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EDITORIAL |
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Use of videolaryngoscopy as a teaching tool for novices performing tracheal intubation results in greater first pass success in neonates and infants |
p. 781 |
Sheila Nainan Myatra, Jeson Rajan Doctor DOI:10.4103/ija.IJA_738_19 PMID:31649387 |
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COMMENTARY |
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Automated anaesthesia record system - Expensive toy or a change whose time has come? |
p. 784 |
Hemant Shinde DOI:10.4103/ija.IJA_743_19 PMID:31649388 |
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SPECIAL ARTICLE |
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Preoperative pregnancy testing in surgical patients: How useful is policy of routine testing |
p. 786 |
Sukhyanti Kerai, Kirti Nath Saxena, Bharti Wadhwa DOI:10.4103/ija.IJA_293_19 PMID:31649389
Surgery in a patient with unrecognised pregnancy has serious ethical and medicolegal implications. There are no guidelines in India for preoperative pregnancy testing (POPT) in surgical patients. This review was undertaken to ascertain utility of routine POPT and whether any specific indication for POPT could be suggested. We performed a literature search to identify publications pertaining to POPT in surgical patients. Searches included PubMed, Google Scholar and internet search for national guidelines. Studies pertaining to incidence of unrecognised pregnancy, cost-effectiveness of POPT, effect of surgery and anaesthesia on pregnancy are included. We excluded articles which were available in languages other than English and those whose full texts were unavailable. Most of the literature about reproductive outcomes after anaesthesia exposure is based on old data. The evidence for teratogenic effect of anaesthetic drugs on human foetus is still inconclusive. Apart from anaesthesia and surgery, the outcome after surgery in unrecognised pregnant patient depends on other factors such as indication for surgery, high incidence of foetal loss in early pregnancy, stress and lifestyle of patient. As it is difficult to unsnarl the effect of these factors, POPT should be offered to all patients who based on history could be possibly pregnant. The cost-effectiveness of POPT appears doubtful, but considering costs associated with miscarriages and medicolegal litigations due to unclear association with anaesthesia, it may indeed be cost-effective.
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ORIGINAL ARTICLES |
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Efficacy and safety of videolaryngoscopy-guided verbal feedback to teach neonatal and infant intubation. A prospective randomised cross over study |
p. 791 |
Anita Saran, Nandini M Dave, Priyanka P Karnik DOI:10.4103/ija.IJA_823_18 PMID:31649390
Background and Aims: Neonatal endotracheal intubation is challenging due to the miniature anatomy, which is distinct from adults and reserves only less oxygen and time before desaturation begins. As a result, teaching neonatal intubation becomes fraught with difficulties. This study aimed to determine the efficacy and safety of videolaryngoscopy-guided verbal feedback compared to conventional laryngoscopy verbal feedback in neonatal and infant intubation. Methods: In this prospective randomised cross over study, 24 trainees were randomly allocated to two groups, video-assisted verbal feedback followed by conventional verbal feedback (V/C) and conventional verbal feedback followed by video-assisted verbal feedback (C/V). one hundred forty-four ASA grade I-II patients aged 1 day to 6 months requiring general anaesthesia with endotracheal intubation were included. Each trainee performed three intubations with one technique and switched to other technique to perform three more intubations. Primary outcome was first attempt success rate and secondary outcomes were time to best view, time to intubation, ease of intubation, manoeuvres used and complications. Results: Overall first attempt intubation success rate was higher with video-assisted verbal feedbacks compared to conventional verbal feedback (83.3% vs. 44.4%, P value = <0.001). The time to best view (19.8 s vs. 26.8 s, P value = <0.001) and intubation (30 s vs. 41.7 s) was achieved faster with video-assisted part of the study. Conclusion: Our study results show that video-assisted verbal feedback to trainees resulted in high intubation success rate and reduced complications like oesophageal intubation and desaturation in neonatal and infant intubations.
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Completeness of manual data recording in the anaesthesia information management system: A retrospective audit of 1000 neurosurgical cases |
p. 797 |
Sangeetha R Palaniswamy, Vikyath Jain, Dhritiman Chakrabarti, Suparna Bharadwaj, Kamath Sriganesh DOI:10.4103/ija.IJA_450_19 PMID:31649391
Background and Aims: Anaesthesia information management system (AIMS) is increasingly implemented in many hospitals. Considering the capital cost involved in its installation and maintenance, it is important to evaluate its performance and adoptability by end users. This study assessed the completeness of manual data recording in the AIMS one year after its implementation and also evaluated potential predictors for completeness. Methods: In this retrospective audit of AIMS, 1000 electronic anaesthesia records of patients undergoing neurosurgical procedures over one year were assessed for completeness of 41 preidentified items, one year after its implementation. Parameters evaluated were patient identifiers, personnel identifiers, demographics, airway management parameters, anaesthesia management items and end-of-anaesthesia parameters. We hypothesised that completeness of anaesthesia record can be predicted by nature of surgeries, case sequence, seniority of anaesthesiologist and phase ( first or second) of the study period. Results: We observed higher completeness of manual data recording during phase 2 of AIMS use compared to phase 1. Higher grade of anaesthesiologist, second case of the day and emergency surgery led to reduction in completeness of data entry. Anaesthesiologist grade significantly predicted complete entry of 18 (44%) variables, case number predicted 8 (20%) variables and phase- and procedure-type predicted 6 (15%) and 5 (12%) variables, respectively. Conclusion: Completeness of manual data recording in the electronic AIMS is poor after one year of implementation. First case of the day, second phase of study period, elective cases and trainee anaesthesiologist are associated with better completeness of manual data recording in the AIMS.
