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2015| April | Volume 59 | Issue 4
Online since
April 13, 2015
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BRIEF COMMUNICATIONS
Prone position ventilation in Acute Respiratory Distress Syndrome: An overview of the evidences
Sumita P Agrawal, Akhil D Goel
April 2015, 59(4):246-248
DOI
:10.4103/0019-5049.155004
PMID
:25937653
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9,124
1,676
3
Anaesthetic management for drainage of frontoparietal abscess in a patient of uncorrected Tetralogy of Fallot
Anjana S Wajekar, Anita N Shetty, Shrikanta P Oak, Ruchi A Jain
April 2015, 59(4):244-246
DOI
:10.4103/0019-5049.155003
PMID
:25937652
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7,058
1,163
1
CLINICAL INVESTIGATIONS
Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation
Usha Shukla, T Prabhakar, Kiran Malhotra, Dheeraj Srivastava, Kriti Malhotra
April 2015, 59(4):234-239
DOI
:10.4103/0019-5049.155001
PMID
:25937650
Background
and
Aims:
Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy.
Methods:
A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (
n
= 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's
t
-test and Chi-square test (level of significance
P
= 0.05).
Results:
VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B.
Conclusion:
Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol.
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5,536
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1
Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea
Melveetil S Sreejit, Venkateswaran Ramkumar
April 2015, 59(4):216-221
DOI
:10.4103/0019-5049.154998
PMID
:25937647
Background and Aims:
Induction of general anaesthesia
per
se
as also the use of 100% oxygen during induction of anaesthesia, results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. We aimed to assess the effect of application of a continuous positive airway pressure (CPAP) of 5 cm H
2
O during pre-oxygenation and induction of anaesthesia on the period of apnoea before the occurrence of clinically significant desaturation.
Methods:
In this prospective, randomised, and double-blind study, 40 patients posted for elective surgery were enrolled. Duration of apnoea was measured as the time from the administration of succinylcholine hydrochloride to the time when oxygen saturation fell to 93%. Student's
t
-test was used for comparing the duration of apnoea.
Results:
The safe duration of apnoea was found to be significantly longer in patients receiving CPAP of 5 cm H
2
O (Group P;
n
= 16) compared to the group receiving no CPAP (Group Z;
n
= 20), that is, 496.56 ± 71.68 s versus 273.00 ± 69.31 s (
P
< 0.001).
Conclusion:
The application of CPAP of 5 cm H
2
O using a Mapleson "A" circuit with a fixed positive end-expiratory pressure device during 5 min of pre-oxygenation with 100% oxygen prior to the induction of anaesthesia provides a clearly longer duration of apnoea before clinically significant arterial desaturation occurs.
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3,876
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3
SPECIAL ARTICLE
Pyrexia: An update on importance in clinical practice
Ragi Jain, Deepesh Saxena
April 2015, 59(4):207-211
DOI
:10.4103/0019-5049.154996
PMID
:25937645
Pyrexic patients are usually attended with some scepticism by anaesthesiologists. Main reasons are the absence of comprehensible guidelines pertaining to anaesthesia in such patients and the presence of innumerable aetiologies of pyrexia. This article has tried to fill the existing void in the medical literature regarding anaesthesia in a patient with pyrexia. The article aims to discuss common and relevant causes of pyrexia, their pathophysiology in anaesthetic perspective, and the subsequent anaesthetic management, though a detailed discourse on all the entities causing pyrexia is beyond the scope of this article. This article will also touch upon the thermoregulatory alterations during anaesthesia. The literature search was performed manually using text and reference books, peer-reviewed journals, online and offline and through internet search engines Google, PubMed and Medline databases, using search terms 'perioperative pyrexia or fever, anaesthesia and thermoregulation'. Articles from 1980 to 2013 in English language were selected.
