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  Citation statistics : Table of Contents
   2013| November-December  | Volume 57 | Issue 6  
    Online since December 20, 2013

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Perioperative respiratory complications in cleft lip and palate repairs: An audit of 1000 cases under 'Smile Train Project'
Kalpana R Kulkarni, Mohan R Patil, Abasaheb M Shirke, Shivaji B Jadhav
November-December 2013, 57(6):562-568
DOI:10.4103/0019-5049.123328  PMID:24403615
Background and Aim: Anaesthesia for cleft surgery in children is associated with a variety of airway related problems. This study aims to review the frequency of associated anomalies and other conditions as well as perioperative respiratory complications during the cleft lip/palate repair surgeries. Methods: An audit of 1000 cleft surgeries in children enrolled under "Smile Train" is presented. Following informed consent, general anaesthesia was induced with endotracheal (ET) intubation using halothane in O 2 and/or intravenous thiopentone 5 mg/kg or propofol 1.5 mg/kg, suxamethonium 1.5 mg/kg or rocuronium 0.8 mg/kg and maintained with halothane/isoflurane 0.4-1% in 50% N 2 O in O 2 with rocuronium. The observational data regarding the occurrence of perioperative complications in 1000 cleft surgeries are mentioned as mean (standard deviation), number and percentage as appropriate. 'Two sample t-test between percentage' is applied for significance. Results: The frequency of isolated cleft lip was 263 (36.4%), cleft palate 183 (25.3%) and combined defect 277 (38.3%) of the operated cases. Other congenital anomalies were present in 21 (2.8%) of the children. The intraoperative airway complications occurred in 13 (2.4%) of cleft lip and 40 (8.7%) of cleft palate repairs (P < 0.05). Post-operative respiratory complications were observed in 9 (1.7%) and 34 (7.4%) patients of cleft lip and palate repairs respectively (P < 0.05). Mortality occurred post-operatively in 2 (0.2%) of cleft repairs (n = 1000). Conclusion: Cleft deformities in children when associated with other congenital anomalies or respiratory problems pre-dispose them to difficult airway and pulmonary complications. Frequency of perioperative respiratory complications were significantly higher with cleft palate repair than with cleft lip repair. Anaesthetic expertise, optimum monitoring facility and specialised post-operative care is necessary to decrease the morbidity.
  10 8,579 1,931
Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors
Smita Prakash, Amitabh Kumar, Shyam Bhandari, Parul Mullick, Rajvir Singh, Anoop Raj Gogia
November-December 2013, 57(6):569-575
DOI:10.4103/0019-5049.123329  PMID:24403616
Background and Aim: Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population. Methods: In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4) was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy. Results: The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC) 3 and 4 in sitting and supine positions, inter-incisor distance (IID) ≤3.5 cm, thyromental (TMD) and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring. Conclusions: We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5%) of minor difficulty in intubation.
  5 7,784 1,668
Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs
Medha Mohta, Emeni L Ophrii, Ashok Kumar Sethi, Deepti Agarwal, Bhupendra Kumar Jain
November-December 2013, 57(6):555-561
DOI:10.4103/0019-5049.123327  PMID:24403614
Background: Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR. Methods: Thirty adults, having ≥3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 μg/ml in group RA or ropivacaine 0.2% with adrenaline 5 μg/ml and fentanyl 2 μg/ml in group RAF. Rescue analgesia was provided by IV morphine. Results: Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity. Conclusion: Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 μg/ml at 0.1-0.2 ml/kg/hr provided effective and safe analgesia to patients with unilateral MFR. Addition of fentanyl 2 μg/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects.
