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ORIGINAL RESEARCH
Meenoti P Potdar, Ajay Tomar, Laxmi Kamat

Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective Randomized, Single-blinded Controlled Study

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:51-57][No of Hits : 725]


ABSTRACT

Aim: The primary aim of the study was to compare epidural ropivacaine with fentanyl and epidural bupivacaine with fentanyl for postoperative epidural analgesia after total knee arthroplasty (TKA). The secondary objective was to assess the outcomes of passive and active mobilizations postoperatively, requirement of rescue analgesia, and adverse effects, such as nausea vomiting, sedation, numbness, motor weakness, hypotension, and respiratory depression.

Materials and methods: After obtaining hospital ethics committee approval and written informed consent, 100 patients were randomly allocated to two groups of 50 each. Group B received 0.125% bupivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Group R received 0.2% ropivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Patients of American Society of Anesthesiologists (ASA) grades I to II of both sexes undergoing elective TKA and giving written consent were included in the study. Patients with coagulation disorders, history of spine surgery, vertebral deformities, and having contraindications for spinal analgesia were excluded from the study. All patients were preoperatively assessed and clinically evaluated thoroughly. They received conventional combined spinal epidural anesthesia followed by epidural infusion in the postoperative period of ropivacaine fentanyl or bupivacaine fentanyl as per the allocation. The postoperative epidural analgesia was supplemented with intravenous (IV) paracetamol 1 gm TDS, and rescue analgesia, if needed, was given with IV tramadol 50 mg. All patients were monitored for postoperative pain by the visual analog scale (VAS), requirement of rescue analgesia, hemodynamic parameters, sedation scores, and adverse effects.

Keywords: Bupivacaine, Epidural, Fentanyl, Ropivacaine, Total knee arthroplasty.

How to cite this article: Potdar MP, Tomar A, Kamat L. Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective, Randomized, Single-blinded Controlled Study. Res Inno in Anesth 2017;2(2):51-57.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sindil Kumar Sahu, Usha Badole

A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:30-31][No of Hits : 1468]


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


 
ORIGINAL ARTICLE
Naina P Dalvi, Narendra Patil

Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:35-40][No of Hits : 1104]


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.


 
CASE REPORT
Naina P Dalvi, Nilam D Virkar

Pneumothorax in a Patient Posted for Cervical Spine Surgery

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:32-34][No of Hits : 1030]


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


 
CASE REPORT
Tazeen Sarguroh, Dipti Kotwani, Shakuntala Basantwani, Bharati Tendolkar

Left Ventricular Rupture during Balloon Mitral Valvuloplasty

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:28-29][No of Hits : 604]


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


 
ORIGINAL ARTICLE
Johann Mathew, SK Gvalani

Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:41-44][No of Hits : 600]


ABSTRACT

Background: Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation.

Study design: Prospective observational study.

Materials and methods: About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience.

Statistical analysis used: Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test.

Results: The incidence of difficult intubation determined by the IDS (=5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of =5 gives high false positive for our population.

Keywords: Airway management, Difficult tracheal intubation, Obesity.

How to cite this article: Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

Source of support: Nil

Conflict of interest: None.


 
ORIGINAL ARTICLE
Sanjeeta R Umbarkar, Manju N Gandhi, Hemlata R Iyer, Roshan S Thawale

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

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:1-4][No of Hits : 578]


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


 
ORIGINAL ARTICLE
Shilpa S Bhojraj, Rajashree D Agaskar, Savi J Kapila, Shital K Patil, Ali A Behranwala

Effect of Single-dose Preoperative Pregabalin on Postoperative Pain after Cardiac Surgery: A Prospective Observational Randomized Double-blind Study

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:4-8][No of Hits : 469]


ABSTRACT

Aim and objective: We evaluated the effect of preoperative single-dose pregabalin (PG) on postoperative pain in patients undergoing on-pump coronary artery bypass graft (CABG) surgery.

Materials and methods: In this double-blind study, 60 adult patients scheduled for elective on-pump CABG surgery were randomized into two groups of 30 each, viz., PG and placebo (PL). Patients received either oral PG 150 mg or a PL, 1 hour before surgery. All patients received general anesthesia. Postoperative pain relief was provided with intravenous tramadol 50 mg 8 hourly. Postoperative pain was assessed, both at rest and during coughing, with the 10-point verbal rating scale (VRS) at 6, 12, 18, and 24 hours after extubation. Time to extubation, pain scores, requirement of additional analgesics, and adverse effects were compared using chi-square test, unpaired t test, and Mann-Whitney U test.

Results: The time to extubation was significantly prolonged in the PG group compared with PL (9.84 ± 1.88 vs 8.66 ± 2.12 hours, p = 0.027). The mean VRS scores at rest and during coughing were significantly lower in the PG group compared with PL (p < 0.05). However, the requirement of additional analgesics, such as paracetamol or tramadol was similar in the two groups.

Conclusion: A single preoperative oral dose of PG 150 mg was effective in reducing postoperative pain in patients undergoing on-pump CABG compared with a PL.

Keywords: On-pump coronary artery bypass graft, Postoperative pain, Preemptive analgesia, Pregabalin.

