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2013| January-February | Volume 57 | Issue 1
Online since
March 14, 2013
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REVIEW ARTICLE
Ophthalmic regional anaesthesia: A review and update
VV Jaichandran
January-February 2013, 57(1):7-13
DOI
:10.4103/0019-5049.108552
PMID
:23716759
Local anaesthetic techniques are increasingly popular for ophthalmic surgery. It is now being provided mainly by anaesthesiologists and varies from an akinetic injection technique to a non-akinetic topical technique. Each technique has its own risk/benefit profile, and proven to be highly successful if performed correctly. The choice of the technique should be individualized based upon specific needs of the patient, the nature and extent of eye surgery, and the anaesthesiologist's and surgeon's preferences and skill. This review article attempts to outline the orbital anatomy, discuss the commonly used agents, current method of pre-operative preparation, available clinical techniques and their inherent complications.
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6
CASE REPORTS
Management of a case of ankylosing spondylitis for total hip replacement surgery with the use of ultrasound-assisted central neuraxial blockade
Rakhee Goyal, Shivinder Singh, Ravindra Nath Shukla, Anuj Singhal
January-February 2013, 57(1):69-71
DOI
:10.4103/0019-5049.108572
PMID
:23716771
Management of a case of ankylosing spondylitis can be very challenging when the airway and the central neuraxial blockade, both are difficult. Ultrasound-assisted central neuraxial blockade may lead to predictable success in the field of regional anaesthesia. We present a young patient with severe ankylosing spondylitis where conventional techniques failed and ultrasound helped in successful combined spinal-epidural technique for total hip replacement surgery.
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1
EDITORIAL
Emergence from anaesthesia: Have we got it all smoothened out?
S Bala Bhaskar
January-February 2013, 57(1):1-3
DOI
:10.4103/0019-5049.108549
PMID
:23716758
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2
CLINICAL INVESTIGATIONS
Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome
Thomas Ledowski, Samuel Hillyard, Brendan O'Dea, Rob Archer, Filipe Vilas-Boas, Barney Kyle
January-February 2013, 57(1):46-51
DOI
:10.4103/0019-5049.108562
PMID
:23716766
Background:
The aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital.
Methods:
Data from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer. Postoperative outcome parameters were complications in the recovery room and radiological diagnosed atelectasis or pneumonia within 30 days.
Results:
Data from 146 patients were analysed. Three reversal strategies were used: no reversal, neostigmine or sugammadex. The TOF ratio was less than 0.7 in 17 patients (nine no reversal, eight neostigmine) and less than 0.9 in 47 patients (24 no reversal, 19 neostigmine, four sugammadex). Those reversed with sugammadex showed fewer episodes of postoperative oxygen desaturation (15% vs. 33%;
P
<0.05). TOF ratios of less than 0.7 (
P
<0.05) and also <0.9 (
P
<0.01) were more likely associated with X-ray results consistent with postoperative atelectasis or pneumonia.
Conclusions:
Our results suggest a significant impact of residual paralysis on patient outcome. The use of sugammadex resulted in the lowest incidence of residual paralysis.
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Endotracheal intubation through the intubating laryngeal mask airway (LMA-Fastrach™): A randomized study of LMA- Fastrach™ wire-reinforced silicone endotracheal tube versus conventional polyvinyl chloride tracheal tube
Megha U Sharma, Satinder Gombar, Kanti K Gombar, Baljit Singh, Nidhi Bhatia
January-February 2013, 57(1):19-24
DOI
:10.4103/0019-5049.108555
PMID
:23716761
Context:
A wire-reinforced silicone tube (LMA-Fastrach™ endotracheal tube) is specially designed for tracheal intubation using intubating laryngeal mask airway (ILMA). However, conventional polyvinyl chloride (PVC) tracheal tubes have also been used with ILMA to achieve tracheal intubation successfully.
