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   2010| March-April  | Volume 54 | Issue 2  
    Online since May 24, 2010

 
 
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REVIEW ARTICLE
Parenteral nutrition: Revisited
Koneru Veera Raghava Chowdary, Pothula Narasimha Reddy
March-April 2010, 54(2):95-103
DOI:10.4103/0019-5049.63637  PMID:20661345
The prevalence of malnutrition among critically ill patients, especially those with a protracted clinical course, has remained largely unchanged over the last two decades. The metabolic response to stress, injury, surgery, or inflammation cannot be accurately predicted and these metabolic alterations may change during the course of illness. Both underfeeding and overfeeding are common in intensive care units (ICU), resulting in large energy and other nutritional imbalances. Systematic research and clinical trials on various aspects of nutritional support in the ICU are limited and make it challenging to compile evidence-based practice guidelines.
  10,850 3,326 1
CLINICAL INVESTIGATIONS
Awareness of basic life support among medical, dental, nursing students and doctors
Shanta Chandrasekaran, Sathish Kumar, Shamim Ahamed Bhat, Saravanakumar , P Mohammed Shabbir, VP Chandrasekaran
March-April 2010, 54(2):121-126
DOI:10.4103/0019-5049.63650  PMID:20661349
To study the awareness of Basic Life Support (BLS) among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. A cross-sectional study was conducted by assessing responses to 20 selected basic questions regarding BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. After excluding the incomplete response forms the data was analysed on 1,054 responders. The results were analysed using an answer key prepared with the use of the Advanced Cardiac Life Support manual. Out of 1,054 responders 345 were medical students, 75 were medical interns, 19 were dental students, 59 were dental interns, 105 were homeopathy interns, 319 were nursing students, 72 were doctors, 29 were dentists, 25 were nursing faculty and six were homeopathy doctors. No one among them had complete knowledge of BLS. Only two out of 1054 (0.19%) had secured 80 - 89% marks, 10 out of 1054 (0.95%) had secured 70 - 79% marks, 40 of 1054 (4.08%) had secured 60 - 69% marks and 105 of 1054 (9.96%) had secured 50 - 59% marks. A majority of them, that is, 894 (84.82%) had secured less than 50% marks. Awareness of BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges is very poor.
  6,707 1,277 7
EDITORIAL
Cardio Pulmonary Resuscitation 2010 - Improve the quality of care
SS Harsoor
March-April 2010, 54(2):91-94
DOI:10.4103/0019-5049.63634  PMID:20661344
  4,453 1,407 1
CLINICAL INVESTIGATIONS
Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study
Manjushree Ray, Dhurjoti Prosad Bhattacharjee, Bimal Hajra, Rita Pal, Nilay Chatterjee
March-April 2010, 54(2):137-141
DOI:10.4103/0019-5049.63659  PMID:20661352
This randomised, placebo-controlled, double-blind study was designed to assess the effect of intravenous clonidine and magnesium sulphate on intraoperative haemodynamics, anaesthetic consumption and postoperative recovery. Seventy five patients undergoing elective upper limb orthopaedic surgery were randomised into three groups. Group C received clonidine 3 μg/kg as a bolus before induction and 1μg/kg/hour by infusion intraopertively. Group M received magnesium sulphate 30 mg/kg as a bolus before induction and 10 mg/kg/hour by infusion. Group P received same volume of isotonic saline. Anaesthesia was induced and maintained with fentanyl citrate and propofol. Muscular relaxation was achieved by vecuronium bromide. Induction time, recovery time and consumption of propofol as well as fentanyl citrate were recorded. Induction of anaesthesia was rapid with both clonidine and magnesium sulphate. Time of bispectral index (BIS) to reach 60 was significantly lower in Group C and Group M (P < 0.0001). Requirements of propofol and fentanyl were significantly less in Group C and Group M (P < 0.001). Postoperative recovery was slower in Group M compared with other two groups (P < 0.001). Perioperative use of both clonidine and magnesium sulphate significantly reduced the consumption of propofol and fentanyl citrate. Magnesium sulphate caused a delayed recovery.
