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   2011| May-June  | Volume 55 | Issue 3  
    Online since July 7, 2011

 
 
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REVIEW ARTICLE
Liposuction: Anaesthesia challenges
Jayashree Sood, Lakshmi Jayaraman, Nitin Sethi
May-June 2011, 55(3):220-227
DOI:10.4103/0019-5049.82652  PMID:21808392
Liposuction is one of the most popular treatment modalities in aesthetic surgery with certain unique anaesthetic considerations. Liposuction is often performed as an office procedure. There are four main types of liposuction techniques based on the volume of infiltration or wetting solution injected, viz dry, wet, superwet, and tumescent technique. The tumescent technique is one of the most common liposuction techniques in which large volumes of dilute local anaesthetic (wetting solution) are injected into the fat to facilitate anaesthesia and decrease blood loss. The amount of lignocaine injected may be very large, approximately 35-55 mg/kg, raising concerns regarding local anaesthetic toxicity. Liposuction can be of two types according to the volume of solution aspirated: High volume (>4,000 ml aspirated) or low volume (<4,000 ml aspirated). While small volume liposuction may be done under local/monitored anaesthesia care, large-volume liposuction requires general anaesthesia. As a large volume of wetting solution is injected into the subcutaneous tissue, the intraoperative fluid management has to be carefully titrated along with haemodynamic monitoring and temperature control. Assessment of blood loss is difficult, as it is mixed with the aspirated fat. Since most obese patients opt for liposuction as a quick method to lose weight, all concerns related to obesity need to be addressed in a preoperative evaluation.
  7,074 3,339 4
CLINICAL INVESTIGATIONS
A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering
Usha Shukla, Kiran Malhotra, T Prabhakar
May-June 2011, 55(3):242-246
DOI:10.4103/0019-5049.82666  PMID:21808395
The aim of this study was to evaluate the efficacy, potency and side effects of clonidine as compared to tramadol in post-spinal anaesthesia shivering. In this prospective double-blind randomized controlled clinical trial, 80 American Society of Anaesthesiologists grade-l (ASAI) patients aged between 18 and 45 years scheduled for various surgical procedures under spinal anaesthesia, who developed shivering were selected.The patients were divided into two groups: Group C (n=40) comprised of patients who received clonidine 0.5mg/kg intravenously (IV) and group patients who received tramadol 0.5 mg/kg IV. Grade of shivering, disappearance of shivering, haemodynamics and side effects were observed at scheduled intervals. Disappearance of shivering was significantly earlier in group C (2.54±0.76) than in group T (5.01±1.02) (P=.0000001). Response rate to treatment in group C was higher (97.5%) than in group T (92.5%), but the difference was not significant. Nausea, vomiting and dizziness were found to be higher in group T (P=0.001, 0.005, 0.001, respectively), while the patients in group C were comparatively more sedated (sedation level, 2; group C, 25%). We conclude that clonidine gives better thermodynamics than tramadol, with fewer side effects.
  6,038 1,498 5
EVIDENCE BASED REPORT
Submental intubation in patients with panfacial fractures: A prospective study
Premalatha M Shetty, Santosh Kumar Yadav, Madhusudan Upadya
May-June 2011, 55(3):299-304
DOI:10.4103/0019-5049.82685  PMID:21808409
Submental intubation is an interesting alternative to tracheostomy, especially when short-term postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Submental intubation with midline incision has been used in 10 cases from October 2008 to March 2010 in the Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore. All patients had fractures of the jaws disturbing the dental occlusion associated with fracture of the base of the skull, or/and a displaced nasal bone fracture. After standard orotracheal intubation, a passage was created by blunt dissection with a haemostat clamp through the floor of the mouth in the submental area. The proximal end of the orotracheal tube was pulled through the submental incision. Surgery was completed without interference from the endotracheal tube. At the end of surgery, the tube was pulled back to the usual oral route. There were no perioperative complications related to the submental intubation procedure. Average duration of the procedure was less than 6 minutes. Submental intubation is a simple technique associated with low rates of morbidity. It is an attractive alternative to tracheotomy in the surgical management of selected cases of panfacial trauma.
