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2016| April | Volume 60 | Issue 4
Online since
March 31, 2016
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ORIGINAL ARTICLES
Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes
SK Malhotra, KV Bharath, Vikas Saini
April 2016, 60(4):242-247
DOI
:10.4103/0019-5049.179448
PMID
:27141106
Background and Aims:
Air-Q
™
is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q
™
(Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach
™
) keeping ILMA as control (Group I).
Methods:
One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case-control study to compare the success rate of tracheal intubation between ILMA (Fastrach
™
) and Air-Q
™
intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts.
Results:
The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (
P
= 0.43).
Conclusion:
The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA.
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Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting
Fizzah Farooq, Robyna Khan, Aliya Ahmed
April 2016, 60(4):248-252
DOI
:10.4103/0019-5049.179450
PMID
:27141107
Background and Aims:
Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved.
Methods:
A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19.
Results:
Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good.
Conclusion:
The survey of patients' satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.
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Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section
Maitreyi Gajanan Mankikar, Shalini Pravin Sardesai, Poonam Sachin Ghodki
April 2016, 60(4):253-257
DOI
:10.4103/0019-5049.179451
PMID
:27141108
Background and Aims:
Transversus abdominis plane (TAP) block is a fascial plane block providing post-operative analgesia in patients undergoing surgery with infra-umbilical incisions. We evaluated analgesic efficacy of TAP block with ropivacaine for 24 h after caesarean section through a Pfannenstiel incision.
Methods:
Sixty patients undergoing caesarean section under spinal anaesthesia were randomised to undergo TAP block with ropivacaine (
n
= 30) versus control group (
n
= 30) with normal saline, in addition to standard analgesia with intravenous paracetamol and tramadol. At the end of the surgery, ultrasound-guided TAP plane block was given bilaterally using ropivacaine or normal saline (15 ml on either side). Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS) and requirement of analgesia. SPSS version 18.0 software was used. Demographic data were analysed using Student's
t
-test and the other parameters using paired
t
-test.
Results:
TAP block with ropivacaine compared with normal saline reduced post-operative VAS at 24 h (
P
= 0.004918). Time for rescue analgesia in the study group was prolonged from 4.1 to 9.53 h (
P
= 0.01631). Mean requirement of tramadol in the first 24 h was reduced in the study group.
Conclusion:
US guided TAP block after caesarean section reduces the analgesic requirement in the first 24 h.
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REVIEW ARTICLE
Anaesthesia for non-obstetric surgery during pregnancy
Madhusudan Upadya, PJ Saneesh
April 2016, 60(4):234-241
DOI
:10.4103/0019-5049.179445
PMID
:27141105
Non-obstetric surgery during pregnancy posts additional concerns to anaesthesiologists. The chief goals are to preserve maternal safety, maintain the pregnant state and achieve the best possible foetal outcome. The choice of anaesthetic technique and the selection of appropriate anaesthetic drugs should be guided by indication for surgery, nature, and site of the surgical procedure. Anaesthesiologist must consider the effects of the disease process itself and inhibit uterine contractions and avoid preterm labour and delivery. Foetal safety requires avoidance of potentially dangerous drugs and assurance of continuation of adequate uteroplacental perfusion. Until date, no anaesthetic drug has been shown to be clearly dangerous to the human foetus. The decision on proceeding with surgery should be made by multidisciplinary team involving anaesthesiologists, obstetricians,surgeons and perinatologists. This review describes the general anaesthetic principles, concerns regarding anaesthetic drugs and outlines some specific conditions of non-obstetric surgeries.
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BRIEF COMMUNICATIONS
Ultrasound guided oblique subcostal transversus abdominis plane block: An observational study on a new and promising analgesic technique
Arghya Mukherjee, Rahul Guhabiswas, Sarang Kshirsagar, Emmanuel Rupert
April 2016, 60(4):284-286
DOI
:10.4103/0019-5049.179468
PMID
:27141114
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2,010
478
LETTERS TO EDITOR
Myocardial ischaemia secondary to intramyometrial injection of methylergonovine maleate
Shruti Jain, Kalpana Baghel
April 2016, 60(4):290-292
DOI
:10.4103/0019-5049.179471
PMID
:27141117
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1,790
297
Use of Airtraq
®
optical laryngoscope for the intubation in Pierre Robin sequence in a teenage child
Amit Shah, Apeksh Patwa, Apeksha Patwa
April 2016, 60(4):295-297
DOI
:10.4103/0019-5049.179474
PMID
:27141120
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ORIGINAL ARTICLES
A retrospective analysis of massive blood transfusion and post-operative complications in patients undergoing supra-major orthopaedic oncosurgeries
Ankit Gupta, Atul Kulkarni
April 2016, 60(4):270-275
DOI
:10.4103/0019-5049.179465
PMID
:27141111
Background and Aims:
Anaesthetic management of patients undergoing supra-major orthopaedic oncosurgeries is challenging. We wanted to evaluate the effects of pre-operative co-morbid conditions, intraoperative blood loss and transfusion, haemodynamic instability on post-operative complications and hospital outcomes in patients after such surgeries.
