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2012| March-April | Volume 56 | Issue 2
Online since
May 17, 2012
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CLINICAL INVESTIGATIONS
Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine
Sukhminder Jit Singh Bajwa, Jasbir Kaur, Amarjit Singh, SS Parmar, Gurpreet Singh, Ashish Kulshrestha, Sachin Gupta, Veenita Sharma, Aparajita Panda
March-April 2012, 56(2):123-128
DOI
:10.4103/0019-5049.96303
PMID
:22701201
Background and Aims:
Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation.
Methods:
One hundred patients scheduled for elective general surgery were randomized into two groups: D and F (n=50 in each group). Group D were administered 1 μg/kg each of dexmedetomidine and fentanyl while group F received 2 μg/kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33:66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student's t test and Mann-Whitney U test.
Results:
The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P<0.001). The mean dose of fentanyl and isoflurane were also decreased significantly (>50%) by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P=0.014).
Conclusions:
Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively.
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9,543
2,051
21
CASE REPORTS
Operative hysteroscopy intravascular absorption syndrome: A bolt from the blue
Navdeep Sethi, Ravindra Chaturvedi, Krishna Kumar
March-April 2012, 56(2):179-182
DOI
:10.4103/0019-5049.96342
PMID
:22701213
Operative hysteroscopy has emerged as an effective alternative to hysterectomy and has become standard surgical treatment for varied gynaecological conditions like abnormal uterine bleeding and uterine myomas. This procedure requires distention of the uterine cavity for adequate visualization of the operative field. 1.5% glycine is a widely used distention medium because it has good optical properties and is non-conductive. However, the intraoperative absorption of this electrolyte-free fluid can cause hyponatraemia, hypoosmolality, hyperglycinaemia and volume overload, including pulmonary oedema. We report a case of operative hysteroscopy intravascular absorption (OHIA) syndrome, presenting abruptly during hysteroscopic myomectomy, employing 1.5% glycine as the fluid distention medium. Successful management of the case and prevention strategies are discussed.
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7,356
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3
CLINICAL INVESTIGATIONS
Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures
Samit Kumar Khutia, Mohan C Mandal, Sabyasachi Das, SR Basu
March-April 2012, 56(2):145-150
DOI
:10.4103/0019-5049.96313
PMID
:22701205
Background:
Paediatric patients often present with different painful conditions that require immediate surgical interventions. Despite a plethora of articles on the ketamine-propofol combination, comprehensive evidence regarding the suitable sedoanalgesia regime is lacking due to heterogeneity in study designs.
Methods:
This prospective, randomized, double-blind, active-controlled trial was conducted in 100 children, of age 3-14 years, American Society of Anesthesiologist physical status IE-IIE, posted for emergency short surgical procedures. Patients were randomly allocated to receive either 2 mL of normal saline (pre-induction) plus calculated volume of drug from the 11 mL of ketamine-propofol solution for induction (group PK, n=50) or fentanyl 1.5 μg/kg diluted to 2 mL with normal saline (pre-induction) plus calculated volume of drug from the 11 mL of propofol solution for induction (group PF, n=50). In both the groups, the initial bolus propofol 1 mg/kg i.v. (assuming the syringes contained only propofol, for simplicity) was followed by adjusted infusion to achieve a Ramsay Sedation Scale score of six. Mean arterial pressure (MAP) was the primary outcome measurement.
Results:
Data from 48 patients in group PK and 44 patients in group PF were available for analysis. Hypotension was found in seven patients (14.6%) in group PK compared with 17 (38.6%) patients in group PF (P=0.009). Intraoperative MAP was significantly lower in group PF than group PK when compared with baseline.
Conclusion:
The combination of low-dose ketamine and propofol is more effective and a safer sedoanalgesia regimen than the propofol-fentanyl combination in paediatric emergency short surgical procedures in terms of haemodynamic stability and lesser incidence of apnoea.
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Comparative evaluation of incidence of emergence agitation and post-operative recovery profile in paediatric patients after isoflurane, sevoflurane and desflurane anaesthesia
Rahil Singh, Meera Kharbanda, Nishant Sood, Vikram Mahajan, Chitra Chatterji
March-April 2012, 56(2):156-161
DOI
:10.4103/0019-5049.96325
PMID
:22701207
Background:
Emergence agitation (EA), although well documented in the clinical literature, still has uncertainties and confusion abound on this subject because of the absence of a clear definition and lack of reliable and valid assessment tools.
Aim:
To compare the incidence and severity of EA and recovery characteristics in paediatric patients under isoflurane, sevoflurane or desflurane anaesthesia and evaluate the effect of age and duration of anaesthesia on the incidence of EA.
