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2014| March-April | Volume 58 | Issue 2
Online since
April 16, 2014
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BRIEF COMMUNICATIONS
Anaesthetic and airway management of a post-burn contracture neck patient with microstomia and distorted nasal anatomy
Rajni Mathur, Pawan K Jain, Pranay Singh Chakotiya, Pratibha Rathore
March-April 2014, 58(2):210-213
DOI
:10.4103/0019-5049.130834
PMID
:24963193
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42,798
2,558
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EDITORIAL
Monitored anaesthesia care: Case for a smarter management
S Bala Bhaskar, K Sudheesh
March-April 2014, 58(2):118-119
DOI
:10.4103/0019-5049.130798
PMID
:24963171
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6,079
1,925
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SPECIAL ARTICLE
Amalgamation of management information system into anaesthesiology practice: A boon for the modern anaesthesiologists
Sukhminder Jit Singh Bajwa
March-April 2014, 58(2):121-126
DOI
:10.4103/0019-5049.130803
PMID
:24963173
Over the years, traditional anaesthesia record keeping system has been the backbone of anaesthesiology ever since its introduction in the 1890s by Dr. Harvey Cushing and Dr. Ernest A. Codman. Besides providing the important information regarding patients' vital physiologic parameters, paper records had been a reliable source for various clinical research activities. The introduction of electronic monitoring gadgets and electronic record keeping systems has revolutionised the anaesthesiology practice to a large extent. Recently, the introduction of anaesthesia information management system (AIMS), which incorporates all the features of monitoring gadgets, such as electronic storage of large accurate data, quality assurance in anaesthesia, enhancing patient safety, ensuring legal protection, improved billing services and effecting an organisational change, is almost a revolution in modern-day anaesthesiology practice. The clinical research activities that are responsible for taking anaesthesiology discipline to higher peaks have also been boosted by the amalgamation of AIMS, enabling multicenter studies and sharing of clinical data. Barring few concerns in its installation, cost factors and functional aspects, the future of AIMS seems to be bright and will definitely prove to be a boon for modern-day anaesthesiology practice.
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CASE REPORTS
Caesarean section in a case of systemic lupus erythematosus
Varsha Vyas, Deepika Shukla, Surekha Patil, Shubha Mohite
March-April 2014, 58(2):193-195
DOI
:10.4103/0019-5049.130827
PMID
:24963187
Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear antibody (ANA) positive parturient with bad obstetric history who underwent elective caesarean section under spinal anaesthesia.
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4,955
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CLINICAL INVESTIGATIONS
Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults
Bhavdip Patel, Rajiv Khandekar, Rashesh Diwan, Ashok Shah
March-April 2014, 58(2):171-175
DOI
:10.4103/0019-5049.130821
PMID
:24963182
Background and Aims:
Intubation is often a challenge for anaesthesiologists. Many parameters assist to predict difficult intubation. The present study was undertaken to assess the validity of different parameters in predicting difficult intubation for general anaesthesia (GA) in adults and effect of combining the parameters on the validity.
Methods:
The anaesthesiologist assessed oropharynx of 135 adult patients. Modified Mallampati test (MMT) was used and the thyromental distance (TMD) and sternomental distances (SMD) for each of the patients were also measured. The Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy. The validity parameters such as sensitivity, specificity, false positive and negatives values, positive and negative predictive values were calculated. The effect of combining different measurements on the validity was also studied. Univariate analysis was performed using the parametric method.
Results:
The study group comprised of 135 patients. The sensitivity and specificity of MMT were 28.6% and 93%, respectively. The TMD (<6.5 CM) had sensitivity and specificity of 100% and 75.8%, respectively. The SMD (<12.5 CM) had sensitivity and specificity of 91% and 92.7%, respectively. Combination of MMT grading and TMD and SMD measurements increased the validity (sensitivity of 100% and specificity of 92.7%).
Conclusion:
MMT had high specificity. The validity of combination of MMT, SMD and TMD as compared to MMT alone was very high in predicting difficult intubation in adult patients. All parameters should be used in assessing an adult patient for surgery under GA.
