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   2014| May-June  | Volume 58 | Issue 3  
    Online since June 23, 2014

 
 
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CLINICAL INVESTIGATIONS
Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering
Geeta Mittal, Kanchan Gupta, Sunil Katyal, Sandeep Kaushal
May-June 2014, 58(3):257-262
DOI:10.4103/0019-5049.135031  PMID:25024466
Background and Aims: Dexmedetomidine (α2 adrenergic agonist) has been used for prevention of post anaesthesia shivering. Its use for the treatment of post-spinal anaesthesia shivering has not been evaluated. The aim of this study was to evaluate and compare the efficacy, haemodynamic and adverse effects of dexmedetomidine with those of tramadol, when used for control of post-spinal anaesthesia shivering. Methods: A prospective, randomised, and double-blind study was conducted in 50 American Society of Anaesthesiologists Grade I and II patients of either gender, aged between 18 and 65 years, scheduled for various surgical procedures under spinal anaesthesia. The patients were randomised in two groups of 25 patients each to receive either dexmedetomidine 0.5 μg/kg or tramadol 0.5 mg/kg as a slow intravenous bolus. Grade of shivering, onset of shivering, time for cessation of shivering, recurrence, response rate, and adverse effects were observed at scheduled intervals. Unpaired t-test was used for analysing the data. Results: Time taken for cessation of shivering was significantly less with dexmedetomidine when compared to tramadol. Nausea and vomiting was observed only in tramadol group (28% and; 20% respectively). There was not much difference in the sedation profile of both the drugs. Conclusion: We conclude that although both drugs are effective, the time taken for cessation of shivering is less with dexmedetomidine when compared to tramadol. Moreover, dexmedetomidine has negligible adverse effects, whereas tramadol is associated with significant nausea and vomiting.
  9 5,625 1,578
Ketofol-Dexmedetomidine combination in ECT: A punch for depression and agitation
Tarek Shams, Ragaa El-Masry
May-June 2014, 58(3):275-280
DOI:10.4103/0019-5049.135037  PMID:25024469
Background and Aims : The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression. Methods : 40 patients aged 18-60 years were scheduled for ECT for treatment of depression. Dexmedetomidine (0.5 μg/kg) diluted to a volume of 10 ml with 0.9% saline or 10 ml 0.9% saline were infused intravenously over 10 minutes before induction of anaesthesia with ketamine and propofol (ketofol). Statistical analysis was carried out using the Statistical Software for the Social Sciences (SPSS) package. Results : Motor seizure duration in ketofol group was significantly less compared to ketofol-dex group (35.8 ± 6.6s versus 38.9 ± 4.9s). Total ketofol used was significantly less in ketofol-dex group compared to ketofol group (78.5 ± 10.8mg versus 90 ± 13.2mg). The number of patients with agitation score >2 was significantly lower in ketofol-dex group (1.4%) compared to ketofol group (8.6%). There was significant decrease (P = 0.000) in mean arterial pressure (MAP) and heart rate (HR) in ketofol-dex group compared to ketofol group at 20, 30, and 40 minutes for MAP and at 10, 20, 30, and 40 minutes for HR. Conclusions : Ketofol-dex mixture in ECT is associated with longer mean seizure duration, effective anti-depression, less incidence of agitation, more patient satisfaction, and acceptable decreases in blood pressure and HR when compared to ketofol alone.
  8 3,129 804
Post-operative cognitive dysfunction in the elderly: A prospective clinical study
Nalini Kotekar, Caroline Sheryl Kuruvilla, Vishakantha Murthy
May-June 2014, 58(3):263-268
DOI:10.4103/0019-5049.135034  PMID:25024467
Background and Aims: Aging population is a major demographic trend worldwide. Globally, 50% of all the elderly individuals are estimated to undergo atleast one surgical procedure and post-operative cognitive dysfunction (POCD) is one of the most common and often poorly understood post-operative complications in this section of the population. This randomised prospective study was conducted to assess the post-operative cognitive status in the elderly undergoing non-cardiac surgery, evaluate the cognitive parameters affected, evaluate the potential risk factors and thereby analyse the potential for implementation of preventive strategies. Methods: This study was conducted on 200 patients aged 60 years or older scheduled for elective non-cardiac surgeries. The baseline cognitive status of the patients was assessed 2 days prior to the date of the surgery. The post-operative cognitive status was assessed on the 3 rd day, 7 th day and after 1 month. Statistical analysis was performed using SAS and SPSS. Results: The incidence of POCD showed a gradual decline from postoperative day 3 to 30. Females were found to be at significant risk in developing POCD. Advancing age and level of education emerged as dominant factors, while type of anaesthesia, duration of surgery, and presence of coexisting comorbidities had no influence on the incidence of cognitive dysfunction. Conclusion: POCD is a definite complication after surgery and anaesthesia in the elderly population. Gender emerged as a significant risk factor with increasing age as a dominating factor contributing to POCD.