How to cite this article: Bhojraj SS, Agaskar RD, Kapila SJ, Patil SK, Behranwala AA. Effect of Single-dose Preoperative Pregabalin on Postoperative Pain after Cardiac Surgery: A Prospective Observational Randomized Double-blind Study. Res Inno in Anesth 2017;2(1):4-8.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Valmik Avhad, Shrikanta Oak, Anita Shetty

Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:9-13][No of Hits : 401]


ABSTRACT

This was a prospective randomized study comparing the safety and efficacy of ProSeal laryngeal mask array (PLMA) vs endotracheal intubation (ETT) in gynecological laparoscopic surgeries undertaken in 80 patients with American Society of Anesthesiologist I and II divided into two groups. The parameters assessed were insertion characteristics, hemodynamic response to insertion, gastric distension, and perioperative complications.
The demographic data were comparable. The first-time success rate was slightly higher for PLMA than for ETT. The time required for achieving effective airway was longer in ETT than in PLMA (25.6 ± 8.1 seconds for ETT vs 18.2 ± 5 seconds for PLMA).
The hemodynamic response to intubation/insertion was more in ETT group than in PLMA group, i.e., there was more rise in pulse rate and mean arterial pressure following ETT than PLMA insertion.
Intraoperatively, no episodes of laryngospasm, bronchospasm, desaturation, and inadequate ventilation were observed in both the groups. Postoperatively, sore throat complaints were observed more with ETT than with PLMA.

Keywords: Endotracheal tube, Hemodynamic parameters, Laparoscopic surgery, ProSeal laryngeal mask array.

How to cite this article: Avhad V, Oak S, Shetty A. Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy. Res Inno in Anesth 2017;2(1):9-13.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sweta Salgaonkar, Anjana S Wajekar, Aditi Lakhotia

A Prospective, Pre- and Post-comparative Study to assess Knowledge about Medical Writing

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:1-3][No of Hits : 356]


ABSTRACT

Background: Medical writing is an important component of any research starting with writing a research protocol up to its culmination into presentations and publications. In spite of numerous mandatory academic projects being undertaken in India, the research output in peer-reviewed journals remains low. Lack of proficiency in medical writing has been cited as one of the important causes for same. We conducted a pre and post continued medical education (CME) multiple choice question (MCQ) questionnaire test to assess the baseline knowledge of the participants in this field and observe their improvement after the CME.

Materials and methods: 210 medical students and faculty from various medical disciplines participated in the workshop. Responses to a 15 item validated MCQ questionnaire under various headings such as literature search, spectrum of formats, statistics, references and reporting were collected from the participants of the CME.

Results: 40.48% of the participants responded for pre-CME questionnaire forms and 36.67% for the post-CME questionnaire forms. In the post-CME questionnaire, a vast improvement was obtained in almost all questions, observed most prominently in the sections on literature search, referencing and reporting guidelines.

Conclusion: Training programs in medical writing should be included as a part of the curriculum from undergraduate days. Till the time that this becomes a reality, we should continue to equip ourselves with good medical writing skills by organizing such educative programs.

Keywords: Publications, Medical writing, Questionnaire, Research.

How to cite this article: Salgaonkar S, Wajekar AS, Lakhotia A. A Prospective, Pre- and Post-comparative Study to assess Knowledge about Medical Writing. Res Inno in Anesth 2017;2(1):1-3.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Priti Devalkar, Sweta Salgaonkar, Vasundhara V Dhale

Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:18-20][No of Hits : 332]


ABSTRACT

The pregnant patient with sickle hemoglobinopathy (SCD) and mitral stenosis (MS) presenting for emergency lower (uterine) segment cesarean section (LSCS) represents a challenge to the anesthesiologist. In such a case, the choice of anesthesia is dependent on the patient’s clinical condition, urgency of surgery, and the reports of laboratory investigations. An understanding of physiological changes in pregnancy and the pathological impact of MS and SCD on pregnancy will help the administration of safe anesthesia for mother and baby. We have discussed the management of a pregnant patient with SCD and MS for emergency LSCS.

Keywords: Emergency lower (uterine) segment cesarean section, Mitral stenosis, Sickle hemoglobinopathy.

How to cite this article: Devalkar P, Salgaonkar S, Dhale VV. Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section. Res Inno in Anesth 2017;2(1):18-20.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Apeksha A Gala, Pritee H Bhirud, Shrividya Chellam

Intravenous Dexamethasone and Its Effect on Blood Glucose in Adult Nondiabetic Patients undergoing General Anesthesia for Superficial Surgery

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:64-67][No of Hits : 308]


ABSTRACT

Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV). It also has significant postoperative analgesic benefits. In spite of these advantages, it is seen that intravenous (IV) dexamethasone may affect the blood glucose profile of the patient and healing of wounds. We have studied the effects of IV dexamethasone administered at induction on blood glucose concentrations in adult, nondiabetic patients under general anesthesia (GA) for superficial surgeries, e.g., ear surgeries, breast surgeries, and hernia surgeries.

Keywords: Blood glucose concentration, Intravenous dexamethasone, Nondiabetic adult patients, Superficial surgery.

How to cite this article: Gala AA, Bhirud PH, Chellam S. Intravenous Dexamethasone and Its Effect on Blood Glucose in Adult Nondiabetic Patients undergoing General Anesthesia for Superficial Surgery. Res Inno in Anesth 2017;2(2):64-67.

Source of support: Nil

Conflict of interest: Nil


 
SHORT COMMUNICATION
Vaishali S Badge, FM Ashiqe

Survey of Glycemic Control Protocols in Cardiac Surgery Intensive Care Units

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:24-25][No of Hits : 273]


ABSTRACT

Perioperative Hyperglycaemia can lead to sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias, increased ICU and hospital stay. The different centres follow different protocols to treat hyperglycaemia and still there is a controversy regarding the tight sugar control protocol. This survey was carried out to find the appropriate protocol regarding glycaemic control in various centres in UK.

Keywords: Hyperglycaemia, Sugar control protocol.