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Perioperative management and postoperative outcome of patients undergoing cytoreduction surgery with hyperthermic intraperitoneal chemotherapy |
p. 805 |
Hamed Elgendy, Hanaa Nafady-Hego, Hanan M Abd Elmoneim, Talha Youssef, Abdulaziz Alzahrani DOI:10.4103/ija.IJA_324_19 PMID:31649392
Background and Aims: The existence of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a multidisciplinary approach for peritoneal cancer gains acceptance in many countries including Saudi Arabia. The aim of our study is to describe the perioperative management of patients who received CRS/HIPEC and to report their outcomes and complications at our tertiary centre. Methods: The preoperative characteristics, surgical variables, perioperative management, postoperative course and outcomes of 38 CRS/HIPEC patients were prospectively collected and analysed. Results: The mean age of our patients was 52 years, and 23 (60.5%) of them were females. The overall postoperative mortality was 42.1%. Univariate analyses of risk factors for deaths after HIPEC demonstrated that low preoperative (haemoglobin, potassium, calcium and albumin), high (tumour marker (CA19.9), intraoperative transfusion of human plasma protein (HPP), colloids, postoperative activated partial thromboplastin time and bacterial infections were potential risk factors for patient's mortality. Multivariate analysis of those variables demonstrated that low preoperative calcium [hazard ratio (HR) = 0.116; 95% confidence interval (CI) = 0.033–0.407; P= 0.001], high intraoperative HPP transfusion (HR = 1.004; 95% CI = 1.001–1.003; P= 0.012) and presence of postoperative bacterial infection (HR = 5.987; 95% CI = 1.009–35.54; P= 0.049) were independent predictors of patient's death. Seventy morbidities happened after HIPEC; only bacterial infection independently predicted postoperative mortality. Conclusion: To improve postoperative outcome of CRS/HIPEC, optimisation of transfusion, temperature, electrolytes and using broader-spectrum prophylaxis to manage postoperative infections should be warranted.
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A randomised prospective comparison of equilibration point and changing gas composition during low-flow anaesthesia with sevoflurane vs desflurane |
p. 814 |
Pratibha Toal, Sheetal Chiplonkar, Pratik Panchal DOI:10.4103/ija.IJA_31_19 PMID:31649393
Background and Aims: Safety and economy are the main concerns while using low- flow anaesthesia with newer inhalational agents. The main objective of this study was to use and compare 'equilibration time' of sevoflurane and desflurane after change-over from high-to-low flow anaesthesia. Methods: This prospective study included consenting adult patients between 18–70 years undergoing elective surgery under general anaesthesia. Patients were randomised initially to receive high-flow anaesthesia with 1.3 MAC of either desflurane or sevoflurane with nitrous oxide. After equilibration point, low-flow anaesthesia was initiated. Heart rate, non-invasive blood pressure, pulse oximeter, 5 electrode ECG and gas monitoring was done. Statistical analysis was done with the help of Med CalC version 12.5.0.0 (student version) and IBM SPSS Version 20.0. Results: Mean equilibration time in sevoflurane group was higher (4.59 ± 0.77 minutes) than desflurane group (3.78 ± 0.56 minutes, P < 0.001). Inspired concentrations of both inhalational agents varied from their vaporiser settings over 2 hours, more so with sevoflurane than desflurane. Inspired oxygen concentration (FiO2) remained above 30% during anaesthesia in both groups with stable haemodynamics. Conclusion: Change-over from high-to-low flow anaesthesia is faster in desflurane. With fresh gas flow (FGF) of 1 L with 50% oxygen and dial concentration of 1–1.5% of sevoflurane and 3.8–4.4% of desflurane, the risk of hypoxia is minimal. The disparity between the set and delivered concentrations is more (20%) in sevoflurane than desflurane (12%).
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Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial |
p. 820 |
Kalpana Verma, Aman Malawat, Durga Jethava, Dharam Das Jethava DOI:10.4103/ija.IJA_61_19 PMID:31649394
Background and Aims: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS. Methods: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test. Results: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times. Conclusion: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.
