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2013| July-August | Volume 57 | Issue 4
Online since
September 20, 2013
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REVIEW ARTICLE
One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery
Teddy Suratos Fabila, Shahani Jagdish Menghraj
July-August 2013, 57(4):339-344
DOI
:10.4103/0019-5049.118539
PMID
:24163446
The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as 'One lung ventilation for infants and children', 'Video assisted thoracoscopic surgery for infants and children', and 'Physiologic changes during one lung ventilation for infants and children' were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH) eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.
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SPECIAL ARTICLE
Inhalational anaesthesia with low fresh gas flow
Christian Hönemann, Olaf Hagemann, Dietrich Doll
July-August 2013, 57(4):345-350
DOI
:10.4103/0019-5049.118569
PMID
:24163447
During the inhalation of anaesthesia use of low fresh gas flow (0.35-1 L/min) has some important advantages. There are three areas of benefit: pulmonary - anaesthesia with low fresh gas flow improves the dynamics of inhaled anaesthesia gas, increases mucociliary clearance, maintains body temperature and reduces water loss. Economic - reduction of anaesthesia gas consumption resulting in significant savings of > 75% and Ecological - reduction in nitrous oxide consumption, which is an important ozone-depleting and heat-trapping greenhouse gas that is emitted. Nevertheless, anaesthesia with high fresh gas flows of 2-6 L/min is still performed, a technique in which rebreathing is practically negligible. This special article describes the clinical use of conventional plenum vaporizers, connected to the fresh gas supply to easily perform low (1 L/min), minimal (0.5 L/min) or metabolic flow anaesthesia (0.35 L/min) with conventional Primus Draeger
;
anaesthesia machines in routine clinical practice.
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2
CLINICAL INVESTIGATIONS
A comparative study in the post-operative spine surgeries: Epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for post-operative analgesia
MS Saravana Babu, Anil Kumar Verma, Apurva Agarwal, Chitra MS Tyagi, Manoj Upadhyay, Shivshenkar Tripathi
July-August 2013, 57(4):371-376
DOI
:10.4103/0019-5049.118563
PMID
:24163451
Background:
Anaesthesia for spine surgeries is not only concerned with relieving pain during surgeries but also during the post-operative period. A prospective randomised study was carried out to evaluate the efficacy of epidural route and to compare the efficacy and clinical profile of dexmedetomidine and clonidine as an adjuvant to ropivacaine, in epidural analgesia with special emphasis on their quality of analgesia and the ability to provide the smooth post-operative course.
Methods:
A total of 60 subjects, 33 were men and 27 were women between the age of 18 and 65 years of American Society of Anaesthesiologists (ASA) I/II class who underwent spine surgeries were randomly allocated into two groups, ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising 30 patients each. Group RD received 20 ml of 0.2% ropivacaine and 1 μg/kg of dexmedetomidine while group RC received 20 ml of 0.2% ropivacaine and 2 μg/kg of clonidine through the epidural catheter. Onset of analgesia, time of peak effect, duration of analgesia, cardiorespiratory parameters, side-effects and need of rescue intravenous (IV) analgesics were observed.
Results:
The demographic profile and ASA class were comparable between the groups. None of the patients needed rescue analgesics in either group. Group RD had early onset, early peak effect, prolonged duration and stable cardiorespiratory parameters when compared with group RC. The side-effects profile was also comparable with a little higher incidence of nausea and dry mouth in both groups.
Conclusion:
Epidural route provided acceptable analgesia in spine surgeries and avoided the need of IV analgesics in either group. Dexmedetomidine is a better neuraxial adjuvant compared with clonidine for providing early onset and prolonged post-operative analgesia and stable cardiorespiratory parameters.
