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2011| July-August | Volume 55 | Issue 4
Online since
September 13, 2011
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EDITORIAL
Dexmedetomidine in anaesthesia practice: A wonder drug?
K Sudheesh, SS Harsoor
July-August 2011, 55(4):323-324
DOI
:10.4103/0019-5049.84824
PMID
:22013245
[FULL TEXT]
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17,816
3,980
11
CLINICAL INVESTIGATIONS
Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia
Rajni Gupta, Jaishri Bogra, Reetu Verma, Monica Kohli, Jitendra Kumar Kushwaha, Sanjiv Kumar
July-August 2011, 55(4):347-351
DOI
:10.4103/0019-5049.84841
PMID
:22013249
Background:
Spinal anaesthesia is the most common approach which is used for lower limb surgery. Dexmedetomidine is the recent drug which acts on α2-adrenergic receptors in the dorsal horn of the spinal cord to produce analgesic effects.
Aim:
Efficacy and safety of intrathecal dexmedetomidine added to ropivacaine.
Setting and Design:
Randomised double blind trial.
Methods:
Sixty patients were randomly allocated to receive intrathecally either 3 ml of 0.75% isobaric ropivacaine + 0.5 ml normal saline (Group R) or 3 ml of 0.75% isobaric ropivacaine + 5 μg dexmedetomidine in 0.5 ml of normal saline (Group D).
Results:
The mean time of sensory regression to S2 was 468.3±36.78 minutes in group D and 239.33±16.8 minutes in group R. Duration of analgesia (time to requirement of first rescue analgesic) was significantly prolonged in group D (478.4±20.9 minutes) as compared to group R (241.67±21.67 minutes). The maximum visual analogue scale score for pain was less in group D (4.4±1.4) as compared to group R (6.8±2.2).
Conclusion:
The addition of dexmedetomidine to ropivacaine intrathecally produces a prolongation in the duration of the motor and sensory block.
[ABSTRACT]
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9,507
2,300
20
Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries
Vijay G Anand, M Kannan, A Thavamani, Merlin J Bridgit
July-August 2011, 55(4):340-346
DOI
:10.4103/0019-5049.84835
PMID
:22013248
Purpose:
The objectives of this study were to compare the effects of caudal dexmedetomidine combined with ropivacaine to provide postoperative analgesia in children and also to establish its safety in the paediatric population.
Methods:
In a randomised, prospective, parallel group, double-blinded study, 60 children were recruited and allocated into two groups: Group RD (
n
=30) received 0.25% ropivacaine 1 ml/kg with dexmedetomidine 2 μg/kg, making the volume to 0.5 ml and Group R (
n
=30) received 0.25% ropivacaine 1 ml/kg + 0.5 ml normal saline. Induction of anaesthesia was achieved with 50% N
2
O and 8% sevoflurane in oxygen in spontaneous ventilation. An appropriate-sized LMA was then inserted and a caudal block performed in all patients. Behaviour during emergence was rated with a 4-point scale, sedation with Ramsay's sedation scale, and pain assessed with face, legs, activity, cry, consolability (FLACC) pain score.
Results:
The duration of postoperative analgesia recorded a median of 5.5 hours in Group R compared with 14.5 hours in Group RD, with a
P
value of <0.001. Group R patients achieved a statistically significant higher FLACC score compared with Group RD patients. The difference between the means of mean sedation score, emergence behaviour score, mean emergence time was statistically highly significant (
P
<0.001). The peri-operative haemodynamics were stable among both the groups.
Conclusion:
Caudal dexmedetomidine (2 μg/kg) with 0.25% ropivacaine (1 ml/kg) for paediatric lower abdominal surgeries achieved significant postoperative pain relief that resulted in a better quality of sleep and a prolonged duration of arousable sedation and produced less incidence of emergence agitation following sevoflurane anaesthesia.
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14
Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement
Varshali M Keniya, Sushma Ladi, Ramesh Naphade
July-August 2011, 55(4):352-357
DOI
:10.4103/0019-5049.84846
PMID
:22013250
Background:
Dexmedetomidine, an α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilising properties without significant respiratory depression.