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CLINICAL INVESTIGATIONS
Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study
Liaskou Chara, Vouzounerakis Eleftherios, Moirasgenti Maria, Trikoupi Anastasia, Staikou Chryssoula
March-April 2014, 58(2):176-182
DOI
:10.4103/0019-5049.130822
PMID
:24963183
Background and Aims:
Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study.
Methods:
We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed.
Results:
Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68,
P
< 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65).
Conclusions:
The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.
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BRIEF COMMUNICATIONS
Anaesthetic management of a case of Duchenne muscle dystrophy with Moyamoya disease
Meyong Pincho Bhutia, Mihir Prakash Pandia, Arati Rai
March-April 2014, 58(2):219-221
DOI
:10.4103/0019-5049.130843
PMID
:24963197
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5,111
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Anaesthesia for mediastinal mass
Preeti Thakur, PS Bhatia, N Sitalakshmi, Pooja Virmani
March-April 2014, 58(2):215-217
DOI
:10.4103/0019-5049.130840
PMID
:24963195
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4,799
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CLINICAL INVESTIGATIONS
A prospective observational study of skin to subarachnoid space depth in the Indian population
Smita Prakash, Parul Mullick, Pooja Chopra, Santosh Kumar, Rajvir Singh, Anoop R Gogia
March-April 2014, 58(2):165-170
DOI
:10.4103/0019-5049.130819
PMID
:24963181
Background and Aims:
A pre-puncture estimate of skin to subarachnoid space depth (SSD) may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1) The SSD in Indian males, females, parturients and the overall population; (2) To derive formulae for predicting SSD and (3) To determine which previously suggested formula best suited our population.
Methods:
In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M), females (Group F) and parturients (Group PF). SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with
post hoc
analysis, forward stepwise multivariate regression analysis and paired
t
-tests.
Results:
Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm) was significantly longer than that observed in females (4.55 ± 0.66 cm) but was comparable with SSD in parturients (4.73 ± 0.73 cm). Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI). Stocker's formula when applied correlated best with the observed SSD. Formulae were derived for the three groups.
Conclusions:
We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker's formula was most accurate in predicting SSD in our population.
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Comparative evaluation of subclavian vein catheterisation using supraclavicular versus infraclavicular approach
Anil Thakur, Kiranpreet Kaur, Aditya Lamba, Susheela Taxak, Jagdish Dureja, Suresh Singhal, Mamta Bhardwaj
March-April 2014, 58(2):160-164
DOI
:10.4103/0019-5049.130818
PMID
:24963180
Background and Aims:
Infraclavicular (IC) approach of subclavian vein (SCV) catheterisation is widely used as compared to supraclavicular (SC) approach. The aim of the study was to compare the ease of catheterisation of SCV using SC versus IC approach and also record the incidence of complications related to either approach, if any.
Methods:
In the study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Gp. SC right SCV catheterisation was performed using SC approach and in Gp. IC catheterisation was performed using IC approach. Access time, success rate of cannulation, number of attempts to cannulate vein, ease of guidewire and catheter insertion and length of catheter inserted and any associated complications were recorded.
Results:
The mean access time in group SC for SCV catheterisation was 4.30 ± 1.02 min compared to 6.07 ± 2.14 min in group IC. The overall success rate in catheterisation of the right SCV using SC approach (29 out of 30) was better as compared with group IC (27 out of 30) using IC approach. First attempt success in the SC group was 75.6% as compared with 59.25% in the IC group. All successful subclavian vein catheterisations in SC group and IC group were associated with smooth insertion of guidewire following subclavian venipuncture.
Conclusion:
The SC approach of SCV catheterisation is comparable to IC approach in terms of landmarks accessibility, success rate and rate of complications.
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Dexmedetomidine decreases the requirement of ketamine and propofol during burns debridement and dressings
Prabhavathi Ravipati, Pothula Narasimha Reddy, Chaithanya Kumar, P Pradeep, Rama Mohan Pathapati, Sujith Tumkur Rajashekar
March-April 2014, 58(2):138-142
DOI
:10.4103/0019-5049.130813
PMID
:24963176
Background and Aims:
Dexmedetomidine (Dex), a highly selective α
2
-adrenoreceptor agonist, is used for sedation management in various clinical settings and shows anaesthetic-sparing effect. Our aim was to study the effects of Dex on requirements of propofol, ketamine, and intraoperative haemodynamic variations during burns debridement and dressing changes, and compare its effectiveness and safety with combination of ketamine and propofol.