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Bispectral index score and observer's assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol
Dipanjan Bagchi, Mohan Chandra Mandal, Sabyasachi Das, Sekhar Ranjan Basu, Susanta Sarkar, Jyotirmoy Das
July-August 2013, 57(4):351-357
DOI
:10.4103/0019-5049.118557
PMID
:24163448
Background:
Correlation between the clinical and electroencephalogram-based monitoring has been documented sporadically during the onset of sedation. Propofol and midazolam have been studied individually using the observer's assessment of awareness/sedation (OAA/S) score and Bispectral index score (BIS). The present study was designed to compare the time to onset of sedation for propofol and midazolam using both BIS and OAA/S scores, and to find out any correlation.
Methods:
A total of 46 patients (18-60 years, either sex, American Society of Anesthesiologists (ASA) I/II) posted for infraumbilical surgeries under spinal anaesthesia were randomly allocated to receive either injection propofol 1 mg/kg bolus followed by infusion 3 mg/kg/h (Group P,
n
=23) or injection midazolam 0.05 mg/kg bolus followed by infusion 0.06 mg/kg/h (Group M,
n
=23). Spinal anaesthesia was given with 2.5 ml to 3.0 ml of 0.5% bupivacaine heavy. When sensory block reached T6 level, sedation was initiated. The time to reach BIS score 70 and time to achieve OAA/S score 3 from the start of study drug were noted. OAA/S score at BIS score 70 was noted. Data from 43 patients were analyzed using SPSS 12 for Windows.
Results:
Time to reach BIS score 70 using propofol was significantly lower than using the midazolam (
P
<0.05). Time to achieve OAA/S score 3 using propofol was comparable with midazolam (
P
=0.358).
Conclusion:
A divergence exists between the time to reach BIS score 70 and time to achieve OAA/S score 3 using midazolam, compared with propofol, during the onset of sedation.
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LETTERS TO EDITOR
Methemoglobinemia: What the anaesthetist must know
Sushama Tandale, Nandini M Dave, Madhu Garasia
July-August 2013, 57(4):427-428
DOI
:10.4103/0019-5049.118525
PMID
:24163472
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CLINICAL INVESTIGATIONS
The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anaesthesia during elective spine surgery
Suvadeep Sen, Jayanta Chakraborty, Sankari Santra, Prosenjit Mukherjee, Bibhukalyani Das
July-August 2013, 57(4):358-363
DOI
:10.4103/0019-5049.118558
PMID
:24163449
Background:
Maintenance of adequate depth of anaesthesia in spine surgery is vital to prevent awareness, to reduce stress response and possible autonomic instability frequently associated with spine surgery. Dexmedetomidine, a a
2
-adrenoceptor agonist with analgesic and sedative adjuvant property has been found to reduce dose requirement of multiple anaesthetic agents both for induction and during the maintenance of anaesthesia.
Aim:
The aim of this study is to observe the effect of dexmedetomidine, on the requirement of propofol for induction and maintenance of adequate depth of anaesthesia during spine surgery.
Methods:
It was a prospective, randomised, double-blinded, parallel group, placebo controlled and open-lebel study in tertiary care hospital. A total of 70 patients aged 20-60 years, American Society of Anaesthesiologists GradeI and II, scheduled for elective spine surgery were randomly allocated into two groups. Each patient of Group D (
n
=35) received an initial loading dose of dexmedetomidine at 1 ΅g/kg over 10 min, started 15 min before induction of anaesthesia followed by an infusion at a rate of 0.2 mg/kg/h. Patients of Group P (
n
=35) received the same volume of 0.9% normal saline solution as placebo. Requirement of propofol at induction and during maintenance was calculated maintaining bispectral index between 40 and 60.
P
<0.05 was considered to be statistically significant.
Results:
Mean requirement of propofol was found to be lessened by 48.08% and 61.87% for induction and maintenance of anaesthesia respectively while using dexmedetomidine.
Conclusion:
Administration of dexmedetomidine significantly reduces the requirement of propofol while maintaining desired depth of anaesthesia without any significant complication.
