axillary brachial plexus blockade in moyamoya disease?
Saban Yalcin, Hasan Cece, Halil Nacar, Mahmut Alp Karahan
March-April 2011, 55(2):160-162
DOI
:10.4103/0019-5049.79897
PMID
:21712873
Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.
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3,234
419
Anaesthesia for the separation of conjoined twins
Jaya Lalwani, KP Dubey, Pratibha Shah
March-April 2011, 55(2):177-180
DOI
:10.4103/0019-5049.79902
PMID
:21712878
Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins. We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date. We highlight the responsibility of anaesthesia team in anaesthetising the two individual patients simultaneously, need of careful monitoring and anticipation of complications like massive blood loss, hypotension, hypokalemia, hypoxia and hypercabia. Detailed description of successful management is reported.
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8,601
826
Differential blockade to assess surgical repair by intraoperative active mobilization in knee injuries-Beyond labour analgesia
G Vijay Anand, M Kannan, D Palaramakrishnan
March-April 2011, 55(2):181-183
DOI
:10.4103/0019-5049.79903
PMID
:21712879
Motor-sparing selective epidural analgesia has long been practised in the field of labour analgesia. However, the utility of such techniques in other fields remain limited. We present the successful use of a similar technique of differential blockade in a case of quadriceps plasty with realignment of patella for recurrent dislocation of patella. A very low concentration of bupivacaine and fentanyl was used through continous epidural. The adequacy of repair was assessed intraoperatively by active movement of operated limb by patient himself.
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Catatonia and jaw dislocation in the postoperative period with epidural morphine
Satyen Parida, Varsha D Allampalli, Sudeep Krishnappa
March-April 2011, 55(2):184-186
DOI
:10.4103/0019-5049.79904
PMID
:21712880
We report a case of temporomandibular joint dislocation occurring in the postoperative period in a patient, who developed catatonia following administration of a single dose of epidural morphine. The catatonic response to epidural morphine was delayed by several hours in the postoperative period, and might have resulted from intrathecal migration of the drug, through an initial dural puncture while locating the epidural space. The temporomandibular joint dislocation was diagnosed only after reversal of the effects of morphine with naloxone, when the patient complained of inability to fully close her mouth.
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2,754
353
CORRESPONDENCE
Guidewire impaction during percutaneous dilatational tracheostomy
Pramendra Agrawal, Babita Gupta, Nita D'souza, Kapil Dev Soni, Chandni Sinha
March-April 2011, 55(2):215-215
DOI
:10.4103/0019-5049.79888
PMID
:21712895
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2,809
376
LETTERS TO EDITOR
Fracture of first rib after sternotomy
Dheeraj Arora, Yatin Mehta
March-April 2011, 55(2):212-213
DOI
:10.4103/0019-5049.79886
PMID
:21712893
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2,021
310
Role of amino acid infusion in delayed recovery from neuromuscular blockers
Anju Gupta, Nishkarsh Gupta
March-April 2011, 55(2):213-214
DOI
:10.4103/0019-5049.79887
PMID
:21712894
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1,847
363
Tri-colour concept with the use of LMA CTrach
Geetanjali Chilkoti, Medha Mohta
March-April 2011, 55(2):205-206
DOI
:10.4103/0019-5049.79880
PMID
:21712888
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1,836
325
Ramp position for intubating morbidly obese parturient: What's new?
Chitra Rajeswari Thangaswamy, Lenin Babu Elakkumanan
March-April 2011, 55(2):206-207
DOI
:10.4103/0019-5049.79881
PMID
:21712889
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3,559
934
Use of LMA as ventilatory device for PCT: Our experience
Sneh Lata, Amit Kumar, Adarsh C Swami, Sunny Rupal, Ashwini Sharma
March-April 2011, 55(2):207-208
DOI
:10.4103/0019-5049.79882
PMID
:21712890
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1,914
305
Patient with post infective demyelinating disease for dynamic hip screw repair under epidural anaesthesia
Pritee H Bhirud, Dhanwanti Rajwade, Ragini Suchak
March-April 2011, 55(2):208-210
DOI
:10.4103/0019-5049.79884
PMID
:21712891
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2,155
388
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