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Effect of varying time intervals between fentanyl and propofol administration on propofol requirement for induction of anaesthesia: Randomised controlled trial |
p. 827 |
Vanlal Darlong, Anirban Som, Dalim K Baidya, Ravindra Pandey, Jyotsna Punj, Aparna Pande DOI:10.4103/ija.IJA_259_19 PMID:31649395
Background and Aims: Administration of fentanyl before induction of anaesthesia with propofol should facilitate smooth induction, with a reduction in induction dose of propofol and its side effects. This study was designed to examine the effect of varying intervals between fentanyl and propofol administration on the dose of propofol required for induction of anaesthesia. Methods: After institutional ethical clearance, 129 American Society of Anesthesiologists physical status I--II patients, aged 18--65 years, undergoing elective surgery under general anaesthesia were randomised into three groups. Fentanyl 2 mcg/kg was administered immediately prior to, 3 and 5 min before induction with propofol in Groups 1, 2, and 3, respectively. Requirement of propofol induction dose and haemodynamic parameters was recorded. Statistical analysis was performed using software SPSS (SPSS Inc., Chicago, Illinois, USA). Results: Total dose of propofol required for induction was highest in Groups 1 and lowest Group 3 (Group 1 vs. 2 vs. 3: 86.28 ± 21.12 vs. 71.67 ± 21.68 vs. 59.98 ± 20.35 mg, P< 0.00001). Dose of propofol required per kg body weight was significantly higher in Group 1 (1.41 ± 0.34 mg/kg) compared to both Group 2 (1.14 ± 0.38 mg/kg) and Group 3 (0.97 ± 0.32 mg/kg) (P < 0.00001). Incidence of hypotension during induction was significantly lower in Group 3 (14%) and Group 2 (17.1%) than in Group 1 (35.6%; P= 0.03). Conclusion: Administering fentanyl 5 min prior to propofol causes marked reduction in the dose requirement of the latter along with a significantly decreased incidence of hypotension during induction.
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Role of pre-emptive Huff's manoeuvre and acupressure in reducing the incidence of fentanyl induced cough; a risk factor for postoperative nausea vomiting in female patients: A prospective randomised controlled study |
p. 834 |
Parul Gupta, Parul Jindal, Nidhi Kumar DOI:10.4103/ija.IJA_549_19 PMID:31649396
Background and Aims: Fentanyl-induced cough is found to occur more often in females and it has been observed to be a risk factor for post-operative nausea and vomiting (PONV). We studied the effect of pre-emptive Huff's manoeuvre and acupressure in reducing incidence of PONV in patients who had fentanyl-induced cough (FIC). Methods: This prospective, experimental and randomised study was conducted on 336 patients who were randomly divided into three groups. Group A (n = 112): acupressure was applied, Group B (n = 112): Huff's manoeuvre was performed and Group C (n = 112) was the control group. Thereafter the patients were given a rapid bolus of injection fentanyl at a dose of 2 μ/kg before induction of anaesthesia. Any episode of cough within 60 seconds of fentanyl administration was classified as FIC, and the severity was graded based on the number of coughs (mild 1 – 2, moderate 3 – 4, and severe 5 or more). The occurrence of PONV was recorded. Statistical analysis done using ANOVA test, Kruskal Wallis. Results: Incidence of FIC was 8%, 7.1%, and 25.9% in Acupressure, Huff's and control group respectively. The incidence of PONV was found to be higher in patients who had FIC rather than the patients who did not have FIC. Conclusion: We conclude that use of Acupressure and Huff's manoeuvre have been demonstrated to be efficacious in reducing FIC and also have an impact in reducing PONV.
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Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial |
p. 841 |
Anupama Rajanbabu, Nitu Puthenveettil, Akhila Appukuttan, Anjitha Asok DOI:10.4103/ija.IJA_471_19 PMID:31649397
Background and Aims: Transverse abdominis plane (TAP) block has been used regularly as part of multimodal analgesia for caesarean sections and other lower abdominal surgeries. Adequate postoperative analgesia provided with regional blocks allows faster postoperative recovery and better patient satisfaction. In our study, we are comparing the analgesic efficacy of laparoscopic-guided TAP block with port infiltration using a local anaesthetic in patients undergoing gynaecologic robotic surgeries. Methods: After obtaining approval from the hospital ethics committee, Central Trial Registry of India (CTRI) clearance and written informed consent from patients, this prospective double-blinded randomised control trial was conducted on patients undergoing robotic-assisted gynaecologic surgery under general anaesthesia. Group B patients received bilateral TAP block under direct laparoscopic vision with 15 ml of 0.1% ropivacaine on each side and Group C patients received routine port site infiltration with 30 ml of 0.1% ropivacaine. Postoperative pain score was measured till 24 hours, need for rescue analgesics, complications associated were noted. Independent two sample 't' test, Mann Whitney u test, Chi-square and Fisher's exact test were used for statistical analysis. Results: Pain score was significantly lower in Group B patients up to 24h (P < 0.001). The use of rescue analgesic was also significantly less in group B compared to Group C (P < 0.001). No adverse events were noted in both groups. Conclusion: Laparoscopic-guided TAP block is effective and superior to port site infiltration in providing postoperative analgesia in patients undergoing robotic-assisted gynaecologic surgery.