  7 5,108 1,793
Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomized study
Geeta P Parikh, Veena R Shah, Kalpana S Vora, Beena K Parikh, Manisha P Modi, Pratibha Kumari
May-June 2014, 58(3):293-297
DOI:10.4103/0019-5049.135040  PMID:25024472
Background and Aim: Percutaneous nephrolithotomy (PCNL) is a common for managing renal calculi. Pain in the initial post operatie period is relieved by infiltration of local anaesthetic around the nephrostomy tract.We aimed to compare the analgesic efficacy of bupivacaine and ropivacaine. Methods: A total of 100 adult patients undergoing elective PCNL- under balanced general anaesthesia were randomly divided into bupivacaine group (Group B) and ropivacaine group (Group R). After completion of procedure, 23G spinal needle was inserted at 6 and 12 O'clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A volume of 10 ml of either 0.25% bupivacaine or 0.25% ropivacaine solution was infiltrated in each tract while withdrawing the needle. Post-operative pain was assessed using visual analogue scale (VAS) and dynamic visual analogue scale (D-VAS) for initial 24 h. Intravenous tramadol was given as rescue analgesia when VAS >4. Time to first rescue analgesic, number of doses and total amount of tramadol required in initial 24 h and side-effects were noted. Results: Visual analogue scale and D-VAS at 6 h and 8 h in Group B was significantly higher than Group R. Mean time to first rescue analgesia in Group R was significantly longer than Group B. Mean number of doses of tramadol and total consumption of tramadol in 24 h was less in Group R, though not statistically significant. Conclusion: Peritubal infiltration of 0.25% ropivacaine infiltration along the nephrostomy tract is more effective than 0.25% bupivacaine in alleviating initial post-operative pain after PCNL.
  4 2,060 435
BRIEF COMMUNICATIONS
Comparison of 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia in lower extremity orthopaedic surgeries
Shalina Chandran, S Hemalatha, PN Viswanathan
May-June 2014, 58(3):336-338
DOI:10.4103/0019-5049.135078  PMID:25024483
  3 3,504 762
CASE REPORTS
Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle
Harsha Shanthanna
May-June 2014, 58(3):327-329
DOI:10.4103/0019-5049.135050  PMID:25024480
We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.
  3 2,662 659
SPECIAL ARTICLE
Post-operative delirium in elderly patients
B Vijayakumar, P Elango, R Ganessan
May-June 2014, 58(3):251-256
DOI:10.4103/0019-5049.135026  PMID:25024465
Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge about the disease, diagnosis, pathogenesis, preventive strategies, and treatment of post-operative delirium.
  3 4,166 1,362
CASE REPORTS
Re-expansion pulmonary oedema - differential lung ventilation comes to the rescue
Shreepathi K Achar, Souvik Chaudhuri, HM Krishna, MS Sagar
May-June 2014, 58(3):330-333
DOI:10.4103/0019-5049.135051  PMID:25024481
Re-expansion pulmonary oedema (REPE) is a rare complication following re-inflation of a chronically collapsed lung, which is often fatal. We present a case of a 22-year-old male who presented to the hospital with severe respiratory distress and a history of blunt abdominal trauma 3 months back. He was diagnosed to have left sided diaphragmatic hernia with a mediastinal shift to the right, and was posted for emergency repair of the same. After surgical decompression of the left hemi-thorax and reduction of the abdominal contents, re-expansion of the left lung was achieved, following which patient developed REPE. A left sided double lumen tube was then inserted to prevent flooding and cross contamination of the right lung and ventilation of both lungs was maintained intraoperatively. Post-operatively, REPE was successfully managed by differential lung ventilation with a lung salvage strategy to the left lung and a lung protective strategy to the right lung.
