Indian Journal of Anaesthesia  
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   2015| June  | Volume 59 | Issue 6  
    Online since June 15, 2015

 
 
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CLINICAL INVESTIGATIONS
Effect of peri-operative intravenous infusion of lignocaine on haemodynamic responses to intubation, extubation and post-operative analgesia
Shruti Jain, Rashid M Khan
June 2015, 59(6):342-347
DOI:10.4103/0019-5049.158733  PMID:26195829
Background and Aims: Lignocaine in intravenous (IV) bolus dose has been used for minimising haemodynamic changes associated with intubation and extubation. Furthermore, IV infusion has been used for post-operative analgesia. We investigated whether IV peri-operative lignocaine (bolus and infusion) would be able to produce both the effects simultaneously in elective laparoscopic cholecystectomies. Methods: In this randomised prospective study, 60 patients undergoing elective laparoscopic cholecystectomy were randomly divided into two groups of 30 each. In Group A, patients received 6 ml normal saline as bolus over 10 min followed by 6 ml/h infusion whereas in Group B, patients received preservative free 2% lignocaine 1.5 mg/kg IV bolus (made to a volume of 6 ml with normal saline) administered over a period of 10 min and thereafter an infusion at a rate of 1.5 mg/kg/h (pre-diluted in normal saline made to a volume of 6 ml/h. P < 0.05 was considered as significant. Results: The rise in pulse rate (PR) and mean arterial pressure (MAP) were less in Group B as compared to the Group A (P < 0.05) during intubation as well as during extubation. Furthermore, the Group B had significant longer mean pain-free post-operative period of 5½ h as compared to 54.43 min in the Group A (P < 0.05). Conclusion: Administration of lignocaine infusion attenuates the rise in PR as well as MAP during the peri-intubation and peri-extubation period. Furthermore, infusion of lignocaine significantly increases the mean pain-free period post-operatively.
  3,661 1,215 -
Is dexmedetomidine better than propofol and fentanyl combination in minor day care procedures? A prospective randomised double-blind study
Gaurav Singh Tomar, Farhat Singh, S Ganguly, Neeraj Gaur
June 2015, 59(6):359-364
DOI:10.4103/0019-5049.158740  PMID:26195832
Background and Aims: The growing popularity and trend of day care (ambulatory) anaesthesia has led to the development of newer and efficient drug regimen. We decided to evaluate the efficacy of two drug regimens namely dexmedetomidine and propofol with midazolam and fentanyl for moderate sedation characteristics in minor surgical procedures in terms of analgesia, intra-operative sedation, haemodynamic stability and side effects related. Methods: Totally, 60 adult American Society of Anaesthesiologists class I-II patients posted for day care surgeries of duration <45 min divided into two groups; Group D, where dexmedetomidine loading dose at 1 μg/kg was administered over 10 min followed by maintenance infusion initiated at 0.6 μg/kg/h and titrated to achieve desired clinical effect with dose ranging from 0.2 to 0.7 μg/kg, Group P, where midazolam at 0.02 mg/kg and fentanyl at 2 μg/kg IV boluses were given followed by propofol infusion. Statistical analysis was done using student t-test, analysis of variance and Chi-square analysis. P < 0.05 was considered to be significant. Results: Degree of sedation (Observer's Assessment of Activity and Sedation Scale ≤3) was comparable in both groups (P > 0.05). Rescue analgesia with fentanyl was needed in 30% patients of Group D compared to 17.63% patients of Group P (P < 0.05). The level of arousal was faster and better in Group D at 5 min after the procedure (P < 0.05). Haemodynamics were stable in Group D as with Group P patients (P < 0.005). Dry mouth reported by 16.67% patients. Conclusion: Dexmedetomidine can be a useful adjuvant rather than the sole sedative-analgesic agent during minor surgeries and be a valuable alternative to propofol in terms of moderate sedation, haemodynamic stability with minimal transient side effects.
  3,574 1,270 -
EDITORIAL
Shoulder arthroscopy and complications: Can we afford to relax?