Methods:
We assessed the efficacy of dexmedetomidine in attenuating sympathoadrenal response to tracheal intubation and analysed reduction in intraoperative anaesthetic requirement. Sixty patients scheduled for elective surgery of more than 3 hours were randomly selected. Control group received isoflurane-opioid and study group received isoflurane-opioid-dexmedetomidine anaesthesia. Dexmedetomidine infusion in a dose of 1 μg/kg was given over 10 min before the induction of anaesthesia and was continued in a dose of 0.2-0.7 μg/kg/Hr until skin closure. All patients were induced with thiopentone, fentanyl and vecuronium. Haemodynamic variables were continuously recorded.
Results:
The need for thiopentone and isoflurane was decreased by 30% and 32%, respectively, in the dexmedetomidine group as compared to the control group. After tracheal intubation, maximal average increase was 8% in systolic and 11% in diastolic blood pressure in dexmedetomidine group, as compared to 40% and 25%, respectively, in the control group. Similarly, average increase in heart rate was 7% and 21% in the dexmedetomidine and control groups, respectively. Fentanyl requirement during the operation was 100±10 μg in the control group and 60±10 μg in the dexmedetomidine group.
Conclusion:
Perioperative infusion of dexmedetomidine is effective in attenuating sympathoadrenal response to tracheal intubation. It has significant anaesthetic and opioid sparing effect.
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CASE REPORTS
Anaesthetic management of a case of Wolff-Parkinson-White syndrome
Savitri D Kabade, Safiya Sheikh, Bhavya Periyadka
July-August 2011, 55(4):381-383
DOI
:10.4103/0019-5049.84868
PMID
:22013256
We report a case of fibroid uterus with Wolff-Parkinson-White (WPW) syndrome in a 48-year-old female, posted for elective hysterectomy. Patient gave history of short recurrent episodes of palpitation and electrocardiograph confirmed the diagnosis of WPW syndrome. The anaesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia like paroxysmal supra-ventricular tachycardia (PSVT) and atrial fibrillation (AF). Epidural anaesthesia is preferred compared to general anaesthesia to avoid polypharmacy, noxious stimuli of laryngoscopy and intubation. To deal with perioperative complications like PSVT and AF, anti-arrhythmic drugs like adenosine, beta blockers and defibrillator should be kept ready. Perioperative monitoring is essential as patients can develop complications.
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6,665
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4
REVIEW ARTICLES
Non-invasive ventilation in the postoperative period: Is there a role?
Ashu S Mathai
July-August 2011, 55(4):325-333
DOI
:10.4103/0019-5049.84829
PMID
:22013246
Non-invasive positive pressure ventilation or non-invasive ventilation (NIV) has emerged as a simpler and safer alternative to invasive mechanical ventilation in patients developing acute postoperative respiratory failure. The benefits of NIV as compared to intubation and mechanical ventilation include lower complications, shorter duration of hospital stay, reduced morbidity, lesser cost of treatment and even reduced mortality rates. However, its use may not be uniformly applicable in all patient groups. This article reviews the indications, contraindications and evidence supporting the use of NIV in individual patient groups in the postoperative period. The anaesthesiologist needs to recognise the subset of patients most likely to benefit from NIV therapy so as to apply it most effectively. It is equally important to promptly identify signs of failure of NIV therapy and be prepared to initiate alternate ways of respiratory support. The author searched PubMed and Ovid MEDLINE, without date restrictions. Search terms included Non-invasive ventilation, postoperative and respiratory failure. Foreign literature was included, though only articles with English translation were used.
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5,262
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2
CLINICAL INVESTIGATIONS
General anaesthesia does not contribute to long-term post-operative cognitive dysfunction in adults: A meta-analysis
Joanne Guay
July-August 2011, 55(4):358-363
DOI
:10.4103/0019-5049.84850
PMID
:22013251
Context:
The contribution of anaesthesia itself to post-operative cognitive dysfunction (POCD) or the potential protective effect of one specific type of anaesthesia on the occurrence of POCD is unclear.
Aims:
This is a meta-analysis evaluating the effects of the anaesthetic technique (regional
vs.
general anaesthesia) on POCD of patients undergoing non-cardiac surgery.
Settings and Design:
Meta-analysis performed in a University affiliated hospital.
Methods:
A search for randomized controlled trials (RCT) comparing regional anaesthesia to general anaesthesia for surgery was done in PUBMED, MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, PsychINFO and Current Contents/all editions in 2009.
Statistical Analysis:
Data were analyzed with comprehensive Meta-analysis Version 2.2.044.