  2 2,324 448
Emphysematous pancreatitis predisposed by Olanzapine
Sukhen Samanta, Sujay Samanta, Krishanu Banik, Arvind Kumar Baronia
May-June 2014, 58(3):323-326
DOI:10.4103/0019-5049.135049  PMID:25024479
A 32-year-old male presented to our intensive care unit with severe abdominal pain and was diagnosed as acute pancreatitis after 2 months of olanzapine therapy for bipolar disorder. His serum lipase was 900 u/L, serum triglyceride 560 mg/dL, and blood sugar, fasting and postprandial were 230 and 478 mg/dL, respectively on admission. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of acute pancreatitis. Repeat CECT showed gas inside pancreas and collection in peripancreatic area and patient underwent percutaneous drainage and antibiotics irrigation through the drain into pancreas. We describe the rare case of emphysematous pancreatitis due to development of diabetes, hypertriglyceridemia and immunosuppression predisposed by short duration olanzapine therapy.
  2 1,720 343
Acute cyanide Intoxication: A rare case of survival
Durga Jethava, Priyamvada Gupta, Sandeep Kothari, Puneet Rijhwani, Ankit Kumar
May-June 2014, 58(3):312-314
DOI:10.4103/0019-5049.135045  PMID:25024476
A 30-year-old male jewellery factory worker accidentally ingested silver potassium cyanide and was brought to the emergency department in a state of shock and profound metabolic acidosis. This patient was managed hypothetically with use of injection thiopentone sodium intravenously until the antidote was received. Cyanide is a highly cytotoxic poison and it rapidly reacts with the trivalent iron of cytochrome oxidase thus paralysing the aerobic respiration. The result is severe lactic acidosis, profound shock, and its fatal outcome. The patient dies of cardio-respiratory arrest secondary to dysfunction of the medullary centres. It is rapidly absorbed, symptoms begin few seconds after exposure and death usually occurs in <30 min. The average lethal dose for potassium cyanide is about 250 mg. We used repeated doses of thiopentone sodium till the antidote kit was finally in our hands, hypothesising that it contains thiol group similar to the antidote thiosulphate. Moreover, it is an anticonvulsant. We were successful in our attempts and the patient survived though the specific antidotes could be administered after about an hour.
  2 3,005 526
CLINICAL INVESTIGATIONS
Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion
Aloka Samantaray
May-June 2014, 58(3):281-286
DOI:10.4103/0019-5049.135038  PMID:25024470
Background and Aim: Central venous catheter (CVC) insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA) field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Methods: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 μg/kg) or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points. Results: The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7]) and at the end of procedure (5 [4-5]), which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively). The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008). Conclusions: Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose.
  2 1,724 465
HISTORY
John Scott Haldane: The father of oxygen therapy
KC Sekhar, SSC Chakra Rao
May-June 2014, 58(3):350-352
DOI:10.4103/0019-5049.135087  PMID:25024490
John Scott Haldane was a versatile genius who solved several problems of great practical significance. His ability to look beyond the laboratory and investigate theory added crucial findings in the field of respiratory physiology. His work on high altitude physiology, diving physiology, oxygen therapy, and carbon monoxide poisoning led to a sea change in clinical medicine and improved safety and reduced mortality and morbidity in many high risk situations.
  2 2,594 581
LETTERS TO EDITOR
A patient with acute abducens nerve palsy for lower segment caesarean section
Abhijit S Nair, B Vijay Kumar
May-June 2014, 58(3):359-360
DOI:10.4103/0019-5049.135095  PMID:25024496
  2 1,189 303
BRIEF COMMUNICATIONS
Predictors of postoperative cognitive dysfunction in adult patients undergoing elective cardiac surgery
Madanmohan Shiraboina, Syamasundara Ayya, Y Srikanth, RV Kumar, Padmaja Durga, Ramachandran Gopinath
May-June 2014, 58(3):334-336
DOI:10.4103/0019-5049.135077  PMID:25024482
  1 1,547 398
CASE REPORTS
Leukemoid like reaction in a post CABG patient
G Padmakumar, J Ravikrishnan, P Jayakumar, K Prasad
May-June 2014, 58(3):315-318
DOI:10.4103/0019-5049.135046  PMID:25024477
The presentation of leukemoid reaction in patients post-cardiac surgery is rare with limited prior reports in the English language literature. We report a case of raised leukocyte count with no evidence of infection in a patient post coronary artery bypass graft surgery. The exaggerated inflammatory response by the patient to extra-corporeal circulation was drastically elevated, but fell short of the leukaemoid reaction definition - so we have defined it as a leukaemoid like reaction. A clear correlation between the extra-corporeal circulation and inflammatory response is documented.
