• Users Online: 1652
  • Print this page
  • Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2016| June  | Volume 60 | Issue 6  
    Online since June 2, 2016

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery
Tuhin Mistry, Vandana Mangal, Gaurav Sharma, Aachu Agrawal
June 2016, 60(6):393-397
DOI:10.4103/0019-5049.183385  PMID:27330200
Background and Aims: Supraclavicular approach to the brachial plexus may be associated with complications such as pneumothorax, inadvertent vascular puncture, inter-scalene block and neurovascular injuries. The present study was conceived to find out the variation in depth of brachial plexus to suggest the minimum length of needle required to effectively perform the block, thus preventing possible complications. Methods: After approval from our Institutional Ethical Committee, informed and written consent was obtained from each of the ninety American Society of Anesthesiologists Physical Status I and II patients recruited, of either sex in the age group of 20–50 years. Supraclavicular fossa was scanned using a high-frequency linear probe, and the distances (shortest distance [SD] from skin to the most superficial neural element and longest distance [LD] from skin to the most deep neural element) were measured using on-screen callipers on optimal frozen image. Pearson correlation was used to find out the relation between these two distances and demographic parameters. Results: Mean SD was 0.60 ± 0.262 cm, and mean LD was found to be 1.34 ± 0.385 cm. We observed significant correlation between these two distances with weight and body mass index (BMI). Conclusion: Significant correlation was observed between SD and LD with weight and BMI. We suggest that a needle with a shaft length of 3 cm will be sufficient to reach the sheath of the brachial plexus during performance of the block.
  5,808 1,250 1
Comparative evaluation of intrathecal morphine and intrathecal dexmedetomidine in patients undergoing gynaecological surgeries under spinal anaesthesia: A prospective randomised double blind study
Pranjali Kurhekar, S Madan kumar, D Sampath
June 2016, 60(6):382-387
DOI:10.4103/0019-5049.183387  PMID:27330198
Background and Aims: Inrathecal opioids like morphine added to local anaesthetic agents have been found to be effective in achieving prolonged post-operative analgesia. Intrathecal dexmedetomidine may be devoid of undesirable side effects related to morphine and hence, this study was designed to evaluate analgesic efficacy, haemodynamic stability and adverse effects of both these adjuvants in patients undergoing gynaecological surgeries. Methods: This was a prospective, randomised, double blind study involving 25 patients in each group. Group M received 15 mg of 0.5% hyperbaric bupivacaine with 250 μg of morphine while Group D received 15 mg of 0.5% hyperbaric bupivacaine with 2.5 μg of dexmedetomidine. Characteristics of spinal block, time for first rescue analgesic and total dose of rescue analgesics were noted. Vital parameters and adverse effects were noted perioperatively. Data analysis was done with independent two sample t-test and Mann–Whitney U test. Results: Time for first rescue analgesic (P = 0.056) and total analgesic demand were similar in both groups. Duration of sensory (P = 0.001) and motor (P = 000) block was significantly higher in dexmedetomidine group. Itching was noticed in 36% and nausea in 52% of patients in the morphine group, either of which was not seen in dexmedetomidine group. Conclusion: Intrathecal dexmedetomidine produces prolonged motor and sensory blockade without undesirable side effects but intraoperative hypotension was more frequent in dexmedetomidine group.
  4,095 1,064 1
Efficacy of midazolam as oral premedication in children in comparison to triclofos sodium
Kolathu Parambil Radhika, Melveetil S Sreejit, Konnanath T Ramadas
June 2016, 60(6):415-419
DOI:10.4103/0019-5049.183389  PMID:27330204
Background and Aims: The perioperative behavioural studies demonstrate that children are at greater risk of experiencing turbulent anaesthetic induction and adverse behavioural sequelae. We aimed to compare the efficacy of midazolam 0.5 mg/kg with triclofos sodium 100 mg/kg as oral premedication in children undergoing elective surgery. Methods: In this prospective, randomised and double-blind study, sixty children posted for elective lower abdominal surgery were enrolled. The patients were randomly divided into midazolam group (Group M) and triclofos sodium group (Group T) of thirty each. Group M received oral midazolam 0.5 mg/kg 30 min before induction, and Group T received oral triclofos sodium 100 mg/kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. Mann–Whitney U-test was used for comparing the grade of sedation, ease of separation and acceptance of face mask. Results: Oral midazolam produced adequate sedation in children after premedication in comparison to oral triclofos (P = 0.002). Both drugs produced successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. Conclusions: Oral midazolam is superior to triclofos sodium as a sedative anxiolytic in paediatric population.