Settings and Design:
Randomized prospective double-blinded study.
Methods:
Seventy-five American Society of Anaesthesiologists I and II patients, aged between 4 months and 7 years, were included in the study. Patients were induced with sevoflurane and oxygen. Anaesthesia was maintained with O
2
+ N
2
O and isoflurane, sevoflurane or desflurane according to randomization. Caudal block and paracetamol suppository was administered before the surgical incision. In the Post-Anesthesia Care Unit (PACU), degree of agitation was assessed using the Paediatric Anaesthesia Emergence Delirium Scale. Aldrette score, Face, Legs, Activity, Cry, Consolability score and any adverse events were noted.
Statistical Analysis:
Chi-square/Fischer exact test was applied for categorical variables; for continuous variables, the analysis of variance/non-parametric Kruskall-Wallis test was applied. Two-sample t-test/non-parametric Wisconsin Mann-Whitney test was applied between the two groups. Statistical significance was determined at P<0.05.
Results:
Incidence and intensity of EA were comparable in all three groups. Age and duration of anaesthesia do not appear to have any bearing on the incidence of EA. Rapid emergence with sevoflurane and desflurane did not translate into early discharge from PACU.
Conclusions:
EA is a multifactorial syndrome. More well-conducted studies using validated scales and standardized protocols should be carried out to better understand this phenomenon.
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14
Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery
Gaurav Jain, Pranav Bansal, Girdhari L Garg, Dinesh K Singh, Ghanshyam Yadav
March-April 2012, 56(2):129-134
DOI
:10.4103/0019-5049.96306
PMID
:22701202
Background:
To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine (0.25%) and ropivacaine (0.5%) for thyroid surgery.
Methods:
In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications.
Results:
Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups.
Conclusion:
We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.
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5,343
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3
SPECIAL ARTICLE
Insulinoma and anaesthetic implications
Jyotsna Goswami, Pallavi Somkuwar, Yogesh Naik
March-April 2012, 56(2):117-122
DOI
:10.4103/0019-5049.96301
PMID
:22701200
Insulinoma is a rare neuroendocrine tumour of the pancreas , which is usually small, solitary and benign. It may be part of the multiple endocrine neoplasia type 1 syndrome. It is diagnosed by clinical, biochemical and imaging modalities. Hypoglycaemic symptoms can be medically controlled by diazoxide or somatostatin analogues. Localisation of the tumour is a challenge to clinicians. Surgical resection is the curative treatment with a high success rate. Intraoperatively, ultrasound and surgical palpation help to confirm the site of tumour. Intraoperatively, maintenance of optimum glucose levels is of main concern because there may be severe hypoglycemia while handling the tumour, symptoms of which remain masked under general anaesthesia. Glucose infusion and frequent plasma glucose monitoring to maintain plasma glucose level more than 60 mg/dL is found to be helpful. We performed a systematic search in PubMed, Cochrane Library and also in Google. We used the following text words for our search: Insulinoma, neuro-endocrine tumors, multiple endocrine neoplasia, hypoglycemia, anaesthetic management of insulinoma, glucose management. In this article, we review the incidence and epidemiology of insulinoma, its clinical features, diagnosis, localisation and treatment, with special emphasis on anaesthetic management.
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4,572
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2
CLINICAL INVESTIGATIONS
Negative pressure versus loss of resistance technique for interpleural block
Pankaj Kundra, Karuppiah Ajeetha
March-April 2012, 56(2):151-155
DOI
:10.4103/0019-5049.96318
PMID
:22701206
Background:
Loss of resistance is a commonly practiced technique among the trainees. But, for performing interpleural block (IPB), negative-pressure identification techniques have been popularized. This study was designed to evaluate the two techniques in trainee anaesthetists.
Methods:
Sixty American society of anaesthesiologist (ASA) grade 1 and 2 women scheduled for elective breast surgeries under general anaesthesia were recruited for the study. The patients were randomly assigned to receive IPB (25 mL of 0.5% bupivacaine with adrenaline 5 mg/mL) with either loss of resistance technique (group LR, n=45) or the negative-pressure technique (group NP, n=45). The success rate and ease of performance was evaluated by the number of attempts and time taken.
Results:
Higher first attempt success rate was observed in group LR (90%) when compared with group NP (80%), with a significantly shorter mean time to successful identification of interpleural space in the group LR (5 min) than in the group NP (5.8 min), P<0.01log rank test. All patients had satisfactory IPB and the median numbers of segments blocked were 7 (5-9) and 6 (5-7) in groups LR and NP, respectively. No significant complications were observed in any of the patients.