  1 2,331 316
CLINICAL INVESTIGATIONS
Tracheal intubation in patients with cervical spine immobilization: A comparison of McGrath ® video laryngoscope and Truview EVO2 ® laryngoscope
Ruchi Bhola, Swaran Bhalla, Radha Gupta, Ishwar Singh, Sunil Kumar
May-June 2014, 58(3):269-274
DOI:10.4103/0019-5049.135035  PMID:25024468
Background and Aims: Literature suggests that glottic view is better when using McGrath® Video laryngoscope and Truview® in comparison with McIntosh blade. The purpose of this study was to evaluate the effectiveness of McGrath Video laryngoscope in comparison with Truview laryngoscope for tracheal intubation in patients with simulated cervical spine injury using manual in-line stabilisation. Methods: This prospective randomised study was undertaken in operation theatre of a tertiary referral centre after approval from the Institutional Review Board. A total of 100 consenting patients presenting for elective surgery requiring tracheal intubation were randomly assigned to undergo intubation using McGrath® Video laryngoscope (n = 50) or Truview® (n = 50) laryngoscope. In all patients, we applied manual-in-line stabilisation of the cervical spine throughout the airway management. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Demographic data, airway assessment and haemodynamics were compared using the Chi-square test. A P < 0.05 was considered significant. Results: The time to successful intubation was less with McGrath video laryngoscope when compared to Truview (30.02 s vs. 38.72 s). However, there was no significant difference between laryngoscopic views obtained in both groups. The number of second intubation attempts required and incidence of complications were negligible with both devices. Success rate of intubation with both devices was 100%. Intubation with McGrath Video laryngoscope caused lesser alterations in haemodynamics. Conclusions: Both laryngoscopes are reliable in case of simulated cervical spine injury using manual-in-line stabilisation with 100% success rate and good glottic view.
  1 2,909 633
EDITORIAL
From pre-operative comorbidities to post-operative cognitive dysfunction: The challenging face of geriatric anaesthesia
S Bala Bhaskar, Sukhminder Jit Singh Bajwa
May-June 2014, 58(3):248-250
DOI:10.4103/0019-5049.135024  PMID:25024464
  1 2,950 930
BRIEF COMMUNICATIONS
Missed nasopharyngeal teratoma: A cause for recurrent respiratory distress in a neonate
M Manjuladevi, Kshma A Kilpadi, Jiby Jose, Apoorwa Kothari
May-June 2014, 58(3):338-341
DOI:10.4103/0019-5049.135079  PMID:25024484
  - 1,444 221
Klippel-Feil syndrome and neuraxial anaesthesia
Sukhyanti Kerai, KN Saxena, Bharti Taneja
May-June 2014, 58(3):341-343
DOI:10.4103/0019-5049.135081  PMID:25024485
  - 1,657 336
Anaesthetic management of a case of hereditary spherocytosis for splenectomy and cholecystectomy
Krishna Chaithanya, P Narasimha Reddy, Sangamitra Gandra, A Srikanth
May-June 2014, 58(3):343-345
DOI:10.4103/0019-5049.135082  PMID:25024486
  - 4,724 580
Colostomy in an ischiopagus, 3 rd PND conjoined twins with cross-circulation: Anaesthetic management
Rashmi Pal, Kishore K Arora
May-June 2014, 58(3):345-347
DOI:10.4103/0019-5049.135083  PMID:25024487
  - 1,621 252
A case of subacute intestinal obstruction with overt hypothyroidism in stupor scheduled for emergency laparotomy
Anand T Talikoti, Shrirang Rao, M Ravi, H Priyamargavi
May-June 2014, 58(3):347-349
DOI:10.4103/0019-5049.135085  PMID:25024488
  - 2,280 409
CASE REPORTS
Perioperative considerations in a sickle cell patient undergoing cardiopulmonary bypass
Monish S Raut, Jasbir Singh Khanuja, Sushant Srivastava
May-June 2014, 58(3):319-322
DOI:10.4103/0019-5049.135047  PMID:25024478
An 11-year-old child, a known case of sickle cell anaemia with a history suggestive of sickling crisis in the past was scheduled for surgical pulmonary valvotomy. Pre-operative blood transfusion and hydroxyurea were administered. Pre-operative blood transfusion is indicated in sickle cell disease patients to raise the haematocrit level and lower sickle haemoglobin (HbS) levels. Before the start of cardiopulmonary bypass (CPB), exchange transfusion was performed to reduce HbS level and raise adult haemoglobin level. Hypothermia was prevented by employing normothermic CPB.
