Indian Journal of Anaesthesia  
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  Citation statistics : Table of Contents
   2016| January  | Volume 60 | Issue 1  
    Online since January 26, 2016

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Evaluation of caudal dexamethasone with ropivacaine for post-operative analgesia in paediatric herniotomies: A randomised controlled study
Santosh Choudhary, Neelam Dogra, Jaideep Dogra, Priyanka Jain, Sandeep Kumar Ola, Brajesh Ratre
January 2016, 60(1):30-33
DOI:10.4103/0019-5049.174804  PMID:26962252
Background and Aims: Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing infra-umbilical surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone 0.1 mg/kg as an adjuvant to the ropivacaine improved analgesic efficacy after paediatric herniotomies. Methods: Totally 128 patients of 1–5 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective inguinal herniotomy were randomly allocated to two groups in double-blind manner. Group A received 1 ml/kg of 0.2% ropivacaine caudally and Group B received 1 ml/kg of 0.2% ropivacaine, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by faces, legs, activity, cry and consolability tool score, rescue analgesic requirement and adverse effects were noted for 24 h. Results: Results were statistically analysed using Student's t-test. Pain scores measured at 1, 2, 4, and 6 h post-operative, were lower in Group B as compared to Group A. Mean duration of analgesia in Group A was 248.4 ± 54.1 min and in Group B was 478.046 ± 104.57 min with P = 0.001. Rescue analgesic requirement was more in Group A as compared to Group B. Adverse effects after surgery were comparable between the two groups. Conclusion: Caudal dexamethasone added to ropivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal ropivacaine alone.
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Does dexmedetomidine improve analgesia of superficial cervical plexus block for thyroid surgery?
BS Santosh, Sripada Gopalakrishna Mehandale
January 2016, 60(1):34-38
DOI:10.4103/0019-5049.174797  PMID:26962253
Background and Aims: Bilateral superficial cervical plexus block (BSCPB) is effective in reducing pain following thyroid surgeries. We studied the effect of dexmedetomidine on duration and quality of analgesia produced by BSCPB with 0.5% ropivacaine in patients undergoing thyroid surgeries. Methods: In this prospective double-blinded study, 60 adults undergoing thyroid surgeries were randomised into two equal groups to receive BSCPB, either with 20 ml 0.5% ropivacaine (Group A) or 20 ml 0.5% ropivacaine with 0.5 μg/kg dexmedetomidine (Group B) after induction of anaesthesia. Visual analogue scale (VAS) was used to assess analgesia postoperatively at 0, 2, 4, 6, 12 and 24 h and patient satisfaction at 24 h. Haemodynamics were recorded peri-operatively. Wilcoxon signed rank test and Mann–Whitney U-test were applied for VAS and sedation scores. Unpaired t-test was applied for age, weight, duration of surgery and duration of post-operative analgesia. Results: There was significantly longer duration of analgesia in Group B (1696.2 ± 100.2 vs. 967.8 ± 81.6 min; P < 0.001) and higher patient satisfaction at 24 h (7 [7–9] vs. 5 [4–6]; P < 0.001). While VAS score for pain were similar up to 6 h, they were lower in Group B at 12 h (0 [0–1] vs. 2 [1–2]; P < 0.001) and 24 h (2 [2–2] vs. 5 [5–6]; P < 0.001). Haemodynamic stability and sedation scores were similar across the groups. There were no adverse events. However, pain during swallowing persisted in both the groups. Conclusion: Combination of 0.5% ropivacaine and dexmedetomidine for BSCPB provided significantly prolonged and better quality of postoperative analgesia and patient satisfaction than with 0.5% ropivacaine alone in patients undergoing thyroidectomy.
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Anaesthesia for robotic thyroidectomy for thyroid cancer and review of literature
Shagun Bhatia Shah, Uma Hariharan, Anita Kulkarni, Namrata Choudhary Dabas
January 2016, 60(1):55-57
DOI:10.4103/0019-5049.174801  PMID:26962257
Robotic thyroidectomy (RT) is a new gasless, scarless technique which utilises the da Vinci surgical robot to excise thyroid tumours. Anaesthetic management must be modified according to the patient position and robotic surgery equipment. Anaesthesiologists need to be geared up to face the new challenges posed by advancements in surgical techniques in order to maintain patient safety. Another vital aspect of this surgery is documenting possible recurrent laryngeal nerve palsy, for which a C-Mac D-Blade video laryngoscope serves as a valuable tool. Post-operative pain management in RT also merits special attention.