S Bala Bhaskar, M Manjuladevi
June 2015, 59(6):335-337
DOI:10.4103/0019-5049.158729  PMID:26195827
  3,948 877 3
CLINICAL INVESTIGATIONS
Effect of intravenous ondansetron on reducing the incidence of hypotension and bradycardia events during shoulder arthroscopy in sitting position under interscalene brachial plexus block: A prospective randomized trial
Srinivasa Rao Nallam, Sudheer Dara
June 2015, 59(6):353-358
DOI:10.4103/0019-5049.158739  PMID:26195831
Background and Aims: Sudden, profound hypotension and bradycardia events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. The present study was designed to know whether intravenous (IV) ondansetron (selective 5-hydroxy tryptamine 3-antagonist) can help in reducing the HBEs associated with shoulder arthroscopy performed in sitting position under interscalene brachial plexus block (ISBPB). Methods: A total of 100 patients (age 20-50 years) undergoing shoulder arthroscopy performed in the sitting position under ISBPB were assigned randomly to one of the two groups: Group C received 10 ml of normal saline and Group T received 4 mg of ondansetron diluted in 10 ml of normal saline` IV. All patients received ISBPB using levobupivacaine 0.5%. Assessment of motor and sensory blockade, pulse rate, systolic blood pressure, respiration, and side effects were noted every 5 min for first 30 min and every 10 min till the end of surgery. HBEs were recorded in both groups. Results: IV injection of ondansetron significantly reduces the incidence of HBEs from 11 (22.44% in Group C) to 3 (6.1% in Group T). The duration of analgesia was significantly longer in Group C (8.1 ± 3.3) in comparison with Group T (6.3 ± 4.2 h). Conclusion: We conclude that 4 ml of IV ondansetron can significantly reduce the HBEs during shoulder arthroscopy done in the sitting position under ISBPB.
  2,341 650 -
BRIEF COMMUNICATIONS
Prolonged post spinal anaesthesia paralysis
Kartik Syal, Ajay Sood, Rashmi Bhatt, Hitesh Gupta
June 2015, 59(6):376-378
DOI:10.4103/0019-5049.158757  PMID:26195835
  2,246 596 -
EVIDENCE-BASED DATA
Introducing a teaching module to impart communication skills in the learning anaesthesiologists
Vaijayanti Nitin Gadre, Kalpana V Kelkar, Vidya S Kelkar, Maya A Jamkar
June 2015, 59(6):369-375
DOI:10.4103/0019-5049.158744  PMID:26195834
Background and Aims: Pre-operative negative valence communications adversely affect intra and post-operative pain experience. This study was conducted to evaluate the teaching of communication skills by teachers in anaesthesia department and whether the post-operative pain is effectively modified due to the skill of communication acquired by students. Methods: All students and teachers in the department participated in the study. Patients with uncomplicated pregnancy posted for elective lower segment caesarean section were involved. Students were taught to explain the anaesthesia plan pre-operatively to the patients in a positive manner. They were taught the practice of giving positive suggestions before any potentially painful stimulus. Pre-operatively all students informed the patients about the conduct of spinal anaesthesia. The teachers evaluated the students performing spinal block. The performance was rated for procedural and interpersonal skills (direct observation of procedural skills [DOPS] and Smith and Kendall Behavioural scale [SKBS] respectively). The extent of cooperation and the ease with which spinal block could be administered correctly by the student was judged by the teacher. Post-operatively students were randomly provided questionnaires to elicit answers from patients. Results: P value DOPS and SKBS (0.567, 0.867) show no significant statistical variation. P > 0.05 = not significant, indicates no significant variation in procedural and behavioural skills of students in two groups. Conclusion: Teaching of communication skills to students showed a demonstrable effect on their pre-operative dialogue with patients. Pain mechanism was effectively modulated by improving patients' psychology to undergo anaesthesia.
  1,960 509 -
SPECIAL ARTICLE
Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations
Tomas Vymazal
June 2015, 59(6):338-341
DOI:10.4103/0019-5049.158731  PMID:26195828
For symptomatic patients with severe calcified aortic valve stenosis, open heart surgery for aortic valve replacement remains the gold standard. However, elderly patients with an increased risk profile can be treated by using transcatheter approaches (transcatheter aortic valve implantation [TAVI]). The major considerations related to use of general and local anaesthesia for TAVI are discussed in this review.
  1,922 497 -
CLINICAL INVESTIGATIONS
Comparison of electroencephalogram entropy versus loss of verbal response to determine the requirement of propofol for induction of general anaesthesia
Akasapu Karunakara Rao, Indira Gurajala, Ramachandran Gopinath
June 2015, 59(6):348-352
DOI:10.4103/0019-5049.158738  PMID:26195830
Background and Aims: Propofol causes dose-dependent reduction in blood pressure (BP). This study was done to evaluate the use of spectral entropy on the dose of propofol required and the haemodynamic stability during induction of general anaesthesia (GA). Methods: In this randomised controlled study, 72 American Society of Anesthesiologists' physical status I and II patients undergoing general and orthopaedic surgeries were divided into Group S (n-36) and Group C (n-36). Patients in Group C were induced with propofol till loss of response to verbal commands and in Group S until the state entropy was <50 and state and response entropy difference was <10. The induction dose of propofol, haemodynamic parameters and the entropy values were recorded. Numerical data were expressed as a mean ± standard deviation and analysed using unpaired, two-tailed t-test. Categorical data were compared using Chi-square test. P < 0.05 value was considered significant. Results: The dose of propofol per kg was significantly more in the entropy group (1.80 ± 0.23 mg/kg in the Group C and 1.98 ± 0.217 mg/kg in the Group S [P < 0.05]). After induction, at intubation and 1 min after intubation, entropy values were lower in Group S than Group C (P < 0.05). The BP decreased significantly after induction compared with the baseline (P < 0.05), but there was no difference between the groups. Conclusion: Propofol required for induction of GA when guided by electroencephalogram entropy was significantly higher than the induction dose based on loss of verbal response. Both conventional induction and induction with entropy as the endpoint resulted in similar haemodynamic profile.
