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  Citation statistics : Table of Contents
   2011| January-February  | Volume 55 | Issue 1  
    Online since February 9, 2011

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Effect of oral clonidine premedication on perioperative haemodynamic response and post-operative analgesic requirement for patients undergoing laparoscopic cholecystectomy
Shivinder Singh, Kapil Arora
January-February 2011, 55(1):26-30
DOI:10.4103/0019-5049.76583  PMID:21431049
Clonidine has anti-hypertensive properties and augments the effects of anaesthesia, hence we considered it to be an ideal agent to contain the stress response to pneumoperitoneum. We studied the clinical efficacy of oral clonidine premedication in patients undergoing laparoscopic cholecystectomies. Fifty patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to receive premedication with either oral clonidine 150 μg (Group I, n = 25) or placebo (Group II, n = 25) 90 minutes prior to induction. The patients were managed with a standard general anaesthetic. The two groups were compared with respect to haemodynamic parameters, isoflurane concentration, pain and sedation scores, time to request of analgesic and cumulative analgesic requirements. Oral clonidine was found to be significantly better in terms of maintaining stable haemodynamics, having an isoflurane sparing effect and having a prolonged time interval to the first request of analgesia postoperatively compared to the control group. Administration of oral clonidine 150 μg as a pre-medicant in patients undergoing laparoscopic cholecystectomy results in improved perioperative haemodynamic stability and a reduction in the intra-operative anaesthetic and post-operative analgesic requirements.
  12 6,660 1,355
Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery
Shashi Kiran, Rachna Gupta, Deepak Verma
January-February 2011, 55(1):31-35
DOI:10.4103/0019-5049.76605  PMID:21431050
This study was undertaken to study efficacy of single dose of intravenous magnesium sulphate to reduce post-operative pain in patients undergoing inguinal surgery. One hundred patients undergoing inguinal surgery were divided randomly in two groups of 50 each. The patients of magnesium sulphate group (Group-I) received magnesium sulphate 50 mg/kg in 250 ml of isotonic sodium chloride solution IV whereas patients in control group (Group-II) received same volume of isotonic sodium chloride over 30 minutes preoperatively. Anaesthesia was induced with propofol (2 mg/kg) and pethidine (1 mg/kg). Atracurium besylate (0.5 mg/kg) was given to facilitate insertion of LMA. Pain at emergence from anaesthesia and 2, 4, 6, 12 and 24 hours after surgery was evaluated. The timing and dosage of rescue analgesic during first 24 hrs after operation was noted. Pain in postop period was significantly lower in magnesium sulphate group in comparison to control group at emergence from anaesthesia and 2, 4, 6, 12 and 24 hrs postop [1.86 vs. 1.96 (P=0.138), 1.22 vs. 1.82 (P=0.001), 1.32 vs. 1.88 (P=0.000), 2.74 vs. 3.84 (P=0.000), 1.36 vs. 2.00 (P=0.000) and 0.78 vs 1.30 (P=0.000), respectively]. Patients in group-I were more sedated as compared to group-II [sedation score 1.86 vs. 1.40 (P=0.000)]. Rescue analgesia requirement postoperatively in first 4, 8 and 16 hrs was significantly lower in patients of group-1 than in group- II [1.9 vs. 3.8 (P<0.05), 25.50 vs. 52.50 (P<0.05) and 0.000 vs. 7.5 (P<0.05)]. Preoperative magnesium sulphate infusion decreases postop pain and requirement of rescue analgesia.
  11 6,052 1,349
Foot drop after spinal anaesthesia: A rare complication
BC Nirmala, Gowri Kumari
January-February 2011, 55(1):78-79
DOI:10.4103/0019-5049.76590  PMID:21431063
  6 2,592 540
Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia
Ravi Jindal, Ved Prakash Kumra, Krishan Kumar Narani, Jayashree Sood
January-February 2011, 55(1):36-42
DOI:10.4103/0019-5049.76604  PMID:21431051
Both sevoflurane and desflurane have shorter emergence times compared to isoflurane based anaesthesia. Because of its pharmacological properties, desflurane appears to yield a rapid early and intermediate recovery compared with sevoflurane. The aim of this study was to assess the maintenance and emergence characteristics after anaesthesia with sevoflurane or desflurane. One hundred female patients scheduled to undergo daycare laparoscopic gynaecological surgery were enrolled for this prospective study. Patients were randomised into two groups to receive either desflurane [group I (D); n = 50] or sevoflurane [group II (S); n = 50] for maintenance of anaesthesia. The demographic data and the duration of procedure were comparable in both the groups. The early recovery time was shorter after maintenance of anaesthesia with desflurane compared with sevoflurane. However, this faster early recovery failed to lead to early readiness for home discharge. The intraoperative haemodynamic characteristics were comparable with both sevoflurane and desflurane. Both sevoflurane and desflurane provide a similar time to home readiness despite a faster early recovery with desflurane. The intraoperative haemodynamics are similar with both the agents.