  6,479 1,030 3
SPECIAL ARTICLES
Parkinson's disease and anaesthesia
Safiya I Shaikh, Himanshu Verma
May-June 2011, 55(3):228-234
DOI:10.4103/0019-5049.82658  PMID:21808393
Parkinson's disease (PD), one of the most common disabling neurological diseases, affects about 1% of the population over 60 years of age. It is a degenerative disease of the central nervous system caused by the loss of dopaminergic fibers in basal ganglia of the brain. PD is an important cause of perioperative morbidity and with an increasingly elderly population, it is being encountered with greater frequency in surgical patients. Particular anaesthetic problems in PD include old age, antiparkinsonian drug interaction with anaesthetic drugs and various alterations in the respiratory, cardiovascular, autonomic, and neurological systems. This brief review focuses on the preoperative, intraoperative, and postoperative anesthetic management of PD and gives a brief account of intraoperative exacerbation of PDs and anesthetic management of stereotactic pallidotomy.
  5,402 1,797 8
CLINICAL INVESTIGATIONS
Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy
Muralidhar Kanchi, Hema C Nair, Sanjay Banakal, Keshava Murthy, C Murugesan
May-June 2011, 55(3):260-265
DOI:10.4103/0019-5049.82673  PMID:21808398
Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randomly allocated to undergo either conventional laryngoscopy (group A) or video laryngoscopy (group B). The time taken to perform endotracheal intubation and haemodynamic changes associated with intubation were noted in both the groups at different time points. The duration of laryngoscopy and intubation was significantly longer in group B (video laryngoscopy) when compared to group A patients. However, haemodynamic changes were no different between the groups. There were no events of myocardial ischaemia as monitored by surface electrocardiography during the study period in either of the groups. In conclusion, video laryngoscopy did not provide any benefit in terms of haemodynamic response to laryngoscopy and intubation in patients undergoing primary CABG with a Mallampatti grade of <2.
  4,742 711 5
Procalcitonin as an adjunctive biomarker in sepsis
Mahua Sinha, Seemanthini Desai, Sumant Mantri, Anuja Kulkarni
May-June 2011, 55(3):266-270
DOI:10.4103/0019-5049.82676  PMID:21808399
Sepsis can sometimes be difficult to substantiate, and its distinction from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT) assay is one of the biomarkers of sepsis. The present study was aimed to assess the usefulness of PCT assay in critically ill patients with suspected sepsis. The study included 40 patients from the intensive care unit with suspected sepsis. Sepsis was confirmed clinically and/or by positive blood culture. Serum PCT was assayed semi-quantitatively by rapid immunochromatographic technique (within 2 hours of sample receipt). Among 40 critically ill patients, 21 had clinically confirmed sepsis. There were 12 patients with serum PCT ≥10 ng/ml (8, blood culture positive; 1, rickettsia; 2, post-antibiotic blood culture sterile; and 1, non-sepsis); 7 patients with PCT 2-10 ng/ml (4, blood culture positive; 1, falciparum malaria; 2, post-antibiotic blood culture sterile); 3 patients with PCT of 0.5 to 2 ng/ml (sepsis in 1 patient); and 18 patients with PCT < 0.5 ng/ml (sepsis in 2 patients). Patients with PCT ≥ 2 ng/ml had statistically significant correlation with the presence of sepsis (P<0.0001). The PCT assay revealed moderate sensitivity (86%) and high specificity (95%) at a cut-off ≥ 2 ng/ml. The PCT assay was found to be a useful biomarker of sepsis in this study. The assay could be performed and reported rapidly and provided valuable information before availability of culture results. This might assist in avoiding unwarranted antibiotic usage.
  3,992 892 10
CASE REPORTS
Congenital lobar emphysema in neonates: Anaesthetic challenges
Mridu Paban Nath, Sachin Gupta, Ashish Kumar, Anulekha Chakrabarty
May-June 2011, 55(3):280-283
DOI:10.4103/0019-5049.82688  PMID:21808403
Congenital lobar emphysema (CLE) is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.
  4,004 554 2
Anaesthetic management and implications of a case of chronic inflammatory demyelinating polyneuropathy
Babita Gupta, Pramendra Agrawal, Nita D'souza, Chhavi Sawhney
May-June 2011, 55(3):277-279
DOI:10.4103/0019-5049.82683  PMID:21808402
A 60-year-old man with chronic inflammatory demyelinating polyneuropathy (CIDP) was posted for surgery of the neck femur fracture and was successfully managed. We discuss the anaesthetic considerations during regional and general anaesthesia of this patient with CIDP. A brief review of the available literature reveals no consensus on the choice of anaesthetic management.