Methods:
Sixty adult patients posted for elective debridement and dressing were included in the study. Thirty patients received Dex (intramuscular)(IM) 1 μg/kg, 1 h before shifting to the operation theatre while the other thirty did not. Anaesthesia was induced with propofol and ketamine followed by adjusted infusion to achieve a Ramsay Sedation Scale score (RSS) of six in all patients. Intraoperatively haemodynamic parameters were recorded at regular intervals of 5, 15, 30, 45, and 60 min. The mean data between the groups were compared by unpaired
t
test and medians by Mann-Whitney U test. Within group analysis was performed by using repeated measures ANOVA.
P
< 0.05 was considered significant.
Results:
The dose requirement of ketamine and propofol in Dex group was significantly lower when compared to control group (100.5 ± 17.58 mg vs. 231.5 ± 60.39 mg (
P
< 0.0001) and 127.7 ± 15.47 mg vs. 254 ± 59.22 mg (
P
< 0.0001) respectively). Additionally, recovery time was lower in the Dex group as compared to the control group, 9.57 ± 1.50 min vs. 11.53 ± 2.56 min (
P
= 0.0006). Haemodynamic variations were also significantly lower in the Dex group as compared to the control group.
Conclusion:
Dexmedetomidine (1 μg/kg IM) reduced the requirement of propofol and ketamine, with more stable intraoperative haemodynamics.
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Prevalence of low back pain experienced after delivery with and without epidural analgesia: A non-randomised prospective direct and telephonic survey
Shemila Abbasi, M Hamid, Z Ahmed, Fauzia Haq Nawaz
March-April 2014, 58(2):143-148
DOI
:10.4103/0019-5049.130814
PMID
:24963177
Background and
Aims:
The most frequent concern of patients receiving epidural analgesia for labour pain relief is post-partum back pain. This survey was designed to assess the prevalence of post-partum backache with and without epidural analgesia among post-partum women.
Methods:
The study was conducted at a university teaching hospital and women presenting to labour room for labour and delivery formed the target population. A total of 482 women were recruited during the study period. Response rate was 95.4% and these cases were included in our statistical analysis. Two forms were designed for data collection before and after delivery; form I was filled by one of the investigators while form II was filled by a research assistant to prevent bias which included follow-up of back pain. The primary outcome variable was backache quantified with visual analogue scale score. Out of 460 women, 230 women received epidural analgesia for labour and 230 women had not.
Results:
The prevalence of post-partum back pain in epidural analgesia versus non epidural analgesia groups was 40.9% versus 40% on day one and 32.2% versus 35.2% after 1 week. However, after one and 3
rd
months follow-up, backache prevalence was less in epidural analgesia group (unadjusted odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.39-0.99) and (unadjustedd OR: 0.32; 95% CI: 0.15-0.69) respectively. The adjusted odd ratio was 0.59 at 1st month and 0.25 at 3rd month. There was no significant difference between the two groups in pain scores.
Conclusion:
There was no association between the epidural analgesia and post-partum back pain
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An assessment of basic pain knowledge and impact of pain education on Indian Anaesthesiologists - a pre and post questionnaire study
Sumitra G Bakshi, PN Jain, S Kannan
March-April 2014, 58(2):127-131
DOI
:10.4103/0019-5049.130805
PMID
:24963174
Background and Aim:
Under-treatment of pain is a global phenomenon and the basic knowledge of pain amongst health care providers continues to be deficient. The aim of this study was to determine the basic prevalent knowledge of pain among Indian anaesthesiologists and the impact of a pain educational programme on their existing knowledge.
Methods:
A nine lectures pain continuing medical education (CME) program was conducted for 114 young anaesthesiologists. All delegates were given 21-item questionnaire in a pre and post-test design. The 69 paired responses were compared for individual questions using McNemar test and the overall improvement in knowledge was analysed using paired
t
-test.