  1,719 441 3
LETTERS TO EDITOR
Hyperacute onset of Guillain Barre Syndrome in the immediate postpartum period following Caesarean section under spinal anaesthesia
Byrappa Vinay, Bansal Sonia, Varadarajan Bhadrinarayan
June 2015, 59(6):391-392
DOI:10.4103/0019-5049.158782  PMID:26195844
  1,716 368 1
CLINICAL INVESTIGATIONS
Change in neck circumference after shoulder arthroscopy: An observational study
Shrividya Chellam, Sheetal Chiplonkar, Ketaki Pathak
June 2015, 59(6):365-368
DOI:10.4103/0019-5049.158742  PMID:26195833
Background and Aims: Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway. Methods: We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema. Results: Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference. Conclusion: Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.
  1,663 339 1
BRIEF COMMUNICATIONS
Reversible cause of intra operative hypoxia in an aspirated patient
Amar Nandhakumar, Suresh Jayabalan, Nandhakumar Subramaniyan
June 2015, 59(6):382-384
DOI:10.4103/0019-5049.158769  PMID:26195838
  1,437 410 1
LETTERS TO EDITOR
Inside preview of procuring narcotic license
Gurkaran Kaur, Gurpreet Kaur, Sukhminder Singh Bajwa
June 2015, 59(6):385-386
DOI:10.4103/0019-5049.158771  PMID:26195839
  1,497 264 -
Ultrasound guided Transversus Abdominis Plane block through surgical wound
Sunil Rajan, Jerry Paul, Lakshmi Kumar
June 2015, 59(6):394-395
DOI:10.4103/0019-5049.158786  PMID:26195846
  1,391 368 -
Marble bone disease and the Anaesthesiologist
Ashima Sharma, G Poojitha Reddy, W Sreedhar Reddy, Gopinath Ramchandran
June 2015, 59(6):390-391
DOI:10.4103/0019-5049.158779  PMID:26195843
  1,319 288 -
BRIEF COMMUNICATIONS
Perioperative management of combined surgery for phaeochromocytoma and double outlet right ventricle: A rare combination
Sambhunath Das, Sanjay Kumar, Mridupaban Nath, Amar P Bhalla
June 2015, 59(6):378-380
DOI:10.4103/0019-5049.158759  PMID:26195836
  1,339 258 -
LETTERS TO EDITOR
Acute Compartment Syndrome of the forearm in a patient undergoing coronary artery bypass surgery
Lalit Raj Garg, Sanjay Chhabra, Gopal Krishan Singla, Sunil Lakhwani
June 2015, 59(6):387-388
DOI:10.4103/0019-5049.158775  PMID:26195841
  1,337 243 -
A home brewed low cost cuff inflator and pressure monitor
Pavan Dhulkhed, Sunil Khyadi, Amit Kadam, Vithal K Dhulkhed
June 2015, 59(6):395-396
DOI:10.4103/0019-5049.158793  PMID:26195847
  1,218 296 -
Laparoscopic adrenalectomy in a post-pneumonectomy state
Abhijit Nair, Venogopal Kulkarni, Gopi Macherla, Sunjoy Verma
June 2015, 59(6):386-387
DOI:10.4103/0019-5049.158773  PMID:26195840
  1,223 244 -
Massive subcutaneous emphysema following laparoscopic nephroureterectomy: An unusual presentation
Suman Saini, Nidhi Agrawal
June 2015, 59(6):389-390
DOI:10.4103/0019-5049.158777  PMID:26195842
  1,049 244 -
BRIEF COMMUNICATIONS
Cerebral vasospasm after selective amygdalohippocampectomy
Ashish Chakravarty, Saurabh Anand
June 2015, 59(6):380-382
DOI:10.4103/0019-5049.158763  PMID:26195837
  1,024 224 -
LETTERS TO EDITOR
Unexpected intra-operative bleeding due to Hermansky-Pudlak Syndrome
Mustafa Ozgur, Bahar Yilmaz
June 2015, 59(6):393-394
DOI:10.4103/0019-5049.158784  PMID:26195845
  945 230 -
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