How to cite this article: Badge VS, Ashiqe FM. Survey of Glycemic Control Protocols in Cardiac Surgery Intensive Care Units. Res Inno in Anesth 2017;2(1):24-25.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Banashree Mandal, Deeksha Katoch, Sabia Handa

Management of a Case of Dropped Nucleus following Small Incision Cataract Surgery in a Patient with Thoracic Kyphoscoliosis and Review of Literature

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:21-23][No of Hits : 257]


ABSTRACT

A curved spine accompanied by restricted neck motion poses a challenge for an ophthalmic surgeon, especially a vitreoretinal surgeon, who needs the patient’s eyes in a horizontal position to operate with the microscope. Literature is sparse with case reports of thoracic kyphoscoliosis for vitreoretinal surgery, although many reports are available for cataract surgery. We report a case of thoracic kyphoscoliosis and ankylosing spondylitis with dropped nucleus into the vitreous cavity following a complicated cataract surgery posted for pars plana vitrectomy, pars plana lensectomy, and phacofragmentation under general anesthesia and review the current literature of such case.

Keywords: Extreme positioning, General anesthesia, Thoracic kyphoscoliosis, Vitreoretinal surgery.

How to cite this article: Mandal B, Katoch D, Handa S. Management of a Case of Dropped Nucleus following Small Incision Cataract Surgery in a Patient with Thoracic Kyphoscoliosis and Review of Literature. Res Inno in Anesth 2017;2(1):21-23.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Aarti Kulkarni, Paulomi Dey

Comparison between Clinical Efficacies of Levobupivacaine Plain and Levobupivacaine with Fentanyl for Urological Surgeries under Subarachnoid Block

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:34-39][No of Hits : 252]


ABSTRACT

Background and aims: Spinal anesthesia for urological operations has been frequently used, because symptoms of overhydration, transurethral resection of prostate (TURP) syndrome, and bladder perforation can be recognized. This prospective randomized study was conducted to compare the clinical efficacies of levobupivacaine with and without fentanyl in subarachnoid block with respect to onset and duration of sensory and motor block and duration of analgesia in urological surgeries.

Materials and methods: This randomized study was conducted in 100 patients of American Society of Anesthesiologists (ASA) physical status grades I and II, posted for urological surgeries. Patients were randomly allocated to two groups and were given the following drugs intrathecally as per group distribution: Group I: 2.5 mL of 0.5% isobaric levobupivacaine and group II: 2.2 mL of 0.5% isobaric levobupivacaine with 15 μg (0.3 mL) fentanyl citrate. Parameters monitored were onset and duration of sensory and motor block, hemodynamic parameters, postoperative analgesia, and side effects. Data were analyzed using Student’s t-test for the continuous variables and chi-square test for categorical variables.

Results: The onset of sensory level of T10 was earlier in group II (4.74 ± 0.723 minutes) than in group I (5.7 ± 0.953 minutes). Duration of sensory block was longer in group I (292.2 ± 8.154 minutes) than in group II (260 ± 11.066 minutes). Motor block regressed earlier in group II (181.2 ± 7.73 minutes) than in group I. Hemodynamic parameters and side effects were similar in both the groups.

Conclusion: From our study, we concluded that plain levobupivacaine provided a longer duration of sensory and motor subarachnoid blockade. However, addition of fentanyl as a spinal adjuvant had a dose-sparing effect with earlier onset and early regression of motor block and no hemodynamic alterations.

Keywords: Intrathecal fentanyl, Levobupivacaine, Spinal adjuvant, Transurethral resection of prostate, Urology.

How to cite this article: Kulkarni A, Dey P. Comparison between Clinical Efficacies of Levobupivacaine Plain and Levobupivacaine with Fentanyl for Urological Surgeries under Subarachnoid Block. Res Inno in Anesth 2017;2(2):34-39.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Apeksha A Gala, Naina P Dalvi, Sunil K Gvalani, Sourav Mahajan

A Case of suspected Sick Sinus Syndrome due to combined Beta-blocker and Calcium Channel Blocker Therapy: Anesthesia Management

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:68-70][No of Hits : 243]


ABSTRACT

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Abnormalities encompassed by this syndrome may include inappropriate sinus bradycardia, sinus arrest, bradyarrhythmias, or tachyarrhythmias. We present a case of a 54-year-old hypertensive male posted for L4-L5 decompression, whom we suspected to develop SSS due to overdose of combined beta-blocker (BB) and calcium channel blocker (CCB) therapy.

Keywords: Beta-blocker-calcium channel blocker toxicity, Inotropes, Preanesthesia checkup, Sick sinus syndrome.

How to cite this article: Gala AA, Dalvi NP, Gvalani SK, Mahajan S. A Case of suspected Sick Sinus Syndrome due to combined Beta-blocker and Calcium Channel Blocker Therapy: Anesthesia Management. Res Inno in Anesth 2017;2(2):68-70.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Swagat Pattajoshi, Aparna A Nerurkar, Bharati A Tendolkar

A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:29-33][No of Hits : 229]


ABSTRACT

Introduction: Abnormal blood glucose levels alter the course and result of surgery. This study aims to quantify the incidence of hypoglycemia or hyperglycemia in the preoperative period and to assess the impact of duration of nil per os (NPO), age, intravenous fluids (IVFs), blood transfusion, severity of pain and anxiety, and steroid or antibiotic administration on preoperative blood glucose levels in nondiabetic patients.

Materials and methods: The NPO duration, age, IVF, blood transfusion, pain and anxiety score, steroid and antibiotic administration were noted in 1,000 nondiabetic patients presenting for both elective and emergency surgery. Blood glucose level was measured before induction of anesthesia by capillary finger-prick method. The values of blood glucose levels were analyzed for correlation with above-mentioned parameters.

