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  Citation statistics : Table of Contents
   2007| January-February  | Volume 51 | Issue 1  
    Online since March 20, 2010

 
 
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CASE REPORTS
Anaesthetic Management for Laparoscopic Cholecystectomy in two patients with biopsy proven Polymyositis
Shikha Sharma, Lakshmi Jayaraman, Nitin Sethi, Jayashree Sood
January-February 2007, 51(1):43-46
Two patients aged 46 and 31 years with biopsy proven polymyositis presented for laparoscopic cholecystectomy. They gave history of fall while walking and difficulty in climbing stairs. There were clinical features of peripheral muscle weakness but no respiratory muscle involvement. They were being managed conservatively.Pre-operative investigations were within normal limits. They received no sedation preoperatively. Anaesthesia was induced with 1-1.5 mgkg-1 of propofol and ProSeal laryngeal mask airway was inserted under propofol anaesthesia in case 1 and after atracurium besylate 10 mg I.V. in case 2. Anaesthesia was maintained with a continuous infusion of propofol, bolus dose of fentanyl and nitrous oxide in oxygen. Bispectral index (BIS) was monitored and maintained between 40-60. Anaesthesia was reversed with neostigmine 2.5 mg and glycopyrrolate 0.4 mg. BIS values returned to pre-anaesthetic level of 80-90 after 5-10 min, suggesting that use of propofol, ProSeal Laryngeal Mask Airway and atracurium besylate with peripheral nerve monitoring can be a safe means of inducing and maintaining anaesthesia in patients with polymyositis.
  1 4,167 382
CLINICAL INVESTIGATIONS
Management of tracheobronchial foreign body aspirations in paediatric age group - A 10 year retrospective analysis
Vijaykumar T Kalyanappagol, NH Kulkarni, LH Bidri
January-February 2007, 51(1):20-23
A retrospective analysis of management of tracheobronchial tree in paediatric age group was done over a period of 10 years. These children were aged 0 month to 12 years and male children were predominant. Bronchoscopy performed under general anaesthesia in 316 cases of suspected foreign body inhalation, out of which 206 were positive for the same. There were no post operative complications in any case.
  1 9,727 1,697
CASE REPORTS
Anaesthetic challenges in a patient with mitochondrial cytopathy undergoing surgery
DN Dhananjay, Shyam Sundar, Kurian P Thomas, Lakshmi Kumar, Suresh G Nair
January-February 2007, 51(1):47-49
This article will highlight certain basic aspects in the management of a case of mitochondrial cytopathy that is unknown to most of us. Clinical condition of the patient is the most important aspect in the management, as the patients with mild disease may be at lower risk for complications while those with severe disease are at a higher risk. We managed a 45year old lady posted for incisional hernia repair
  - 1,942 296
Aerophagia an unusual cause of near fatal ventilatory insufficiency
Ashok Jadon
January-February 2007, 51(1):37-38
Aerophagia or excessive ingestion of air is commonly seen in psychiatric children. Aerophagia though rarely occurs during anaesthesia has been reported which ketamine anaesthesia mainly during recovery period. Early recognition and management of this condition is warranted as this may lead to serious, and some time fatal ventilatory inadequacy due to acute gastric dilatation
  - 1,504 250
Pain Management in a Rare Malignant Spinal Cord Tumor
PF Kotur, Anu Annie Abraham, Vijay Umarani, Raviraj Ghorpade
January-February 2007, 51(1):50-52
Primary Intraspinal Primitive neuroectodermal tumor is a rare tumor with a poor prognosis. Only few cases have been reported in literature. An 18-year-old girl presented with acute low back pain with no neurological deficit. The tumor could be excised in total. MRI done 6 weeks post operatively was suggestive of a recurrence of the tumor at an alarming rate. The case was referred to our Department for pain management until a definitive treatment plan could be executed
  - 1,265 262
Management of a case of twin pregnancy with anaemia with arteriovenous malformation in impending cardiac failure for emergency caesarean section
Chitra Juwarkar, Lucia Misquita, Gayatri Chandrashekar Shetty
January-February 2007, 51(1):53-56
A 28year old primigravida at 31.2 weeks of gestation with twin pregnancy with giant arterio-venous malformation ( AVM ) in impending cardiac failure presented for caesarean section. Diagnosis was confirmed by CT scan. The pregnancy had to be terminated at 31.2 weeks as patient's cardiac condition worsened. Here we present the anaesthetic management of this case for caesarean section
  - 1,641 272
An Unusual Laryngeal Injury
A Kohli, P Bhadoria, A Bhalotra, R Anand, P Goyal
January-February 2007, 51(1):57-59
Blunt injuries to the anterior neck are most commonly due to road traffic accidents but the incidence of such types of injuries are decreasing probably due to stricter laws pertaining to seat belts and drunken driving. Experience in managing such injuries is limited due to their rarity. The mainstay of management revolves around establishing and maintaining a patent airway and integrity of the spine. Here we document a case of a 25 year old male who met with a Road traffic accident while driving a motorbike and sustained a clear cut linear wound on the right side of the neck with minimal airleak due to the helmet clip. On exploration, he was found to have massive epiglottic edema, mucosal abrasions, lacerations and a thyroid cartilage fracture. The mechanism of injury was probably a combination of penetrating and blunt trauma neck. This case highlights the mechanism of laryngeal injury, its presentation and management
  - 1,605 330
A rare case of peripartum cardiomyopathy posted for caesarean section
Nalini Kotekar, NV Nagalakshmi, Chandrashekar
January-February 2007, 51(1):60-64