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Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia
Deepti Saigal, Rama Wason
July-August 2013, 57(4):364-370
DOI
:10.4103/0019-5049.118559
PMID
:24163450
Background:
Although different techniques have been developed for administering combined spinal epidural (CSE) anaesthesia, none can be described as an ideal one.
Objectives:
We performed a study to compare two popular CSE techniques: Double segment technique (DST) and single segment (needle through needle) technique (SST) with another alternative technique: Paramedian epidural and midline spinal in the same intervertebral space (single space dual needle technique: SDT).
Methods:
After institutional ethical clearance, 90 consenting patients undergoing elective lower limb orthopaedic surgery were allocated to receive CSE into one of the three groups (
n
=30 each): Group I: SST, Group II: SDT, Group III: DST using computerized randomization. The time for technique performance, surgical readiness, technical aspects of epidural and subarachnoid block (SAB) and morbidity were compared.
Results:
SDT is comparable with SST and DST in time for technique performance (13.42±2.848 min, 12.18±6.092 min, 11.63±3.243 min respectively;
P=
0.268), time to surgical readiness (18.28±3.624 min, 17.64±5.877 min, 16.87±3.137 min respectively;
P=
0.42) and incidence of technically perfect block (70%, 66.66%, 76.66%; respectively
P=
0.757). Use of paramedian route for epidural catheterization in SDT group decreases complications and facilitates catheter insertion. There was a significant number of cases with lack of dural puncture appreciation (SST=ten, none in SDT and DST;
P=
0.001) and delayed cerebrospinal fluid reflux (SST=five, none in SDT and DST;
P=
0.005) while performance of SAB in SST group. The incidence of nausea, vomiting, post-operative backache and headache was comparable between the three groups.
Conclusion:
SDT is an acceptable alternative to DST and SST.
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CASE REPORTS
Anaesthetic management of a case of idiopathic intracranial hypertension
Bina P Butala, Veena R Shah
July-August 2013, 57(4):401-403
DOI
:10.4103/0019-5049.118570
PMID
:24163458
Idiopathic intracranial hypertension (IIH) is a rare headache syndrome characterized by prolonged elevation of intracranial pressure without related pathology in either the brain or the composition of cerebrospinal fluid. Herein, we provide a brief review of the clinical presentation of IIH and the anaesthetic considerations in a female posted for transcervical resection of the endometrium and right nephrectomy with the disorder. Most of patients with IIH are reported during pregnancy and came for management of labour and delivery. To our knowledge no such case has been described previously.
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3,257
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Electrical storm: Role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation
Shrinivas Gadhinglajkar, Rupa Sreedhar, M Unnikrishnan, Narayanan Namboodiri
July-August 2013, 57(4):397-400
DOI
:10.4103/0019-5049.118568
PMID
:24163457
An electrical storm is usually associated with catecholaminergic surge following myocardial ischaemia and manifest as recurrent ventricular arrhythmias, requiring frequent DC shocks. Delivering repeated DC shocks induces myocardial damage and further worsens the arrhythmias, which are resistant to the antiarrhythmic drugs. Cardiac sympathetic blockade abates the excessive catecholaminergic drive and help pacifying the malignant ventricular arrhythmias. We treated the electrical storm in a 52-year-old male with ultrasound-guided left sympathetic ganglion block followed by surgical left cardiac sympathetic denervation. The patient remained symptom-free without any incident of ventricular arrhythmias for 8 months after the surgery. The ultrasonography during blockade of the stellate ganglion enhances the success rate of the technique, reduces the quantity of local anaesthetic required to produce desired effects and prevents technical complications. Supraclavicular surgical access to the upper thoracic sympathetic chain obviates the necessity for one lung ventilation and lateral decubitus during surgery, when the patient is in hemodynamically unstable condition. Sympathectomy can be performed under general anaesthesia taking cautions to avoid sympathetic stimulation in intraoperative period.