  4,457 982 13
Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries
CS Sanikop, Sonal Bhat
March-April 2010, 54(2):132-136
DOI:10.4103/0019-5049.63654  PMID:20661351
A one-year randomized placebo-controlled trial was conducted to study the effectiveness of intravenous lidocaine in the prevention of post extubation laryngospasm in children, following cleft palate surgeries. Children of age three months to six years were randomly assigned into two groups. Group P placebo (saline) and Group L (Lidocaine), 1.5 mg/kg. A sample size of 74 with n = 37 in each group was selected. The anaesthetic procedure was standardized. At the end of the procedure, three minutes after reversal, the study drug, that is, intravenous lidocaine (1.5 mg/kg) or placebo (saline) was administered and two minutes later the child was extubated. Following extubation for 10 minutes, the haemodynamic parameters, that is, pulse, blood pressure, oxygen saturation, severity of coughing, and laryngospasm were noted. The total reduction of laryngospasm and coughing was 29.9% and 18.92% with IV lidocaine. Significant alterations in haemodynamics and oxygen saturation were noted for 10 minutes, following extubation. Hence, intravenous lidocaine 1.5 mg/kg was effective in the prevention of post extubation laryngospasm in children undergoing cleft palate surgeries.
  4,064 870 11
Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain
Alka Chandra, Jayant N Banavaliker, Pradeep K Das, Sheel Hasti
March-April 2010, 54(2):116-120
DOI:10.4103/0019-5049.63648  PMID:20661348
The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15-40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I) patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0-10 visual analog scale (VAS) was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS) but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively), and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side effects and with a good haemodynamic stability; however, the effects are short lasting.
  3,596 656 9
CASE REPORTS
Acute methemoglobinemia due to ingestion of nitrobenzene (paint solvent)
Hema Saxena, Anand Prakash Saxena
March-April 2010, 54(2):160-162
DOI:10.4103/0019-5049.63635  PMID:20661357
A case of acute poisoning with nitrobenzene is presented where clinical evaluation and timely management, with repeated intravenous methylene blue helped to save a life. It is important to take care of the secondary cycling of nitrobenzene from body stores in patients presenting late, after heavy exposure.
  3,680 556 9
MEDICOLEGAL ARTICLE
Vicarious liability - Medicolegal status of anaesthesiologist
Shivakumar Kumbar
March-April 2010, 54(2):183-183
  3,286 667 1
CLINICAL INVESTIGATIONS
L-type calcium channel blockers, morphine and pain: Newer insights
Rakesh Kumar, RD Mehra, S Basu Ray
March-April 2010, 54(2):127-131
DOI:10.4103/0019-5049.63652  PMID:20661350
Earlier, we had reported that co-administration of opioids and L-type calcium channel blockers (L-CCBs) like diltiazem could prove useful in the treatment of cancer pain. Much of this report was based upon earlier published work involving animal models of pain exposed to brief periods of noxious radiant heat without any tissue injury. However, pain in clinical situations usually result from tissue injury. Thus, the aim of the current investigation was to study the analgesic effect of this combination of drugs in the rat formalin test which is associated with actual tissue injury. Wistar rats (n=60) received either L-CCB (nifedipine/nimodipine/verapamil/diltiazem i.p.) or morphine (s.c.) or both drugs. The formalin test was done 30 min after morphine or placebo injection. The naloxone reversal test was also done. Administration of L-CCBs alone, particularly diltiazem, increased pain in the formalin test. In contrast, co-administration of these L-CCBs with morphine led to decreased pain response, though statistically significant decrease was noted only with nimodipine + morphine. Naloxone reversed this analgesic effect, indicating that it was primarily an opioid-mediated effect. The results show that administration of L-CCBs alone may prove counterproductive in the therapeutic management of pain (anti-analgesic effect). However, co-administration of both drugs (morphine and nimodipine) in quick succession could lead to adequate pain relief.
  3,304 588 12
Comparison of propofol (1%) with admixture (1:1) of thiopentone (1.25%) and propofol (0.5%) for laryngeal mask airway insertion in children undergoing elective eye surgery: Double-masked randomized clinical trial
Renu Sinha, Dilip Shende, Rakesh Garg
March-April 2010, 54(2):104-108
DOI:10.4103/0019-5049.63641  PMID:20661346
Intravenous propofol 1% has been the preferred agent for Laryngeal Mask Airway (LMA) insertion. Admixture of thiopentone 1.25% and propofol 0.5% (1:1) has been used by various authors for induction as well as insertion of LMA in adults. There is no previous report where this admixture has been used for insertion of LMA in children. This study has been designed to investigate whether this admixture can be a suitable alternative to propofol, in relation to ease of insertion of the LMA, haemodynamic stability, cost containment, pain on injection and recovery in children. In this randomized, double-masked study, 50 ASA grade 1 and 2 patients of age 3 - 15 years and weighing more than 10 kg were included. The patients were divided into two groups; the P group received propofol 1%, while the Ad group received an admixture of thiopentone 1.25% and propofol 0.5% (1:1). All the children were evaluated for incidence of apnoea, pain on injection, jaw relaxation, ease of LMA insertion, coughing, gagging, laryngospasm, involuntary limb movements, incidence of hypotension and recovery. The demographic data, incidence of apnoea, pain on injection, jaw relaxation, ease of LMA insertion, coughing, gagging and involuntary movements were comparable in both groups. In the P group recovery was faster as compared to the Ad group. The admixture was cost effective as compared to Propofol alone [Indian National Rupees (INR) 24.64 ± 7.62 vs. INR 48.75 ± 23.25] (P = 0.001)). Admixture of propofol and thiopentone was a cheap, safe and effective alternative to propofol alone, for LMA insertion in children.