Results: Overall incidence of hypoglycemia was found to be 23.3%. About 27.2% of patients including 34.95% children posted for elective surgery and 33.37% of patients including 8.73% children posted for emergency surgery group were hypoglycemic. The incidence of hyperglycemia was 1.51 and 1.08% for adults in elective and emergency category respectively. Age showed widely varied association to preoperative blood glucose levels; blood glucose levels increased with age in male patients, with patients aged between 18 and 40 years admitted for emergency surgery (p = 0.006), but decreased with age in patients older than 60 years irrespective of gender and type of surgery (p = 0.014). The preoperative blood glucose levels increased with higher preoperative pain and anxiety (p = 0.05) and administration of steroids (p = 0.00043). Similarly, with increase in duration of NPO, preoperative blood glucose levels decreased in adult females (p = 0.000) and males over 40 years (p = 0.049), both admitted for emergency surgery. Only preoperative normal saline (NS; p = 0.001), 6% hydroxyethyl starch (HES; p = 0.043), Isolyte P (p = 0.000), and blood transfusion (p = 0.05) showed significant correlation.

Conclusion: Preoperative blood glucose monitoring is recommended mandatorily for all patients posted for emergency surgery. It is also recommended for elective pediatric and geriatric surgery patients, patients with high anxiety and/or pain, increased NPO duration, and preoperative administration of steroid, NS, 6% HES, or blood.

Keywords: Age, Anxiety, Blood glucose, Blood sugar, Intravenous fluids, Nil by mouth, Nil per os, Nondiabetic, Pain, Preoperative, Steroids.

How to cite this article: Pattajoshi S, Nerurkar AA, Tendolkar BA. A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery. Res Inno in Anesth 2017;2(2):29-33.

Source of support: Nil

Conflict of interest: None


 
SHORT COMMUNICATION
Vaishali S Badge, Henry Skinner

Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:26-27][No of Hits : 223]


ABSTRACT

Cardiac surgery is one of the largest consumer of blood and blood products in medicine. The transfusion rate in cardiac surgery accounts to almost 40-90%. Although lifesaving, it still increases the risk of allergic reactions, risk of transmission of infection, increased morbidity and mortality. The aim of this study was to find out causes of anaemia and requirement of blood or blood products in cardiac surgical patients.

Keywords: Anaemia, Blood transfusion.

How to cite this article: Badge VS, Skinner H. Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery. Res Inno in Anesth 2017;2(1):26-27.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sachin Vaishnav, Anita Shetty, Manjula Sarkar

Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:14-17][No of Hits : 219]


ABSTRACT

The stress response to an intense painful surgical stimulus is characterized by activation of the sympathetic nervous system and an increased secretion of the stress hormones. The ability of the alpha agonist dexmedetomidine (DEX) to decrease heart rate (HR) and arterial blood pressure in perioperative period was tested. One hundred and thirty two patients undergoing craniotomy for supratentorial tumor were randomly distributed to receive either saline (B group) or DEX (A group). The placebo group received saline, whereas the treatment group (A group) received a single bolus dose of DEX (1μg/kg) intravenously over 10 minutes before induction of anesthesia. Hemodynamic parameters, such as HR and arterial blood pressure were measured. Both the groups were comparable with respect to age, sex, American Society for Anesthesiologist grade, and duration of surgery. The arterial blood pressure and HR were found to be lower in the DEX group when compared with the placebo group.

Keywords: Supratentorial tumors, Dexmedetomidine, Hemodynamics.

How to cite this article: Vaishnav S, Shetty A, Sarkar M. Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery. Res Inno in Anesth 2017;2(1):14-17.

Source of support: Nil

Conflict of interest: None


 
Editorial
SK Gvalani

Microcirculation: A New Focus

[Year:2017] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:27] [Pages No:iv][No of Hits : 208]


ABSTRACT

Prompt and aggressive fluid resuscitation with precise central venous pressure (CVP) monitoring is a common practice in shock states. The development of multi-organ failure is a direct consequence of tissue hypoperfusion and inadequate oxygen transport.


 
CASE REPORT
Harsha Narkhede, Shrikanta P Oak, Isha Singhal, Neha Apte, Monal Shah

Anesthetic Management of Emergency Cesarean Section in a Patient with Congenital Venous Malformation.

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:73-75][No of Hits : 205]


ABSTRACT

Blue rubber bleb nevus syndrome (BRBNS) is characterized by typical bluish, soft, and compressible lesions with rubber-like consistency present since birth. In this syndrome, venous malformation (VM) is always present since birth and is commonly found in the cheek, tongue, lip and jaw, and sometimes may be present in deep tissue, bone, or muscle. A vascular malformation is known to grow in size throughout the life of an individual with sudden enlargement in size during puberty and pregnancy due to hormonal changes. We report the successful management of a case of congenital VM of the lip and mandible posted for emergency cesarean section under spinal anesthesia.

Keywords: Blue rubber bleb nevus syndrome, Cesarean section, Congenital venous malformation, Pregnancy, Spinal anesthesia.

How to cite this article: Narkhede H, Oak SP, Singhal I, Apte N, Shah M. Anesthetic Management of Emergency Cesarean Section in a Patient with Congenital Venous Malformation. Res Inno in Anesth 2017;2(2):73-75.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Pragya Sachan, Naina P Dalvi

Monitoring of Depth of Anesthesia using Entropy Monitor during Cardiopulmonary Bypass

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:45-50][No of Hits : 199]


ABSTRACT

Aim: To monitor the depth of anesthesia using entropy monitor during cardiopulmonary bypass (CPB) using (1) numerical indices provided by entropy monitor [response entropy (RE) and state entropy (SE), burst suppression ratio (BSR)] and (2) modified version of Brice questionnaire used after 48 hours of surgery.

