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1.  CASE REPORT
A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block
Sindil Kumar Sahu, Usha Badole
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:30-31] [No of Hits : 376]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0008 | FREE

ABSTRACT

Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block.

Keywords: Recurrent laryngeal nerve palsy, Supraclavicular brachial plexus block, Ultrasound guidance.

How to cite the article: Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.

Source of support: Nil

Conflict of interest: None

 
2.  CASE REPORT
Left Ventricular Rupture during Balloon Mitral Valvuloplasty
Tazeen Sarguroh, Dipti Kotwani, Shakuntala Basantwani, Bharati Tendolkar
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:28-29] [No of Hits : 335]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0007 | FREE

ABSTRACT

Balloon mitral valvuloplasty (BMV) is a viable alternative to valve replacement surgery in patients with mitral stenosis. One of the rare complications of the procedure requiring immediate resuscitation and surgical repair is cardiac tamponade due to ventricular rupture. We report the anesthetic management of a 38 year old female with hemopericardium during BMV due to left ventricular rupture.

Keywords: BMV, Capnography, Electrocardiogram, Left ventricular rupture.

How to cite this article: Sarguroh T, Kotwani D, Basantwani S, Tendolkar B. Left Ventricular Rupture during Balloon Mitral Valvuloplasty. Res Inno Anaesth 2016;1(1):28-29.

Source of support: Nil

Conflict of interest: None

 
3.  ORIGINAL ARTICLE
Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 µg vs Sufentanyl 5 µg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries
Sanjeeta R Umbarkar, Manju N Gandhi, Hemlata R Iyer, Roshan S Thawale
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:1-4] [No of Hits : 298]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0001 | FREE

ABSTRACT

Aim: To compare the efficacy and safety of intrathecal fentanyl 20 µg vs sufentanil 5 µg as adjuvant to bupivacaine 0.5% (12.5 mg) using combined spinal epidural (CSE) technique for lower limb orthopedic surgeries.

Background: Use of local anesthetics along with opioids intrathecally has been widely reported. We aimed to compare two commonly used opioids as adjuvants to local anesthetic agents in combined spinal epidural techniques.

Materials and methods: A total of 60 patients were recruited in this prospective, randomized, double-blind study to receive either intrathecal sufentanil 5 µg (Group S) or fentanyl 20 µg (Group F) as adjuvants to 12.5 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block and the pain scores were assessed perioperatively. Duration of analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering. and postdural puncture headache (PDPH) were recorded.

Results: Demographic data and hemodynamic and respiratory parameters were comparable in both the groups. Onset of analgesia-time to reach highest level of analgesia-was faster in the sufentanil group. Sufentanil group patients had higher grade of motor block. Patients in fentanyl group had higher score of sedation than those of sufentanil group. None of the patients in any group had nausea, vomiting, or pruritus.

Conclusion: Addition of either fentanyl or sufentanil to intrathecal bupivacaine as an adjuvant in CSE technique enhances the quality of analgesia and motor block with minimal side effects. Hence, this is useful in orthopedic patients, especially in the geriatric age group.

Keywords: Combined spinal epidural technique, Fentanyl, Intrathecal adjuvant, Lower limb surgeries, Sufentanil.

How to cite this article: Umbarkar SR, Gandhi MN, Iyer HR, Thawale RS. Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 µg vs Sufentanil 5 µg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries. Res Inno Anaesth 2016;1(1): 1-4.

Source of support: Funding by Research Society of TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India

Conflict of interest: None

 
4.  ORIGINAL ARTICLE
A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions
Hemangi S Karnik, Aparna A Nerurkar, Nishant Bawankule
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:19-24] [No of Hits : 266]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0005 | FREE

ABSTRACT

Background: Neurosurgical patients are operated in supine, prone, lateral, and sitting positions, which cause physiological changes in cardiorespiratory parameters. Noninvasive cardiac output (NICO) monitor developed by Novametrix Medical System Inc is a noninvasive cardiac output monitor, which also measures and displays other parameters like stroke volume, cardiac index, pulmonary capillary blood flow, alveolar and dead space ventilation, peak flow rates, airway pressures, and respiratory volumes. We felt that a study using the NICO monitor in anesthetized patients undergoing neurosurgery in different positions would quantify the cardiopulmonary changes, identify risk factors, and improve intraoperative management.

