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   2018| April  | Volume 62 | Issue 4  
    Online since April 11, 2018

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Target controlled infusion total intravenous anaesthesia and Indian patients: Do we need our own data?
Goverdhan Dutt Puri
April 2018, 62(4):245-248
DOI:10.4103/ija.IJA_244_18  PMID:29720748
  6,136 927 -
Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature
Rakesh Garg, Swati Bhan, Saurabh Vig
April 2018, 62(4):254-262
DOI:10.4103/ija.IJA_46_18  PMID:29720750
Surgical resection of the primary tumour with axillary dissection is one of the main modalities of breast cancer treatment. Regional blocks have been considered as one of the modalities for effective perioperative pain control. With the advent of ultrasound, newer interventions such as fascial plane blocks have been reported for perioperative analgesia in breast surgeries. Our aim is to review the literature for fascial plane blocks for analgesia in breast surgeries. The research question for initiating the review was 'What are the reported newer regional anaesthesia techniques (fascial plane blocks) for female patients undergoing breast surgery and their analgesic efficacy?.' The participants, intervention, comparisons, outcomes and study design were followed. Due to the paucity of similar studies and heterogeneity, the assessment of bias, systematic review or pooled analysis/meta-analysis was not feasible. Of the 989 manuscripts, the present review included 28 manuscripts inclusive of all types of published manuscripts. 15 manuscripts directly related to the administration of fascial plane blocks for breast surgery across all type of study designs and cases were reviewed for the utility of fascial plane blocks in breast surgeries. Interfascial blocks score over regional anaesthetic techniques such as paravertebral block as they have no risk of sympathetic blockade, intrathecal or epidural spread which may lead to haemodynamic instability and prolonged hospital stay. This review observed that no block effectively covers the whole of breast and axilla, thus a combination of blocks should be used depending on the site of incision and extent of surgical resection.
  4,646 1,249 -
Ultra-modified rapid sequence induction with transnasal humidified rapid insufflation ventilatory exchange: Challenging convention
Ketan Sakharam Kulkarni, Nandini Dave, Shriyam Saran, Madhu Garasia, Sandesh Parelkar
April 2018, 62(4):310-313
DOI:10.4103/ija.IJA_536_17  PMID:29720758
During positive pressure ventilation, gastric inflation and subsequent pulmonary aspiration can occur. Rapid sequence induction (RSI) technique is an age-old formula to prevent this. We adopted a novel approach of RSI for patients with high risk of aspiration and evaluated it further in patients undergoing laparoscopic surgeries. We believe that, in patients with risk of gastric insufflation and pulmonary aspiration, transnasal humidified rapid-insufflation ventilatory exchange can be useful in facilitating pre- and apnoeic oxygenation till tracheal isolation is achieved.
  4,056 591 -
A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair
Kirti Kamal, Parul Jain, Teena Bansal, Geeta Ahlawat
April 2018, 62(4):292-297
DOI:10.4103/ija.IJA_548_17  PMID:29720755
Background and Aims: Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery. Methods: Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well as the postoperative pain scores were also evaluated. Results: Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II (P = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II (P = 0. 004). Conclusion: USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block.
  3,246 676 -
Current practice patterns of supraglottic airway device usage in paediatric patients amongst anaesthesiologists: A nationwide survey
Ruchi A Jain, Devangi A Parikh, Anila D Malde, Bhuvneshwari Balasubramanium
April 2018, 62(4):269-279
DOI:10.4103/ija.IJA_65_18  PMID:29720752
Background and Aims: Supraglottic airway devices (SGADs) are increasingly being used for airway management in paediatric patients undergoing general anaesthesia. This survey was designed to assess the nationwide practice patterns of SGAD usage in paediatric patients. Methods: A questionnaire of 28 questions was circulated amongst 16,532 members of the Indian Society of Anaesthesiologists through online survey engine Google Forms® and served manually to 500 delegates attending the Asian Society of Paediatric Anaesthesiologists conference 2017. Percentage, mean and standard deviation were calculated using Microsoft Excel 2016 (Redmond, WA, USA). Results: Four hundred and five (2.3%) valid responses were obtained. The most commonly used device was i-gel© (60.74%). Three hundred and four (75.06%) respondents had access to second-generation SGADs. Second-generation devices (60.74%) were more commonly used than first-generation devices (39.26%). Anaesthesiologists utilised SGADs in various challenging scenarios such as in the difficult airway (53.33%), remote locations (55.47%), ophthalmologic (38.77%) and long-duration surgeries (17.53%). Sixty per cent respondents did not use SGADs in laparoscopic surgery. Disposable SGADs were reused by 77.28% respondents. Oropharyngeal seal and intracuff pressures were not measured by 86.91% and 56.92% respondents, respectively. Difficulty in size selection (84.19%), securing position (82.22%) and maintaining unobstructed ventilation (78.76%) were common problems encountered while using SGADs. Conclusion: Although there is a widespread use of second-generation SGADs in Indian paediatric anaesthesia, safe practices such as using capnography, measurement of oropharyngeal seal pressure, cuff pressure and appropriate disinfection are lacking.