  - 3,175 539
Anaesthetic management of shoulder arthroscopic repair in Parkinson's disease with deep brain stimulator
Ranju Gandhi, Reeta Chawla
May-June 2014, 58(3):309-311
DOI:10.4103/0019-5049.135044  PMID:25024475
We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson's disease (PD) with deep brain stimulator (DBS) using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG) normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.
  - 1,729 490
CLINICAL INVESTIGATIONS
Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices
KV Hashim, Mary Thomas
May-June 2014, 58(3):298-302
DOI:10.4103/0019-5049.135042  PMID:25024473
Background and Aims: Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients. Methods: A total of 60 diabetic patients undergoing general anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack-Lehane scores were noted. Statistical analysis was performed using Fischer exact test. Results: Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy. Conclusion: The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.
  - 2,999 965
Effects of pretreatment with different neuromuscular blocking agents on facilitation of intubation with rocuronium: A prospective randomized comparative study
DS Shashank, N Ratan Singh, L Kameshwar Singh
May-June 2014, 58(3):303-308
DOI:10.4103/0019-5049.135043  PMID:25024474
Background and Aims: Priming principle refers to administration of a small dose of non-depolarising blocker, which when followed by a large intubating dose produces a relatively rapid and profound blockade to ensure suitable conditions for endotracheal intubation. We aimed to compare the effects of rocuronium, vecuronium, and atracurium as "pretreatment" drugs on intubating conditions with rocuronium facilitated endotracheal intubation. Methods: This double-blinded, randomised controlled prospective study was carried out at a tertiary health care hospital on patients undergoing surgical procedures under general anaesthesia. They were randomly allocated into three groups (n = 35) by computer generated randomisation chart to receive either rocuronium (0.06 mg/kg body weight) (Group A); vecuronium (0.01 mg/kg body weight) (Group B) or, atracurium (0.05 mg/kg body weight) (Group C), followed by intubating dose (0.6 mg/kg body weight) of rocuronium. The haemodynamic parameters and intubating conditions were studied and statistically analysed by ANOVA test and Student's t-test as applicable using statistical package for the social sciences 16.0 for windows (SPSS Inc., Chicago, IL, USA). Results: Excellent intubating conditions were noted in maximum number of patients in Group C (97.41%). No significant differences were observed in the systolic blood pressure in all the three groups at all-time intervals. The mean arterial pressure rose significantly from baseline value to maximum, at '0' min in all the groups; however, no significant difference was observed amongst the groups (P > 0.05). Conclusion: Pretreatment with rocuronium bromide can facilitate endotracheal intubation in 60 s irrespective of non-depolarising muscle relaxants used for priming; however, it cannot attenuate haemodynamic changes associated with laryngoscopy and intubation.
  - 2,595 607
Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study
Prachee Sachan, Nidhi Kumar, JP Sharma
May-June 2014, 58(3):287-292
DOI:10.4103/0019-5049.135039  PMID:25024471
Background and Aims: Mixing adjuvants with hyperbaric bupivacaine in a single syringe before injecting the drugs intrathecally is an age old practice. In doing so, the density of the hyperbaric solution and also of the adjuvant drugs may be altered, thus affecting the spread of drugs. Administering local anaesthetic and the adjuvants separately may minimise the effect of the changes in densities. We aimed to compare block characteristics, intraoperative haemodynamics and post-operative pain relief in parturients undergoing caesarean section (CS) after administering hyperbaric bupivacaine and clonidine intrathecally as a mixture and sequentially. Methods: In this single-blind prospective randomised controlled study at a tertiary care centre from 2010 to 12, 60 full-term parturients scheduled for elective CSs were divided into two groups on the basis of technique of intrathecal drug administration. Group M received mixture of clonidine (75 mcg) and hyperbaric bupivacaine 0.5% (10 mg) intrathecally, whereas Group B received clonidine (75 mcg) followed by hyperbaric bupivacaine 0.5% (10 mg) through separate syringes. Observational descriptive statistics, analysis of variance test, Wilcoxon test and Chi-square test were used as applicable. Results: Duration of analgesia was significantly longer in Group B (474.33 ± 20.79 min) in which the drug was given sequentially than in Group M (337 ± 18.22 min). Furthermore, the time to achieve highest sensory block and complete motor block was significantly less in Group B without any major haemodynamic instability and neonatal outcome. Conclusions: When clonidine and hyperbaric bupivacaine were administered in a sequential manner, block characteristics improved significantly compared to the administration of the mixture of the two drugs.