  2,988 699 2
Prospective randomized comparative study of use of PLMA and ET tube for airway management in children under general anaesthesia
Mamta G Patel, VN Swadia, Geetika Bansal
March-April 2010, 54(2):109-115
DOI:10.4103/0019-5049.63643  PMID:20661347
ProSeal TM Laryngeal Mask Airway (PLMA) for children had been introduced in 2004, by Dr. Archie Brain. It has, in addition to Classic Laryngeal Mask Airway (CLMA), a drainage tube for providing a bypass channel for gastric contents to prevent regurgitation and pulmonary aspiration. A randomized prospective study was performed comprising of 60 ASA - I/II patients, between the age groups of 3 and 10 years, of either sex. All the patients were premedicated with oral Midazolam and Glycopyrollate. General anaesthesia with caudal epidural analgesia was given in all the cases. Inhalation with 8% Sevoflurane was used as a sole induction agent in all the patients. They were randomly divided into two groups. PLMA was inserted in patients of Group P and Endotracheal Tube (ETT) in patients of Group I. In all cases, after PLMA / ETT insertion; caudal epidural analgesia was given and general anaesthesia (GA) using Sevoflurane was provided for maintenance of anaesthesia. Muscle relaxant was not used in our study. We studied parameters such as number of attempts, ease of insertion and conditions during insertion, haemodynamic parameters, changes in SpO 2 , EtCO 2 , gastric insufflation, regurgitation, pulmonary aspiration, postoperative airway complications and so on. We found that insertion of PLMA as well as ETT was performed in the first attempt in all the patients. Ease of insertion and conditions during insertion were comparable in both the groups. Changes in SpO 2 and EtCO 2 were comparable. However, highly significant changes in haemodynamic parameters were observed in the ETT group. Complications such as sore throat (13.33% cases), coughing (40% cases), vomiting (3.33% cases) and hypoxia (3.33% cases) were observed in the ETT group. No gastric insufflation or regurgitation was noted in our study. Thus, we concluded that PLMA could be used as an effective and safe airway device in children compared to ETT undergoing general anaesthesia.
  2,850 673 6
CASE REPORTS
Early and effective use of ketamine for treatment of phantom limb pain
Harsha Shanthanna, Medha Huilgol, Vinay Kumar Manivackam
March-April 2010, 54(2):157-159
DOI:10.4103/0019-5049.63632  PMID:20661356
Treatment for phantom limb pain is difficult and challenging. There is often suboptimum treatment with fewer than 10% receiving lasting relief. Treatments based broadly on other neuropathic pains may not be appropriate for a clinical success. We report a case of phantom limb pain, which proved resistant to multiple analgesics, including opioids and continuous epidural blockade. Treatment with intravenous (IV) ketamine as an alternate day infusion, gave complete remission of phantom limb pain. This demonstrates an early and effective use of a potent NMDA antagonist for treatment of phantom limb pain. Mechanisms underlying phantom limb pain are briefly discussed.
  2,698 596 8
CLINICAL INVESTIGATIONS
Influence of colloid infusion on coagulation during off-pump coronary artery bypass grafting
K Muralidhar, Rajnish Garg, SK Mohanty, Sanjay Banakal
March-April 2010, 54(2):147-153
DOI:10.4103/0019-5049.63653  PMID:20661354
This study was conducted to determine the influence of colloid infusion on coagulation in patients undergoing off-pump coronary artery bypass grafting (OP-CABG). Thirty patients undergoing elective OP-CABG received medium molecular weight hydroxyethyl starch group I (MMW-HES 200/0.5), low molecular weight hydroxyethyl starch group II (LMW-HES 130/0.4) or gelatin group III (GEL) in a prospective randomized trial. Blood samples were assessed for hemoglobin (Hb), activated coagulation time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPPT), platelet count, fibrinogen and von Willebrand factor (vWF) at specified intervals. Total volume of the colloid infused and postoperative chest-time drainage was also measured. There was a significant decrease in Hb, platelet count, fibrinogen levels in all these groups, which did not warrant blood transfusion. After the colloid infusion, vWF decreased significantly to 67% from baseline in group I as compared to 85 and 79% in group II and group III, respectively. vWF levels remained lower than the baseline value in the first 24 hours in group I, whereas this factor level increased above the baseline values in groups II and III, 6 hours postoperatively. Postoperative chest tube drainage in 24 hours was significantly higher in group I (856 ± 131 ml) as compared to group II (550 ± 124 ml) and group III (582 ± 159 ml). LMW-HES 130/0.4 was superior to MMW-HES 200/0.5 and gelatin in patients undergoing OP-CABG, in terms of better preservation of coagulation associated with enhanced volume effect.