  3,480 460 1
EDITORIAL
Pulse oximetry: Mandatory for sedation during regional/local Anaesthesia (but watch for hypoventilation!)
JV Divatia
May-June 2011, 55(3):217-219
DOI:10.4103/0019-5049.82649  PMID:21808391
  3,089 717 -
CASE REPORTS
Fulminant hepatic failure after repeated exposure to isoflurane
Halemani R Kusuma, Neelam K Venkataramana, Shailesh AV Rao, Arun L Naik, DS Gangadhara, Keshavan H Venkatesh
May-June 2011, 55(3):290-292
DOI:10.4103/0019-5049.82696  PMID:21808406
Inhalational agents are used routinely for maintenance of anaesthesia. Post anaesthesia hepatic failure has been documented following exposure to halothane. However, there are very few reports of such complications following isoflurane anaesthesia. A 6-year-old child developed fulminant hepatic failure 2 days following craniotomy under general anaesthesia. There was no evidence of viral, autoimmune, or metabolic causes of hepatitis. No other medications known to cause hepatitis, except low dose paracetamol, were administered. The clinical and histological picture of our case is similar to that of halothane hepatitis, which has a significant mortality rate. We report this as a possible fulminant hepatic failure resulting from exposure to isoflurane anaesthesia.
  3,196 443 3
BRIEF COMMUNICATION
Post-operative analgesia regime following joint replacement
Prem Kakar, Vinod Gagrani, Umesh Deshmukh, Gurpreet Popli
May-June 2011, 55(3):305-306
DOI:10.4103/0019-5049.82681  PMID:21808410
  3,034 578 -
CLINICAL INVESTIGATIONS
A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator
Vikram Uday Lahori, Anjana Raina, Smriti Gulati, Dinesh Kumar, Satya Dev Gupta
May-June 2011, 55(3):253-259
DOI:10.4103/0019-5049.82670  PMID:21808397
Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB) in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.
  2,833 624 1
Does unilateral hip flexion increase the spinal anaesthetic level during combined spinal-epidural technique?
Medha Mohta, Deepti Agarwal, AK Sethi
May-June 2011, 55(3):247-252
DOI:10.4103/0019-5049.82668  PMID:21808396
Needle-through-needle combined spinal-epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique.
  2,927 514 -
LETTERS TO EDITOR
Use of intubating laryngeal mask airway for intubation in patient with massive goitrous thyroid
Rakesh Garg, Sujata Sharma, Seema Rathee, Mridula Pawar
May-June 2011, 55(3):314-315
DOI:10.4103/0019-5049.82661  PMID:21808417
  2,850 393 1
Tramadol-induced respiratory depression in a morbidly obese patient with normal renal function
Thrivikrama P Tantry, Dinesh Kadam, Pramal Shetty, Karunakara K Adappa
May-June 2011, 55(3):318-320
DOI:10.4103/0019-5049.82667  PMID:21808420
  2,695 408 6
SPECIAL ARTICLES
The impact of increasing oximetry usage in India: A pilot study
Gretl A McHugh, Brian J Pollard, Sarla Hooda, Gavin M.M Thoms
May-June 2011, 55(3):235-241
DOI:10.4103/0019-5049.82662  PMID:21808394
The overall goal of the global oximetry (GO) project was to increase patient safety during anaesthesia and surgery in low and middle income countries by decreasing oximetry costs and increasing oximetry utilisation. Results from the overall project have been previously published. This paper reports specifically on pilot work undertaken in four hospitals in one Indian State. The aim of this work was to assess the impact of increasing oximetry provision in terms of benefits to anaesthetists and in the identification of patient problems during anaesthesia, to identify training needs and to explore perceptions regarding barriers to more comprehensive oximetry coverage. Data collection was by interview with hospital staff, use of a log-book to capture data on desaturation episodes and a follow-up questionnaire at 10 months after the introduction of additional oximeters. Increasing oximetry utilisation in the four hospitals was viewed positively by the anaesthetic staff and enabled improvement in monitoring patients. Of the 939 monitored patients studied, 214 patients (23%) experienced a total of 397 desaturation episodes. For nearly half of the patients undergoing caesarean section under regional anaesthesia following a desaturation event supplementary oxygen was required. In 53 of the 379 female sterilisations (14%) desaturation episodes occurred and in eight patients, there were 17 episodes of desaturation due to obstruction. In the recovery room, 91 of the 939 patients were monitored using the oximeters with 12 patients (13%) requiring oxygen. This study has highlighted that pulse oximetry must be used even in patients having surgical procedures or caesarean section under regional or local anaesthesia as these procedures are associated with hypoxic episodes. Anaesthetists must ensure they are complying with the Indian Society of Anaesthesiologists monitoring standards for anaesthesia and ensure patients are monitored by pulse oximetry.
