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2015| March | Volume 59 | Issue 3
Online since
March 12, 2015
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BRIEF COMMUNICATIONS
Survey of supraglottic airway devices usage in anaesthetic practice in South Indian State
S Mohideen Abdul Kadar, Rachel Koshy
March 2015, 59(3):190-193
DOI
:10.4103/0019-5049.153044
PMID
:25838594
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127,152
855
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EDITORIAL
The challenges and excitement of liver transplantation
Vijay Vohra
March 2015, 59(3):141-143
DOI
:10.4103/0019-5049.153034
PMID
:25838584
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5,258
1,521
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REVIEW ARTICLE
Acute liver failure in pregnancy: Challenges and management
Chandra Kant Pandey, Sunaina Tejpal Karna, Vijay Kant Pandey, Manish Tandon
March 2015, 59(3):144-149
DOI
:10.4103/0019-5049.153035
PMID
:25838585
Acute liver failure (ALF) in pregnancy negatively affects both maternal and foetal outcome. The spectrum of liver disease in pregnancy may range from mild asymptomatic transaminitis to fatal and irreversible deterioration in liver functions leading to significant morbidity and even mortality. In this comprehensive review, we searched articles published as review articles, clinical trials, and case series in the Medline from 1970 to 2012. The overall outcome of ALF in pregnancy depends on the aetiology, timely diagnosis, prompt management, and early referral to a centre equipped in managing medical or obstetric complication. The foetal outcome is affected by the stage of pregnancy in which the mother has a deterioration of the liver function, with a worst prognosis associated with first or second-trimester liver failure. When ALF complicates pregnancy, liver transplantation is the one of the viable options. Management protocols need to be individualised for each case keeping in mind the risk versus benefit to both the mother and the foetus.
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4,117
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LETTERS TO EDITOR
Myasthenia gravis: A challenge
Bhagyalakshmi Ramesh
March 2015, 59(3):197-198
DOI
:10.4103/0019-5049.153047
PMID
:25838597
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3,738
927
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CLINICAL INVESTIGATIONS
Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone
Ashok Jadon, Shreya Dixit, Sunil Kr Kedia, Swastika Chakraborty, Amit Agrawal, Neelam Sinha
March 2015, 59(3):171-176
DOI
:10.4103/0019-5049.153039
PMID
:25838589
Background and Aims:
Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic.
Methods:
After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (
n
= 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (
n
= 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's
t
-test were used and
P
< 0.05 was considered as significant.
Results:
The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (
P
= 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (
P
= 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (
P
= 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (
P
= 0.0859).
Conclusion:
Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.
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3,653
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Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study
SS Nethra, M Sathesha, Dixit Aanchal, Pradeep A Dongare, SS Harsoor, D Devikarani
March 2015, 59(3):177-181
DOI
:10.4103/0019-5049.153040
PMID
:25838590
Background and Aim:
The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α
2
agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries.
Methods:
This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests.
Results:
Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively) in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively). However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).
Conclusion:
Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.
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BRIEF COMMUNICATIONS
Anaesthetic considerations for tracheal resection in oncological thyroid surgeries
Namrata Ranganath, BHR Arathi, PV Ramamani, VB Gowda
March 2015, 59(3):188-190
DOI
:10.4103/0019-5049.153043
PMID
:25838593
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CLINICAL INVESTIGATIONS
Comparison of neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients
Shilpa Bhimasen Joshi, KS Vasudeva Upadhyaya, M Manjuladevi
March 2015, 59(3):165-170
DOI
:10.4103/0019-5049.153038
PMID
:25838588
Background and Aims:
Obese patients are more vulnerable to residual neuromuscular block (NMB) and its associated complications in the post-operative period. This study was carried out to compare neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients, objectively using neuromuscular (NM) monitoring.
Methods:
Twenty female patients each belonging to normal weight, overweight and obese, based on body mass index, requiring general anaesthesia were recruited for this prospective cross sectional study. NMB was induced with vecuronium (0.1 mg/kg) dose based on patient's real body weight (RBW) and monitored using acceleromyographic train of four (TOF). All patients received neostigmine 40 μg/kg and glycopyrrolate 10 μg/kg at 25% of spontaneous recovery of first twitch height (T1) of TOF (DUR 25%) and were allowed to recover to TOF ratio of 0.9. Statistical analysis was done using analysis of variance test.
Results:
Recovery of TOF ratio to 0.5 was comparable in all three groups. Recovery of TOF ratio to 0.7 was delayed in obese (9.82 ± 3.21 min) compared with normal weight group (7.50 ± 2.52 min). Recovery of TOF to 0.9 was significantly delayed in both overweight (12.18 ± 4.29 min) and obese patients (13.78 ± 4.30 min). DUR 25% was significantly longer in overweight (mean, standard deviation [range]; 30.10 [19-40 min]) and obese (28.8 [12-45 min]) compared with normal weight patients (22.75 [16-30 min]).
Conclusion:
In overweight and obese patients, when vecuronium induction dose is based on RBW, neostigmine induced recovery of NMB is delayed in late phases (TOF 0.7-0.9), which may result in vulnerability for associated complications of incomplete recovery. Ensuring safe recovery thus requires objective NM monitoring.
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Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study
Upasana Goswami, Savita Babbar, Saurabh Tiwari
March 2015, 59(3):150-155
DOI
:10.4103/0019-5049.153036
PMID
:25838586
Background
and
Aims:
General anaesthesia (GA) may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period.