Results:
The pre-test score for correct answers was 61.9%. The post-test score was 69.8% and this improvement was found to be statistically significant (
P
< 0.001). A significant improvement in perception was detected that 'opioids usage was less likely to cause addiction' (correct responses increased from 4.2 to 77.4%,
P
= 0.001).
Conclusion:
The questionnaire study found that the current basic knowledge about pain amongst young anaesthesiologists is deficient. The physician's major concerns were opioid addiction and respiratory depression with opioid usage. The results of pre and post-test questionnaire survey have shown that pain education can help in improving knowledge of pain management.
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CASE REPORTS
Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax
Rachna Wadhwa, Zainab Ahmad, Mahendra Kumar
March-April 2014, 58(2):186-189
DOI
:10.4103/0019-5049.130825
PMID
:24963185
Traumatic diaphragmatic hernia (TDH) is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.
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CLINICAL INVESTIGATIONS
Study of patient satisfaction and self-expressed problems after emergency caesarean delivery under subarachnoid block
VR Hemanth Kumar, Sameer M Jahagirdar, Umesh Kumar Athiraman, R Sripriya, S Parthasarathy, M Ravishankar
March-April 2014, 58(2):149-153
DOI
:10.4103/0019-5049.130815
PMID
:24963178
Background and Aims:
Subarachnoid block is one of the common modes of anaesthesia opted for emergency caesarean section, if the maternal and foetal conditions are favourable. Various factors influence the quality of care administered during the procedure. This questionnaire based study was undertaken to look for self-expressed problems in peri-operative period in patients undergoing emergency caesarean surgery under subarachnoid block.
Methods:
All the parturients who underwent emergency caesarean section under subarachnoid block during 6 months period were distributed a questionnaire in post-operative period. They were encouraged to fill and return the form within 15 days. Patient satisfaction and the self-expressed problems were analysed at the end of 6 months.
Results:
One hundred and seventy five out of 220 parturients responded. 58.3% of them said that they were explained about the anaesthesia prior to surgery and 85.3% overall remained anxious. With people around them, 93.1% of them felt comfortable and 91.4% expressed that they were made comfortable inside the theatre. The self-expressed problems were shivering (43.4%), breathlessness (21.7%), pain (20%), post-operative headache (15.4%) and backache (19.4%). Parturients who heard their babies cry was 85.1%. After their babies were shown after delivery, 77.1% mothers slept well; 86.9% fed their babies within 4 h of delivery.
Conclusion:
Pre-operative communication in emergency caesarean section by health personnel did not reduce the anxiety level, which shows that communication was ineffective. Intra-operative psychological support like making the patient comfortable, showing baby to mother and early breast feeding improve bonding between child and mother and essentially contribute to patient satisfaction.
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CASE REPORTS
Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia
Pranjali Madhav Kurhekar, VSG Yachendra, Simi P Babu, Raghavelu Govindasamy
March-April 2014, 58(2):196-198
DOI
:10.4103/0019-5049.130828
PMID
:24963188
Cardiac arrest associated with spinal anaesthesia has been well researched. Myocardial stunning after successful resuscitation from cardiac arrest is seen in up to 2/3
rd
of in-hospital cardiac arrests. Myocardial stunning after resuscitation from cardiac arrest associated with spinal anaesthesia has probably not been reported earlier. Our case, an ASA physical status I lady, posted for tubal reanastomosis surgery developed bradycardia followed by asystole, approximately 5 minutes after giving subarachnoid block. Return of spontaneous circulation (ROSC) was achieved within 2 minutes with cardiopulmonary resuscitation (CPR) and defibrillation for pulseless ventricular tachycardia. Patient developed delayed pulmonary oedema, which was probably due to myocardial stunning. In the present case, inadequate preloading could have precipitated bradycardia progressing to cardiac arrest which, after resuscitation led to reversible myocardial dysfunction. We conclude that early vasopressor infusion, titrated fluids and echocardiography should be considered in immediate post cardiac arrest phase following spinal anaesthesia.
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Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality
Deepak Thapa, Vanita Ahuja
March-April 2014, 58(2):183-185
DOI
:10.4103/0019-5049.130824
PMID
:24963184
Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.