Conclusion:
Both techniques are safe and effective, but the loss of resistance technique is associated with a higher first attempt success rate performed in a shorter time by trainee anaesthetists.
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5,257
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CASE REPORTS
Medication error: Subarachnoid injection of tranexamic acid
Bina P Butala, Veena R Shah, Guruprasad P Bhosale, Rajkiran B Shah
March-April 2012, 56(2):168-170
DOI
:10.4103/0019-5049.96335
PMID
:22701210
Some factors have been identified as contributing to medical errors, such as labels, appearance and location of ampoules. We present a case of accidental injection of tranexamic acid instead of Bupivacaine during spinal anaesthesia. One minute after the injection of 3 mL of the solution, the patient developed myoclonus of her lower extremities. Accidental intrathecal injection of the wrong drug was suspected and a used ampoule of tranexamic acid was discovered in the trash can. The ampoules of Bupivacaine (5 mg/mL, trade name "Sensovac Heavy") and tranexamic acid (500 mg/mL, Trade name "Nexamin") were similar in appearance. Her myoclonus was successfully treated with phenytoin, sodium valproate, thiopental sodium infusion, midazolam infusion and supportive care of haemodynamic and respiratory systems. The surgery was temporarily deferred. The patient's condition progressively improved to full recovery.
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4,807
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12
CLINICAL INVESTIGATIONS
Pre-treatment with intravenous granisetron to alleviate pain on propofol injection: A double-blind, randomized, controlled trial
Ahsan Ahmed, Saikat Sengupta, Tanmoy Das, Amitava Rudra, Asif Iqbal
March-April 2012, 56(2):135-138
DOI
:10.4103/0019-5049.96308
PMID
:22701203
Background:
Propofol is one of the widely used intravenous (i.v.) anaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. A number of techniques has been tried to minimize propofol-induced pain with variable results. Recently, a 5-HT
3
antagonist, ondansetron pre-treatment, has been shown to reduce propofol-induced pain. The aim of our randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with intravenous granisetron, which is routinely used in our practice for prophylaxis of post-operative nausea and vomiting, would reduce propofol-induced pain.
Methods:
Eighty-two women, aged 18-50 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anaesthesia were randomly assigned to one of the two groups. One group received 2 mL 0.9% sodium chloride while the other group received 2 mL granisetron (1 mg/mL), and were accompanied by manual venous occlusion for 1 min. Then, 2 mL propofol was injected through the same cannula. Patients were asked by a blinded investigator to score the pain on injection of propofol with a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain.
Results:
Twenty-four patients (60%) complained of pain in the group pre-treated with normal saline as compared with six (15%) in the group pre-treated with granisetron. Pain was reduced significantly in the granisetron group (
P
<0.05). Severity of pain was also lesser in the granisetron group compared with the placebo group (2.5% vs. 37.5%).
Conclusion:
We conclude that pre-treatment with granisetron along with venous occlusion for 1 min for prevention of propofol-induced pain was highly successful.
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Intubating conditions following rapid sequence induction with three doses of succinylcholine
Smita Prakash, Sushma Barde, Preeti Thakur, Anoop Raj Gogia, Rajvir Singh
March-April 2012, 56(2):139-144
DOI
:10.4103/0019-5049.96309
PMID
:22701204
Background:
The aim of this prospective, randomized, double-blind study was to compare tracheal intubating conditions and the duration of apnoea following administration of 0.4, 0.6 and 1.0 mg/kg of succinylcholine during simulated rapid sequence induction of anaesthesia.
Methods:
Anaesthesia was induced with fentanyl 2 μg/kg and propofol 2 mg/kg followed by application of cricoid pressure. Patients were randomly allocated to three groups according to the dose of succinylcholine administered (0.4, 0.6 or 1.0 mg/kg). Intubating conditions were assessed at 60 s after succinylcholine administration. Time to first diaphragmatic contraction (apnoea time) and time to resumption of regular spontaneous breathing were noted.
Results:
Excellent intubating conditions were obtained in 52.4%, 95.7% and 100% of the patients after 0.4, 0.6 and 1.0 mg/kg succinylcholine, respectively; P<0.001. Acceptable intubating conditions (excellent and good grade combined) were obtained in 66.7%, 100% and 100% of the patients after 0.4, 0.6 and 1.0 mg/ kg succinylcholine, respectively; P<0.001. Apnoea time and resumption of regular spontaneous breathing were dose-dependent. Apnoea time was 3.8±1.1 min, 4.3±0.9 min and 8.2±3.4 min in groups 0.4, 0.6 and 1.0 mg/kg, respectively; P<0.001. Time to regular spontaneous breathing was 5.3±1.2 min, 5.5±1.1 min and 8.9±3.5 min in groups 0.4, 0.6 and 1.0 mg/kg, respectively; P<0.001.