Materials and methods: Design: Prospective observational study. Setting: Cardiovascular thoracic surgery (CVTS) operation theater (OT) of our hospital. Participants: 100 patients undergoing CPB surgery and willing to participate in the study. Intervention: Brain and facial muscular activity recorded using disposable sensor with three electrodes attached to patient’s forehead and a sensor cable that connects the sensor to entropy module. Entropy indices were calculated and displayed in real time. All patients were then interviewed 48 hours after surgery about any recall of intraoperative awareness using the modified Brice questionnaire.

Measurements and results: Basic statistics was assessed by using MS Excel Office 2007 data analysis Tool Pack. The association between two variables was determined by Pearson chi-square test. After skin incision, mean RT and ST were found to decrease significantly till peak hypothermia. After start of rewarming, mean RT and ST were found to increase significantly till skin closure.

Conclusion: In our study, we did not find any awareness in all 100 studied subjects, leading to the conclusion that anesthesia technique used for CPB is optimal.

Clinical significance: It can be concluded that entropy monitor might aid CPB surgery in many ways. It monitors the depth of anesthesia and probably prevents intraoperative awareness, helps in reducing anesthetic dosage, and hence, reduction in cost of anesthesia.

Keywords: Cardiopulmonary bypass, Depth of anesthesia, Electroencephalogram-based monitors, Entropy, Monitoring.

How to cite this article: Sachan P, Dalvi NP. Monitoring of Depth of Anesthesia using Entropy Monitor during Cardiopulmonary Bypass. Res Inno in Anesth 2017;2(2):45-50.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Tanya R Jha, Meenoti P Potdar

Knotted Ryle’s Tube: A Rare Complication

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:71-72][No of Hits : 183]


ABSTRACT

Ryle’s tube (RT) insertion is a commonly performed procedure in emergency departments, intensive care units, and operation theaters. The complications associated with RT include ulceration, bleeding, misplacement of the tube in airway, and clogging of the tube. Intragastric knotting is a rare complication of RT insertion. The removal of such knotted RT should be done cautiously so as to avoid trauma, preferably under direct laryngoscopic vision.

Keywords: Intragastric tube, Knotted, Ryle’s tube.

How to cite this article: Jha TR, Potdar MP. Knotted Ryle’s Tube: A Rare Complication. Res Inno in Anesth 2017;2(2):71-72.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Ketan S Kulkarni, Nandini M Dave, Shriyam S Kulkarni, Gita Nataraj, Shivani Shinde, Indrani Chincholi, Madhu Garasia

A Prospective, Randomized Study comparing the Efficacy and Safety of Adhesive Strip (Steri-Strips™) Fixation vs Subcutaneous Tunneling for securing Epidural Catheters in Pediatric Patients

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:40-44][No of Hits : 173]


ABSTRACT

Introduction: Effective epidural catheter fixation is a key aspect of postoperative pain management in pediatric patients. We conducted a prospective, randomized study comparing the efficacy and safety of adhesive strip (Steri-Strips™) vs subcutaneous tunneling for successful epidural catheter fixation.

Materials and methods: American Society of Anesthesiologists (ASA) grades I and II patients between the age group of 1 day and 12 years were included in the study. The parameters studied were inward and outward migration, and dislodgment of catheter. Erythema, induration, catheter snapping, catheter obstruction, total duration of epidural infusion, and catheter tip culture were also recorded. Feedback from the operator for ease of fixation technique was noted and reviewed.

Results: This study was performed in 64 patients posted for various abdominal, thoracic, and genital surgeries, requiring postoperative epidural analgesia. The epidural catheter was successfully placed in the first attempt in 61 patients. Outward migration was seen in six patients with Steri-Strips-taped catheters and in one patient with a tunneled catheter. Accidental removal was done in five patients with tunneled catheters and one patient with strip-taped catheter. Rescue analgesics were required in these patients. No inward migration of catheter was seen in both the groups. Bleeding from tunneling site was seen in five patients.

Conclusion: In comparison with a tunneling technique for epidural catheter fixation, a simple method of applying Steri- Strips™ to epidural catheters significantly reduces the incidence of accidental removal.

Keywords: Epidural catheter fixation, Pediatric patients, Steri- Strip, Subcutaneous tunneling.

How to cite this article: Kulkarni KS, Dave NM, Kulkarni SS, Nataraj G, Shinde S, Chincholi I, Garasia M. A Prospective, Randomized Study comparing the Efficacy and Safety of Adhesive Strip (Steri-Strips™) Fixation vs Subcutaneous Tunneling for securing Epidural Catheters in Pediatric Patients. Res Inno in Anesth 2017;2(2):40-44.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Indrani H Chincholi, Harprit K Madan, Sonali D Patira

Pain Perception following Administration of Propofol with 7.5 mg Ephedrine, 15 mg Ephedrine, or Lignocaine: A Comparative Study

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:58-63][No of Hits : 172]


ABSTRACT

Introduction: Propofol is the drug of choice for induction of anesthesia because of its rapid onset, easy titration, and short duration of action. However, pain on propofol injection is an unpleasant experience felt by many of our patients. Many factors have been investigated to decrease the pain on propofol injection but it is still a mystery.

Aim: To compare the effect of two doses of ephedrine (7.5 and 15 mg) and lignocaine on pain during injection of propofol and to compare their hemodynamic parameters and note for any complications.