Results:
Twenty-six RCTs including 2365 patients: 1169 for regional anaesthesia and 1196 for general anaesthesia were retained. The standardized difference in means for the tests included in the 26 RCTs was -0.08 (95% confidence interval: -0.17-0.01;
P
value 0.094; I-squared = 0.00%). The assessor was blinded to the anaesthetic technique for 12 of the RCTs including only 798 patients: 393 for regional anaesthesia and 405 for general anaesthesia. The standardized difference in means for these 12 studies is 0.05 (-0.10-0.20;
P=
0.51; I-squared = 0.00%).
Conclusions:
The present meta-analysis does not support the concerns that a single exposure to general anaesthesia in an adult would significantly contribute to permanent POCD after non-cardiac surgery.
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20
REVIEW ARTICLES
Ayurvedic medicine and anaesthesia
Sameer L Pradhan, Priya S Pradhan
July-August 2011, 55(4):334-339
DOI
:10.4103/0019-5049.84832
PMID
:22013247
The use of herbal medicines has increased dramatically over the past few years. The United States alone noted a 380% increase in the consumption of these products. Although the common practice of taking over-the-counter herbal soups, herbal teas and other such prepacked preparations was not associated with adverse events at large, still, some herbs are known to cause problems, especially when large doses are taken. The American Society of Anaesthesiologist (ASA) has taken a conservative stance and recommended that it is prudent to stop these products at least 2-3 weeks prior to anaesthesia and surgery. This advice may be difficult to implement as most preoperative evaluations occur only a few days prior to surgery. Some of the Ayurvedic preparations have shown to improve the patient outcome when taken during the perioperative period. Hence, the conservative stance by ASA may not always benefit the patient. More scientific studies are needed to have more targeted recommendations. This article puts forward the facts that need to be addressed by researchers in the future.
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4,927
1,027
4
CASE REPORTS
Posterior reversible encephalopathy syndrome at term pregnancy
Shreepathi Krishna Achar, Nanda Shetty, Tim Thomas Joseph
July-August 2011, 55(4):399-401
DOI
:10.4103/0019-5049.84856
PMID
:22013261
Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome associated with various clinical conditions, presenting with headache, encephalopathy, seizures, cortical visual disturbances or blindness. Imaging predominantly shows parieto-occipital white matter changes, with vasogenic oedema being the most accepted pathophysiology. We report a 25-year-old primigravida who presented in term pregnancy with seizures and blindness, scheduled for emergency caesarean section. She was managed peroperatively under general anaesthesia and shifted to intensive care unit. Postoperative computed tomography brain revealed an intra-axial hypodensity involving predominantly white matter regions of bilateral parieto-occipital lobes, right caudate nucleus and right cerebellum, suggestive of PRES. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment. The importance of prompt suspicion and management in preventing short- and long-term neurological deficits in reversible condition like PRES is highlighted.
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5,031
559
7
Cauda equina syndrome after spinal anaesthesia in a patient with asymptomatic tubercular arachnoiditis
Divya Sethi, Madhu Gupta, Suvidha Sood
July-August 2011, 55(4):375-377
DOI
:10.4103/0019-5049.84864
PMID
:22013254
A 14-year-old boy underwent emergency debridement surgery of right foot under spinal anaesthesia. Four hours after the surgery, the patient developed symptoms of cauda equina syndrome (CES). Postoperative magnetic resonance imaging of the patient's spine suggested underlying tubercular arachnoiditis. The boy was started on intravenous methylprednisolone and antitubercular therapy. He responded to the therapy and recovered completely in 2 weeks without any residual neurological deficits. We suggest that underlying pathological changes in the subarachnoid space due to tubercular arachnoiditis contributed to maldistribution of the local anaesthetic drug leading to CES.
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4,820
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LETTERS TO EDITOR
Anaesthetic management of transurethral resection of prostate in a patient with aortic and mitral valve replacement
Indira Gurajala, Suryaprakash Vaddi, Rahul Devraj, P Narasimha Reddy
July-August 2011, 55(4):435-437
DOI
:10.4103/0019-5049.84838
PMID
:22013281
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4,308
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CASE REPORTS
Anaesthetic management of Wolff-Parkinson-White syndrome for hysterectomy
Sandeep Sahu, Sunaina Tejpal Karna, Amit Karna, Indu Lata, Deepa Kapoor
July-August 2011, 55(4):378-380
DOI
:10.4103/0019-5049.84866
PMID
:22013255
Wolff-Parkinson-White syndrome (WPW) is an uncommon cardiac disorder having an aberrant pathway between atria and ventricles. We are reporting a known case of WPW syndrome for hysterectomy under combined spinal epidural anaesthesia. Management of the present case is an important pearl to revisit management of WPW syndrome. The perioperative management should be tailored according to the nature of surgery and the clinical presentation of the patient.