  3,233 626 -
Effect of epidural clonidine on characteristics of spinal anaesthesia in patients undergoing gynaecological surgeries: A clinical study
Rachna Prasad, RS Raghavendra Rao, Ashwini Turai, P Prabha, R Shreyavathi, Karuna Harsoor
June 2016, 60(6):398-402
DOI:10.4103/0019-5049.183395  PMID:27330201
Background and Aims: Combined spinal–epidural (CSE) anaesthesia is being increasingly used for effective post-operative analgesia. This study was designed to evaluate the effect of epidural clonidine on characteristics of spinal anaesthesia for gynaecological surgeries. Methods: This was a prospective randomised, double-blind, controlled study involving sixty patients belonging to American Society of Anesthesiologists Physical Status I and II who underwent gynaecological surgeries were randomly divided into clonidine (C) group and saline (S) group of thirty each. All patients received CSE anaesthesia. Ten minutes before subarachnoid block (SAB), Group C received clonidine 150 μg diluted to 5 ml in normal saline (NS) and Group S received NS epidurally. Hyperbaric bupivacaine (15 mg) was administered intrathecally for both groups after epidural injection. Sensory and motor block characteristics, analgesia, sedation and haemodynamics were observed. Statistical analysis was performed using appropriate tests. Results: Epidural clonidine produced faster onset (37.83 ± 8.58 s in Group C compared to 50.33 ± 8.80 s in Group S, P = 0.001) and prolonged duration of sensory block (241.17±18.65 minutes in group C compared to 150.33±19.16 minutes in group S, P = 0.001). Time for two segment regression of sensory block was193.67 ± 19.82 min in Group C and 109.33 ± 18.56 min Group S (P < 0.001). The duration of analgesia was 299.00 ± 43.38 min in Group C and 152.50 ± 21.04 min in Group S (P < 0.001). Haemodynamics and sedation scores were comparable between two groups. Conclusion: Administration of clonidine epidurally, 10 min before SAB, caused early onset and prolonged duration of motor blockade and analgesia, without any significant post-operative complication.
  3,098 682 1
Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries
Niveditha Padma Meenakshi Karuppiah, Sumalatha R Shetty, Krishna Prasad Patla
June 2016, 60(6):409-414
DOI:10.4103/0019-5049.183394  PMID:27330203
Background and Aims: Caudal block (CB) with adjuvants is routinely used in children for anaesthesia. We evaluated the efficacy of the α2 adrenergic agonist, dexmedetomidine at two different doses as an adjuvant to bupivacaine in CB. Methods: This study was conducted on ninety children. Control group BD0 received 0.25% bupivacaine 1 ml/kg, whereas, the study groups BD1 and BD2 received 1 μg/kg and 2 μg/kg dexmedetomidine, respectively, with 0.25% bupivacaine 1 ml/kg as a single shot CB. Adequacy of the block, haemodynamic changes, duration of analgesia and side effects were compared. Analysis of Variance was used for between-group comparisons of numerical variables. Student's t-test and Mann–Whitney U-test were used for quantitative data. Results: The demography was comparable. Anal sphincter 5 min after administration of the CB was relaxed in 89.3%, 82.1% and 75% of cases in BD0, BD1 and BD2 groups, respectively. The sphincter was relaxed at the end of surgery in all the cases. Comparable haemodynamics was noted with significantly prolonged duration of analgesia in the groups BD1 (964.2 ± 309 min) and BD2 (1152.6 ± 380.4 min) compared to control (444.6 ± 179.4 min). While no complications were encountered in groups BD0 and BD1, bradycardia was observed in four cases of BD2 group with accompanied hypotension in one of them. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine improves the quality of CB, provides good operating conditions and increases the duration of post-operative analgesia. We conclude that 1 μg/kg is as effective as 2 μg/kg of dexmedetomidine and with a better safety profile.
  3,110 607 1
Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
Arindam Kumar Hazra, Dipasri Bhattacharya, Sayantan Mukherjee, Santanu Ghosh, Manasij Mitra, Mohanchandra Mandal
June 2016, 60(6):388-392
DOI:10.4103/0019-5049.183391  PMID:27330199
Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively,P< 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques.