  4 3,903 2,320
Airway management in severe post-burn contracture of the neck using Airtraq: A case series
Qazi Ehsan Ali, Syed Hussain Amir, Obaid Ahmad Siddiqui, Shaista Jamil
November-December 2013, 57(6):620-622
DOI:10.4103/0019-5049.123342  PMID:24403629
  3 3,080 711
Unusual occurrence of massive subcutaneous emphysema during ERCP under general anaesthesia
Santosh Kumar Jaiswal, Deepak Kumar Sreevastava, Rashmi Datta, Navdeep Singh Lamba
November-December 2013, 57(6):615-617
DOI:10.4103/0019-5049.123340  PMID:24403627
  2 2,298 386
Effect of hyperosmolar sodium lactate infusion on haemodynamic status and fluid balance compared with hydroxyethyl starch 6% during the cardiac surgery
Cindy Elfira Boom, Poernomo Herdono, Chairil Gani Koto, Sjamsul Hadi, I Made Adi Permana
November-December 2013, 57(6):576-582
DOI:10.4103/0019-5049.123330  PMID:24403617
Background and Aim: No solution has been determined ideal for fluid therapy during cardiac surgery. Previous studies have shown that hyperosmolar sodium lactate (HSL) infusion has improved cardiac performance with smaller volume infusion, which resulted in negative fluid balance. This study compared the effects between a patent-protected HSL infusion and hydroxyethyl starch (HES) 6% on haemodynamic status of the patients undergoing cardiac surgery. Methods: In this open-label prospective controlled randomized study, patients were randomly assigned to receive loading dose of either HSL or HES 6%, at 3 mL/kgBW within 15 min, at the beginning of surgery. Haemodynamic parameters and fluid balance were evaluated, while biochemical parameters and any adverse effect were also recorded. Haemodynamic and laboratory parameters were analyzed through repeated measures analysis of variance. Statistical assessment of fluid management was carried out through Student t-test. All statistical analyses were performed using the statistical package for the social sciences ® version 15, 2006 (SPSS Inc., Chicago, IL). Results: Out of 100 enrolled patients in this study (50 patients in each arm), 98 patients were included in analysis (50 in HSL group; 48 in HES group). Cardiac index increased higher in HSL group (P = 0.01), whereas systemic vascular resistance index decreased more in HSL than HES group (P = 0.002). Other haemodynamic parameters were comparable between HSL and HES group. Fluid balance was negative in HSL group, but it was positive in HES group (−445.94 ± 815.30 mL vs. +108.479 ± 1219.91 mL, P < 0.009). Conclusion: Administration of HSL solution during the cardiac surgery improved cardiac performance and haemodynamic status better than HES did.
  2 4,537 524
Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial
Anil P Singh, Sritam S Jena, Rajesh Kr Meena, Mallika Tewari, V Rastogi
November-December 2013, 57(6):583-586
DOI:10.4103/0019-5049.123331  PMID:24403618
Background and Aim: Intravenous (IV) route for fentanyl administration is the gold standard for post-operative pain relief, but complications such as respiratory depression, bradycardia and hypotension have limited this route. The aim of this randomised controlled trial was to compare the efficacy of nebulised fentanyl with IV fentanyl for post-operative pain relief after lower abdominal surgery. Methods: In the post-operative care unit, at the time of first onset of pain( visual analogue scale- VAS score > 4) patients were randomised into three groups and fentanyl was administered either IV 2 μg/kg or by nebulisation of solution containing 3 or 4 μg/kg fentanyl over 8 min in 90 patients divided into three groups of 30 each. Observation were made for pain relief by visual analogue scale score 0-10. Adverse effects such as respiratory depression, bradycardia and hypotension were also recoded. Statistical analysis was performed using Medcalc software version 12, 2012. (MedCalc Software, Ostend, Belgium). Results: In the nebulisation group, it was observed that the analgesic efficacy of fentanyl was dose dependent with a delayed onset of analgesia (10 min vs. 5 min). Nebulisation with 4 μg/kg fentanyl produced analgesia at par to 2 μg/kg IV fentanyl with prolonged duration (90 min vs. 30 min) and with significantly less adverse effects. Conclusions: This study shows that nebulisation with 4 μg/kg fentanyl may be used as an alternative to IV 2 μg/kg fentanyl for adequate post-operative pain relief.