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3,010
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Elective tracheostomy in intensive care unit: Looking between techniques, a three cases report
Fausto Ferraro, Lucia Marullo, Anna d'Elia, Giuseppe Izzo
March-April 2014, 58(2):190-192
DOI
:10.4103/0019-5049.130826
PMID
:24963186
There is no optimal tracheostomy (TS) technique, proved to be the best. For this reason, operators' skills, clinical anatomical and physio-pathological features of the patient should be considered as discriminating factors in the choice of percutaneous dilation tracheostomy (PDT) technique. This article includes reports of three cases of PDT: In the first case distance between jugular notch and the first tracheal ring was too long, the second case involving a patient with mild ectasia of the ascending aorta and aortic regurgitation with De Musset's sign with great risk of perioperative bleeding and a third case, of tracheomalacia with inflammatory stenosis at the 4
th
tracheal ring. All together, this case series describes how decisions were made by an experienced staff, in which the patient characteristics were assessed and techniques best suited for each case were implemented.
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CLINICAL INVESTIGATIONS
Dexmedetomidine ameliorates monitored anaesthesia care
Priyamvada Gupta, Samrat Joshi, Durga Jethava, Ankit Kumar
March-April 2014, 58(2):154-159
DOI
:10.4103/0019-5049.130816
PMID
:24963179
Background and Aims:
Monitored anaesthesia care (MAC) is meant for procedures under local anaesthesia. Various drugs have been used for this purpose. The recently introduced alpha2 agonist, dexmedetomidine provides "conscious sedation" with adequate analgesia and minimal respiratory depression. Hence, the safety and efficacy of two doses of dexmedetomidine for sedation and analgesia were evaluated.
Methods:
A total of 90 patients were distributed in three groups of 30 each: Dexmedetomidine 0.5 μg/kg (DL), dexmedetomidine 1.0 μg/kg (DH) and normal saline (C). The initial loading dose was followed by maintenance infusion of 0.2-0.7 μg/kg/h of dexmedetomidine or equivalent volume of saline. Study drug was started at least 15 min before placement of local anaesthesia. Drugs were titrated to a target level of sedation (=3 on Ramsay sedation scale [RSS]). Midazolam 0.02 mg/kg for RSS < 3 and fentanyl 0.5 μg/kg were supplemented as required. The statistical analysis was performed using Chi-square test and mean and anova analysis.
Results:
In groups DL and DH fewer patients required supplemental midazolam, 56.7% (17/30) and 40% (12/30), compared with control, where 86.7% (26/30)needed midazolam supplements.
P
= 0.000. Both groups DL and DH required significantly less fentanyl (84.8 and 83.9 μg) versus control (144.2 μg). There was significantly increased ease of achieving and maintaining targeted sedation and analgesia in both dexmedetomidine groups when compared with placebo (
P
= 0.001). Adverse events observed with dexmedetomidine were bradycardia and hypotension.
Conclusions:
Dexmedetomidine in the doses studied was considered safe and effective sedative and analgesic for patients undergoing procedures under MAC.
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3
CASE REPORTS
Management of bronchial carcinoid: An anaesthetic challenge
Prasoon Gupta, Ranvinder Kaur, Lalita Chaudhary, Aruna Jain
March-April 2014, 58(2):202-205
DOI
:10.4103/0019-5049.130830
PMID
:24963190
Carcinoid tumours pose a great challenge to anaesthesiologist, especially if carcinoid syndrome is present. We report peri-operative management of a patient with carcinoid syndrome who underwent upper lobectomy. Pre-operative optimisation for 10 days before surgery with injection octreotide and administration on the day of surgery as per guidelines was followed (North American Neuroendocrine Tumour Society guidelines). Our main goals were to prevent mediator release, avoidance of triggering factors and management of peri-operative carcinoid crisis. During tumour handling patient developed carcinoid crisis which was effectively treated with intravenous bolus octreotide and increasing rate of infusion.
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CLINICAL INVESTIGATIONS
Influence of changing trends in anaesthetic practice on morbidity and mortality in elderly patients undergoing lower limb surgery
Moningi Srilata, Padmaja Durga, Gopinath Ramachandran
March-April 2014, 58(2):132-137
DOI
:10.4103/0019-5049.130807
PMID
:24963175
Background and Aims:
Several changes in the management protocols of anaesthesia for geriatric patients were introduced into clinical practice to improve the outcome. Very few studies have evaluated the impact of these management protocols. The aim of our study was to evaluate impact of some of the changes in the peri-operative management protocols of geriatric patients undergoing elective orthopaedic lower limb surgeries on the outcomes.