  5 5,892 1,088
Epidural haematoma: Rare complication after spinal while intending epidural anaesthesia with long-term follow-up after conservative treatment
Devalina Goswami, Jyotirmoy Das, Achyut Deuri, Ajit K Deka
January-February 2011, 55(1):71-73
DOI:10.4103/0019-5049.76596  PMID:21431059
Epidural anaesthesia (EA) is an extensively used procedure for many surgeries. Increase incidence of bleeding in the epidural space [epidural haematoma (EH)] is reportedly more common in patients with altered coagulation and patients on anticoagulation treatment. EH secondary to spinal while intending EA for caesarean section (C-section) in a healthy individual leading to transient or persistent neurological problems is very rare. We report a case of EH after spinal while intending EA for C-section in a healthy young female along with 5-yrs follow-up after conservative treatment.
  4 2,865 604
Anaesthetic management in a patient with multiple sclerosis
Lata M Kulkarni, CS Sanikop, HL Shilpa, Anupama Vinayan
January-February 2011, 55(1):64-67
DOI:10.4103/0019-5049.76598  PMID:21431057
Multiple sclerosis (MS) is a rare autoimmune demyelinating disorder of the central nervous system clinically manifesting as periodic attacks of varied neurologic symptoms, eventually progressing to fixed neurologic deficits and disability. The treatment is symptomatic and directed towards prevention of future progression of the disease involving multiple agents. We present here a case report of a patient with MS who underwent an orthopaedic procedure under general anaesthesia (G.A.) uneventfully. Anaesthetic implications include assessment of neurological deficits with documentation pre- and postoperatively, awareness towards side-effects, potential drug interactions of medications, selection of suitable techniques/anaesthetic agents, neuromuscular monitoring-guided titration of non-depolarizing blocking agents with lowest necessary dose and avoidance of hyperthermia along with temperature, haemodynamic and respiratory monitoring. Lower concentrations of local anaesthetic (LA) should be used for regional blocks keeping in mind the susceptibility of demyelinated neurons, towards LA neurotoxicity. To the best of our knowledge, this is the first report of anaesthetic management of MS in India.
  4 8,026 1,215
Revalidation of a modified and safe approach of stellate ganglion block
Ashok Jadon
January-February 2011, 55(1):52-56
DOI:10.4103/0019-5049.76601  PMID:21431054
Stellate ganglion block (SGB) is very effective in management of chronic regional pain syndrome (CRPS-1). However, serious complication may occur due to accidental intravascular (intra-arterial) injection of local anaesthetic agents. Abdi and others, has suggested a modified technique in which fluoroscopy-guided block is given at the junction of uncinate process and body of vertebra at C7 level. In this approach vascular structures remain away from the trajectory of needle and thus avoid accidental vascular injection. We have used this technique of SGB in nine patients who were treated for CRPS-I. The blocks were effective in all the patients all the time without any vascular or other serious complication.
  3 3,781 664
Does our sleep debt affect patients' safety?
Anurag Tewari, Jose Soliz, Federico Billota, Shuchita Garg, Harsimran Singh
January-February 2011, 55(1):12-17
DOI:10.4103/0019-5049.76572  PMID:21431047
The provision of anaesthesia requires a high level of knowledge, sound judgement, fast and accurate responses to clinical situations, and the capacity for extended periods of vigilance. With changing expectations and arising medico-legal issues, anaesthesiologists are working round the clock to provide efficient and timely health care services, but little is thought whether the "sleep provider" is having adequate sleep. Decreased performance of motor and cognitive functions in a fatigued anaesthesiologist may result in impaired judgement, late and inadequate responses to clinical changes, poor communication and inadequate record keeping, all of which affect the patient safety, showing without doubt the association of sleep debt to the adverse events and critical incidents. Perhaps it is time that these issues be promptly addressed to prevent the silent perpetuation of a problem that is pertinent to our health and our profession. We endeavour to focus on the evidence that links patient safety to fatigue and sleepiness of health care workers and specifically on anaesthesiologists. The implications of sleep debt are deep on patient safety and strategies to prevent this are the need of the hour.