[ABSTRACT]
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3,709
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4
CLINICAL INVESTIGATIONS
Comparison of isoflurane and sevoflurane in anaesthesia for day care surgeries using classical laryngeal mask airway
Dinesh Kumar Sahu, Vinca Kaul, Reena Parampill
July-August 2011, 55(4):364-369
DOI
:10.4103/0019-5049.84857
PMID
:22013252
Background:
In the present study, we compared isoflurane with sevoflurane in day care surgeries in order to determine the suitability of each agent for anaesthesia with Classical laryngeal mask airway (LMA).
Aims:
The aim of this study has been to compare isoflurane and sevoflurane as maintenance anaesthetic agents in day care surgeries with respect to intraoperative haemodynamics, recovery profile, time of first postoperative analgesia and pain score, adverse effects when used with classical LMA.
Settings and Design:
This open - level, prospective randomized study was carried out on 60 patients who were admitted on a day care basis for elective short surgical procedures.
Methods:
The patients were randomly assigned to one of the two study groups of 30 patients each. First group was maintained on isoflurane and second on sevoflurane as inhalational agent.
Statistical Analysis:
The observations obtained in both the groups were recorded and tabulated. Statistical analysis was carried out using the Student
t
test, Chi-square test, Mann-Whitney test.
Results:
Emergence from Sevoflurane was significantly quicker as compared to isoflurane. Sevoflurane group also showed earlier discharge time from the post anaesthesia care unit (PACU)-1 as compared to isoflurane group, but discharge time was same from the PACU-1. Isoflurane has more incidences of mild airway hyper reactivity when compared to sevoflurane.
Conclusions:
It can be concluded that both isoflurane and sevoflurane are suitable for day care anaesthesia. Sevoflurane has little advantages of less airway hyper reactivity and quicker emergence and discharge from PACU-1.
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1
CASE REPORTS
Anaesthesia for non-cardiac surgery in a cardiac transplant recipient
Adarsh C Swami, Amit Kumar, Sunny Rupal, Sneh Lata
July-August 2011, 55(4):405-407
DOI
:10.4103/0019-5049.84849
PMID
:22013263
Cardiac transplantation has become the standard therapy for idiopathic dilated cardiomyopathy and end-stage ischaemic heart disease. With the introduction of newer immunosuppressants, together with better patient selection, improved perioperative monitoring and care, the overall survival of recipients has improved. An increasing number of patients who received a transplant present for either elective or emergency non-cardiac surgery. We hereby discuss the perioperative management of such a patient who came to our set-up for bipolar haemiarthroplasty.
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3,131
843
7
Near hanging: Early intervention can save lives
Ritika Gandhi, Neeta Taneja, Paritosh Mazumder
July-August 2011, 55(4):388-391
DOI
:10.4103/0019-5049.84863
PMID
:22013258
Hanging is a common method of suicide/homicide in the Indian scenario. We report three successive cases of attempted suicidal hangings seen over a period of 4 months in our intensive care wards. All of them presented gasping with poor clinical status and required immediate intubation, resuscitation, assisted ventilation and intensive care treatment. None had cervical spine injury, but one patient developed aspiration pneumonia. All the three patients received standard supportive intensive care and made full clinical recovery without any neurological deficit. We conclude that the cases of near hanging should be aggressively resuscitated and treated irrespective of dismal initial presentation. This is well supported by the excellent outcomes in our cases despite their poor initial condition.
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10
CLINICAL INVESTIGATIONS
Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India
Omender Singh, Yash Javeri, Deven Juneja, Manish Gupta, Gurpreet Singh, Rohit Dang
July-August 2011, 55(4):370-374
DOI
:10.4103/0019-5049.84860
PMID
:22013253
Background and Aim:
There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU). We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital.
Methods:
We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained.