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3,199
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CLINICAL INVESTIGATIONS
Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray
Zahid Hussain Khan, Shahriar Arbabi
July-August 2013, 57(4):381-386
DOI
:10.4103/0019-5049.118567
PMID
:24163453
Background:
Unanticipated difficult tracheal intubation remains a primary concern of anaesthesiologists and upper lip bite test (ULBT) is one of the assessments used in predicting difficult intubation. In this study, we aimed to check the utility of lateral neck X-ray measurements in improving the diagnostic value of the ULBT.
Methods:
In a prospective study conducted from January 2007 until December 2010, we recorded personal and demographic data of 4500 patients who entered the study and subjected them to standard lateral neck radiography. Before the induction of anaesthesia, clinical examination and ULBT results were recorded and during induction of anaesthesia laryngoscopic grading was evaluated and recorded in questionnaires. All the compiled data were analysed by SPSS 14.0 (SPSS Inc., Chicago, IL, USA) software. Diagnostic value for each test was calculated and compared.
Results:
Negative predictive values (NPVs) were high in all tests. ULBT had the highest specificity and NPV compared with the other tests. The positive predictive value for all the tests had been low, but marginally high in the ULBT.
Conclusion:
Although all the tests used had relatively acceptable predictive values, combination of tests appeared to be more predictive. Highest sensitivities were observed with ULBT, mandibulohyoid distance and thyromental distance respectively. Use of radiological parameters may not be suitable as screening tools, but may help in anticipating and preparing for a difficult scenario.
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CASE REPORTS
Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection
Suresh Babu Kale, Jagannathan Raghavan
July-August 2013, 57(4):390-393
DOI
:10.4103/0019-5049.118564
PMID
:24163455
A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.
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Emergency laparotomy for necrotising enterocolitis in a newborn with hypoplastic left heart syndrome
Lulu Sherif, Sherif Jain, Kishan Shetty, Sharan Badiger
July-August 2013, 57(4):387-389
DOI
:10.4103/0019-5049.118562
PMID
:24163454
Necrotising enterocolitis (NEC) and congenital heart disease are two distinct disease processes, but they appear to be inter-related, particularly in patients with the congenital heart condition known as hypoplastic left heart syndrome (HLHS). Both NEC and HLHS are causes of significant morbidity and mortality in the neonatal population. As medical and surgical advances allow for the palliation and correction of complex heart lesions at an earlier gestational age and lower birth weight, the already high-risk of NEC in this population is likely to increase. In this article, we report a case of a neonate with unpalliated HLHS who underwent emergency laparotomy for NEC. We also discuss the pathophysiology of these two diseases and the perioperative care of this rare group of patients.
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2,754
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BRIEF COMMUNICATIONS
Breaking the midnight fast: An observational cross-sectional audit of preoperative fasting policies and practices at a Tertiary Care Hospital
Mayank Kulshrestha, Jean Jacob Mathews, M Kapadia, Sadhana Sanwatsarkar
July-August 2013, 57(4):414-417
DOI
:10.4103/0019-5049.118545
PMID
:24163464
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2,488
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EDITORIALS
Pharmaco‑genomics and anaesthesia: Mysteries, correlations and facts
S Bala Bhaskar, Sukhminder Jit Singh Bajwa
July-August 2013, 57(4):336-337
DOI
:10.4103/0019-5049.118517
PMID
:24163445
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2,410
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BRIEF COMMUNICATIONS
Cerebral salt wasting syndrome in craniopharyngioma
Sankari Santra, Jayanta Chakraborty, Bibhukalyani Das
July-August 2013, 57(4):404-405
DOI
:10.4103/0019-5049.118533
PMID
:24163459
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CASE REPORTS
Perioperative management of an elderly patient of hypertrophic obstructive cardiomyopathy for knee arthroplasty and the role of peripheral nerve blocks
Sunny Rupal, Adarsh C Swami, Swati Jindal, Sneh Lata
July-August 2013, 57(4):394-396
DOI
:10.4103/0019-5049.118566
PMID
:24163456
This case report exemplifies how the anaesthetic technique of general anesthesia with continuous bilateral femoral nerve block for bilateral knee arthroplasty was well chosen for the management of perioperative complications in an elderly patient with hypertrophic obstructive cardiomyopathy (HOCM). A 69-year-old female patient of HOCM was scheduled for bilateral total knee replacement. Echocardiography revealed severe left ventricular outflow tract obstruction with peak systolic gradient of 56 mmHg. The surgery was conducted under general anaesthesia with invasive monitoring and bilateral continuous femoral nerve blocks for postoperative analgesia. Postoperatively, she developed pulmonary oedema due to the liberal administration of fluids. This complication was successfully managed without interrupting the management of pain. Management of patients with HOCM for noncardiac surgery requires knowledge of variable presentation of two forms of disease. Also, this case report highlights the practical advantage of continuous femoral nerve block (CFNB)s over epidural anaesthesia.