  3 50,167 1,235
Robotic invasion of operation theatre and associated anaesthetic issues: A review
Prem N Kakar, Jyotirmoy Das, Preeti Mittal Roy, Vijaya Pant
January-February 2011, 55(1):18-25
A Robotic device is a powered, computer controlled manipulator with artificial sensing that can be reprogrammed to move and position tools to carry out a wide range of tasks. Robots and Telemanipulators were first developed by the National Aeronautics and Space Administration (NASA) for use in space exploration. Today's medical robotic systems were the brainchild of the United States Department of Defence's desire to decrease war casualties with the development of 'telerobotic surgery'. The 'master-slave' telemanipulator concept was developed for medical use in the early 1990s where the surgeon's (master) manual movements were transmitted to end-effector (slave) instruments at a remote site. Since then, the field of surgical robotics has undergone massive transformation and the future is even brighter. As expected, any new technique brings with it risks and the possibility of technical difficulties. The person who bears the brunt of complications or benefit from a new invention is the 'Patient'. Anaesthesiologists as always must do their part to be the patient's 'best man' in the perioperative period. We should be prepared for screening and selection of patients in a different perspective keeping in mind the steep learning curves of surgeons, long surgical hours, extreme patient positioning and other previously unknown anaesthetic challenges brought about by the surgical robot. In this article we have tried to track the development of surgical robots and consider the unique anaesthetic issues related to robot assisted surgeries.
  3 9,588 2,656
Anaesthetic management in patients with glucose-6-phosphate dehydrogenase deficiency undergoing neurosurgical procedures
Sebastian Valiaveedan, Charu Mahajan, Girija P Rath, Ashish Bindra, Manish K Marda
January-February 2011, 55(1):68-70
DOI:10.4103/0019-5049.76597  PMID:21431058
Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is an X-linked recessive enzymopathy responsible for acute haemolysis following exposure to oxidative stress. Drugs which induce haemolysis in these patients are often used in anaesthesia and perioperative pain management. Neurosurgery and few drugs routinely used during these procedures are known to cause stress situations. Associated infection and certain foodstuffs are also responsible for oxidative stress. Here, we present two patients with G-6-PD deficiency who underwent uneventful neurosurgical procedures. The anaesthetic management in such patients should focus on avoiding the drugs implicated in haemolysis, reducing the surgical stress with adequate analgesia, and monitoring for and treating the haemolysis, should it occur.
  2 3,382 592
A case of hypotension after intranasal adrenaline infiltration causing a clinical dilemma during the intraoperative period
Shyam Bhandari, Mozammil Shaffi, S Bano, Suhail Sarwar Siddiqui, Jahangir Ahmad
January-February 2011, 55(1):74-76
DOI:10.4103/0019-5049.76595  PMID:21431060
Solutions containing adrenaline are widely used for presurgical infiltration. Haemodynamic changes associated with its use are well documented in the literature. Prolonged intraoperative hypotension after subcutaneous infiltration of diluted adrenaline is an uncommon scenario. We believe that our case of the prolonged episode of hypotension was secondary to infiltration of nasal septum with a high concentration of adrenaline. As β2 receptor activation leads to skeletal muscle vasodilation, a decrease in preload may have lead to profound hypotension. Postoperatively, the patient was examined and any autonomic or endocrinological pathology was ruled out.
  2 2,651 453
Metallic foreign object in postoperative chest radiograph?
Dheeraj Arora, Abhishek Bansal, Yatin Mehta
January-February 2011, 55(1):84-85
DOI:10.4103/0019-5049.76576  PMID:21431069
  2 1,905 321
A comparison of the upper lip bite test with hyomental/thyrosternal distances and mandible length in predicting difficulty in intubation: A prospective study
Zahid Hussain Khan, Anahid Maleki, Jalil Makarem, Mostafa Mohammadi, Ramooz Hussain Khan, Ali Zandieh
January-February 2011, 55(1):43-46
DOI:10.4103/0019-5049.76603  PMID:21431052
The incidence of difficulty in tracheal intubation has been reported to range from 0.5 to 18% in patients undergoing surgery. We aimed to elucidate the role of upper lip bite test (ULBT) with other prevailing tests, hyomental/thyrosternal distances (HMD/TSD), and the mandible length (ML) and their possible correlation in predicting difficulty in intubation. After institutional approval and informed consent were obtained, 300 consecutive patients aged 20-60 years of ASA physical status I and II, scheduled for elective surgical procedures requiring tracheal intubation and meeting the inclusion criteria, were enrolled in this study. Each patient was evaluated regarding ULBT, HMD, TSD and ML. Laryngoscopy was assessed by an attending anaesthesiologist blinded to the measurements. The laryngoscopic result was graded according to Cormack and Lehane's Grading system. The negative predictive value (NPV) and positive predictive value (PPV) of ULBT were found to be 94 and 100%, respectively. These corresponding figures for TSD were 88.5 and 0%, respectively. Specificities for ULBT, HMD, ML and TSD were 100, 98.9, 98.9 and 98.1%, respectively. ULBT class and laryngoscopic grading showed the greatest agreement (kappa = 0.61, P < 0.001). An agreement between laryngoscopic grading and HMD and ML also existed (0.003 and <0.001, respectively), but was comparatively weaker. The high specificity, NPV, PPV and accuracy of ULBT as revealed in this study could be a good rationale for its application in the prediction of difficulty or easiness in intubation. ML > 9 cm and HMD > 3.5 cm were good predictors of negative difficult intubation.