Methods:
A retrospective chart review of thirty-eight surgical patients from 1999 (Group 1999) before the introduction of changes and 107 patients from 2007 (Group 2007) after establishing changes was performed and data of peri-operative variables were collected and analysed. The primary outcome measured was in-hospital mortality. The secondary outcomes were occurrence of intra-operative and post-operative complications. Comparison of continuous variables between the two groups was performed using independent sample T test and categorical variables using Chi-square test. Multivariate logistic regression was done to identify independent predictors of mortality.
Results:
The use of beta blockers, deep vein thrombosis prophylaxis with low molecular weight heparin and epidural technique for post-operative analgesia was higher in group 2007. Despite higher prevalence of patients with electrocardiographic changes and anaemia, the incidence of intra-operative or post-operative complications was lower in 2007, though the mortality rate in both the groups was comparable. The independent risk factors for mortality in these geriatric patients were intra-operative hypotension (Odds Ratio (OR) =11.33) and post-operative myocardial ischaemia (OR = 34.5), pulmonary embolism (OR = 17.1) and neurologic changes (OR = 17.1).
Conclusions:
Implementation of new management practices had significantly reduced the incidence of intra- and post-operative complications.
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2,661
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BRIEF COMMUNICATIONS
Awake airway control in patients with anticipated difficult mask ventilation
Pankaj Kundra, Satyen Parida
March-April 2014, 58(2):206-208
DOI
:10.4103/0019-5049.130831
PMID
:24963191
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2,471
588
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CASE REPORTS
Dural ectasia
Neha Gupta, Veena Gupta, Abhishake Kumar, Gaurav Kumar
March-April 2014, 58(2):199-201
DOI
:10.4103/0019-5049.130829
PMID
:24963189
Dural ectasia is one of the likely causes of incomplete or failed spinal anaesthesia. Its association with diseases like Marfans syndrome, neurofibromatosis, osteogenesis imperfecta, vertebral fracture, postopertative adhesions, trauma etc., is often overlooked as a reason for inadequate spinal anaesthesia. Greater than normal volume of cerebrospinal fluid in the lumber theca in dural ectasia is postulated to restrict the spread of intrathecally injected Local anaesthetic. Here, we report a case of failed spinal anaesthesia but successful epidural anaesthesia in later setting in a patient with dural ectasia.
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2,471
426
2
LETTERS TO EDITOR
Sinus arrest with intrathecal dexmedetomidine
Tripat Kaur Bindra, Simarjot Singh Sarin, Ruchi Gupta, Shubhdeep
March-April 2014, 58(2):227-228
DOI
:10.4103/0019-5049.130851
PMID
:24963202
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2,446
417
1
Life-threatening complication following infiltration with adrenaline
Neha Gupta, Veena Gupta
March-April 2014, 58(2):225-227
DOI
:10.4103/0019-5049.130850
PMID
:24963201
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2,365
448
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BRIEF COMMUNICATIONS
Inclusion of the left main bronchus in the clip used to occlude the ductus arteriosus in a premature baby: An unexpected complication
Akhlaque N Bhat, Jiju John, Mohammed KR Riyas, Bader AlKurdi, Husam Salama
March-April 2014, 58(2):213-215
DOI
:10.4103/0019-5049.130838
PMID
:24963194
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2,464
325
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LETTERS TO EDITOR
An unusual cause of upper airway obstruction in a child during general anaesthesia
Sugata Dasgupta, Soumi Das, Dipasri Bhattacharya, Sonia Agarwal
March-April 2014, 58(2):222-223
DOI
:10.4103/0019-5049.130844
PMID
:24963198
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2,287
412
1
Cardiac arrest post tourniquet release under spinal anesthesia
BN Archana, P Vishnu Prasad, A Sreenivasa Babu
March-April 2014, 58(2):237-238
DOI
:10.4103/0019-5049.130868
PMID
:24963209
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2,147
538
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MESSAGE FROM THE HQ
From the ISA National Head Quarters
MV Bhimeswar, Muralidhar Joshi
March-April 2014, 58(2):120-120
PMID
:24963172
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2,207
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BRIEF COMMUNICATIONS