Aim:
To evaluate the success of tracheal intubation using the LMA-Fastrach™ tracheal tube versus conventional PVC tracheal tube through ILMA.
Settings and Design:
Two hundred adult ASA physical status I/II patients, scheduled to undergo elective surgery under general anaesthesia requiring intubation, were randomly allocated into two groups.
Methods:
The number of attempts, time taken, and manoeuvres employed to accomplish tracheal intubation were compared using conventional PVC tubes (group I) and LMA-Fastrach™ wire-reinforced silicone tubes (group II). Intraoperative haemodynamic changes and evidence of trauma and postoperative incidence of sore throat and hoarseness, were compared between the groups.
Statistical Analysis:
The data was analyzed using two Student's
t
test and Chi-square test for demographics and haemodynamic parameters. Mann Whitney U test was used for comparison of time taken for endotracheal tube insertion. Fisher's exact test was used to compare postoperative complications.
Results:
Rate of successful tracheal intubation and haemodynamic variables were comparable between the groups. Time taken for tracheal intubation and manoeuvres required to accomplish successful endotracheal intubation, however, were significantly greater in group I than group II (14.71±6.21 s and 10.04±4.49 s, respectively (
P
<0.001), and 28% in group I and 3% in group II, respectively (
P
<0.05)).
Conclusion:
Conventional PVC tube can be safely used for tracheal intubation through the ILMA.
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BRIEF COMMUNICATIONS
Carotid body tumour excision: Anaesthetic challenges and review of literature
Sheetal R Jagtap, Rochana G Bakhshi, Sonal S Khatavkar, Sourabh J Phadtare, Shubha N Mohite
January-February 2013, 57(1):76-78
DOI
:10.4103/0019-5049.108576
PMID
:23716773
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PAST PRESIDENT’S MESSAGE
The President's Inaugural Address during ISACON 2012, on 28
th
December 2012 at Indore
Anjan Datta
January-February 2013, 57(1):5-6
DOI
:10.4103/0019-5049.108551
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PRESIDENTS MESSAGE
From the desk of the New President
T Prabhakar
January-February 2013, 57(1):4-4
DOI
:10.4103/0019-5049.108550
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CLINICAL INVESTIGATIONS
The preoperative and intraoperative risk factors for early postoperative mechanical ventilation after scoliosis surgery: A retrospective study
Indira Gurajala, Gopinath Ramachandran, Raju Iyengar, Padmaja Durga
January-February 2013, 57(1):14-18
DOI
:10.4103/0019-5049.108554
PMID
:23716760
Background:
Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery.
Methods:
One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics.
Results:
The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (
P
<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254;
P
<0.05).
Conclusion:
The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV.
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Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery
Thrivikrama Padur Tantry, BG Muralishankar, Karunakara Kenjar Adappa, Sudarshan Bhandary, Pramal Shetty, Sunil P Shenoy
January-February 2013, 57(1):35-40
DOI
:10.4103/0019-5049.108559
PMID
:23716764
Background:
One of the challenges of anaesthesia for shoulder arthroscopic procedures is the need for controlled hypotension to lessen intra-articular haemorrhage and thereby provide adequate visualisation to the surgeon. Achievement of optimal conditions necessitates several interventions and manipulations by the anaesthesiologist and the surgeon, most of which directly or indirectly involve maintaining intra-operative blood pressure (BP) control.
Aim:
This study aimed to compare the efficacy and convenience of target controlled infusion (TCI) of propofol and inhalational agent sevoflurane in patients undergoing shoulder arthroscopic surgery after preliminary inter-scalene blockade.
Methods:
Of thirty four patients studied, seventeen received TCI propofol (target plasma concentration of 3 μg/ml) and an equal number, sevoflurane (1.2-1.5 Minimum Alveolar Concentration). N
2
O was used in both groups. Systolic, diastolic, mean blood pressures and heart rate were recorded regularly throughout the procedure. All interventions to control BP by the anaesthesiologist and pump manipulation requested by the surgeon were recorded. The volume of saline irrigant used and the haemoglobin (Hb) content of the return fluid were measured.