[ABSTRACT]
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3,904
934
1
CLINICAL INVESTIGATIONS
Comparison of ramosetron with ondansetron for the prevention of post-operative nausea and vomiting in high-risk patients
Sandip Agarkar, Aparna S Chatterjee
April 2015, 59(4):222-227
DOI
:10.4103/0019-5049.154999
PMID
:25937648
Background and Aims:
Post-operative nausea and vomiting (PONV) has an 80% incidence in high-risk patients. This is despite the availability of several antiemetic drugs. Selective 5-hydroxytryptamine type 3 (5-HT
3
) receptor antagonists are considered first-line for prophylaxis, ondansetron being the most commonly used agent. Ramosetron, another selective 5-HT
3
receptor antagonist, is more potent and longer acting than ondansetron. This study was conducted to evaluate the antiemetic efficacy of ramosetron in comparison with ondansetron in patients at a high risk of PONV.
Methods:
This was a prospective randomised double-blind study carried out over a 6-month period in which 206 patients with at least two risk factors for PONV were randomised to receive ramosetron 0.3 mg or ondansetron 8 mg, 30 min before the end of surgery. The incidence of PONV, severity of nausea and need for rescue antiemetic were recorded over the next 24 h. Primary outcome was the incidence of PONV. Secondary outcomes included severity of nausea and need for rescue. The data were analysed using the Predictive Analytics Software (PASW, version 18: Chicago, IL, USA).
Results:
The incidence of PONV was found to be 35% in the ramosetron group as opposed to 43.7% in the ondansetron group (
P
= 0.199). Need for rescue antiemetic was 23.3% in the ramosetron group and 32% in the ondansetron group (
P
= 0.156) in the 24 h following surgery.
Conclusion:
Ramosetron 0.3 mg and ondansetron 8 mg were equally effective in reducing the incidence of PONV in high risk patients.
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3,014
703
1
LETTERS TO EDITOR
Cardiac arrest from tramadol and fentanyl combination
Shalini Nair, Tony Thomson Chandy
April 2015, 59(4):254-255
DOI
:10.4103/0019-5049.155008
PMID
:25937657
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[PubMed]
2,777
585
2
CLINICAL INVESTIGATIONS
Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery
Lakshmi Kumar, Yamini Sivani Kanneganti, Sunil Rajan
April 2015, 59(4):228-233
DOI
:10.4103/0019-5049.155000
PMID
:25937649
Background
and
Aims:
Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT) targeting cardiac index (CI) and oxygen extraction ratio (O
2
ER) on outcomes of high-risk patients undergoing abdominal surgery.
Methods:
In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III) undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT), in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m
2
and O
2
ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU) and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment.
Results:
Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (
P
< 0.05). The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (
P
< 0.05). There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days) or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days) between Group A and B.
Conclusions:
Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.
[ABSTRACT]
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2,568
546
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Clinical evaluation of nares-vocal cord distance and its correlation with various external body parameters
Bhuwan Sareen, Anu Kapur, Sanjay Kumar Gupta, Parul Bansal Sareen, Hitesh Nischal
April 2015, 59(4):212-215
DOI
:10.4103/0019-5049.154997
PMID
:25937646
Background and Aims:
The optimal visualisation of vocal cords during fibreoptic intubation may be utilised for the nares-vocal cord distance (NVD) estimation. The present study was conducted to measure NVD and to correlate with various external body parameters.
Methods:
This study was conducted on 50 males and 50 females. We measured NVD and analysed its relationship with height, nares to tragus of ear distance (NED), nares to angle of mandible distance (NMD), sternal length (SL), thyro-mental distance (TMD), sterno-mental distance (SMD) and arm span (AS).
Results:
The mean NVD of the males was 18.5 ± 1.5 cm, and that of the females was 15.9 ± 1.1 cm. The relationship between the NVD and body height (males
P
= 0.001,
r
= 0.463, females
P
= 0.000,
r
= 0.555), SL (males
P
= 0.000,
r
= 0.463, females
P
< 0.000,
r
= 0.801) or AS (males
P
= 0.000,
r
= 0.561, females
P
= 0.000,
r
= 0.499) showed a significant correlation but NED, NMD, TMD, SMD did not. After combining male and female groups, (
n
= 100), the correlation of NVD with external body parameters is as follows SL (
r
= 0.887), height (
r
= 0.791), AS (
r
= 0.769), weight (
r
= 0.531), SMD (
r
= 0.466), NED (
r
= 0.459), NMD (
r
= 0.391), TMD (
r
= 0.379).