  2,616 560 8
Effect of nitrous oxide on pain due to rocuronium injection: A randomised, double-blind, controlled clinical trial
Sonal Sharma, Deepak Sharma, Ashish Jain, Anjali Jain
March-April 2010, 54(2):142-146
DOI:10.4103/0019-5049.63660  PMID:20661353
A prospective, randomised, double-blind, placebo-controlled study was carried out to determine the effect of nitrous oxide (N 2 O) on the frequency and severity of pain and withdrawal reactions after injection of rocuronium. Eighty ASA physical status I and II patients undergoing general anaesthesia for elective surgery were enrolled. The patients were randomised to receive 100% oxygen (O 2 ), or 50% N 2 O in O 2 for 3 minutes followed by a subparalysing dose of rocuronium 0.06 mg/kg. After induction of anaesthesia with thiopentone 5 mg/kg, an intubating dose of rocuronium 0.6 mg/kg was given. The patients were observed after injection of rocuronium 0.06 mg/kg, and asked to rate pain in the arm on a 4-point (0-3) verbal rating scale (none, mild, moderate or severe). After the intubating dose of rocuronium, withdrawal reactions were recorded. Thirty-six patients (90%) in the group N 2 O and 15 patients (37.5%) in the group O 2 reported no pain (P < 0.001). The pain was mild in 1 (2.5%) and 9 (22.5%) patients in N 2 O and O 2 groups, respectively (P = 0.006). Moderate pain occurred in 2 (5%) patients in group N 2 O and 15 (37.5%) patients in group O 2 (P = 0.001). Severe pain was reported by one patient in each group (P = 0.47). Withdrawal response after an intubating dose of rocuronium was observed in 6 (15%) and 18 (45%) patients in the N 2 O and O 2 groups, respectively (P < 0.05). Inhalation of 50% N 2 O in O 2 reduces the incidence and severity of pain and the withdrawal reactions associated with rocuronium injection.
  2,396 493 6
CASE REPORTS
Alstrom syndrome: A rare genetic disorder and its anaesthetic significance
Akhilesh Tiwari, Disha Awasthi, Swapnil Tayal, S Ganguly
March-April 2010, 54(2):154-156
DOI:10.4103/0019-5049.63628  PMID:20661355
Alstrom syndrome is a rare autosomal recessive disorder that was first described in 1959, by Carl Henry Alstrom, characterised by multiorgan system involvement ranging from ocular, aural, endocrinal, hepatorenal, gastrointestinal, respiratory and cardiac to the musculoskeletal system, among many others. It exposes the patient to various risks ranging from pulmonary aspiration and increased cardiac morbidity to separational anxiety, and may necessitate postoperative elective ventilation. We hereby present the successful management of one such diagnosed case in a 12-year-old boy, who presented to us for incision and drainage of an abscess present over the nape of his neck, along with foreign body removal from his right ear.
  2,310 480 3
A case of severe subcutaneous emphysema in the post-operative period following cleft lip surgery
B Vijayakumar, R Ganessan, V Anbalagan
March-April 2010, 54(2):163-165
DOI:10.4103/0019-5049.63638  PMID:20661358
Subcutaneous emphysema is not an unknown complication following cleft lip surgery. We describe a case of severe subcutaneous emphysema that developed six hours after surgery. The laryngoscopic intubation was smooth. Following subcutaneous emphysema the patient was treated conservatively with mask oxygen and spontaneous resolution occurred within 48 hours.
  2,383 406 2
Role of amino acid infusion in delayed recovery from neuromuscular blockers
Seema Kalra, Rachna Wadhwa
March-April 2010, 54(2):166-168
DOI:10.4103/0019-5049.63649  PMID:20661359
This case report highlights the anaesthetic management of a patient who had residual muscle paralysis following neuromuscular blockade, which was attributed to hypothermia and corrected by administration of amino acid solution. The various causes of residual neuromuscular blockade should be considered when treating such a patient. Amino acid infusion has been found to hasten the recovery from neuromuscular block due to vecuronium bromide aggravated by hypothermia.