Results:
Seventy (50.7%) patients were males and majority (47.8%) of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%), followed by alcohol, 34/138 (24.63%) and opioids, 10/138 (7.2%). Thirty-two (23%) consumed two or more agents. Commonest mode of toxicity was suicidal (78.3%) and the route of exposure was mainly oral (97.8%). The highest incidence of toxicity was due to drugs (46.3%) followed by household agents (13%). Organ failure was present in 67 patients (48.5%). During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%). All deaths were due to aluminium phosphide poisoning.
Conclusions:
The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.
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7
MEDICO LEGAL ISSUES
Expert witness
SC Parakh
July-August 2011, 55(4):421-422
DOI
:10.4103/0019-5049.84839
PMID
:22013269
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3,392
484
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CASE REPORTS
Acute hypoxaemia due to intraoperative lung collapse after repositioning the patient
Bina P Butala, Veena R Shah, Guruprasad P Bhosale
July-August 2011, 55(4):395-398
DOI
:10.4103/0019-5049.84859
PMID
:22013260
Desaturation after induction of anaesthesia and repositioning due to mucus plug causing atelectasis (lung collapse) is a rare event. We present a case of intraoperative right lung collapse due to mucus plug in a patient undergoing left laparoscopic nephrectomy. Hypoxaemia occurred after the induction of anaesthesia and repositioning. X-ray chest revealed right lung collapse and surgery was subsequently postponed. Lung re-expanded after postural drainage and suction. Postoperatively patient was diagnosed to have retrocardiac bronchiectasis. After preoperative preparation with postural drainage, chest physiotherapy, and antibiotics, the patient underwent surgery uneventfully.
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3,184
519
1
Abdominal compartment syndrome successfully treated with neuromuscular blockade
Kris T Chiles, Colin M Feeney
July-August 2011, 55(4):384-387
DOI
:10.4103/0019-5049.84867
PMID
:22013257
A 48 year old male admitted to the intensive care unit after a cardiac arrest complicated by a stroke intra-operatively during automatic implantable cardioverter defibrillator placement. He post-operatively developed a rigid abdomen, elevated peak and plateau pressures, hypoxia and renal insufficiency. He was diagnosed with abdominal compartment syndrome with an intra-abdominal compartment pressure of 40mmHg. The patient was administered 10 mg of intravenous cisatracuriumbesylate in preparation for bedside surgical abdominal decompression. Cisatracurium eliminated the patients need for surgical intervention by reducing his abdominal compartment pressures to normal and improving his hypoxia and renal function. This case illustrates that neuromuscular blockade should be attempted in patients with abdominal compartment syndrome prior to surgical intervention.
[ABSTRACT]
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3,035
501
4
BRIEF COMMUNICATIONS
Nimodipine potentiates the analgesic effect of morphine in the rat hot-plate test: Implications in the treatment of pain
Rakesh Kumar, Sagolshem S Singh, Pranav , Subrata Basu Ray
July-August 2011, 55(4):413-416
DOI
:10.4103/0019-5049.84843
PMID
:22013266
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[PubMed]
2,875
431
2
LETTERS TO EDITOR
Subclinical hypothyroidism: A cause for delayed recovery from anaesthesia?
V Vijay Kumar, Padmanabha Kaimar
July-August 2011, 55(4):433-434
DOI
:10.4103/0019-5049.84836
PMID
:22013279
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[CITATIONS]
[PubMed]
2,628
598
1
Cardio pulmonary cerebral resuscitation 2010 guidelines
Roona Shad, GS Agnihotri
July-August 2011, 55(4):423-425
DOI
:10.4103/0019-5049.84825
PMID
:22013271
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2,358
794
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Kabuki syndrome and its anaesthetic management
Debashis Roy, Tanmoy Das, Ahsan Ahmed, Amitava Rudra, Debashish Mitra
July-August 2011, 55(4):431-433
DOI
:10.4103/0019-5049.84834
PMID
:22013278
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2,391
422
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CASE REPORTS
Hypercapnia resulting from a faulty co-axial (Bain) circuit
Ishwar Singh, Monika Gupta, Tarun K Singh
July-August 2011, 55(4):402-404
DOI
:10.4103/0019-5049.84853
PMID
:22013262
The Bain co-axial circuit is fully established in general anaesthesia practice. A major concern is the potential malfunctioning of the circuit due to avulsion of the inner fresh gas delivery tube at the machine end of the circuit. The following case report presents a case in which a patient connected to the Bain circuit developed severe hypercapnia in the early intraoperative period due to the above mentioned defect.