Post Partum Cardiomyopathy (PPCM) is a relatively rare form of heart failure associated with pregnancy. It was recognized first in the 19th century by Ritchie and is defined as the onset of acute heart failure in the last trimester or early post partum period in the absence of infections, metabolic, toxic, ischaemic or valvular causes of myocardial dysfunction. Prognosis depends on the degree of cardiomegaly at presentation and in the following 6 months. Initial high risk period carries a mortality of 25 to 50%. Keeping in mind the reduced contractility and ejection fraction with ventricular dilatation proceeding to cardiac failure, the anesthesiologist managing a case of PPCM faces the challenge of avoiding myocardial depression, hypovolemia and increased SVR, all of which may be hazardous
  - 4,695 734
CLINICAL INVESTIGATIONS
Endotracheal tube cuff pressures during general anaesthesia while using air versus a 50% mixture of nitrous oxide and oxygen as inflating agents
Jesni Joseph Manissery, Vijaya Shenoy, M Ambareesha
January-February 2007, 51(1):24-27
The present study was aimed at assessing the efficacy of filling a 50% mixture of nitrous oxide : oxygen (50%N 2 O:O 2 ) in the endotracheal tube cuff to provide stable cuff pressures during general anaesthesia with 67%N 2 O. The endotracheal tube cuff pressures with air (control) as the inflating agent in the tubes were found to have a total mean pressure of 62.60±12.33 at the end of one hour of general anaesthesia. When comparing the endotracheal tube cuff pressures in the Mallinckrodt tubes with that of the Portex tubes, with air as the inflating agent, the Portex tubes showed a significantly lower cuff pressures at the end of one hour. The endotracheal tube cuff pressures with 50%N 2 O:O 2 as the inflating agent showed a total mean pressure of 27.63 ± 3.221 at the end of one hour of general anaesthesia. This indicates that inflation of the cuff of the endotracheal tubes with a 50%N 2 O:O 2 rather than air maintains a stable intra cuff pressure. Therefore, the method of using a 50%N 2 O:O 2 for filling endotracheal tube cuff can be adopted for endotracheal tubes with high-volume, low-pressure cuffs to prevent both excessive cuff pressure and disruption of cuff seal, during general anaesthesia lasting up to one hour.
  - 3,237 455
Tramadol for control of shivering (Comparison with pethidine)
Aditi A Dhimar, Mamta G Patel, VN Swadia
January-February 2007, 51(1):28-31
Shivering is common problem faced by an anaesthesiologist during intraoperative as well as in postoperative period. Shivering occurs during both general anaesthesia and regional anaesthesia, but it is more frequent and troublesome during regional anaesthesia. This randomized, prospective study conducted in 60 ASA grade I, II, or III patients, was designed to explore the efficacy and potency of Tramadol in comparison to Pethidine for control of shivering under regional anaesthesia. Patients received Tramadol or Pethidine in a dose of 1mg.kg -1 I.V after the appearance of shivering. Disappearance and recurrence of shivering, as well as haemodynamics were observed at scheduled intervals. Onset of disappearance of shivering was found at 1 minute in Tramadol group (T)( p < 0.05) and at 3 minutes in Pethidine group (P)( p < 0.05 ). The complete disappearance of shivering took 5 minutes in T group while 20 minutes in P group.Reccurence rate of shivering was 10% in T and 50% in P group patients respectively (p < 0.05). None of the patients had any complications except nausea and vomiting (6.6% and 20% in group T and P respectively, p> 0.05). Thus Tramadol and Pethidine were equally efficacious, but Tramadol was more potent with respect to control of shivering and its recurrence .It was concluded that I.V Tramadol is qualitatively superior to Pethidine for control of shivering.
  - 26,746 1,479
Comparative study of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients for major orthopaedic surgery
Dipasri Bhattacharya, I Tewari, S Chowdhuri
January-February 2007, 51(1):32-36
Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block in this decade for high risk geriatric patients because here the advantages of both spinal and epidural anaesthesia are summated avoiding the side effects. This study is designed to compare the clinical effects of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients undergoing major orthopaedic procedure. Sixty patients aged 65 to 80 years, ASA III were randomly allocated into two equal groups. Group A (n=30) received sequential combined spinal epidural anaesthesia with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 20 mg fentanyl through spinal route, and the expected incompleteness of spinal block was managed with small incremental dose of 0.5% isobaric bupivacaine through epidural catheter, 1.5 to 2 ml for every unblocked segment to achieve T10 sensory level. Group B (n=30) received spinal anaesthesia with 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 20 mg of fentanyl. Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (p< 0.01) along with the provision of prolonging analgesia as compared to group B. So sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia for high risk geriatric patients undergoing major orthopaedic surgery.
  - 3,387 704
EVIDENCE BASED DATA
Is routine pre-operative electrocardiogram necessary?
PF Kotur
January-February 2007, 51(1):65-65
BEARs are the summary of the evidences pertaining to a specific clinical dilemma encountered in the day today anaesthetic practice. They are not the systematic reviews but rather contain the best evidence (highest level) available to any practicing anaesthesiologist. The search strategies adopted will not be discussed in detail
  - 1,685 318
GUEST EDITORIAL
Correspondence : Letter to Editor
Harjinder Kohli
January-February 2007, 51(1):49-49
  - 1,474 0
REVIEW ARTICLE
Transfusion support in liver transplantation
TVSP Murthy
January-February 2007, 51(1):13-19
Solid-organ transplantation continues to grow as a treatment modality. Transfusion support remains an integral part of solid-organ transplantation, imparting demands on the transfusion service not only quantitatively in terms of blood product support, but also due to the unique requirements for specialized blood components, the complex serologic problems, and the immunologic effects of transfusion on both the allograft and the recipient.
  - 2,894 574