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CASE REPORTS |
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Recurrent syncope in a child and video assisted thoracoscopic surgery - The long and short of it |
p. 847 |
Manpreet Kaur, Nirupa Ramakumar, Sangam Yadav, Rajeshwari Subramaniam DOI:10.4103/ija.IJA_180_19 PMID:31649398
Long QT syndrome (LQTS) is a myocardial repolarisation disorder caused by cardiac ion channelopathy and one of its common presentations is recurrent syncope. This reduced repolarisation reserve in LQTS can be unmasked by perioperative factors like electrolyte imbalance, drugs, hypothermia and changes in cardiac autonomic tone. We report the anaesthetic management of left thoracoscopic sympathectomy in a 5-year-old child with LQTS and epicardial pacemaker in situ. It is very challenging to isolate the lung on one hand and prevent the predisposition to torsadogenic potential on the other.
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Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus |
p. 851 |
Jyotsna Punj DOI:10.4103/ija.IJA_331_19 PMID:31649399
Medical management along with stellate ganglion block is frequently given to prevent the vasculitis of fingers in patients of systemic lupus erythematosus (SLE). Bilateral stellate ganglion block is rarely given due to the concern of phrenic and recurrent laryngeal nerve palsy. In this article, we describe the management of a recently diagnosed SLE patient presented with progressive gangrene of fingers of both upper limbs. Meticulously planned serial bilateral ultrasound-guided stellate ganglion blocks were successfully given to prevent impending loss of digits with no complications.
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BRIEF COMMUNICATION |
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Thrombosis incidence after recombinant active factor VII administration in paediatric cardiac surgery |
p. 856 |
Keitaro Tachi, Shinji Takahashi, Maiko Ishigaki, Shin Nakayama, Soichiro Yamashita, Yuji Hiramatsu, Makoto Tanaka DOI:10.4103/ija.IJA_181_19 PMID:31649400 |
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LETTERS TO EDITOR |
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Awake fibreoptic intubation with a wire-guide to reduce the impingement of endotracheal tube onto airway soft tissue |
p. 860 |
Luca Guzzetti, Cecilia Novazzi, Simone Binda, Alessandro Bacuzzi DOI:10.4103/ija.IJA_247_19 PMID:31649401 |
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Fibreoptic bronchoscopy in lateral position as a rescue airway management technique in a child with temporo-mandibular joint ankylosis |
p. 862 |
Arun Raja Thangavel, Sakthirajan Panneerselvam, Priya Rudingwa, Ranjith Kumar Sivakumar DOI:10.4103/ija.IJA_298_19 PMID:31649402 |
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Feeding jejunostomy in advanced malignancy of oesophagus under combined coeliac plexus and bilateral TAP blocks - A case report |
p. 863 |
Srinidhi Srikanth, Parthasarathy Srinivasan DOI:10.4103/ija.IJA_329_19 PMID:31649403 |
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Surgical site fire during surgery in operating room under general anaesthesia |
p. 865 |
Shalendra Singh, Shreyas Kate, Sonia Bhan, Virender Suhag DOI:10.4103/ija.IJA_347_19 PMID:31649404 |
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Anaesthetic management of a rare case of Langerhans cell histiocytosis |
p. 866 |
Shalendra Singh, Shreyas Kate, Rashmi Datta, Virender Suhag DOI:10.4103/ija.IJA_350_19 PMID:31649405 |
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Cervical plexus block for carotid endarterectomy: Is ultrasound safe enough? |
p. 868 |
Amit Nagpal, Mohit Mittal, Shalvi Mahajan, Adarsh C Swami DOI:10.4103/ija.IJA_351_19 PMID:31649406 |
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Intensive care management of multiorgan failure following single low dose methotrexate for ectopic pregnancy: An intriguing case report |
p. 870 |
Divya Gupta, Sukhyanti Kerai DOI:10.4103/ija.IJA_366_19 PMID:31649407 |
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Using endotracheal tube as an adaptor to provide incentive spirometry to tracheostomised patients |
p. 872 |
Summit D Bloria, Pallavi Bloria, Ankur Luthra, Ketan Kataria DOI:10.4103/ija.IJA_371_19 PMID:31649408 |
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