  3,005 637 3
CASE REPORTS
Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge
Shruti Redhu, Prabhakar Suman Prakash, Virendra Jain, Hari Hara Dash
June 2016, 60(6):420-423
DOI:10.4103/0019-5049.183388  PMID:27330205
Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.
  2,647 807 -
ORIGINAL ARTICLES
Effect of addition of dexmedetomidine to ropivacaine 0.2% for femoral nerve block in patients undergoing unilateral total knee replacement: A randomised double-blind study
Bhawana Sharma, Sunny Rupal, Adarsh Chandra Swami, Sneh Lata
June 2016, 60(6):403-408
DOI:10.4103/0019-5049.183392  PMID:27330202
Background and Aims: Total knee replacement (TKR) patients experience considerable post-operative pain. We evaluated whether addition of perineural dexmedetomidine to ropivacaine 0.2% in the femoral nerve block would enhance post-operative analgesia in patients undergoing unilateral TKR under spinal anaesthesia. Methods: Fifty patients were allocated randomly to two groups of 25 each. Group D received ropivacaine (0.2%) with dexmedetomidine (1.5 μg/kg), and Group C received ropivacaine (0.2%) with normal saline. Pain scores, time to the first request for analgesia and total consumption of ropivacaine in 48 h, along with haemodynamic parameters and sedation scores, were recorded. Quantitative data were compared using t-test, categorical data using Chi-square or Fisher's exact test and time variables using ANOVA. Results: The mean pain scores were significantly low till 2 h post-operatively in Group D. Time to the first demand for analgesia after initial loading dose was statistically prolonged in Group D, with mean duration of 346.8 ± 240 min, compared to 150 ± 115.2 min in Group C (P = 0.001). Total local anaesthetic consumption was also decreased over 24 and 48 h in Group D (P = 0.001). Haemodynamically, there was no significant variation in heart rate from their baseline mean values in either group (P > 0.05). However, the drop in systolic and mean blood pressure post-surgery was significant till 4 (P = 0.002) and 8 h (P = 0.02), respectively, in Group D. Group D patients were also significantly more sedated till 4 h post-operatively (P < 0.005). Conclusion: Adding dexmedetomidine to ropivacaine 0.2% in the femoral nerve block in patients undergoing unilateral TKR improves the quality and prolongs the duration of post-operative analgesia.
  2,706 719 2
Comparison of ultrasound imaging in transverse median and parasagittal oblique planes for thoracic epidurals: A pilot study
Rakhi Khemka, Sonal Rastogi, Neha Desai, Arunangshu Chakraborty, Subir Sinha
June 2016, 60(6):377-381
DOI:10.4103/0019-5049.183398  PMID:27330197
Background and Aims: The use of ultrasound (US) scanning to assess the depth of epidural space to prevent neurological complications is established in current practice. In this study, we hypothesised that pre-puncture US scanning for estimating the depth of epidural space for thoracic epidurals is comparable between transverse median (TM) and paramedian sagittal oblique (PSO) planes. Methods: We performed pre-puncture US scanning in 32 patients, posted for open abdominal surgeries. The imaging was done to detect the depth of epidural space from skin (ultrasound depth [UD]) and needle insertion point, in parasagittal oblique plane in PSO group and transverse median plane in TM group. Subsequently, epidural space was localised through the predetermined insertion point by 'loss of resistance' technique and needle depth (ND) to the epidural space was marked. Correlation between the UD and actual ND was calculated and concordance correlation coefficient (CCC) was used to determine the degree of agreement between UD and ND in both the planes. Results: The primary outcome, i.e., the comparison between UD and ND, done using Pearson correlation coefficient, was 0.99 in both PSO and TM groups, and the CCC was 0.93 (95% confidence interval [95% CI]: 0.81–0.97) and 0.90 (95% CI: 0.74–0.96) in PSO and TM groups respectively, which shows a strong positive association between UD and ND in both groups. Conclusion: The use of pre-puncture US scanning in both PSO and TM planes for estimating the depth of epidural space at the level of mid- and lower-thoracic spine is comparable.
  2,505 560 -
LETTERS TO EDITOR
Laparoscopic port as an integral component of endoscopy mask: A novel innovation!