Materials and methods: This study was a prospective, randomized, double-blinded, single-center study on 150 adult patients of both the sexes belonging to American Society of Anesthesiologists (ASA) grades I and II for elective surgery under general anesthesia. The aim was to compare the analgesic effect of lignocaine, ephedrine 7.5 and 15 mg in ameliorating propofol injection pain. About 50 patients were allocated to each of the three groups receiving lignocaine 2% (1.5 mL), ephedrine 7.5 mg, and ephedrine 15 mg intravenously admixed with propofol. The intensity of pain at the time of propofol injection was assessed using verbal rating scale (VRS) 4-point scale before the patient lost consciousness.

Statistical analysis: Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version 22.0 software. The qualitative data were summarized as frequency and percentages. The Fischer exact test was used to analyze the data. The continuous data were summarized as mean and standard deviation. The group and intergroup analyses were done using repeated measures analysis of variance (ANOVA) test. A p-value <0.05 was considered significant.

Results: Median (interquartile range) of the pain score was 1 (2) in group E-7.5 mg, 0 (1) in group E-15 mg, and 0(1) in group L. Results were statistically significant.

Conclusion: Adding 15 mg ephedrine was as effective as adding lignocaine for the prevention of propofol injection pain and ephedrine had a better and stable hemodynamic profile.

Keywords: Ephedrine, Pain, Propofol.

How to cite this article: Chincholi IH, Madan HK, Patira SD. Pain Perception following Administration of Propofol with 7.5 mg Ephedrine, 15 mg Ephedrine, or Lignocaine—A Comparative Study. Res Inno in Anesth 2017;2(2):58-63.

Source of support: Nil

Conflict of interest: None


 
Editorial
SK Gvalani

Simulation: The Way Ahead!

[Year:2017] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:46] [Pages No:iv][No of Hits : 160]


ABSTRACT

Medical simulation originated in ancient times when models of human patients built-in clay and stone were first used to demonstrate the clinical features of disease in humans.1 Modern medical simulation began in the 1960s with the manufacture of Resusci-Anne, the most widely used mannequin of the twentieth century.


 
CASE REPORT
V Sreeram, Pallavi Waghalkar, W Atul, Digambar Sarje

Anesthesia Management of Prolonged Surgery with Duration of 15 Hours for Correction of Post Koch’s Kyphosis

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:73-75][No of Hits : 482]


ABSTRACT

Anesthetic management of post koch’s kyphosis correction of 48 yr old female is discussed.The patient was under anesthesia for long duration of 15 hours which also included Wake up test. After surgery 3 months later patient went home walking. It is emphasized that with good team work between orthopedician, anesthesiologist, chest physician and nursing staff will make it possible to produce excellent outcome in these cases.

Keywords: Anesthesia, Deformity, Koch’s, Kyphosis, Monitoring, Spine, Test, Wakeup.

How to cite this article: Sreeram V, Waghalkar P, Atul W, Sarje D. Anesthesia Management of Prolonged Surgery with Duration of 15 Hours for Correction of Post Koch’s Kyphosis. Res Inno in Anesth 2016;1(2):73-75.

Source of support: Nil

Conflict of interest: None.


 
ORIGINAL ARTICLE
Hemangi S Karnik, Aparna A Nerurkar, Nishant Bawankule

A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:19-24][No of Hits : 452]


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


 
CASE REPORT
Anjana Wajekar, Manisha Taware, Uma Kamat

Convulsion on Table in an American Society of Anesthesiologists Grade I Pregnant Patient Posted for Emergency Cesarean Section: Anesthesia Management

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:25-27][No of Hits : 416]


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


 
ORIGINAL ARTICLE
Naina P Dalvi, Harshali Salunkhay, Shubha N Mohite

A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:5-9][No of Hits : 414]


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


 
CASE REPORT
Reena Gautam

Anesthesia Mumps: An Unusual Presentation

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:69-70][No of Hits : 385]


ABSTRACT

Anesthesia mumps is an acute transient swelling of parotid gland following general anesthesia.There are several case reports of anesthesia mumps postoperatively in adults, however there are very few reports in children. Increase in secretions along with improper drainage of saliva causes enlargement of parotid gland. This article lists the various causes implicated for this and the methods to prevent its occurrence. The purpose of this article is to highlight the occurrence of anesthesia mumps in pediatric patient even after a short procedure.

Keywords: Acute transient swelling, Anesthesia mumps, General anesthesia, Parotid gland.

How to cite this article: Gautam R. Anesthesia Mumps: An Unusual Presentation. Res Inno in Anesth 2016;1(2):69-70.

Source of support: Nil

Conflict of interest: None.


 
ORIGINAL ARTICLE
SK Gvalani, L Pradeep

Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:45-51][No of Hits : 368]


ABSTRACT

Context: The duration of neuromuscular block with rocuronium is affected by old age as well as renal impairment. It would be helpful for anesthetists to know the variation in the block in elderly patients with renal failure and the significance of neuromuscular monitoring in this group.

Aim: The aim of our study is to investigate the neuromuscular effects of 0.6 mg/kg rocuronium under general anesthesia in young adults and elderly patients with or without renal failure.

Study design: Prospective randomized controlled study.

Materials and methods: Young and elderly 100 patients were divided into 4 groups of 25 each, with or without renal failure. General anesthesia with propofol 2 mg kg intravenous (iv), fentanyl 2 µg kg iv, and 60% N2O in O2 were given. Neuromuscular monitoring was started immediately after the induction of anesthesia and before the administration of muscle relaxant. After the stabilization of control responses, 0.6 mg kg rocuronium was injected intravenously. The onset time, time to achieve maximum block, and the recovery times were noted.