Conclusion:
A dose of 0.6 mg/kg succinylcholine can be used for rapid sequence induction of anaesthesia as it provides acceptable intubating conditions with a shorter apnoea time compared with a dose of 1 mg/kg.
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3
LETTERS TO EDITOR
Malposition of internal jugular vein catheter into contralateral internal jugular vein: An uncommon position
Gyaninder Pal Singh, Hemanshu Prabhakar, Bapura Kiran Reddy
March-April 2012, 56(2):205-207
DOI
:10.4103/0019-5049.96317
PMID
:22701225
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4,154
383
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BRIEF COMMUNICATIONS
Awareness and attitudes towards labour pain and labour pain relief of urban women attending a private antenatal clinic in Chennai, India
Joyce Nilima James, Kunder Samuel Prakash, Manickam Ponniah
March-April 2012, 56(2):195-198
DOI
:10.4103/0019-5049.96331
PMID
:22701219
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3,541
504
4
LETTERS TO EDITOR
Acute aluminium phosphide poisoning: Can we predict survival?
Hossein Sanaei-Zadeh
March-April 2012, 56(2):207-208
DOI
:10.4103/0019-5049.96319
PMID
:22701226
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3,623
374
1
CASE REPORTS
Seizures in the early post-partum period: A diagnostic dilemma
Sunil Jamadarkhana, Robert C Law
March-April 2012, 56(2):183-185
DOI
:10.4103/0019-5049.96339
PMID
:22701214
We discuss the differential diagnosis and management of early post-partum seizures and headache following a presumed dural puncture in a 20-year-old female. She initially presented with generalised tonic-clonic seizures preceded by nausea and headache on the fourth post-partum day along with a decreased Glasgow Coma Scale (8/15). Although clinical and laboratory examination including lumbar puncture, computerized tomography and magnetic resonance imaging were normal, a persistent headache was the only symptom. This headache improved dramatically after an epidural blood patch on the eighth post-partum day. The following discussion emphasises that various causes of post-partum seizures and headache should be considered before attributing it to dural puncture alone.
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Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy
Anand T Talikoti, BS Sindhu, SP Kavyashree, KS Kishore Kumar
March-April 2012, 56(2):189-192
DOI
:10.4103/0019-5049.96334
PMID
:22701216
Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy.
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3,024
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Unmasking of tracheomalacia following short-term mechanical ventilation in a patient of adult respiratory distress syndrome
Harihar V Hegde, Ravi L Bhat, Raghunath D Shanbag, MP Bharat, P Raghavendra Rao
March-April 2012, 56(2):171-174
DOI
:10.4103/0019-5049.96338
PMID
:22701211
Patients with chronic obstructive pulmonary disease (COPD) are susceptible to airway malacia, which may be unmasked following mechanical ventilation or tracheostomy decannulation. Dynamic imaging of central airways, a non-invasive test as effective as bronchoscopy to diagnose airway malacia, has increased the recognition of this disorder. We describe a 70-year-old woman admitted with adult respiratory distress syndrome. She had cardiorespiratory arrest on admission, from which she was successfully resuscitated. She had obesity, hypertension, diabetes mellitus, recurrent ventricular tachycardia, sarcoidosis with interstitial lung disease and COPD. She received short-term (18 days) mechanical ventilation with tracheostomy and developed respiratory distress following tracheostomy decannulation.
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3,021
425
2
LETTERS TO EDITOR
Malignant hyperthermia: Dantrolene sodium - A must have
Alok Sharma, Hemangi Karnik, Sanjay Kukreja, Kanchan Jagger
March-April 2012, 56(2):212-213
DOI
:10.4103/0019-5049.96327
PMID
:22701231
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2,626
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1
Preparation of the airway for awake intubation
Smita Prakash
March-April 2012, 56(2):209-210
DOI
:10.4103/0019-5049.96322
PMID
:22701228
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2,666
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CASE REPORTS
Airtraq
®
optical laryngoscope for tracheal intubation in patients with severe ankylosing spondylitis: A report of two cases
Qazi Ehsan Ali, Syed Hussain Amir, Obaid Ahmed Siddiqui, Abu Nadeem, Abdulla Zoheb Azhar
March-April 2012, 56(2):165-167
DOI
:10.4103/0019-5049.96332
PMID
:22701209
Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq
®
optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal thyroidectomy and were successfully intubated using the Airtraq
®
laryngoscope.