Methods:
After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT), digit span test (DST), Rivermead behavioural memory test (RBMT), mini mental state examination (MMSE) score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at
P
< 0.05.
Results:
There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h.
Conclusion:
Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries.
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CASE REPORT
Anaesthetic concerns during adrenalectomy for Cushing's syndrome with known hyperhomocysteinemia
Nirmala Jonnavithula, Praveen Reddy Elmati, Kiran Kumar Duddu, PVLN Murthy, Gopinath Ramachandran
March 2015, 59(3):182-185
DOI
:10.4103/0019-5049.153041
PMID
:25838591
Maintenance of homeostasis during anaesthesia in the patient with two major metabolic disorders whose systemic effects either compliment or contradict each other is a challenge to the anaesthesiologist. A 25-year-old male patient with Cushing's syndrome and known hyperhomocysteinemia was scheduled for open adrenalectomy. Both these disorders compound the hypercoagulable state and differ in glucose metabolism. In addition, obesity, difficult airway, electrolyte and metabolic derangements that accompany Cushing's syndrome warrant special attention. He was on anticoagulant therapy and inferior vena cava filter following an episode of pulmonary thromboembolism with deep vein thrombosis. Perioperative hydrocortisone was administered. Thoracic epidural catheter was placed at T10-T11 interspace, standard general anaesthesia was administered without nitrous oxide. Patient was extubated following an uneventful procedure and discharged home on 10
th
post-operative day. Understanding the anaesthetic implications and the pathophysiological interactions of multiple metabolic disorders with a potential for multisystem involvement is key to the successful management of these patients.
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3,007
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CLINICAL INVESTIGATIONS
The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study
Nagwa Ibrahim, Ashraf Hasanin, Sabry Abd Allah, Eman Sayed, Mohamed Afifi, Khaled Yassen, Wesam Saber, Magdy Khalil
March 2015, 59(3):156-164
DOI
:10.4103/0019-5049.153037
PMID
:25838587
Background
and
Aims:
Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters.
Methods:
After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (
n
= 25) or terlipressin group (
n
= 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index <2600 dyne.s/cm5
/
m2 till day 4. Nor-epinephrine was used as appropriate. Haemodynamic and transoesophageal Doppler parameters (intraoperative), renal function, peak portal vein blood flow velocity (PPV), hepatic artery resistive index (HARI), urine output (UOP), liver enzymes, catecholamine support were compared intra-operatively and 4 days post-operatively. Desflurane administration was guided with entropy.
Results:
Terlipressin maintained better MAP and SVR (
P
< 0.01) during reperfusion versus controls (66.5 ± 16.08 vs. 47.7 ± 4.7 mmHg and 687.7 ± 189.7 vs. 425.0 ± 26.0 dyn.s/cm
5
), respectively. Nor epinephrine was used in 5 out of 25 versus 20 in controls. Urea, creatinine and UOP were significantly better with terlipressin. PPV was reduced with terlipressin post-reperfusion versus controls (44.8 ± 5.2 vs. 53.8 ± 3.9 ml/s, respectively,
P
< 0.01) without affecting HARI (0.63 ± 0.06 vs. 0.64 ± 0.05, respectively,
P
> 0.05) and was sustained post-operatively.
Conclusion:
Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.
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BRIEF COMMUNICATIONS
Emergency anaesthetic management of penetrating thoracic trauma: Combining skill with fortuity
Sumanlata Gupta, Satyen Parida, Ajith Kumar Pillai, Ramesh Varadharajan
March 2015, 59(3):186-187
DOI
:10.4103/0019-5049.153042
PMID
:25838592
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LETTERS TO EDITOR
Acute onset of intracranial subdural haematoma 2 days after spinal anaesthesia
Sanjeev Kumar, Mukund Prasad, Ravinder Kumar
March 2015, 59(3):201-202
DOI
:10.4103/0019-5049.153050
PMID
:25838600
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1,852
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BRIEF COMMUNICATIONS
A tryst with a dysmorphic parturient with congenital syphilis
Madhuri S Kurdi, Kaushic A Theerth, Jagadish G Sutagatti, Ashwini Halesh
March 2015, 59(3):193-195
DOI
:10.4103/0019-5049.153045
PMID
:25838595
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1,953
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LETTERS TO EDITOR
Delayed recovery of consciousness after elbow arthroscopy
Pradyumna Ramchandra Raval, Dilip J Malkan
March 2015, 59(3):198-199
DOI
:10.4103/0019-5049.153048
PMID
:25838598
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1,646
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An add-on advantage of isoflurane graphical monitoring: Detection of intraoperative bronchospasm
Sanjay Kumar, Mukesh Tripathi
March 2015, 59(3):200-201
DOI
:10.4103/0019-5049.153049
PMID
:25838599
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1,654
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1
Big cuff: Big problem
Sangeeta Dhanger, Stalin Vinayagam
March 2015, 59(3):202-204
DOI
:10.4103/0019-5049.153051
PMID
:25838601
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1,494
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Anaesthetic management of a case of adrenal and extra-adrenal phaeochromocytoma for preoperative embolisation
Mathews Jacob, Saurabh Macwana, D Vivekanand
March 2015, 59(3):196-197
DOI
:10.4103/0019-5049.153046
PMID
:25838596
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1,477
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ERRATUM
Anaesthetic considerations in an infant with Beckwith-Weidemann syndrome and hepatoblastoma for partial hepatectomy: Erratum
March 2015, 59(3):205-205
DOI
:10.4103/0019-5049.153052
PMID
:25838602
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1,210
233
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