  2 3,507 941
An indigenous method to prevent intraoperative kinking of gas sampling line
Lenin Babu Elakkumanan, Sivaraman Baskaran, Senthilnathan Muthapillai
November-December 2013, 57(6):631-632
DOI:10.4103/0019-5049.123351  PMID:24403636
  2 1,387 343
Airway management for tracheal stent insertion in a patient with difficult airway
Sakshi Arora, AK Bhargava, Ranju Singh
November-December 2013, 57(6):617-619
DOI:10.4103/0019-5049.123341  PMID:24403628
  1 2,101 416
Anaesthetic management in a child with an atypical triad for reconstructive scoliosis surgery
Jasveer Singh, Dheeraj Kapoor, Meghana Srivastava, Manpreet Singh
November-December 2013, 57(6):596-598
DOI:10.4103/0019-5049.123334  PMID:24403621
Scoliosis may be of varied aetiology and may be associated with severe congenital anomalies. It often poses a challenge in its anaesthetic management. We present anaesthetic management of a child who underwent scoliosis reconstruction with a rare triad of cerebral palsy, glucose-6-phosphate dehydrogenase deficiency and severe mitral regurgitation. Anaesthetic management in these patients should focus primarily on associated co-morbidities and congenital anomalies affecting the course of the perioperative management and thereafter comprehensive pre-operative strategies must be executed to enhance the safety profile during the surgery.
  1 2,556 435
Airway management in Escobar syndrome: A formidable challenge
Shaji Mathew, Souvik Chaudhuri, HD Arun Kumar, Tim Thomas Joseph
November-December 2013, 57(6):603-605
DOI:10.4103/0019-5049.123336  PMID:24403623
Escobar syndrome is a rare autosomal recessive disorder characterized by flexion joint and digit contractures, skin webbing, cleft palate, deformity of spine and cervical spine fusion. Associated difficult airway is mainly due to micrognathia, retrognathia, webbing of neck and limitation of the mouth opening and neck extension. We report a case of a 1 year old child with Escobar syndrome posted for bilateral hamstrings to quadriceps transfer. The child had adequate mouth opening with no evidence of cervical spine fusion, yet we faced difficulty in intubation which was ultimately overcome by securing a proseal laryngeal mask airway (PLMA) and then by intubating with an endotracheal tube railroaded over a paediatric fibreoptic bronchoscope passed through the lumen of a PLMA.
  1 2,478 551
Tracheal perforation in a neonate: A devastating complication following traumatic endotracheal intubation
Jui Y Lagoo, Jiby Jose, Kshma A Kilpadi
November-December 2013, 57(6):623-624
DOI:10.4103/0019-5049.123343  PMID:24403630
  1 1,484 364
Phenytoin induced sinoatrial bradyarrhythmia in the perioperative period
Aanchal Kakkar, Gitanjali Chilkoti, Medha Mohta, AK Sethi, Mansi Arora
November-December 2013, 57(6):628-630
DOI:10.4103/0019-5049.123347  PMID:24403634
  1 2,116 341
Comment on "Anaesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumour"
Adriano BS Hobaika, Artur Palhares Neto
November-December 2013, 57(6):635-636
DOI:10.4103/0019-5049.123355  PMID:24403640
  1 1,497 258
Comment on "Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study"
Ashok Jadon
November-December 2013, 57(6):637-638
DOI:10.4103/0019-5049.123358  PMID:24403642
  1 2,143 340
Ultrasound guided percutaneous electro-coagulation of ilioinguinal and iliohypogastric nerves for treatment of chronic groin pain
T Sivashanmugam, Ashish Saraogi, S Robinson Smiles, M Ravishankar
November-December 2013, 57(6):610-612
DOI:10.4103/0019-5049.123338  PMID:24403625
  - 2,646 351