  3,028 469 -
Effect site concentration of propofol at induction and recovery of anaesthesia - A correlative dose-response study
Vasanth Sukumar, Arathi Radhakrishnan, Venkatesh H Keshavan
April 2018, 62(4):263-268
DOI:10.4103/ija.IJA_670_17  PMID:29720751
Background and Aims: Sound knowledge about effect site concentration (Ce) of propofol aids in smooth induction, maintenance and early recovery. We studied the correlation between Ce of propofol at loss of response to verbal command and recovery concentration using target-controlled infusion (TCI) in Indian patients who underwent spine surgeries. Methods: Ninety patients undergoing spine surgeries were included. Total intravenous anaesthesia (TIVA) technique with TCI for propofol using modified Marsh model was used. Entropy and neuromuscular transmission were used. Ce at induction and recovery and the corresponding state entropy (SE) values were noted. Results: The mean propofol Ce and SE at induction were 2.34 ± 0.24 μg/ml and 52 ± 8, respectively. The mean propofol Ce and SE at recovery were 1.02 ± 0.22 μg/ml and 86.80 ± 2.86, respectively. The Ce at recovery was approximately 50% of the induction value. The correlation coefficient 'r' between Ce at induction and recovery was 0.56. The mean infusion dose of propofol during the maintenance period was 81 ± 14.33 μg/kg/min. The average induction dose of propofol was 1.17 ± 0.2 mg/kg. Conclusion: There is a positive correlation between Ce at induction and recovery. Ce for recovery may have to be set at a lower level during TCI-TIVA and appropriately infusion should be stopped for early recovery. The induction and maintenance doses of propofol are lower than the recommended doses. Data emphasise the need for pharmacokinetic model based on our population characteristics.
  2,729 535 -
Use of supraglottic airway devices in paediatric patients in the Indian context – some we know, some we need to know and march ahead
Priyam Saikia
April 2018, 62(4):249-253
DOI:10.4103/ija.IJA_241_18  PMID:29720749
  2,530 467 -
Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study
Mona Blough El Mourad, Asmaa Fawzy Amer
April 2018, 62(4):285-291
DOI:10.4103/ija.IJA_791_17  PMID:29720754
Background and Aims: Pain after modified radical mastectomy (MRM) has been successfully managed with thoracic paravertebral block (TPVB). The purpose of this study was to evaluate the effect of adding dexamethasone or ketamine as adjuncts to bupivacaine in TPVB on the quality of postoperative analgesia in participants undergoing MRM. Methods: This prospective randomised controlled study enrolled ninety adult females scheduled for MRM. Patients were randomised into three groups (30 each) to receive ultrasound-guided TPVB before induction of general anaesthesia. Group B received bupivacaine 0.5% + 1 ml normal saline, Group D received bupivacaine 0.5% + 1 ml dexamethasone (4 mg) and Group K received bupivacaine 0.5% + 1 ml ketamine (50 mg). Patients were observed for 24 h postoperatively to record time to first analgesic demand as a primary outcome, pain scores, total rescue morphine consumption and incidence of complications. Results: Group K had significantly longer time to first analgesic demand than group D and control group (18.0 ± 6.0, 10.3 ± 4.5 and 5.3 ± 3.1 hours respectively; P = 0.0001). VAS scores were significantly lower in group D and group K compared to control group at 6h and 12 h postoperative (p 0.0001 and 0.0001 respectively) while group K had lower VAS at 18 hours compared to other two groups (P = 0.0001). Control group showed the highest mean 24 h opioid consumption (8.9 ± 7.9 mg) compared to group D and group K (3.60 ± 6.92 and 2.63 ± 5.24 mg, P = 0.008,0.001 respectively). No serious adverse events were observed. Conclusion: Ketamine 50 mg or dexamethasone 4 mg added to bupivacaine 0.5% in TPVB for MRM prolonged the time to first analgesic request with no serious side effects.