  2,240 465 -
CASE REPORTS
Radial artery pseudo aneurysm after percutaneous cannulation using Seldinger technique
Anil Ranganath, Deepak Hanumanthaiah
May-June 2011, 55(3):274-276
DOI:10.4103/0019-5049.82680  PMID:21808401
Cannulation of a peripheral artery in a patient allows for continuous blood pressure (BP) monitoring and facilitates frequent arterial blood gas (ABG) analysis. Complications include thrombosis, embolism risk, haemorrhage, sepsis, and formation of pseudo aneurysms. A 75-year-old male admitted via casualty with a collapse secondary to seizures. Patient was intubated and mechanically ventilated for 7 days. A right radial artery catheter was inserted on admission to casualty. The arterial catheter remained in situ for 7 days. Five days following its removal, the skin site appeared inflamed and a wound swab grew methicillin resistant Staphylococcus aureus (MRSA). Eight days later a distinct bulging of the radial artery was noticed. An ultrasound was done and it showed radial artery pseudoaneurysm, the diagnosis was confirmed by angiogram. Delayed radial artery pseudoaneurysm formation has only been reported in association with infection, and less than twenty of these cases have been reported in the literature.
  2,333 339 1
Acute atrial fibrillation in emergency surgery:Is it rare?
Saravanan Ankichetty, Amar Nandhakumar, Rajeev Subramanyam, Lashmi Venkatraghavan
May-June 2011, 55(3):287-289
DOI:10.4103/0019-5049.82694  PMID:21808405
Atrial fibrillation (AF) is a common arrhythmia with an estimated clinical prevalence of approximately 1% in the general population and as high as 9% in individuals by the age of 80 years. The aetiology is multifactorial. Systemic disease, e.g., inflammatory processes, sarcoidosis, autoimmune disorders, has also been linked to the development of AF. Myocardial dysfunction observed in sepsis could contribute to arrhythmias and inflammation per se could induce or provoke AF. We describe the successful management of an acute AF in an elderly patient scheduled for emergency laparotomy and closure of hollow viscous perforation.
  2,158 475 -
MEDICOLEGAL ISSUES
Intraoperative bronchospasm leading to hypoxic brain damage: Medicolegal update
Amit V Padvi, Namita M Baldwa, Mahesh S Baldwa
May-June 2011, 55(3):307-308
DOI:10.4103/0019-5049.82677  PMID:21808411
  2,102 506 -
CLINICAL INVESTIGATIONS
Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study
Rakesh Garg, Puneet Khanna, Renu Sinha
May-June 2011, 55(3):271-273
DOI:10.4103/0019-5049.82679  PMID:21808400
An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.
  2,214 310 -
CASE REPORTS
Tubercular mediastinal lymphadenopathy: An unusual cause of failed decannulation and tracheostomy
Deepak Thapa, Vanita Ahuja, Purva Khandelwal
May-June 2011, 55(3):293-295
DOI:10.4103/0019-5049.82693  PMID:21808407
Literature has described many causes of failed decannulation and weaning. However, failed decannulation and weaning from ventilator due to a hilar lymph node compressing upon a bronchus has not been described. We report a case of a 30-year-old man with Guillain-Barré syndrome who had quadriparesis and respiratory distress. After 1 year of intensive care unit admission, he was ambulatory, haemodynamically stable, devoid of sepsis, had effective cough with tracheostomy in situ. Every attempt of decannulation led to pooling of secretions in left side of chest, hypercarbia and altered sensorium. This was followed by re-institution of ventilator support. Chest x-ray was unremarkable, but computed tomography (CT) chest done during this time showed a mass compressing upon left lower lobe bronchus. Flexible fibre-optic bronchoscopy and transbronchial biopsy confirmed the diagnosis to be tubercular lymph node. After 1 month of starting of anti-tubercular treatment, there was resolution of the mass with relief of the bronchial compression and a successful decannulation thereafter. Role of CT in difficult cases of weaning is emphasized, and role of bronchoscopy is highlighted in difficult cases of weaning and decannulation.