Laparoscopic surgeries during second and third trimesters of pregnancy in a tertiary care centre in South India: Anaesthetic implications and long-term effects on children
Nisha Rajmohan, Hassy Prakasam, J Simy
November-December 2013, 57(6):612-615
DOI:10.4103/0019-5049.123339  PMID:24403626
  - 3,234 616
Anaesthetic management of two different cases of mediastinal mass
Hemalatha Subbanna, Poola N Viswanathan, Manjula B Puttaswamy, Ashwini Andini, Tulsi Thimmegowda, Sondekoppa N Bhagirath
November-December 2013, 57(6):606-609
DOI:10.4103/0019-5049.123337  PMID:24403624
We report the management of two paediatric cases undergoing median sternotomy and right lateral thoracotomy for mediastinal mass. An 8-year-old boy presented with a history of intermittent fever and episodes of respiratory illness since 3 years and a 16-year-old girl presented with dyspnoea, cough, fever and dysphagia for solid foods. Radiological investigation confirmed the diagnoses. Absence of pressure symptoms pointed towards a compressible mass in the boy and indicated a non-compressible mass in the girl. We discuss the anaesthetic management of the younger patient with an uneventful course as opposed to the older patient where airway obstruction ensued soon after induction and led to near-cardiopulmonary arrest necessitating rescue measures. Swift measures at securing airway while simultaneously resuscitating the patient served to successfully revert an otherwise fateful eventuality.
  - 2,346 462
Perioperative management of liver transplantation with concurrent coronary artery disease: Report of two cases
Piyush Srivastava, Lalit Sehgal, Nalin Sharma, Anil Agrawal, Vivek Vij
November-December 2013, 57(6):599-602
DOI:10.4103/0019-5049.123335  PMID:24403622
Coronary artery disease (CAD), even if asymptomatic, has been known to complicate the perioperative management of patients undergoing liver transplantation. Perioperative outcome for such patients is worse than those without CAD despite improvement in risk stratification and management of CAD. We hereby report the successful perioperative management of two patients with CAD undergoing living-related liver transplantation. Maintaining systemic vascular resistance, goal-directed volume administration and surgical technique avoiding total clamping of IVC was the mainstay of stable intraoperative course. Moreover, a lower model for end stage liver disease (MELD) score at the time of liver transplant may also have been contributory to successful outcome in our patients.
  - 2,766 432
Airway management in cervical spine ankylosing spondylitis: Between a rock and a hard place
Naveen Eipe, Susan Fossey, Stephen P Kingwell
November-December 2013, 57(6):592-595
DOI:10.4103/0019-5049.123333  PMID:24403620
We report the perioperative course of a patient with long standing ankylosing spondylitis with severe dysphagia due to large anterior cervical syndesmophytes at the level of the epiglottis. He was scheduled to undergo anterior cervical decompression and the surgical approach possibly precluded an elective pre-operative tracheostomy. We performed a modified awake fibreoptic nasal intubation through a split nasopharyngeal airway while adequate oxygenation was ensured through a modified nasal trumpet inserted in the other nares. We discuss the role of nasal intubations and the use of both the modified nasopharyngeal airways we used to facilitate tracheal intubation. This modified nasal fibreoptic intubation technique could find the application in other patients with cervical spine abnormalities and in other anticipated difficult airways.