  - 4,059 837
COMMENTS ON PUBLISHED ARTICLE
Warming measures in paediatric cleft surgeries
Priyanka Sethi, Neeraj Gupta
May-June 2014, 58(3):371-371
DOI:10.4103/0019-5049.135103  PMID:25024504
  - 1,076 270
CORRIGENDUM
Corrigendum

May-June 2014, 58(3):349-349
  - 774 171
ISACON ABSTRACTS
ISACON abstracts

May-June 2014, 58(3):372-382
  - 7,136 740
LETTERS TO EDITOR
Massive haemoptysis and endotracheal tube blockade during subclavian vein cannulation
Upendra Hansda, Rekha Das, Rashmi R Satapathy, Sumita Mohanty
May-June 2014, 58(3):353-354
DOI:10.4103/0019-5049.135089  PMID:25024491
  - 1,242 317
Split cord malformation and the anaesthesiologist
Prakash K Dubey, Shashi Kant
May-June 2014, 58(3):354-355
DOI:10.4103/0019-5049.135090  PMID:25024492
  - 1,134 241
Parathyroidectomy under superficial cervical plexus block in a patient with severe kyphoscoliosis
Ki Hwa Lee, Sang Yoon Jeon
May-June 2014, 58(3):355-356
DOI:10.4103/0019-5049.135091  PMID:25024493
  - 1,281 251
Posterior tracheal wall rupture following uneventful general endotracheal anaesthesia
Neetika Mishra, Tirtha Sahoo, Bikas Kusum Mandal, Sabyasachi Das
May-June 2014, 58(3):357-358
DOI:10.4103/0019-5049.135092  PMID:25024494
  - 1,842 258
Right molar approach for uvulectomy of secondary non-hodgkins lymphoma of uvula
Akrity Singh, Rakesh Kumar Singh
May-June 2014, 58(3):358-359
DOI:10.4103/0019-5049.135094  PMID:25024495
  - 1,194 247
Lithotripsy under low dose spinal anaesthesia with dexmedetomidine in a patient with hypertrophic obstructive cardiomyopathy
Ravipati Prabhavathi, Pothula Narasimha Reddy, Rama Mohan Pathapati, Sujith Tumkur Rajashekar
May-June 2014, 58(3):360-362
DOI:10.4103/0019-5049.135096  PMID:25024497
  - 1,617 369
Post-operative pulmonary embolism: Transthoracic echocardiography as a diagnostic tool
MP Nikhil, Avanish Bhandary, Sreeram R Cadambe, Sumalatha R Shetty
May-June 2014, 58(3):362-363
DOI:10.4103/0019-5049.135097  PMID:25024498
  - 1,338 350
Foreign body oesophagus: The case of a missing second coin
Vijay G Yaliwal, Harihar V Hegde, JS Arunkumar, Santosh S Garag, P Raghavendra Rao
May-June 2014, 58(3):364-365
DOI:10.4103/0019-5049.135098  PMID:25024499
  - 1,301 280
Unusual cause for raised airway pressures related to anaesthesia workstation
Nithin Abraham Raju, Sneha Ann Ancheri, Anita Shirley Joselyn, Bharath Kumar
May-June 2014, 58(3):365-366
DOI:10.4103/0019-5049.135099  PMID:25024500
  - 1,104 238
Macintosh blade entrapment during direct laryngoscopy
Ghanshyam Yadav, Gaurav Jain
May-June 2014, 58(3):366-368
DOI:10.4103/0019-5049.135100  PMID:25024501
  - 1,339 284
Monitor screen display inversion: Potential for risk during anaesthesia
Pritee Bhirud, Sheetal Y Chiplonkar
May-June 2014, 58(3):368-369
DOI:10.4103/0019-5049.135101  PMID:25024502
  - 1,134 227
Mishap due to error in labelling-word of caution!
Chitra Juwarkar, Pabitra Ghoshal, Annie John
May-June 2014, 58(3):369-370
DOI:10.4103/0019-5049.135102  PMID:25024503
  - 982 233
MESSAGES
Pages From Old Issues of IJA 1979

May-June 2014, 58(3):243-245
  - 902 253
Pages From Old Issues of IJA 1979

May-June 2014, 58(3):246-247
  - 904 196
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