Materials and methods: A total of 40 consecutive patients undergoing neurosurgical procedures-20 in prone, 16 in lateral and 4 in sitting position-were studied. The hemodynamic and cardiorespiratory parameters were noted in supine position about 15 minutes after induction of general anesthesia using standard protocol and 15 minutes after giving surgical position using NICO monitor.

Conclusion: We conclude that under anesthesia, the prone and sitting positions negatively affect derived cardiac parameters like cardiac output, cardiac index, and stroke volume, and lateral position tends to improve these parameters while the respiratory parameters are not significantly affected.

Keywords: Lateral position, Neurosurgery, NICO monitor, Noninvasive cardiac output, Positioning under anesthesia, Prone position, Sitting position.

How to cite this article: Karnik HS, Nerurkar AA, Bawankule N. A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions. Res Inno Anaesth 2016;1(1):19-24.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries
Naina P Dalvi, Narendra Patil
[Year:2016] [Month:July-December] [Volume:1 ] [Number:2] [Pages:40] [Pages No:35-40] [No of Hits : 254]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0010 | FREE

ABSTRACT

Introduction: This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanyl-bupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries.

Materials and methods: Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine +0.5 mL (25 µg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine +0.5 mL (25 mg) of tramadol (group T) intrathecally.
Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals.

Results: Sixty patients were randomized to the group F (n=30) and group T (n=30). The duration of sensory blockade was significantly prolonged in group F (314.66±49.25 minutes) as compared to group T (261.66±27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66±40.97 minutes) compared to group T (214.66±26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301±38.75 minutes).
Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients.

Discussion: Fentanyl 25 µg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia.

Keywords: Fentanyl, Intrathecal adjuvant, Postoperative analgesia, Tramadol.

How to cite this article: Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

Source of support: Nil

Conflict of interest: None.

 
6.  CASE REPORT
Convulsion on Table in an American Society of Anesthesiologists Grade I Pregnant Patient Posted for Emergency Cesarean Section: Anesthesia Management
Anjana Wajekar, Manisha Taware, Uma Kamat
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:25-27] [No of Hits : 252]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0006 | FREE

ABSTRACT

Convulsions occurring on the operating table in any patient, especially a pregnant patient, can be a nightmare. Initial management with regard to airway, breathing, and anticonvulsants remains the same. The differential diagnosis includes eclampsia, hypoglycemia, peripartum cerebrovascular thrombosis, subarachnoid hemorrhage, infection, intracranial tumor, head injury, idiopathic epilepsy, vasculitis, amniotic fluid embolism, etc. Magnetic resonance imaging of the brain of our patient revealed posterior reversible encephalopathy syndrome, a neuroradiological diagnosis. Management is supportive with anticonvulsants, cerebral decongestants, and treating the underlying cause including blood pressure control and early cesarean section. There is a small risk of permanent neurological damage or death.

Keywords: Cesarean section, Convulsions, Posterior reversible encephalopathy syndrome.

Abbreviations: Amniotic fluid embolism - AFE; Posterior reversible encephalopathy syndrome - PRES; American Society of Anesthesiologists - ASA; G2P1L1 - Gravida 2, para 1, live birth 1

How to cite this article: Wajekar A, Taware M, Kamat U. Convulsion on Table in an American Society of Anesthesiologists Grade I Pregnant Patient Posted for Emergency Cesarean Section: Anesthesia Management. Res Inno Anaesth 2016;1(1): 25-27.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block
Naina P Dalvi, Harshali Salunkhay, Shubha N Mohite
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:5-9] [No of Hits : 249]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0002 | FREE

ABSTRACT

Introduction: This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block.

Materials and methods: Patients of either sex, aged 18-60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 µg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine- bupivacaine-midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine-bupivacaine (LB).
Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score.

Results: A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively.

Conclusion: In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia.

Keywords: Brachial plexus block, Midazolam in local anesthetics, Postoperative analgesia.