  2,322 431 -
Anaesthesia for laparoscopic nephrectomy: Does end-tidal carbon dioxide measurement correlate with arterial carbon dioxide measurement?
Nithin Jayan, Jaya Susan Jacob, Mohan Mathew
April 2018, 62(4):298-302
DOI:10.4103/ija.IJA_740_17  PMID:29720756
Background and Aims: Not many studies have explored the correlation between arterial carbon dioxide tension (PaCO2) and end-tidal carbon dioxide tension (ETCO2) in surgeries requiring pneumoperitoneum of more than 1 hour duration with the patient in non-supine position. The aim of our study was to evaluate the correlation of ETCO2with PaCO2in patients undergoing laparoscopic nephrectomy under general anaesthesia. Methods: A descriptive study was performed in thirty patients undergoing laparoscopic nephrectomy from September 2014 to August 2015. The haemodynamic parameters, minute ventilation, PaCO2and ETCO2measured at three predetermined points during the procedure were analysed. Correlation was checked using Pearson's Correlation Coefficient Test. P <0.05 was considered statistically significant. Results: Statistical analysis of the values showed a positive correlation between ETCO2and PaCO2(P < 0.05). Following carbon dioxide insufflation, both ETCO2and PaCO2increased by 5.4 and 6.63 mmHg, respectively, at the end of the 1st hour. The PaCO2-ETCO2gradient was found to increase during the 1st hour following insufflation (4.07 ± 2.05 mmHg); it returned to the pre-insufflation values in another hour (2.93 ± 1.43 mmHg). Conclusion: Continuous ETCO2monitoring is a reliable indicator of the trend in arterial CO2fluctuations in the American Society of Anesthesiologists Grades 1 and 2 patients undergoing laparoscopic nephrectomy under general anaesthesia.
  2,205 341 -
Comparison of landmark versus pre-procedural ultrasonography-assisted midline approach for identification of subarachnoid space in elective caesarean section: A randomised controlled trial
Sangeeta Dhanger, Stalin Vinayagam, Bhavani Vaidhyanathan, Idhuyya Joseph Rajesh, Debendra Kumar Tripathy
April 2018, 62(4):280-284
DOI:10.4103/ija.IJA_488_17  PMID:29720753
Background and Aims: Identification of subarachnoid space in pregnant patients can pose a great challenge to anaesthesiologists. This study was designed to compare conventional landmark technique with pre-procedural ultrasonography-assisted midline approach for identification of the subarachnoid space in elective caesarean section. Methods: After institute ethics committee approval and written informed consent, 100 parturients scheduled for elective caesarean section under spinal anaesthesia were included in this prospective randomised control trial and divided into Group L (n = 50) (landmark technique) and Group U (n = 50) (ultrasound-guided technique). Parameters such as time taken for the identification of the interspace, distance between skin and dura mater, number of insertion attempts (the primary outcome), number of passes and time taken were recorded in both the groups. Statistical analysis was done using SPSS software 16. Results: Demographic profiles of both groups were comparable. The number of attempts for needle insertion (1.04 ± 0.19 vs. 1.97 ± 0.77), number of passes in the same interspinous space (1.26 ± 0.44 vs. 1.90 ± 0.51) and the total time for successful lumbar puncture (31.90 ± 6.30 vs. 51.80 ± 12.28 s) were significantly less in Group U as compared to Group L, but the time of identification of interspinous space was significantly more in Group U (56.70 ± 13.08 s) as compared to Group L (47.10 ± 10.45 s). Conclusion: Pre-procedural ultrasound is a useful tool for successful lumbar puncture in parturients as it reduces the number of attempts with fewer side effects as compared to conventional landmark technique.