Statistical analysis used: The statistical analysis of the data from the study was performed with the Statistical Package for the Social Sciences (SPSS) software for Window Release 14.0. One-way analysis of variance, Bonferroni’s, and chi-square test were used to compare patients’ characteristics.

Results: The duration of block as well as the recovery indices were significantly prolonged in the elderly compared to the young patients. Maximum prolongation was observed in the elderly group with renal failure. This underlines the importance of neuromuscular monitoring in these patients.

Keywords: Neuromuscular block, Renal failure, Rocuronium.

How to cite this article: Gvalani SK, Pradeep L. Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure. Res Inno in Anesth 2016;1(2):45-51.

Source of support: Nil

Conflict of interest: None.


 
ORIGINAL ARTICLE
Yogita Patil, Priyanka Karnik, Madhu Garasia

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

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:10-14][No of Hits : 335]


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


 
ORIGINAL ARTICLE
Mehul Mange, Manjula Sarkar

Cerebral Oxygenation during Pediatric Cardiac Surgery: Identification of Vulnerable Periods using Near-infrared Spectroscopy

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:15-18][No of Hits : 320]


ABSTRACT

Objective: Neurologic sequelae remain a well-recognized complication of pediatric cardiac surgery. The aetiology of neurologic injury is almost certainly multifactorial, imbalance between cerebral oxygen supply and demand is likely to play an important role. We sought to measure regional cerebral oxygenation in children undergoing cardiac surgery using nearinfrared spectroscopy to ascertain such vulnerable periods.

Materials and methods: This study is an observational study of 18 children (median age 1.3 years) undergoing cardiac surgery. Regional cerebral oxygenation was monitored using the INVOS3100 cerebral oximeter and related to hemodynamic parameters at each stage of the procedure.

Results: Prior to the onset of bypass, 10 patients had a decrease in regional cerebral oxygenation, reaching a saturation less than 35% in 5 cases. The most common cause was handling and dissection around the heart prior to and during caval cannulation. With institution of bypass, regional cerebral oxygenation increased. Discontinuation of bypass caused a precipitous decrease in regional cerebral oxygenation in three patients, reaching less than 40%.

Conclusions: These observations suggest that the pre- and early post-bypass periods are vulnerable times for provision of adequate cerebral oxygenation. Near-infrared spectroscopy is a promising tool for monitoring O2 supply/demand relationships especially during circulatory arrest.

Keywords: Cardiopulmonary bypass, Cerebral oximetry, Children, Deep hypothermic circulatory arrest, Near-infrared spectroscopy.

How to cite this article: Mange M, Sarkar M. Cerebral Oxygenation during Pediatric Cardiac Surgery: Identification of Vulnerable Periods using Near-infrared Spectroscopy. Res Inno Anaesth 2016;1(1):15-18.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Anjana S Wajekar, Anita N Shetty, Shrikanta P Oak, Ruchi A Jain

Anesthetic Management of a Sellar Mass Excision in a Patient of Multiple Endocrine Neoplasia Type 1 Syndrome: A Rare Case

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:65-68][No of Hits : 310]


ABSTRACT

Multiple endocrine neoplasia (MEN) type 1 is an autosomal dominant disease, commonly characterized by neoplasms of parathyroid glands, pituitary gland and pancreas islet cells. The anesthesia management in such patients for surgical procedures is challenging due to multiple endocrine gland involvement and its resultant implications, making every case a unique entity. The anesthesia management for MEN type I patients pose unique challenges to the anesthesiologist requiring meticulous preoperative evaluation, intraoperative anticipation, prevention and management of potential complications along with postoperative monitoring. We present a case of successful management of excision of a sellar mass in a patient with MEN type I syndrome with full postoperative recovery with the use of propofol, dexmedetomidine and desflurane anesthesia.

Keywords: Dexmedetomidine, Hormones, Multiple endocrine neoplasia (MEN) type 1, Pituitary.

How to cite this article: Wajekar AS, Shetty AN, Oak SP, Jain RA. Anesthetic Management of a Sellar Mass Excision in a Patient of Multiple Endocrine Neoplasia Type 1 Syndrome: A Rare Case. Res Inno in Anesth 2016;1(2):65-68.

Source of support: Nil

Conflict of interest: None.


 
Editorial
SK Gvalani

The Anesthesiologist as a Medical Teacher

[Year:2016] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:34] [Pages No:iv][No of Hits : 301]


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.


 
CASE REPORT
Preeti Rustagi, Naina P Dalvi, Bharati A Tendolkar, Suhas Kotak

Acute Hyponatremia following Hypotonic Intravenous Fluid in a 4-year-old Child

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:63-64][No of Hits : 288]


ABSTRACT

Hyponatremia is the most frequently encountered electrolyte disorder in hospitalized patients. It develops due to either surplus water or decreased sodium in the extracellular fluid. In children, the source of excess water is frequently the administration of hypotonic intravenous fluids. The current recommendations of hypotonic maintenance fluids may be appropriate for a healthy child, but may not apply to hospitalized children who are more likely to have a nonosmotic stimulus for antidiuretic hormone (ADH) production, such as anxiety, stress, pain, etc. Fall in plasma sodium concentration acutely to < 130 mmol/L leads to brain cell swelling and devastating neurological outcome. Previous studies have reported the potential harm with these solutions and the need to reconsider their routine use in children. We present a case report of 4-year-old child, admitted with head injury and normal CT brain, who developed hyponatremic convulsions following administration of Isolyte-P as maintenance fluid as per standard guidelines.

Keywords: Hyponatremia, Hypotonic intravenous fluid, Nonosmotic stimulus for antidiuretic hormone.