How to cite this article: Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine- Bupivacaine vs only Lignocaine-Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
Pneumothorax in a Patient Posted for Cervical Spine Surgery
Naina P Dalvi, Nilam D Virkar
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:32-34] [No of Hits : 233]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0009 | FREE

ABSTRACT

A 54-year-old female posted for cervical laminectomy was started on antihypertensive drugs on admission. Magnetic resonance imaging showed cervical degeneration with posterior disk herniation at C3-C4 and disk bulge at L5-S1. After attaching the monitors, patient was premedicated and anesthetized. During mask ventilation, abdomen gradually distended. After intubation under vision, reduced air entry on right side and increased resistance was felt during manual ventilation. Salbutamol puff was given through endotracheal tube. Still air entry remained decreased on right side. X-ray and C-arm showed right-sided pneumothorax. Inter-costal drainage (ICD) was inserted in right 5th intercostal space in midaxillary line. Post-ICD X-ray showed significant expansion of right lung. Patient was ventilated and extubated after 4 hours. Highresolution computerized tomography confirmed the diagnosis. Surgery was rescheduled. On the 8th day, patient developed purulent drainage through ICD in the ward. She was diagnosed to have pulmonary Koch’s and was treated successfully.

Keywords: Laminectomy, Tension pneumothorax, Tuberculosis.

How to cite this article: Dalvi NP, Virkar ND. Pneumothorax in a Patient Posted for Cervical Spine Surgery. Res Inno Anaesth 2016;1(1):32-34.

Source of support: Nil

Conflict of interest: None

 
9.  Editorial
The Anesthesiologist as a Medical Teacher
SK Gvalani
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:iv] [No of Hits : 225]
Full Text PDF | Abstract | FREE

ABSTRACT

The Anesthesiologist as a Medical Teacher

The primary responsibility of the anesthesiologist is patient care. The training of students is an equally crucial and demanding task. Most of us as clinicians have no formal training in teaching. The medical education units attached to the medical colleges try to fill this lacuna. The importance of such training has increased as society needs selfless dedicated doctors.

 
10.  ORIGINAL ARTICLE
Randomized Prospective Study of Comparison of Intravenous Lornoxicam and Intravenous Fentanyl for Intraoperative and Postoperative Analgesia in Minor to Moderate Ear, Nose and Throat Surgeries
Yogita Patil, Priyanka Karnik, Madhu Garasia
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:10-14] [No of Hits : 210]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0003 | FREE

ABSTRACT

Introduction: In day care ear, nose, and throat (ENT) surgeries, patients are admitted and discharged on the same day, provided they are free of anesthetic and surgical side effects. In this prospective randomized study, we compared the perioperative analgesic efficacy and side effects like nausea, sedation, and respiratory depression 24 hours postsurgery with use of lornoxicam and fentanyl.

Background: Although opioids are traditionally used in managing postoperative pain, their side effects like nausea, respiratory depression, sedation, constipation, urinary retention, and itching limit their use. This may result in delayed discharge and prolonged hospital stay in day care surgery. Nonsteroidal anti-inflammatory drugs have central and peripheral analgesic effects, anti-inflammatory properties, and relatively better tolerability with few side effects.1,2.

Materials and methods: After institutional Ethics Committee approval, 100 patients were randomly allocated into two groups (50 each). Various parameters like intraoperative heart rate, blood pressure, postoperative pain, analgesic requirement, respiratory depression, sedation, and nausea scores were studied.

Statistical analysis: Analysis of quantitative data with unpaired t-test and qualitative data with chi-square test.

Results: The heart rate was higher in the fentanyl group (B) than in the lornoxicam group (A) during reversal and extubation, with p-value <0.05. The visual analog scale scores were higher in group (B) than in group (A), with p value <0.05 for 2 hours. Need for rescue analgesia was more in group (B) with 51 patients within hour of surgery and 11 patient in group (A) up to 8 hours postsurgery. The p values for nausea scores were 0.0001, 0.0011, and 0.0001 at 30 min, 1 hour, and 2 hours, respectively, and were higher in group (B).The p value for sedation score was 0.002. The respiratory rate was lower in group (B) up to 8 hours postsurgery.

Conclusion: Lornoxicam has good intraoperative and better postoperative analgesia as compared with fentanyl in minor to moderate ENT surgeries. The need for rescue analgesia is less in lornoxicam group. Lornoxicam was also found to have a lower incidence of side effects like nausea, sedation, and respiratory depression.

Keywords: Fentanyl, Lornoxicam, Minor to moderate surgery, Respiratory depression.

How to cite this article: Patil Y, Karnik P, Garasia M. Randomized Prospective Study of Comparison of Intravenous Lornoxicam and Intravenous Fentanyl for Intraoperative and Postoperative Analgesia in Minor to Moderate Ear, Nose, and Throat Surgeries. Res Inno Anaesth 2016;1(1):10-14.

Source of support: Nil

Conflict of interest: None

 
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