Methods:
We collected data from the patient files, anaesthesia records and the electronic medical records about pre-operative morbidities, intraoperative management, complications, blood loss, fluid therapy and blood products transfused. We also collected data on post-operative complications, intensive care unit (ICU) and hospital length of stay (LOS) and status at discharge. Data were summarised using percentages for categorical data and mean and median for continuous data.
Results:
The mean blood loss was 4567.44 ml (range 1200-16,000 ml); 95% of all patients received blood transfusion. Twenty patients needed massive blood transfusion. Fresh frozen plasma was needed in 17 patients while 1 patient needed single donor platelets. Haemodynamic instability was present in 38 patients, of which 8 needed continuous vasopressor infusion. Nineteen patients were ventilated post-operatively. Coagulopathy occurred in 22 patients while thrombocytopaenia was seen in 6 patients. The median ICU LOS was 3 (1-6) days, and median hospital stay was 17 (6-53) days. All patients were discharged alive.
Conclusion:
Supra-major orthopaedic oncosurgeries are associated with massive intraoperative blood loss and transfusion. Common complications include anaemia, coagulopathy and hyperbilirubinaemia and prolonged ICU stay. Meticulous care, anticipating the complications with timely treatment can lead to excellent outcomes.
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2,050
528
BRIEF COMMUNICATIONS
Life-threatening subcutaneous emphysema due to laparoscopy
Angel Blanco Coronil, Alfonso Moreno Sanchez-Canete, Ashish A Bartakke, Javier Garcia Fernandez, Ana Garcia
April 2016, 60(4):286-288
DOI
:10.4103/0019-5049.179469
PMID
:27141115
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2,475
479
CASE REPORTS
Anaesthetic management of left main bronchial glomus tumour
Mathangi Krishnakumar, Rammurti Sharma, Harshwardhan Singh Pawar, Shahbaz Hasnain
April 2016, 60(4):276-279
DOI
:10.4103/0019-5049.179466
PMID
:27141112
Glomus tumours involving bronchus are rare. Surgical resection is the treatment of choice for this tumour, with excellent prognosis. The nature and location of tumour pose a significant challenge for perioperative anaesthetic management. However, there is a paucity of case reports on anaesthetic risks involved in case of a bronchial glomus tumour. We present a case of glomus tumour involving left main stem bronchus, subjected to bronchial sleeve resection. The various anaesthetic implications of this tumour type and airway management with right double lumen tube are discussed.
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1,743
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Difficult mask ventilation made easy: Three cases of Parry Romberg syndrome
Kavitha Jayaram, Indira Gurajala, Gopinath Ramachandran
April 2016, 60(4):280-283
DOI
:10.4103/0019-5049.179467
PMID
:27141113
Parry Romberg syndrome presenting as hemifacial atrophy poses various perioperative problems due to multi-system involvement. These patients have several anaesthetic implications which are published as case reports. In spite of several case reports, airway issues associated with this disease is under-discussed. This report of three cases discusses airway difficulties and the multiple methods to tackle them in an easier way by focussing concentration on airway assessment and appropriate preoperative planning.
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EDITORIAL
The transversus abdominis plane block: Case for optimal tap
S Bala Bhaskar, H Balasubramanya
April 2016, 60(4):231-233
DOI
:10.4103/0019-5049.179444
PMID
:27141104
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3,315
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LETTERS TO EDITOR
Sedation for magnetic resonance imaging in a child with lingual venolymphatic malformation
Mahantesh Shivangouda Mudakangoudar, Harihar Vishwanath Hegde, Bhavana A Koppad
April 2016, 60(4):289-290
DOI
:10.4103/0019-5049.179470
PMID
:27141116
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1,361
353
Anaesthetic management of Mowat-Wilson syndrome
Amit Sudhir Deshmukh, Kalpna Vinod Kelkar, Sunita M Khedkar, Yogesh Gavali
April 2016, 60(4):292-294
DOI
:10.4103/0019-5049.179472
PMID
:27141118
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1,578
264
Anaesthetic challenges in a child with sickle-cell disease and congenital heart block
Indu Bala, Neeru Sahni, Sanwar Mal Mitharwal
April 2016, 60(4):294-295
DOI
:10.4103/0019-5049.179473
PMID
:27141119
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1,625
354
Restoration of 'red plug' to rescue a ProSeal
®
laryngeal mask airway
SK Singhal, Swati Chhabra
April 2016, 60(4):297-298
DOI
:10.4103/0019-5049.179475
PMID
:27141121
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1,366
242
A different fibre-optic device for double lumen tube position confirmation!