Results:
TCI propofol could achieve lower systolic, mean BP levels and the number of interventions required was also lower as compared to the sevoflurane group. The number of patients with measurable Hb was lower in the TCI propofol group and this translated into better visualisation of the joint space. A higher volume of saline irrigant was required in the sevoflurane group. No immediate peri-operative anaesthetic complications were noted in either category.
Conclusion:
TCI propofol appears to be superior to and more convenient than sevoflurane anaesthesia in inter-scalene blocked patients undergoing shoulder arthroscopy.
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CASE REPORTS
Thrombocytopenia-associated multiple organ failure or severe haemolysis, elevated liver enzymes, low platelet count in a postpartum case
Manish Jagia, Salah Taqi, Mahmoud Hanafi, Fakeir Aisha
January-February 2013, 57(1):62-65
DOI
:10.4103/0019-5049.108568
PMID
:23716769
Thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathic syndrome that includes thrombotic thrombocytopenic purpura, secondary thrombotic microangiopathy, and disseminated intravascular coagulation. We report a case of postpartum female who presented with TAMOF or severe Haemolysis, elevated liver enzymes, low platelet count (HELLP) which was managed with plasma exchange. This case report is to make clinicians aware that TAMOF, severe HELLP, and other differential diagnosis in a postpartum case have a thin differentiating line and plasma exchange can be considered as one of the management options.
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3,450
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2
BRIEF COMMUNICATIONS
Hard palate tumour - a nightmare for the anaesthesiologists: Role of modified molar approach
Sanchita B Sharma, Mridu Paban Nath, Chandni Pasari, Anulekha Chakrabarty, Dipika Choudhury
January-February 2013, 57(1):83-84
DOI
:10.4103/0019-5049.108581
PMID
:23716777
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3,386
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LETTERS TO EDITOR
Awake airtraq intubation in plexiform neurofibroma of face: A new experience
Qazi Ehsan Ali, Syed H Amir, Muzammil Shafi, Tariq R Chaudhri
January-February 2013, 57(1):97-98
DOI
:10.4103/0019-5049.108594
PMID
:23716788
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CLINICAL INVESTIGATIONS
Comparative electrocardiographic effects of intravenous ondansetron and granisetron in patients undergoing surgery for carcinoma breast: A prospective single-blind randomised trial
Ashish Ganjare, Atul P Kulkarni
January-February 2013, 57(1):41-45
DOI
:10.4103/0019-5049.108560
PMID
:23716765
Background:
Postoperative nausea and vomiting (PONV) are common and distressing symptoms after surgery performed under general anaesthesia. 5-hydroxytryptamine
3
antagonists are routinely used for prevention and treatment of PONV. The aim of our study was to compare the incidence of QTc prolongation and quantify the amount of QTc prolongation with ondansetron and granisetron.
Methods:
This prospective, randomised, single-blind study was carried out in the OT and Recovery Room (RR) of a tertiary referral cancer centre. After obtaining Institutional Review Board approval and written informed consent from the patients, 70 patients undergoing elective surgery for carcinoma breast were included. In the RR, patients randomly received 8 mg of ondansetron or 1 mg of granisetron intravenously. Serial ECGs were recorded at various intervals, Non-invasive blood pressure and SpO
2
were also recorded. Chi-square test and Mann-Whiteny test were used for statistical analysis.
Results:
The demographics were similar in both groups. The incidence of significant QTc prolongation was significantly higher in the ondansetron group (22 of 37 (59.4%) vs. 11 of 33 patients (33.33%) (
P
<0.05)). There was an increase in the QTc interval in both the groups as compared to the baseline. The median prolongation in QTc interval from baseline was much more in the ondansetron group; this was statistically significant only at 5 and 15 min.