  - 3,867 737
The P-POSSUM scoring systems for predicting the mortality of neurosurgical patients undergoing craniotomy: Further validation of usefulness and application across healthcare systems
SJ Mercer, Arpan Guha, VJ Ramesh
November-December 2013, 57(6):587-591
Background and Aims: Continuous audit of clinical practice is an essential part of making improvements in medicine and enhancing patient care. Validated tools are needed to gather evidence for comparisons. Recently, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores were evaluated in Indian patients undergoing elective craniotomy and it was concluded that P-POSSUM was highly accurate in predicting overall mortality. We wished to study whether this system could be used in a different country and health care system [United Kingdom, UK]. We have evaluated these scores in patients undergoing elective and emergency craniotomies in a tertiary centre in the UK. Methods: Data was collected from all neurosurgical patients who underwent craniotomy overone year. Preoperative variables were collected prior to induction of anaesthesia, and operative variables were also collected. Chi-square test was used for expected and actual mortality differences. Survivor and non-survivor demographics were compared by one-way ANOVA for continuous and Chi-square for categorical variables. Results: One hundred and forty-five patients were studied. Mean [SD] physiologic score of the patients was 18.83 [5.07], and mean [SD] operative score was 18.09 [3.75]. P-POSSUM was a better predictor for elective patients and for those undergoing immediate life-saving surgery. Conclusion: This study confirms and validates the findings of previous work that P-POSSUM is an accurate and reliable tool for estimating in-hospital mortality. It also confirms its usefulness in comparison of results across healthcare systems internationally. Larger scale evaluations may be needed to examine its usefulness in emergency procedures.
  - 3,827 714
Response to Comments: Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study
Ballarapu Girija Kumari, Aloka Samantaray, AnantaKiran Kumar, Padmaja Durga, Gudaru Jagadesh
November-December 2013, 57(6):638-639
DOI:10.4103/0019-5049.123359  PMID:24403643
  - 1,682 306
Response to Comments: Anaesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumour
Suma M Thampi, Deepu David, Tony Thomson Chandy, Amar Nandhakumar
November-December 2013, 57(6):636-637
DOI:10.4103/0019-5049.123356  PMID:24403641
  - 1,515 367
Impacted foreign body bronchus: Role of percussion in removal
Shilpa Goyal, Nari Mary Lyngdoh, Amit Goyal, Neizekhotuo Brian Shunyu, Samarjeet Dey, Mohammad Yunus
November-December 2013, 57(6):630-631
DOI:10.4103/0019-5049.123349  PMID:24403635
  - 1,885 314
Neuraxial block in a patient with dural ectasia
Deepak Hanumanthaiah, Vinod Sudhir
November-December 2013, 57(6):624-625
DOI:10.4103/0019-5049.123344  PMID:24403631
  - 1,165 271
A rare case of fatal acute respiratory distress syndrome following diesel oil siphonage
Dheeraj Kapoor, Nitika Goel, Manpreet Singh, Jasveer Singh
November-December 2013, 57(6):625-627
DOI:10.4103/0019-5049.123345  PMID:24403632
  - 1,718 296
Neuraxial techniques in patients with lumbar tattoos: A national survey from New Zealand
Kiran Polisetty, Saleem Khoyratty, Martin Minehan
November-December 2013, 57(6):627-628
DOI:10.4103/0019-5049.123346  PMID:24403633
  - 1,193 265
Anaesthesia challenges in Freeman-Sheldon syndrome
Kiran Patel, Anuya Gursale, Dilip Chavan, Pradnya Sawant
November-December 2013, 57(6):632-633
DOI:10.4103/0019-5049.123352  PMID:24403637
  - 2,250 355
Ginko biloba may cause asymptomatic ventricular premature contractions!
Surya Kumar Dube, Charu Mahajan, Hemanshu Prabhakar, Gyaninder Pal Singh
November-December 2013, 57(6):633-634
DOI:10.4103/0019-5049.123353  PMID:24403638
  - 1,653 288
Use of laryngeal mask airway in premature infant
Pramod Velankar, Milind Joshi, Preety Sahu
November-December 2013, 57(6):634-635
DOI:10.4103/0019-5049.123354  PMID:24403639
  - 1,472 300
Pages From Old Issues of IJA Silver Jubilee 1977

November-December 2013, 57(6):551-552
  - 1,955 9,783
Pages From Old Issues of IJA 1965

November-December 2013, 57(6):553-554
  - 1,864 2,773