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The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink
Rakesh Aggarwal, Nithya Gogtay, Rajeev Kumar, Peush Sahni, The Indian Association of Medical Journal Editors
January 2016, 60(1):1-5
DOI:10.4103/0019-5049.174800  PMID:26962247
  1 2,596 755
Effect of indocyanine green dye administration on cerebral oxygen saturation
Byrappa Vinay, MN Chidananda Swamy, HR Sunil Kumar, Rudrappa Satish
January 2016, 60(1):64-65
DOI:10.4103/0019-5049.174803  PMID:26962260
  1 990 223
Carbon dioxide embolism during endoscopic thyroidectomy
Sunil Rajan, Jerry Paul, Lakshmi Kumar
January 2016, 60(1):65-66
DOI:10.4103/0019-5049.174806  PMID:26962261
  1 1,114 288
Does tranexamic acid reduce blood loss during head and neck cancer surgery?
Atul P Kulkarni, Devendra A Chaukar, Vijaya P Patil, Rajendra B Metgudmath, Rohini W Hawaldar, Jigeeshu V Divatia
January 2016, 60(1):19-24
DOI:10.4103/0019-5049.174798  PMID:26962250
Background and Aims: Transfusion of blood and blood products poses several hazards. Antifibrinolytic agents are used to reduce perioperative blood loss. We decided to assess the effect of tranexamic acid (TA) on blood loss and the need for transfusion in head and neck cancer surgery. Methods: After Institutional Review Board approval, 240 patients undergoing supramajor head and neck cancer surgeries were prospectively randomised to either TA (10 mg/kg) group or placebo (P) group. After induction, the drug was infused by the anaesthesiologist, who was blinded to allocation, over 20 min. The dose was repeated every 3 h. Perioperative (up to 24 h) blood loss, need for transfusion and fluid therapy was recorded. Thromboelastography (TEG) was performed at fixed intervals in the first 100 patients. Patients were watched for post-operative complications. Results: Two hundred and nineteen records were evaluable. We found no difference in intraoperative blood loss (TA - 750 [600–1000] ml vs. P - 780 [150–2600] ml, P = 0.22). Post-operative blood loss was significantly more in the placebo group at 24 h (P - 200 [120–250] ml vs. TA - 250 [50–1050] ml, P = 0.009), but this did not result in higher number of patients needing transfusions (TA - 22/108 and P - 27/111 patients, P = 0.51). TEG revealed faster clot formation and minimal fibrinolysis. Two patients died of causes unrelated to study drug. Incidence of wound complications and deep venous thrombosis was similar. Conclusion: In head and neck cancer surgery, TA did not reduce intraoperative blood loss or need for transfusions. Perioperative TEG variables were similar. This may be attributed to pre-existing hypercoagulable state and minimal fibrinolysis in cancer patients.
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A prospective, comparative, randomised, double blind study on the efficacy of addition of clonidine to 0.25% bupivacaine in scalp block for supratentorial craniotomies
Anjana Sagar Wajekar, Shrikanta P Oak, Anita N Shetty, Ruchi A Jain
January 2016, 60(1):39-43
DOI:10.4103/0019-5049.174809  PMID:26962254
Background and Aims: Scalp blocks combined with general anaesthesia reduce pin and incision response, along with providing stable perioperative haemodynamics and analgesia. Clonidine has proved to be a valuable additive in infiltrative blocks. We studied the efficacy and safety of addition of clonidine 2μg/kg to scalp block with 0.25% bupivacaine (Group B) versus plain 0.25% bupivacaine (Group A) for supratentorial craniotomies. Methods: Sixty patients were randomly divided into two groups to receive scalp block: Group A (with 0.25% bupivacaine) and Group B (with 0.25% bupivacaine and clonidine (2μg/kg). Bilateral scalp block was given immediately after induction. All the patients received propofol based general anaesthesia. Intraoperatively, propofol infusion was maintained at 75 to 100 μg/kg/h up to dura closure and reduced to 50-75 μg/kg/h up to skin closure with atracurium infusion stopped at dura closure. Heart rate (HR) and mean arterial pressure (MAP) were monitored at pin insertion, at 5 minute intervals from incision till dura opening and again at 5 minute interval from dura closure up to skin closure. Fentanyl 0.5 μg/kg was given if a 20% increase in either HR and/or MAP was observed. Postoperative haemodynamics and verbal rating scores (VRS) were recorded. When the VRS score increased above 3, rescue analgesia was given. Any intraoperative haemodynamic complications were noted. Results: Group A showed a significant increase in haemodynamic variables during the perioperative period as compared to group B (P < 0.05). Addition of clonidine 2 μg/kg in the infiltrative block also provided significantly prolonged postoperative analgesia. Conclusions: Addition of clonidine to scalp block provided better perioperative haemodynamic stability and significantly prolonged analgesia.