  1 3,848 933
Negative pressure pulmonary oedema
Mukul C Kapoor
January-February 2011, 55(1):10-11
DOI:10.4103/0019-5049.76566  PMID:21431046
  1 6,730 2,466
Management of thoracoscopic thymectomy in a myasthenia gravis patient
Kavita Adate, Archana Shinde, Shalini Thombre, Kalpana Harnagle
January-February 2011, 55(1):77-78
DOI:10.4103/0019-5049.76591  PMID:21431062
  1 3,725 745
Popliteal artery thrombosis following total knee arthroplasty: A preventable complication with surveillance
Vijaya Pant, Preety Mittal Roy, Jyotirmoy Das, Umesh Deshmukh, Prem Kakar
January-February 2011, 55(1):85-86
DOI:10.4103/0019-5049.76575  PMID:21431070
  1 2,512 351
Ondansetron causing near fatal catastrophe in a renal transplant recipient
Sandeep Sahu, Sunaina Tejpal Karna, Anil Agarwal, Sushil Prakash Ambesh, Aneesh Srivastava
January-February 2011, 55(1):81-82
DOI:10.4103/0019-5049.76582  PMID:21431066
  1 2,514 470
Temperature monitoring: An often neglected but essential standard monitor
Indira Malik
January-February 2011, 55(1):82-83
DOI:10.4103/0019-5049.76580  PMID:21431067
  1 2,010 891
Yet another modification of Guedel's airway
Vanita Ahuja, Virender K Arya, Babloo Kumar
January-February 2011, 55(1):83-84
DOI:10.4103/0019-5049.76579  PMID:21431068
  1 2,046 350
Mesenteric ischaemia ocurring as a late complication after-aorto-femoral bypass
Neeti Makhija, Raveen Singh, Usha Kiran, Madhava Kekani, Minati Choudhury
January-February 2011, 55(1):57-60
DOI:10.4103/0019-5049.76600  PMID:21431055
Patients with coexisting peripheral vascular disease and coronary artery disease constitute a high risk surgical group. Perioperative management of such patients is an anaesthetic challenge. A 57-year-old male presented with critical limb ischaemia and impending gangrene of the right lower limb. Associated coronary artery disease with triple vessel involvement was diagnosed on coronary angiography. This patient underwent an aorto-femoral bypass. The postoperative course was complicated by the development of mesenteric ischaemia requiring emergency laparotomy and bowel resection.
  - 2,910 334
Desflurane anaesthesia in myotonic dystrophy
Ranju Gandhi, Anil Kumar Jain, Jayashree Sood
January-February 2011, 55(1):61-63
DOI:10.4103/0019-5049.76599  PMID:21431056
Myotonic dystrophy (MD) is a rare genetic disorder with multisystem involvement characterised by myotonia and progressive muscle weakness and wasting. These patients pose significant challenges to the anaesthesiologist in view of the muscular and extramuscular involvement and sensitivity to anaesthetic drugs. The literature is replete with reports of postanaesthetic respiratory and cardiovascular complications in these patients. But an ideal anaesthetic technique in MD patients remains to be determined. Rapid recovery is desirable to reduce postoperative respiratory complications. Though there are a few case reports of maintenance of anaesthesia with isoflurane and sevoflurane, there are scanty reports of use of desflurane in these patients. We present successful management of a patient with MD for laparoscopic cholecystectomy using a carefully titrated desflurane-based anaesthesia and discuss the perioperative considerations.