Pritee H Bhirud, Pratibha V Toal
April 2016, 60(4):298-300
DOI
:10.4103/0019-5049.179476
PMID
:27141122
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1,353
249
Anaesthesia consent in public hospital population - An ethical dilemma
Tanaya Sparkle
April 2016, 60(4):300-301
DOI
:10.4103/0019-5049.179477
PMID
:27141123
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296
ORIGINAL ARTICLES
A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury
Satyen Parida, Ramesh Varadharajan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Hemavathi Balachander, Ashok Shankar Badhe, Pankaj Kundra
April 2016, 60(4):258-263
DOI
:10.4103/0019-5049.179463
PMID
:27141109
Background and Aims:
Evidence and utility of the individual steps of the rapid sequence induction and tracheal intubation protocols have been debated, especially in the setting of traumatic brain injury. The purpose of this survey was to determine preferences in the current approach to rapid sequence intubation ( RSI) in head injury patients among a population of anaesthesiologists from South India.
Methods:
A questionnaire was E-mailed to all the members of the Indian Society of Anaesthesiologists' South Zone Chapter to ascertain their preferences, experience and comfort level with regard to their use of rapid sequence intubation techniques in adult patients with head injury. Participants were requested to indicate their practices for RSI technique for a head-injured patient upon arrival at the Emergency Medical Services department of their hospital.
Results:
The total response rate was 56.9% (530/932). Of the total respondents, 35% of the clinicians used cricoid pressure routinely, most respondents (68%) stated that they pre-oxygenate the patients for about 3 min prior to RSI, thiopentone (61%) and propofol (34%) were commonly used prior to intubation. Rocuronium was the muscle relaxant of choice for RSI among the majority (44%), compared to succinylcholine (39%). Statistical analyses were performed after the initial entry onto a spreadsheet. Data were summarised descriptively using frequency distribution.
Conclusion:
In a rapid sequence intubation situation, the practice differed significantly among anaesthesiologists. Owing to disagreements and paucity of evidence-based data regarding the standards of RSI, it is apparent that RSI practice still has considerable variability in clinical practice.
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Comparison of ultrasound-guided transversus abdominis plane block with bupivacaine and ropivacaine as adjuncts for postoperative analgesia in laparoscopic cholecystectomies
Shradha Sinha, Sanjeev Palta, Richa Saroa, Abhishek Prasad
April 2016, 60(4):264-269
DOI
:10.4103/0019-5049.179464
PMID
:27141110
Background and Aims:
Transversus abdominis plane (TAP) block is a popular technique for post-operative analgesia in abdominal surgeries. The aim of the study was to evaluate the relative efficacy of bupivacaine versus ropivacaine for post-operative analgesia using ultrasound-guided TAP block in laparoscopic cholecystectomies.
Methods:
Sixty adults undergoing elective laparoscopic cholecystectomy were randomised to receive ultrasound-guided TAP block at the end of the surgical procedure with either 0.25% bupivacaine (Group I,
n
= 30) or 0.375% ropivacaine (Group II,
n
= 30). All patients were assessed for post-operative pain and rescue analgesic consumption at 10 min, 30 min, 1 h, 4 h, 8 h, 12 h and 24 h time points. Means for normally distributed data were compared using Student's
t
-test, and proportions were compared using Chi-square or Fisher's exact test whichever was applicable.
Results:
Patients receiving ultrasound-guided TAP block with ropivacaine (Group II) had significantly lower pain scores when compared to patients who received the block with bupivacaine (Group I) at 10 min, 30 min and 1 h. However, both the drugs were equivalent for post-operative analgesia and 24 h cumulative rescue analgesic requirement (median [interquartile range]) (75.00 [75.00-75.00] in Group I vs. 75.00 [75.00-93.75] in Group II,
P
= 0.366).
Conclusion:
Ultrasound-guided TAP block with ropivacaine provides effective analgesia in the immediate post-operative period up to 1 h as compared to bupivacaine. However, both the drugs are similar in terms of 24 h cumulative rescue analgesic requirement.
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