Scimitar syndrome in pregnancy
Moira A Hendrie, Deepak Mathur
March-April 2014, 58(2):208-210
DOI
:10.4103/0019-5049.130832
PMID
:24963192
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2,164
386
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LETTERS TO EDITOR
Anaesthetic management of a case of distal myopathy
Neelam Agrawal, Ankur Sharma, Ravindra Batra
March-April 2014, 58(2):228-230
DOI
:10.4103/0019-5049.130853
PMID
:24963203
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2,220
297
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Prevalence and indications of general anesthesia for adult cataracts in a tertiary care centre in India
Sudarshan Khokhar, Shikha Gupta, Anasua Ganguly, Dilip Shende
March-April 2014, 58(2):231-232
DOI
:10.4103/0019-5049.130858
PMID
:24963205
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2,206
306
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A rare case of angioedema after anaesthesia
Madhu Gupta, Shalini Subramanian, Anil Kumar, Divya Sethi
March-April 2014, 58(2):232-233
DOI
:10.4103/0019-5049.130861
PMID
:24963206
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2,005
397
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MESSAGES
Pages From Old Issues of IJA 1970
March-April 2014, 58(2):111-115
PMID
:24963169
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1,847
534
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BRIEF COMMUNICATIONS
Anaesthetic management of a dopamine-secreting phaeochromocytoma in multiple endocrine neoplasia 2B syndrome
Rajeev Kumar Dubey, Nimisha Verma, Chandra Kant Pandey
March-April 2014, 58(2):217-219
DOI
:10.4103/0019-5049.130841
PMID
:24963196
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1,937
396
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LETTERS TO EDITOR
Anaesthetic management in a patient with Lennox-Gastaut syndrome
Tasneem Dhansura, Nitin Bhorkar, Prashant Pawar, Shweta Gandhi
March-April 2014, 58(2):238-239
DOI
:10.4103/0019-5049.130862
PMID
:24963210
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1,988
314
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MESSAGES
Pages From Old Issues of IJA 1970
March-April 2014, 58(2):116-117
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1,781
471
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LETTERS TO EDITOR
Response to comments: Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial
Anil P Singh, Rajesh Meena, V Rastogi
March-April 2014, 58(2):241-241
DOI
:10.4103/0019-5049.130856
PMID
:24963212
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1,926
275
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Takotsubo cardiomyopathy in aneurysmal subarachnoid haemorrhage
Vidhu Bhatnagar, S Manikandan
March-April 2014, 58(2):233-235
DOI
:10.4103/0019-5049.130863
PMID
:24963207
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1,801
349
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Comments on "Nebulised fentanyl for post operative pain relief, a prospective double blind controlled randomised clinical trial"
Laurence E Mather
March-April 2014, 58(2):240-241
DOI
:10.4103/0019-5049.130857
PMID
:24963211
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1,733
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Revisiting epidural anaesthesia in a parturient with idiopathic pulmonary hypertension posted for caesarean section
Manas Vithal Manohar, Archana Vaidya, Sandhya Bakshi
March-April 2014, 58(2):235-236
DOI
:10.4103/0019-5049.130864
PMID
:24963208
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1,675
343
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Oro-facial dysmorphism with visible glossoepiglottic fold in a heteropagus: First description
Priyam Saikia, Dipika Choudhury, Kabita Kalita
March-April 2014, 58(2):223-224
DOI
:10.4103/0019-5049.130845
PMID
:24963199
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1,673
246
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All endotracheal tubes that appear endotracheal are not so!
Harihar V Hegde
March-April 2014, 58(2):230-231
DOI
:10.4103/0019-5049.130854
PMID
:24963204
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1,492
408
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Intra-operative vascular injury and its management in a case of Ehler-Danlos syndrome
Kartik Syal, Dheeraj Singha, Ajay Sood
March-April 2014, 58(2):224-225
DOI
:10.4103/0019-5049.130846
PMID
:24963200
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1,605
255
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