Conclusion:
Granisetron may be a safer option than ondanasetron for prevention and treatment of PONV due to lesser prolongation QTc interval. (ClinicalTrials.gov ID: NCT01352130)
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An easily made, low-cost phantom for ultrasound airway exam training and assessment
Kristopher M Schroeder, Jagan Ramamoorthy, Richard E Galgon
January-February 2013, 57(1):31-34
DOI
:10.4103/0019-5049.108558
PMID
:23716763
Background:
Recent manuscripts have described the use of ultrasound imaging to evaluate airway structures. Ultrasound training tools are necessary for practitioners to become proficient at obtaining and interpreting images. Few training tools exist and those that do can often times be expensive and rendered useless with repeated needle passes.
Methods:
We utilised inexpensive and easy to obtain materials to create a gel phantom model for ultrasound-guided airway examination training.
Results:
Following creation of the gel phantom model, images were successfully obtained of the thyroid and cricoid cartilages, cricothyroid membrane and tracheal rings in both the sagittal transverse planes.
Conclusion:
The gel phantom model mimics human airway anatomy and may be used for ultrasound-guided airway assessment and intervention training. This may have important safety implications as ultrasound imaging is increasingly used for airway assessment.
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3
ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients
Aparna Sinha, Lakshmi Jayaraman, Dinesh Punhani, Bishnu Panigrahi
January-February 2013, 57(1):25-30
DOI
:10.4103/0019-5049.108557
PMID
:23716762
Background:
The primary objective of this study was to compare the effect of ventilation using the ProSeal
TM
laryngeal mask airway (PLMA) with facemask and oropharyngeal airway (FM), prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery.
Methods:
Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO
2
1.0) in the ramp position with continuous positive airway pressure of 10 cm H
2
O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H
2
O) was initiated. The difficulty in mask ventilation (DMV) in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane) in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO
2
≤95%), moderate (SpO
2
≤90%) and severe (SpO
2
≤85%).
Results:
Significant rise in pO
2
was observed within both groups (
P
=0.001), and this was significantly higher in the PLMA (
P
=0.0001) when compared between the groups. SpO
2
≥ 90% (
P
=0.018) was seen in 19/20 (95%) patients in PLMA and 13/20 (65%) in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed.
Conclusion:
ProSeal
TM
laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.
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3
LETTERS TO EDITOR
Post-oesophagectomy and gastric pull-up: Anaesthetic implications
M Raghunandan, Chenanda A Biddappa
January-February 2013, 57(1):98-100
DOI
:10.4103/0019-5049.108595
PMID
:23716789
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2,833
455
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Addiction and seizure ability of tramadol in high-risk patients
Omid Mehrpour
January-February 2013, 57(1):86-87
DOI
:10.4103/0019-5049.108584
PMID
:23716779
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2,778
489
10
BRIEF COMMUNICATIONS
Peri-operative red cell transfusion management in a rare H-deficient (Para-Bombay) blood group variant
Nirmala Jonnavithula, Shanthi Bonagiri, Gopinath Ramachandran, RC Mishra
January-February 2013, 57(1):78-79
DOI
:10.4103/0019-5049.108577
PMID
:23716774
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CASE REPORTS
Postoperative airway compromise in shoulder arthroscopy: A case series
M Manjuladevi, Surbhi Gupta, KS Vasudeva Upadhyaya, AM Kutappa
January-February 2013, 57(1):52-55
DOI
:10.4103/0019-5049.108563
PMID
:23716767
Shoulder arthroscopy is a routine procedure performed for diagnostic and therapeutic purposes. Complications related to patient positioning and anaesthesia are not infrequent. Airway compromise is related to the duration of surgery, surgical technique and equipment, amount of irrigation fluid used and limited access to the patient. Thorough knowledge, both by surgeon and anaesthesiologist, is the key to anticipate, prevent and treat this complication early.