  2,035 400 -
Unusual adverse effect of dexmedetomidine and its management
Sathishkumar Selvaraj, Sakthirajan Panneerselvam
April 2018, 62(4):317-318
DOI:10.4103/ija.IJA_66_18  PMID:29720761
  1,938 419 -
Bilateral transmuscular quadratus lumborum block performed in single lateral decubitus position without changing position to the contralateral side
Ashok Jadon, Priyanka Jain, Lavina Dhanwani
April 2018, 62(4):314-315
DOI:10.4103/ija.IJA_750_17  PMID:29720759
  1,804 249 -
Sono-anatomical analysis of right internal jugular vein and carotid artery at different levels of positive end-expiratory pressure in anaesthetised paralysed patients
Girijapati Machanalli, Amar P Bhalla, Dalim Kumar Baidya, Devalina Goswami, Praveen Talawar, Rahul Kumar Anand
April 2018, 62(4):303-309
DOI:10.4103/ija.IJA_716_17  PMID:29720757
Background and Aims: Increasing the cross-sectional area (CSA) of the internal jugular vein (IJV) improves the success rate of cannulation and decreases complications. Application of positive end-expiratory pressure (PEEP) may increase the CSA of IJV beyond that achieved in Trendelenburg position. However, the optimum PEEP to achieve maximal increase in CSA of IJV and the effect of PEEP on IJV and CA relationship is not known. Methods: In this prospective, blinded, randomised controlled study, 120 anesthetised paralysed patients of the American Society of Anesthesiologists physical Status I–II were placed in 20° Trendelenburg position. Patients were randomised into four groups as follows: PEEP of 0, 5, 10 and 15 cmH2O. CSA, anteroposterior (AP) diameter and transverse diameter (Td) of IJV and overlapping of IJV with CA were assessed using two-dimensional ultrasound. Statistical analysis was performed in SPSS version 21.0 software using Chi-square/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests and P < 0.05 was considered statistically significant. Results: There was significant increase in AP diameter, CSA and Td with the application of PEEP 10–15 cmH2O. Increase in CSA up to 25% with PEEP 10 and 44% with PEEP 15 was noted. There was a significant decrease in the overlapping of the internal CA with an increase in PEEP. It ranged from 21% at P0 to 17% P15. Conclusion: Application of PEEP 10–15 cmH2O in Trendelenburg position significantly increased CSA and AP diameter of IJV and decreased CA overlap of IJV in anesthetised paralysed patients.
  1,670 254 -
Post-operative seizures after spine surgery: A dilemma
Ashutosh Kaushal, Subodh Kumar, Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
April 2018, 62(4):315-317
DOI:10.4103/ija.IJA_786_17  PMID:29720760
  1,573 207 -
Tracheostomy over Ambu® Aura40™ in cannot intubate situation due to effects of chemoradiation
Prashant Sirohiya, Vinod Kumar, Rakesh Garg, Nishkarsh Gupta
April 2018, 62(4):319-320
DOI:10.4103/ija.IJA_11_18  PMID:29720762
  1,199 211 -
Should single medial canthus injection be the default option for peribulbar blocks?
Santhana G Kannan
April 2018, 62(4):321-322
DOI:10.4103/ija.IJA_45_18  PMID:29720763
  1,242 142 -
Safer methods of ophthalmic block
Renu Sinha, Kanil Ranjith Kumar
April 2018, 62(4):323-323
DOI:10.4103/ija.IJA_220_18  PMID:29720764
  1,155 188 -
The link between pulmonary hypertension and adverse renal transplant outcome may be renal venous hypertension
Hilary P Grocott
April 2018, 62(4):324-324
DOI:10.4103/ija.IJA_154_18  PMID:29720765
  989 142 -
Reply to 'The link between pulmonary hypertension and adverse renal transplant outcome may be renal venous hypertension'
Sohan Lal Solanki, Vipin Kumar Goyal, Birbal Baj
April 2018, 62(4):325-325
DOI:10.4103/ija.IJA_179_18  PMID:29720766
  991 134 -