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2,706
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4
Labour analgesia and anaesthetic management of a primigravida with uncorrected Pentology of Fallot
K Sandhya, Shivakumar Shivanna, CA Tejesh, N Rathna
March-April 2012, 56(2):186-188
DOI
:10.4103/0019-5049.96336
PMID
:22701215
Tetraology of Fallot is the most common congenital heart disease causing intracardiac right-left shunts. It is characterized by presence of ventricular septal defect, aortic overriding, pulmonary artery outflow obstruction and right ventricular hypertrophy. When these features are associated with atrial septal defect, it is often referred to as Pentology of Fallot (POF). If the lesions remain uncorrected, they can cause significant morbidity and mortality to the patient. Pregnancy and labour in such a patient present with significant haemodynamic changes, which can be challenging to the anaesthesiologist. Our patient with POF was managed with labour analgesia and subsequently epidural anaesthesia for drainage of vulval haematoma with successful outcome.
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2,693
536
2
LETTERS TO EDITOR
Improvised device for negative-pressure leak test
Ashish Saraogi, VR Hemanth Kumar, S Parthasarathy, M Ravishankar
March-April 2012, 56(2):201-202
DOI
:10.4103/0019-5049.96311
PMID
:22701221
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2,669
412
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CASE REPORTS
A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury
Taopheeq B Rabiu, Amos E Fadare
March-April 2012, 56(2):162-164
DOI
:10.4103/0019-5049.96329
PMID
:22701208
Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.
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2,261
454
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LETTERS TO EDITOR
Management of difficult airway. Awake and under anaesthesia
Ashish Bangaari, Trevor Nair
March-April 2012, 56(2):210-211
DOI
:10.4103/0019-5049.96323
PMID
:22701229
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[PubMed]
1,903
767
1
CASE REPORTS
Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision
Thrivikrama Padur Tantry, Sunil P Shenoy, Pramal Shetty, Karunakara K Adappa
March-April 2012, 56(2):175-178
DOI
:10.4103/0019-5049.96341
PMID
:22701212
Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.
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2,224
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LETTERS TO EDITOR
Local infiltration analgesia following total knee arthroplasty
Karthik G Ramamoorthy
March-April 2012, 56(2):208-209
DOI
:10.4103/0019-5049.96320
PMID
:22701227
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1,988
488
1
BRIEF COMMUNICATIONS
Anaesthesia for thoracoscopic lung biopsy without tracheal instrumentation
Munisha Agarwal, Divya Jain, Vijyant Sabarwal
March-April 2012, 56(2):194-195
DOI
:10.4103/0019-5049.96330
PMID
:22701218
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2,070
399
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A rare case of hypertrophic obstructive cardiomyopathy posted for adrenalectomy for pheochromocytoma
Shweta R Yemul-Golhar, Pradnya M Bhalerao, Yogesh Gavali, Kalpana V Kelkar
March-April 2012, 56(2):198-200
DOI
:10.4103/0019-5049.96333
PMID
:22701220
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2,029
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LETTERS TO EDITOR
Our experiences in a patient with Progeria syndrome
MM Neema, Abhay Kumar Babar, Priyanka Sharma, Aditya Tewari
March-April 2012, 56(2):203-205
DOI
:10.4103/0019-5049.96314
PMID
:22701223
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1,802
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Removing a trapped epidural catheter: Concerns
Rakesh Garg, Ramesh Chand Gupta
March-April 2012, 56(2):211-212
DOI
:10.4103/0019-5049.96324
PMID
:22701230
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1,718
403
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Re: A rare complication of epidural anaesthesia. A case report with brief review of literature
Adriano BS Hobaika
March-April 2012, 56(2):205-205
DOI
:10.4103/0019-5049.96315
PMID
:22701224
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1,556
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Unusual bulging (ballooning) of the laryngeal mask airway cuff causing secondary loss of airway
Surjya Prasad Upadhyay, Piyush N Mallick, Manish Jagia
March-April 2012, 56(2):193-194
DOI
:10.4103/0019-5049.96328
PMID
:22701217
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1,564
324
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LETTERS TO EDITOR
The use of N-acetylcysteine to prevent hepatic dysfunction during laparoscopic surgery
Rakesh Garg, Ramesh Chand Gupta
March-April 2012, 56(2):202-203
DOI
:10.4103/0019-5049.96312
PMID
:22701222
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