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LETTERS TO EDITOR
Comment: Molar approach with backward, upward, right and posterior manoeuvre
Neeraj Kumar, Rajnish Kumar
July-August 2013, 57(4):431-432
DOI
:10.4103/0019-5049.118529
PMID
:24163476
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2,260
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Nasal intubation in an adult male with Le Fort II fracture and pneumocephalus using a nasogastric tube
Upasana Goswami, Dipali Taneja
July-August 2013, 57(4):419-420
DOI
:10.4103/0019-5049.118514
PMID
:24163466
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2,179
335
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EDITORIALS
The diamond jubilee of the Indian Journal of Anaesthesia: A look-back, for the future
S Bala Bhaskar
July-August 2013, 57(4):334-335
DOI
:10.4103/0019-5049.118510
PMID
:24163444
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2,058
337
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LETTERS TO EDITOR
Modification of submental intubation using oral Ring-Adair-Elwyn tubes in faciomaxillary surgeries: A novel approach
Joseph I Raajesh, Tripathy K Debendra, Devakumari Shanmugam, Ravindra R Bhat
July-August 2013, 57(4):418-419
DOI
:10.4103/0019-5049.118513
PMID
:24163465
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1,952
376
2
BRIEF COMMUNICATIONS
Does pre-operative echocardiography delay hip fracture surgery?
Mustansir Alibhai, Aadhar Sharma, Moiz K Alibhai, Ross A Fawdington, AP Moreau
July-August 2013, 57(4):408-410
DOI
:10.4103/0019-5049.118538
PMID
:24163461
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2,041
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LETTERS TO EDITOR
Dexmedetomidine as sedative and analgesic in a patient of sickle cell disease for total hip replacement
Tasneem Dhansura, Shakir Kapadia, Shweta Gandhi
July-August 2013, 57(4):425-426
DOI
:10.4103/0019-5049.118521
PMID
:24163470
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1,945
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Comment: Ondansetron: Timing and dosage
Deepak Hanumanthaiah, Vinod Sudhir
July-August 2013, 57(4):429-430
DOI
:10.4103/0019-5049.118527
PMID
:24163474
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1,870
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1
BRIEF COMMUNICATIONS
Leiomyoma of trachea: An anaesthetic challenge
Archna Koul, Jayashree Sood
July-August 2013, 57(4):412-414
DOI
:10.4103/0019-5049.118543
PMID
:24163463
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[PubMed]
1,892
355
1
LETTERS TO EDITOR
Unanticipated difficult airway
Vishnu Panwar, Pramod Kohli
July-August 2013, 57(4):420-422
DOI
:10.4103/0019-5049.118516
PMID
:24163467
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1,802
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A case of triple vessel disease posted for buccal mucosal graft urethroplasty under low dose spinal anaesthesia with dexmedetomedine
R Prabhavathi, Narasimha P Reddy, TS Chandra Sekhar, Vivek T Menacherry
July-August 2013, 57(4):428-429
DOI
:10.4103/0019-5049.118526
PMID
:24163473
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1,889
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Retained foreign bodies: Vigilance is the price of safety
Madhu Gupta, Deepika Govil, Iti Shri
July-August 2013, 57(4):422-423
DOI
:10.4103/0019-5049.118519
PMID
:24163468
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1,815
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1
CLINICAL INVESTIGATIONS
Are active warming measures required during paediatric cleft surgeries?