  2,262 261 1
Failed rapid sequence induction in an achondroplastic dwarf
Jasleen Kaur, Padmaja Durga, Nirmala Jonnavithula, Gopinath Ramachandran
May-June 2011, 55(3):296-298
DOI:10.4103/0019-5049.82691  PMID:21808408
Achondroplasia, a common cause of short limbed type of dwarfism is due to quantitative decrease in rate of endochondral ossification. This abnormal bone growth leads to disproportionate body and head structure, thus placing them under high risk for anaesthetic management. There is paucity in literatures, regarding appropriate drug dosage selection in these patients. Use of drugs as per standard dosage recommendations based on body weight or body surface area, may not be adequate in these patients owing to discrepancies in overall body weight and lean body weight, especially during rapid sequence induction. Here, we report a case of failed rapid sequence induction due to abnormal response to administered drugs in an adult achondroplastic dwarf. Standard doses of thiopentone and rocuronium had to be repeated thrice to achieve adequate conditions for intubation.
  2,124 370 4
LETTERS TO EDITOR
Dermatomyositis with scleroderma-overlap syndrome and its anaesthetic implications
Shweta R Yemul-Golhar, Pradnya M Bhalerao, Sunita M Khedkar, Shashank S Shettar, Kalpana V Kelkar
May-June 2011, 55(3):316-317
DOI:10.4103/0019-5049.82664  PMID:21808418
  2,090 317 -
CASE REPORTS
Accidental transection of flexometallic endotracheal tube during partial maxillectomy
Sushma D Ladi, Shubhada Aphale
May-June 2011, 55(3):284-286
DOI:10.4103/0019-5049.82689  PMID:21808404
We report a rare case of an 18-year-old female patient in whom accidental sectioning of flexometallic endotracheal tube occurred during partial maxillectomy for mass lesion under general anaesthesia. She was managed successfully by tracheostomy.
  1,912 300 1
LETTERS TO EDITOR
Molar approach of intubation in a neonate with large intraoral swelling
Apurva Mittal, Yogita Dwivedi, Komal Joshi, Arpita Saxena, Amrita Gupta
May-June 2011, 55(3):312-313
DOI:10.4103/0019-5049.82657  PMID:21808415
  1,789 319 1
Red plug: An alternative to the blocked ProSeal TM laryngeal mask airway inflation valve
Bimla Sharma, Chand Sahai, Jayashree Sood
May-June 2011, 55(3):317-318
DOI:10.4103/0019-5049.82665  PMID:21808419
  1,691 257 -
Dangerous sedation in an obese patient
Leena Rachel Koshy, Shaloo Ipe, Saramma P Abraham, Grace Maria George
May-June 2011, 55(3):313-314
DOI:10.4103/0019-5049.82659  PMID:21808416
  1,528 319 2
Is central-line guidewire sufficient for retrograde intubation?
Harihar V Hegde, P Raghavendra Rao, Shrirang V Torgal
May-June 2011, 55(3):321-321
DOI:10.4103/0019-5049.82671  PMID:21808422
  1,461 302 -
CORRESPONDENCE
Air-conditioning for infection control
Mohd Saif Ghaus
May-June 2011, 55(3):322-322
DOI:10.4103/0019-5049.82674  PMID:21808423
  1,394 329 -
LETTERS TO EDITOR
Use of recombinant factor VIIa in orthotopic liver transplant
Pradeep Bhatia
May-June 2011, 55(3):309-310
DOI:10.4103/0019-5049.82651  PMID:21808412
  1,326 338 -
Challenges in the management of obese parturient
Preety Mittal Roy, Vimarsh Madan, Vijaya Pant, Jyotirmoy Das
May-June 2011, 55(3):320-321
DOI:10.4103/0019-5049.82669  PMID:21808421
  1,235 327 -
Clonidine for an unusual isolated femoral nerve stretch injury
Prakash K Dubey
May-June 2011, 55(3):311-312
DOI:10.4103/0019-5049.82655  PMID:21808414
  1,358 196 -
Authors' reply
Jalpa Makwana, Saloni Paranjape, Jyotsna Goswami
May-June 2011, 55(3):310-311
PMID:21808413
  1,294 210 -
ANNOUCEMENT
Annoucement

May-June 2011, 55(3):227-227
  1,184 238 -
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