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Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis
Rohini V Bhat Pai, Harihar V Hegde, MCB Santhosh, S Roopa, Shrinivas S Deshpande, P Raghavendra Rao
January-February 2013, 57(1):72-75
DOI
:10.4103/0019-5049.108575
PMID
:23716772
Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis) and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.
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2,568
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2
Our experience with implantation of VentrAssist left ventricular assist device
Hiriyur Shivalingappa Jayanthkumar, Chinnamuthu Murugesan, John Rajkumar, Bandlapally Ramanjaneya Gupta Harish, Kanchi Muralidhar
January-February 2013, 57(1):56-61
DOI
:10.4103/0019-5049.108565
PMID
:23716768
Perioperative anaesthetic management of the VentrAssist
TM
left ventricular assist device (LVAD) is a challenge for anaesthesiologists because patients presenting for this operation have long-standing cardiac failure and often have associated hepatic and renal impairment, which may significantly alter the pharmacokinetics of administered drugs and render the patients coagulopathic. The VentrAssist is implanted by midline sternotomy. A brief period of cardiopulmonary bypass (CPB) for apical cannulation of left ventricle is needed. The centrifugal pump, which produces non-pulsatile, continuous flow, is positioned in the left sub-diaphragmatic pocket. This LVAD is preload dependent and afterload sensitive. Transoesophageal echocardiography is an essential tool to rule out contraindications and to ensure proper inflow cannula position, and following the implantation of LVAD, to ensure right ventricular (RV) function. The anaesthesiologist should be prepared to manage cardiac decompensation and acute desaturation before initiation of CPB, as well as RV failure and severe coagulopathic bleeding after CPB. Three patients had undergone implantation of VentrAssist in our hospital. This pump provides flow of 5 l/min depending on preload, afterload and pump speed. All the patients were discharged after an average of 30 days. There was no perioperative mortality.
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LETTERS TO EDITOR
Successful detection and management of kinked tracheal tube in a patient with severe post-burn contracture of the neck
Smita Prakash, Amitabh Kumar, Meenakshi Kumar, Anoop R Gogia
January-February 2013, 57(1):90-91
DOI
:10.4103/0019-5049.108587
PMID
:23716782
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2,522
352
1
Milky urine! A cause for concern?
Jyotsna Punj, Rahul Anand, V Darlong, R Pandey
January-February 2013, 57(1):87-88
DOI
:10.4103/0019-5049.108585
PMID
:23716780
[FULL TEXT]
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[PubMed]
2,280
353
4
Folding back of central venous catheter in the internal jugular vein: Methods to diagnose it at the time of insertion?
Amitabh Kumar, Kapil Gupta, Shyam Bhandari, Ram Singh
January-February 2013, 57(1):104-105
DOI
:10.4103/0019-5049.108600
PMID
:23716794
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[PubMed]
2,098
476
1
CASE REPORTS
Utility of intra-operative ultrasound in choosing the appropriate site for blood pressure monitoring in Takayasu's arteritis
Prasad Krishnamurthy Narasimha, Souvik Chaudhuri, Tim Thomas Joseph
January-February 2013, 57(1):66-68
DOI
:10.4103/0019-5049.108571
PMID
:23716770
Takayasu's arteritis (TA) is rare, chronic progressive, pan-endarteritis involving the aorta and its main branches, with a specific predilection for young Asian women. Anaesthesia for TA patients is complicated by their severe uncontrolled hypertension, extreme arterial blood pressure differentials, aortic regurgitation (AR), end-organ dysfunction, stenosis/aneurysms of major blood vessels and difficulties encountered in monitoring arterial blood pressure. We present the usefulness of ultrasound during anaesthetic management of a 35-year-old woman posted for emergency caesarean section due to intra-uterine growth retardation, foetal tachycardia in active labour, who was already diagnosed to have TA along with moderate AR and uncontrolled hypertension, using epidural technique. The use of intra-operative doppler helped resolve the initial dilemma about the diagnosis and treatment of the differential blood pressure between the affected and the normal upper limb in the absence of prior arteriogram.