Sunil Rajan, Ramachandra Halemani, Nitu Puthenveettil, Ramasubramanian Baalachandran, Priyanka Gotluru, Jerry Paul
July-August 2013, 57(4):377-380
DOI
:10.4103/0019-5049.118565
PMID
:24163452
Background:
During paediatric cleft surgeries intraoperative heat loss is minimal and hence undertaking all possible precautions available to prevent hypothermia and use of active warming measures may result in development of hyperthermia. This study aims to determine whether there will be hyperthermia on active warming and hypothermia if no active warming measures are undertaken. The rate of intraoperative temperature changes with and without active warming was also noted.
Methods:
This study was conducted on 120 paediatric patients undergoing cleft lip and palate surgeries. In Group A, forced air warming at 38°C was started after induction. In Group B, no active warming was done. Body temperature was recorded every 30 min starting after induction until 180 min or end of surgery. Intragroup comparison of variables was done using Paired sample test and intergroup comparison using independent sample
t
-test.
Results:
In Group A, all intraoperative temperature readings were significantly higher than baseline. In Group B, there was a significant reduction in temperature at 30 and 60 min. Temperature at 90 min did not show any significant difference, but further readings were significantly higher. Maximum rise in temperature occurred in Group A between 120 and 150 min and maximum fall in temperature in Group B was seen during first 30 min.
Conclusion:
In pediatric cleft surgeries, we recommend active warming during the first 30 minutes if the surgery is expected to last for <2h, and no such measures are required if the expected duration is >2h.
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2
BRIEF COMMUNICATIONS
Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases
Vinod Hosalli, Uday S Ambi, Anilkumar Ganeshnavar, Shivanand Hulakund, DS Prakashappa
July-August 2013, 57(4):410-412
DOI
:10.4103/0019-5049.118541
PMID
:24163462
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1,708
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LETTERS TO EDITOR
Loss of integrity of a reinforced endotracheal tube by patient bite
Rashmi Jain, Nitin Sethi, Jayashree Sood
July-August 2013, 57(4):424-424
DOI
:10.4103/0019-5049.118520
PMID
:24163469
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PRESIDENTS MESSAGE
Indian Journal of Anaesthesia (IJA) at 60 years
Brig T Prabhakar
July-August 2013, 57(4):333-333
DOI
:10.4103/0019-5049.118507
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LETTERS TO EDITOR
Beware! defects in pipeline supplies can occur: Be aware of this possibility after engineering work in related areas of the hospital
SP Devanandan
July-August 2013, 57(4):426-427
DOI
:10.4103/0019-5049.118522
PMID
:24163471
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Comment: Hard palate tumour: A nightmare for the anaesthesiologists: Role of modified molar approach
KL Subramanyam
July-August 2013, 57(4):432-433
DOI
:10.4103/0019-5049.118530
PMID
:24163477
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Response: Comparative electrocardiographic effects of intravenous ondansetron and granisetron in patients undergoing surgery for carcinoma breast: A prospective single blind randomised trial
Ashish Ganjare, Atul P Kulkarmi
July-August 2013, 57(4):430-431
DOI
:10.4103/0019-5049.118528
PMID
:24163475
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BRIEF COMMUNICATIONS
Predicting intraoperative cardiovascular complication in patients with anterior mediastinal mass-role of central venous pressure monitoring
T Sivashanmugham, Sameer Mahamud Jahirdar, S Parthasarathy, G Muthurangan
July-August 2013, 57(4):406-408
DOI
:10.4103/0019-5049.118534
PMID
:24163460
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