Abinash Patro, Vansh Priya, Rameez Riaz, Ashish Kannaujia
June 2016, 60(6):439-441
DOI:10.4103/0019-5049.183401  PMID:27330213
  1,966 273 -
CASE REPORTS
Anaesthesia management of a case of Jervell and Lange-Nielsen syndrome for minimally invasive bilateral thoracoscopic cervicothoracic sympathectomy
Preety Mittal Roy, Sangeeta Khanna, Yatin Mehta, Ali Z Khan
June 2016, 60(6):424-426
DOI:10.4103/0019-5049.183390  PMID:27330206
Long QT syndrome (LQTS) is an arrhythmogenic cardiac disorder resulting from the malfunction of cardiac ion channels. Patient with LQTS may present with syncope, seizures or sudden cardiac death secondary to polymorphic ventricular tachycardia (VT) or torsades de pointes. Patient may be asymptomatic in the pre-operative period but may develop VT for the first time in operation theatre. We are reporting anaesthetic management of a child with LQTS planned for bilateral thoracoscopic cervicothoracic sympathectomy.
  1,825 289 -
LETTERS TO EDITOR
Ruptured femoral artery pseudoaneurysm: A life-threatening, iatrogenic catastrophe!
Lata M Kulkarni, Shivani M Sirsat
June 2016, 60(6):437-439
DOI:10.4103/0019-5049.183393  PMID:27330212
  1,862 250 -
Curious case of raccoon eye under general anaesthesia
Siri Kandavar, Nita Varghese, Madhu Rao, Shricharith Shetty
June 2016, 60(6):442-443
DOI:10.4103/0019-5049.183382  PMID:27330215
  1,688 284 -
BRIEF COMMUNICATIONS
Anaesthetic management of parturient with malaria and thrombocytopaenia
Ashish Khanna, Naresh Dua, Raminder Sehgal, Jayashree Sood
June 2016, 60(6):429-431
DOI:10.4103/0019-5049.183386  PMID:27330208
  1,539 317 -
Case of isovaleric acidaemia for cataract surgery: Anaesthetic implications
Kalpana Vinod Kelkar, Vaijayanti Nitin Gadre
June 2016, 60(6):427-429
DOI:10.4103/0019-5049.183396  PMID:27330207
  1,575 267 -
LETTERS TO EDITOR
Difficult bag mask ventilation: Catheter mount cap, a cause for concern
Raghu S Thota, Sheila Nainan Myatra
June 2016, 60(6):444-445
DOI:10.4103/0019-5049.183383  PMID:27330216
  1,556 277 -
Intraoperative wandering atrial pacemaker with isoflurane anaesthesia
Sulagna Bhattacharjee, Puneet Khanna, Sumit Bansal, Souvik Maitra
June 2016, 60(6):441-442
DOI:10.4103/0019-5049.183384  PMID:27330214
  1,499 236 -
General anaesthesia for parturients with spondyloepiphyseal dysplasia: Risky but possible!
Sukanya Mitra, Swati Jindal, Richa Saroa, Sanjeev Palta
June 2016, 60(6):435-437
DOI:10.4103/0019-5049.183397  PMID:27330211
  1,451 212 -
Post-operative myocardial infarction complicating donor hepatectomy: Implications for donor safety
Lakshmi Kumar, Pavithra Ramamurthi, Sunil Rajan, Sudhindran Surendran
June 2016, 60(6):433-435
DOI:10.4103/0019-5049.183381  PMID:27330210
  1,389 257 -
Non-islet cell tumour hypoglycaemia: A case report
Sudivya Prashast Sharma, Atul Prabhakar Kulkarni
June 2016, 60(6):432-433
DOI:10.4103/0019-5049.183399  PMID:27330209
  1,404 207 -
COMMENTS ON PUBLISHED ARTICLE
Tracheo-oesophageal fistula with sub-glottic stenosis: Another option for airway management
Renu Sinha, S Shwetha
June 2016, 60(6):447-447
DOI:10.4103/0019-5049.183402  PMID:27330218
  1,351 254 -
Laryngeal mask airway for transsternal thymectomy in myasthenic patients
Mesut Sener
June 2016, 60(6):446-446
DOI:10.4103/0019-5049.183400  PMID:27330217
  1,297 235 -