How to cite this article: Rustagi P, Dalvi NP, Tendolkar BA, Kotak S. Acute Hyponatremia following Hypotonic Intravenous Fluid in a 4-year-old. Res Inno in Anesth 2016;1(2):63-64.

Source of support: Nil

Conflict of interest: None.


 
CASE REPORT
Namita Baldwa, Sona Dave, Pinakin Gujjar

Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:58-60][No of Hits : 265]


ABSTRACT

We report the successful management of an emergency craniotomy performed for extradural hematoma (EDH) evacuation in a known case of von Willebrand disease (vWD).
The case presented a challenge because vWD is associated with extensive bleeding, which was compounded by the emergency nature and type of the surgery. Extensive laboratory investigations could not be carried out, and preoperative optimization was limited.

Keywords: Emergency, Extradural hematoma, Von Willebrand disease.

How to cite this article: Baldwa N, Dave S, Gujjar P. Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications. Res Inno in Anesth 2016;1(2):58-60.

Source of support: Nil

Conflict of interest: None.


 
ORIGINAL ARTICLE
Meenoti Pramod Potdar, Laxmi Laxman Kamat, Manjeet Prakash Save, Tanya R Jha

Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:52-57][No of Hits : 252]


ABSTRACT

Introduction: The addition of neuraxial fentanyl or clonidine potentiates the effect of local anesthetic and increases the duration of action and quality of intraoperative and postoperative analgesia. We decided to conduct this study to analyze the synergistic effect of clonidine and fentanyl with bupivacaine on the duration of analgesia surgies. The primary aim is to determine the duration of analgesia for a combination of intrathecal clonidine and fentanyl with bupivacaine in knee arthroscopic surgeries.

Materials and methods: We included 100 patients undergoing operative arthroscopio procedure and randomly allocated the patients into four different groups of 25 each.

Group S: 15 mg 0.5% hyperbaric bupivacaine with 1.0 mL normal saline (NS).
Group F: 15 mg 0.5% HB with 25 µcg fentanyl citrate and 0.5 mL NS.
Group C: 15 mg 0.5% HB with 75 µcg clonidine and 0.5 mL NS.
Group FC: 15 mg 0.5% HB with 25 µcg fentanyl citrate and 75 µcg clonidine.
All the patients received the spinal dosage of 4 mL.

Results: The duration of spinal analgesia was greatest in group FC (458.4±179.96 minutes, p-value 0.001). The rescue analgesic requirement in 24 hours was significantly less in group FC, and the incidence of side effects was comparable.

Conclusion: The combination of clonidine and fentanyl with bupivacaine intrathecally does augment its sensory, motor, and analgesic action further, and hence it has an additional advantage with similar side effects.

Keywords: Arthroscopic, Bupivacaine, Clonidine fentanyl, Intrathecal, Postoperative analgesia.

How to cite this article: Potdar MP, Kamat LL, Save MP, Jha TR. Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure. Res Inno in Anesth 2016;1(2):52-57.

Source of support: Nil

Conflict of interest: None.


 
CASE REPORT
Neeraj Barnwal, Raylene Dias, Rahul Mamde

Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:61-62][No of Hits : 239]


ABSTRACT

Cushing’s syndrome in an acromegalic patient is a very rare presentation. To differentiate a Cushing’s disease from Cushing’s syndrome due to ectopic adrenocorticotropic hormone (ACTH) secreting tumors, inferior petrosal sinus sampling (IPSS) is required. Acromegaly patients have associated airway abnormalities posing a challenge to administration of anesthesia. Traditionally, most IPSS was done under general anesthesia. But now it is being recognized that general anesthesia for this procedure has its own implications and hence conscious sedation is being used for this purpose. We describe our experience with the novel agent dexmedetomidine for conscious sedation in this procedure.

Keywords: Acromegaly, Cushing’s syndrome, Dexmedetomidine, Inferior petrosal sinus sampling.

How to cite this article: Barnwal N, Dias R, Mamde R. Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling. Res Inno in Anesth 2016;1(2):61-62.

Source of support: Nil

Conflict of interest: None.


 
CASE REPORT
Sonia Nayak

Pneumothorax during Cardiomyotomy: Management

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:71-72][No of Hits : 215]


ABSTRACT

Laparoscopic cardiomyotomy is the surgical mode of treatment for patients suffering from achalasia cardia. These patients are at a risk of developing intraoperative pneumothorax with hemodynamic and respiratory changes. We reported case of pneumothorax during laparoscopic cardiomyotomy. Patient developed hypotension, tachycardia, decreased air entry and increased peak airway pressure. We managed that case successfully. Hemodynamics was maintained with fluid and ephedrine. Patient was ventilated with 100% Oxygen and put on pressure cycled ventilator mode. Postoperatively patient was observed in ICU. While managing such cases, anesthetists should be aware of this complication and be vigilant.

Keywords: Achalasia cardia, Laparoscopic cardiomyotomy, Pneumothorax.

How to cite this article: Nayak S. Pneumothorax during Cardiomyotomy: Management. Res Inno in Anesth 2016;1(2):71-72.

Source of support: Nil

Conflict of interest: None.


 
EDITORIAL
Sunil Gvalani

Editorial

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:iv][No of Hits : 185]


ABSTRACT

ANESTHESIOLOGY: A Spurt of Growth

The last four decades have witnessed a remarkable growth in anesthesiology as a specialty in India. The changes have been varied and remarkable.

A simple combination of a basic anesthesia machine and an electrocardiogram (ECG) monitor has now evolved into an anesthesia workstation with all possible parameters monitored. Intensive monitoring definitely allows us to achieve greater safety assuming proper vigilance.



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