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2,165
377
1
BRIEF COMMUNICATIONS
The practical aspects of propofol target controlled infusion for magnetic resonance imaging in children: An audit from the Royal Marsden Hospital
Emily Haberman, Alex Oliver
January-February 2013, 57(1):80-82
DOI
:10.4103/0019-5049.108578
PMID
:23716775
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1,973
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1
LETTERS TO EDITOR
McSleepy, da Vinci, Kepler Intubation System
et al
.
Shagun Bhatia Shah
January-February 2013, 57(1):101-102
DOI
:10.4103/0019-5049.108597
PMID
:23716791
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1,968
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OBITUARY
Dr. Arun Kumar Patil
BP Mallanna
January-February 2013, 57(1):106-106
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1,644
545
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LETTERS TO EDITOR
Management of laryngeal mask airway induced hiccups using dexmedetomedine
Chethan Manohara Koteswara, Jitendra Kumar Dubey
January-February 2013, 57(1):85-85
DOI
:10.4103/0019-5049.108583
PMID
:23716778
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1,820
365
1
Patient position for spinal anaesthesia: Flexed-back versus straight-back
Smita Prakash
January-February 2013, 57(1):95-95
DOI
:10.4103/0019-5049.108592
PMID
:23716786
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1,704
464
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Rocuronium and sugammadex and rapid emerge in day-care surgery
HD de Boer, LHDJ Booij
January-February 2013, 57(1):91-92
DOI
:10.4103/0019-5049.108588
PMID
:23716783
[FULL TEXT]
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1,649
507
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Labour analgesia and anaesthetic management of a primigravida with uncorrected pentalogy of fallot: Few concerns
Dalim Kumar Baidya, Bikash Ranjan Ray, Preet Mohinder Singh
January-February 2013, 57(1):102-103
DOI
:10.4103/0019-5049.108598
PMID
:23716792
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1,638
407
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BRIEF COMMUNICATIONS
Incidental laryngeal web simulating intra-operative refractory bronchospasm
Preet Mohinder Singh, Puneet Khanna
January-February 2013, 57(1):82-83
DOI
:10.4103/0019-5049.108580
PMID
:23716776
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1,703
326
1
LETTERS TO EDITOR
Laparoscopic appendicectomy in a child with multiple pituitary hormone deficiency
S Bala Bhaskar, BP Mallanna, Chetana Arun, D Srinivasalu
January-February 2013, 57(1):88-89
DOI
:10.4103/0019-5049.108586
PMID
:23716781
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1,607
310
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Dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine
Priyam Saikia
January-February 2013, 57(1):93-93
DOI
:10.4103/0019-5049.108589
PMID
:23716784
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1,522
375
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Optimal length of central venous catheter insertion in infants
Bikash Ranjan Ray, Dalim Kumar Baidya
January-February 2013, 57(1):100-101
DOI
:10.4103/0019-5049.108596
PMID
:23716790
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1,527
362
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Breathing circuit obstruction caused by kink in the reinforced kink-resistant circle system tube
Sameer Desai, SV Torgal, Raghavendra Rao
January-February 2013, 57(1):96-97
DOI
:10.4103/0019-5049.108593
PMID
:23716787
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1,553
336
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Author's reply
Sukhminder Jit Singh Bajwa, Jasbir Kaur, Gurpreet Singh, Ashish Kulshrestha, Sachin Gupta, Veenita Sharma, Amarjit Singh, SS Parmar
January-February 2013, 57(1):93-94
PMID
:23716785
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1,525
266
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Author's reply
K Sandhya, Shivakumar Shivanna, CA Tejesh, N Rathna
January-February 2013, 57(1):103-104
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1,183
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