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2,326
447
2
LETTERS TO EDITOR
Ultrasound: Contemporary tool for missed pericardial effusion in a trauma patient
Manpreet Kaur, Babita Gupta, Chandni Sinha, Chandan Kumar Dey
July-August 2011, 55(4):434-435
DOI
:10.4103/0019-5049.84837
PMID
:22013280
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[PubMed]
2,421
338
1
CASE REPORTS
Immediate postoperative extubation after liver transplantation at our centre: A report of two cases
Sanjeev Aneja, Raman Raina
July-August 2011, 55(4):392-394
DOI
:10.4103/0019-5049.84861
PMID
:22013259
Liver transplantation is a dynamic field undergoing continuous changes in management. Prolonged postoperative mechanical ventilation has been a norm but now there is a trend towards early extubation. We developed a protocol for early extubation based on bispectral index monitoring. This protocol was applied in two cases with satisfactory outcome.
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2,291
422
2
BRIEF COMMUNICATIONS
Partial facial nerve paralysis after laparoscopic surgery under general anaesthesia
Dalim Kumar Baidya, Debesh Bhoi, Renu Sinha, Rahul Kumar Anand
July-August 2011, 55(4):416-418
DOI
:10.4103/0019-5049.84844
PMID
:22013267
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[PubMed]
2,274
433
2
Anaesthesia for a patient with Friedreich's ataxia
Ilango Ganesan
July-August 2011, 55(4):418-420
DOI
:10.4103/0019-5049.84847
PMID
:22013268
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,268
376
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LETTERS TO EDITOR
Rate of administration of intravenous ondansetron
Smita Prakash, Meenu Aggarwal
July-August 2011, 55(4):426-427
DOI
:10.4103/0019-5049.84827
PMID
:22013273
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2,180
460
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Anaesthetic management of a patient with Weill-Marchesani syndrome complicated with mitral regurgitation
Pradipta Bhakta, Hatem Abdulghani Mady, Jyoti Burad, Qutaiba Amir Tawfic
July-August 2011, 55(4):428-430
DOI
:10.4103/0019-5049.84831
PMID
:22013276
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,968
621
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Ranitidine anaphylaxis: A rare occurrence
Varsha H Vyas, Shubha N Mohite, Sonal S Khatavkar, Sheetal R Jagtap
July-August 2011, 55(4):425-426
DOI
:10.4103/0019-5049.84826
PMID
:22013272
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,171
408
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Sequential combined spinal epidural block
Asha Tyagi, Surendra Kumar, Rashmi Salhotra
July-August 2011, 55(4):430-431
DOI
:10.4103/0019-5049.84833
PMID
:22013277
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,731
801
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Look alike drug labels : A worrying issue
Vikramjeet Arora, Sukhminder Jit Singh Bajwa, Jasbir Kaur
July-August 2011, 55(4):428-428
DOI
:10.4103/0019-5049.84830
PMID
:22013275
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
2,150
369
1
BRIEF COMMUNICATIONS
Proteus penneri
lurking in the intensive care unit: An important often ignored nosocomial pathogen
Neelam Kaistha, Neha Bansal, Jagdish Chander
July-August 2011, 55(4):411-413
DOI
:10.4103/0019-5049.84842
PMID
:22013265
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
2,159
325
2
Ischaemia modified albumin: Does it bolster our diagnostic ammunition?
Dilip Gude, Ramesh Babu Byrapaneni
July-August 2011, 55(4):408-411
DOI
:10.4103/0019-5049.84840
PMID
:22013264
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,060
364
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LETTERS TO EDITOR
Lignocaine toxicity after anterior nasal packing
Mridu Paban Nath, Rumi Baruah, Dipika Choudhury, Anulekha Chakrabarty
July-August 2011, 55(4):427-427
DOI
:10.4103/0019-5049.84828
PMID
:22013274
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
1,980
338
3
Serum lactate levels and tissue hypoperfusion in complex corrective paediatric cardiac surgeries
Abhiruchi Patki
July-August 2011, 55(4):423-423
DOI
:10.4103/0019-5049.84823
PMID
:22013270
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,444
309
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th
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