  - 2,659 460
Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center
Tanvir Samra, Mridula Pawar, Amlendu Yadav
January-February 2011, 55(1):47-51
DOI:10.4103/0019-5049.76602  PMID:21431053
H1N1 subtype of influenza A virus has clinical presentation ranging from mild flu like illness to severe lung injury and acute respiratory distress syndrome (ARDS). The aim of our study was to compare the demographic characteristics, clinical presentation, and mortality of critically ill patients with (H1N1+) and without H1N1 infection (H1N1-). We retrospectively analyzed medical charts of patients admitted in "Swine Flu ICU" with ARDS from August 2009 to May 2010. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay was used for detection of H1N1 virus in the respiratory specimens. Clinical data from 106 (H1N1 , 45; H1N1+, 61) patients was collected and compared. Mean delay in presentation to our hospital was 5.7 ± 3.1 days and co-morbidities were present in two-fifth of the total admissions. Sequential Organ Failure Assessment (SOFA) score of patients with and without H1N1 infection was comparable; 7.8 ± 3.5 and 6.6 ± 3.1 on day 1 and 7.2 ± 4.5 and 6.5 ± 3.1 on day 3, respectively. H1N1+ patients were relatively younger in age (34.2 ± 12.9 years vs. 42.8 ± 18.1, P = 0.005) but presented with significantly lower PaO 2 :FiO 2 ratio (87.3 ± 48.7 vs. 114 ± 51.7) in comparison to those who subsequently tested as H1N1 . The total leucocyte counts were significantly lower in H1N1+ patients during the first four days of illness but incidence of renal failure (P = 0.02) was higher in H1N1+ patients. The mortality in both the groups was high (H1N1+, 77%; H1N1, 68%) but comparable. There was a mean delay of 5.7 ± 3.1 days in initiation of antivirals. Patients with H1N1 infection were relatively younger in age and with a significantly higher incidence of refractory hypoxia and acute renal failure. Mortality from ARDS reported in our study in both the groups was high but comparable.
  - 3,961 562
Airway management: How current are we?
Venkateswaran Ramkumar
January-February 2011, 55(1):5-9
DOI:10.4103/0019-5049.76565  PMID:21431045
  - 3,525 1,376
Management of intraoperative bronchospasm
Indira Malik
January-February 2011, 55(1):79-80
DOI:10.4103/0019-5049.76587  PMID:21431064
  - 3,847 2,526
Introduction of flexometallic cuffed endotracheal tube through COBRA perilaryngeal airway
Lulu Fatema Vali, Sonali Khobragade
January-February 2011, 55(1):80-81
DOI:10.4103/0019-5049.76585  PMID:21431065
  - 3,486 370
To err is human… to forgive and remember is divine?
S Bala Bhaskar
January-February 2011, 55(1):86-87
DOI:10.4103/0019-5049.76574  PMID:21431071
  - 1,826 348
Unexplained facts about subcutaneous emphysema after cleft lip surgery
Anju Ghai, Raman Wadhera, Sanjay Johar, Nidhi Garg
January-February 2011, 55(1):87-88
DOI:10.4103/0019-5049.76570  PMID:21431072
  - 1,659 320
Use of cuffed flexometallic tube to control profuse airway bleeding during extraction of tracheal metallic foreign body
Ganga Prasad, Gokul Toshniwal
January-February 2011, 55(1):88-89
DOI:10.4103/0019-5049.76569  PMID:21431073
  - 1,864 282
Cystic hygroma and anaesthetic implication
Geeta Kamal, Aikta Gupta, Sapna Bathla, Neelam Prasad
January-February 2011, 55(1):89-90
DOI:10.4103/0019-5049.76568  PMID:21431074
  - 3,999 743
Fast-track management of pneumothorax in laparoscopic surgery
Raviraj Raveendran, Hari Narayana Prabu, Sarah Ninan, Sathish Darmalingam
January-February 2011, 55(1):91-92
DOI:10.4103/0019-5049.76564  PMID:21431075
  - 2,331 520
Obituary - Dr. Karunakarnta Goswami

January-February 2011, 55(1):92-92
  - 1,266 240
Past President's address
J Ranganathan
January-February 2011, 55(1):2-4
DOI:10.4103/0019-5049.76560  PMID:21431044
  - 2,147 396
Deepak Malviya: President's message
Deepak Malviya
January-February 2011, 55(1):1-1
DOI:10.4103/0019-5049.76559  PMID:21431043
  - 2,463 464
Retraction Notice

January-February 2011, 55(1):76-76
  - 1,695 335