Conclusion:
The relationship of NVD to external body parameters had strong correlation in all parameters in the combined group; whereas when gender was taken into consideration NVD correlated significantly only with SL, height and AS.
[ABSTRACT]
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2,270
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CASE REPORT
Management of tracheomalacia in an infant with Tetralogy of Fallot
Santoshi Kurada, Ranjith B Karthekeyan, Mahesh Vakamudi, Periyasamy Thangavelu
April 2015, 59(4):240-243
DOI
:10.4103/0019-5049.155002
PMID
:25937651
Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1-2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful.
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2,272
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LETTERS TO EDITOR
New approach to treat an old problem: Mannitol for post dural puncture headache!
MM Rizvi, Raj Bahadur Singh, RK Tripathi, Sister Immaculate
April 2015, 59(4):260-261
DOI
:10.4103/0019-5049.155012
PMID
:25937661
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2,082
524
5
BRIEF COMMUNICATIONS
Immune-mediated thrombocytopaenia secondary to pulmonary tuberculosis: Diagnostic and therapeutic dilemma
J Shashibhushan, H Bala Subramanya, N Sunil Kumar, Malappa Poojari
April 2015, 59(4):250-252
DOI
:10.4103/0019-5049.155006
PMID
:25937655
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2,173
317
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Anaesthetic management of a patient with anti-NMDA receptor encephalitis
Mohammed Aslam Shaikh, Tasneem Dhansura, Shweta Gandhi, Tarana Shaikh
April 2015, 59(4):248-250
DOI
:10.4103/0019-5049.155005
PMID
:25937654
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2,123
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LETTERS TO EDITOR
Anaesthetic in the garb of a propellant
Shagun Bhatia Shah, Uma Hariharan, Ajay Kumar Bhargava
April 2015, 59(4):258-260
DOI
:10.4103/0019-5049.155011
PMID
:25937660
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2,007
294
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COMMENTS ON PUBLISHED ARTICLE
Blood transfusion practices in liver transplantation
Jyotirmoy Das, Sangeeta Khanna, Sudhir Kumar, Yatin Mehta
April 2015, 59(4):266-267
DOI
:10.4103/0019-5049.155016
PMID
:25937665
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1,745
374
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LETTERS TO EDITOR
Our encounter with left superior vena cava
Abhijit S Nair, Venugopal Kulkarni, Sunjoy Verma, Ravikiran Mudunuri
April 2015, 59(4):255-257
DOI
:10.4103/0019-5049.155009
PMID
:25937658
[FULL TEXT]
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1,614
236
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Prevention of migration of endotracheal tubes used for aided nasogastric tube placement in anaesthetized patients
Rachel Maria Gomes, Praveen P Raj, Saravana S Kumar, Chinnusamy Palanivelu
April 2015, 59(4):261-262
DOI
:10.4103/0019-5049.155013
PMID
:25937662
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1,335
304
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COMMENTS ON PUBLISHED ARTICLE
Transfusion practices in trauma
Sonal Rastogi
April 2015, 59(4):263-263
DOI
:10.4103/0019-5049.155014
PMID
:25937663
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1,304
328
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RESPONSE TO COMMENTS
Transfusion practices in trauma
V Trichur Ramakrishnan, Srihari Cattamanchi
April 2015, 59(4):264-265
DOI
:10.4103/0019-5049.155015
PMID
:25937664
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1,335
279
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LETTERS TO EDITOR
Bilateral asymptomatic pneumothorax in early post-operative period
Abdelmalek Ghimouz, Claude Lentschener, Laure Bonnet, Philippe Goater
April 2015, 59(4):257-258
DOI
:10.4103/0019-5049.155010
PMID
:25937659
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1,314
256
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Emergency tracheal intubation through intubating laryngeal mask airway in patients with stereotactic frame
in situ
Lakshmi N Kurnutala, Sudhakar Kinthala, D Padmaja
April 2015, 59(4):253-254
DOI
:10.4103/0019-5049.155007
PMID
:25937656
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1,218
282
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ERRATUM
Survey of supraglottic airway devices usage in anaesthetic practice in South Indian State: Erratum
April 2015, 59(4):268-268
DOI
:10.4103/0019-5049.155017
PMID
:25937666
[FULL TEXT]
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1,116
305
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