  2,018 442 2
LETTERS TO EDITOR
Intraoperative bronchospasm with thiopental
Aparna Shukla
March-April 2010, 54(2):181-182
DOI:10.4103/0019-5049.63646  PMID:20661372
  1,762 431 1
Capnography-guided awake nasal intubation
Gayathri Ramanathan
March-April 2010, 54(2):177-178
DOI:10.4103/0019-5049.63639  PMID:20661367
  1,739 389 -
Airway management of a child with multiple congenital anomalies
Rajeev Sharma
March-April 2010, 54(2):178-179
DOI:10.4103/0019-5049.63642  PMID:20661368
  1,610 412 -
Be prepared for intraoperative anaphylaxis
SK Dube, GR Agrawal, BN Pratihary, R Dutta, RK Verma
March-April 2010, 54(2):173-174
DOI:10.4103/0019-5049.63630  PMID:20661363
  1,533 451 -
CASE REPORTS
Anaesthetic management of an unusual complication of myringoplasty
Sandhya Agarwal, Ritu Aggarwal, Savita Babbar
March-April 2010, 54(2):169-171
DOI:10.4103/0019-5049.63651  PMID:20661360
A young male patient was undergoing myringoplasty for right ear chronic suppurative otitis media. While drilling in the middle ear cavity, duramater was breached accidentally. Surgeons were, however, allowed to complete the procedure. Keeping the seriousness of such a complication in mind, an urgent neurosurgical intervention was sought and noncontrast computed tomography head scan was done to analyse the extent of the injury. Osteoplastic craniotomy had to be performed subsequently to evacuate the contusional haematoma over the right temporoparietal region. Throughout the procedure, patient's vitals were monitored vigilantly to prevent any further deterioration of his condition. All the available resources were tapped judiciously to maintain intracranial pressure within normal limits. With a quick responsiveness on the part of the anaesthesia team, an active decision making, appropriate and remarkable anaesthetic management both intra and postoperatively, and good ICU care, a young patient could be salvaged and discharged successfully within a week with no immediate or residual complications related to myringoplasty or any neurological deficit.
  1,473 405 -
LETTERS TO EDITOR
Approach to loose teeth: An alternative solution
Nishkarsh Gupta, Pradeep Karunagaran, Mridula Pawar
March-April 2010, 54(2):178-178
DOI:10.4103/0019-5049.63640  PMID:20661369
  1,478 359 -
Importance for bilateral palpation of pulse old fact rediscovered
Namita Saraswat, Amrita Gupta, Abhijeet Mishra, Uma Srivastava
March-April 2010, 54(2):176-177
DOI:10.4103/0019-5049.63636  PMID:20661366
  1,407 301 -
Kinking of endotracheal tube during posterior fossa surgery
Neerja Bharti, Indu Bala
March-April 2010, 54(2):172-173
DOI:10.4103/0019-5049.63629  PMID:20661362
  1,342 345 1
"Feel of the reservoir bag" … A dying skill in midst of sophisticated equipment!
Rajeev Sharma
March-April 2010, 54(2):172-172
DOI:10.4103/0019-5049.63627  PMID:20661361
  1,333 329 -
Six hours positive pressure ventilation with size 5 laryngeal mask in a 55-kg patient
Jayashree Patki, C Naresh K Reddy
March-April 2010, 54(2):174-175
DOI:10.4103/0019-5049.63631  PMID:20661364
  1,294 290 1
Water in a nitrous oxide flowmeter
Virendra K Arya, Vikramjeet Arora
March-April 2010, 54(2):175-176
DOI:10.4103/0019-5049.63633  PMID:20661365
  1,304 276 1
The wrong drug problem continues
Sarika Katiyar
March-April 2010, 54(2):180-181
DOI:10.4103/0019-5049.63645  PMID:20661371
  1,227 263 -
A reply: Wrong drug problem continues
Vijaya Ramaiah
March-April 2010, 54(2):179-180
DOI:10.4103/0019-5049.63644  PMID:20661370
  1,184 298 -
OBITUARY
Obituary- Dr. C. H. Metgud

March-April 2010, 54(2):156-156
  1,115 203 -
Obituary- Dr. A. K. Gurwara

March-April 2010, 54(2):146-146
  940 202 -
Obituary- Prof. S. B. Lakamanahalli

March-April 2010, 54(2):153-153
  912 188 -