  1 1,693 433
The efficacy of different methods of pre-operative counselling on perioperative anxiety in patients undergoing regional anaesthesia
P Akkamahadevi, VV Subramanian
January 2016, 60(1):58-60
DOI:10.4103/0019-5049.174812  PMID:26962258
  - 1,625 388
Post-operative accidental diagnosis of intra-cerebellar astrocytoma in an emergency appendicectomy case
KS Nagesh, SR Prasad, V Manjunath, PS Nagaraja
January 2016, 60(1):60-63
DOI:10.4103/0019-5049.174796  PMID:26962259
  - 1,381 209
Anaesthetic considerations for liver transplantation in propionic acidemia
Akila Rajakumar, Ilankumaran Kaliamoorthy, Mettu Srinivas Reddy, Mohamed Rela
January 2016, 60(1):50-54
DOI:10.4103/0019-5049.174799  PMID:26962256
Propionic acidemia (PA) is an autosomal recessive disorder of metabolism due to deficiency of the enzyme propionyl-CoA carboxylase (PCC) that converts propionyl-CoA to methylmalonyl-CoA with the help of the cofactor biotin inside the mitochondria. The resultant accumulation of propionyl-CoA causes severe hyperammonaemia and life-threatening metabolic acidosis. Based on the positive outcomes, liver transplantation is now recommended for individuals with recurrent episodes of hyperammonaemia or acidosis that is not adequately controlled with appropriate medical therapies. We report anaesthetic management of two children with PA for liver transplantation at our institution. It is essential for the anaesthesiologist, caring for these individuals to be familiar with the manifestations of the disease, the triggers for decompensation and management of an acute episode.
  - 1,853 397
A quest for utilitarian approach in research
Zahid Hussain Khan
January 2016, 60(1):6-7
DOI:10.4103/0019-5049.174805  PMID:26962248
  - 1,336 296
Defective heat moisture exchange filter causing 'block' in anaesthesia breathing circuit
Hemlata Kapoor, Aparna Date, Kirti Gujarkar, Harshal Wagh
January 2016, 60(1):66-68
DOI:10.4103/0019-5049.174802  PMID:26962262
  - 1,067 227
Legg-Calve-Perthes disease: A must know entity for anaesthesiologists
Teena Bansal, Rajmala Jaiswal
January 2016, 60(1):68-69
DOI:10.4103/0019-5049.174807  PMID:26962263
  - 1,325 393
Guidewire replacement of leaking paediatric intravenous cannula
Parikshit Singh, Kunal Kishore
January 2016, 60(1):70-71
DOI:10.4103/0019-5049.174814  PMID:26962264
  - 1,013 210
Dandy Walker syndrome with giant occipital meningocele with craniovertebral anomalies: Challenges faced during anaesthesia
Rashmi Singh, Neelam Dogra, Priyanka Jain, Santosh Choudhary
January 2016, 60(1):71-73
DOI:10.4103/0019-5049.174811  PMID:26962265
  - 1,311 343
Sevoflurane in an infant with dilated cardiomyopathy due to myocarditis and hypocalcaemia
Narendra Kumar
January 2016, 60(1):73-74
DOI:10.4103/0019-5049.174815  PMID:26962266
  - 1,096 268
A randomized controlled study comparing intrathecal hyperbaric bupivacaine-fentanyl mixture and isobaric bupivacaine-fentanyl mixture in common urological procedures
Madhusudan Upadya, S Neeta, Jesni Joseph Manissery, Nigel Kuriakose, Rakesh Raushan Singh
January 2016, 60(1):44-49
DOI:10.4103/0019-5049.174813  PMID:26962255
Background and Aims: Bupivacaine is available in isobaric and hyperbaric forms for intrathecal use and opioids are used as additives to modify their effects. The aim of this study was to compare the efficacy and haemodynamic effect of intrathecal isobaric bupivacaine-fentanyl mixture and hyperbaric bupivacaine-fentanyl mixture in common urological procedures. Methods: One hundred American Society of Anesthesiologists physical status 1 and 2 patients undergoing urological procedures were randomized into two groups. Group 1 received 3 ml of 0.5% isobaric bupivacaine with 25 μg fentanyl while Group 2 received 3 ml of 0.5% hyperbaric bupivacaine with 25 μg fentanyl. The parameters measured include heart rate, blood pressure, respiratory rate, onset and duration of motor and sensory blockade. Student's unpaired t-test and the χ2 test were used to analyse the results, using the SPSS version 11.5 software. Results: The haemodynamic stability was better with isobaric bupivacaine fentanyl mixture (Group 1) than with hyperbaric bupivacaine fentanyl mixture (Group 2).The mean onset time in Group 1 for both sensory block (4 min) and motor block (5 min) was longer compared with Group 2. The duration of sensory block (127.8 ± 38.64 min) and motor block (170.4 ± 27.8 min) was less with isobaric bupivacaine group compared with hyperbaric bupivacaine group (sensory blockade 185.4 ± 16.08 min and motor blockade 201.6 ± 14.28 min). Seventy percent of patients in Group 2 had maximum sensory block level of T6whereas it was 53% in Group 1. More patients in Group 1 required sedation compared to Group 2. Conclusion: Isobaric bupivacaine fentanyl mixture was found to provide adequate anaesthesia with minimal incidence of haemodynamic instability.
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A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron
Gangur Basappa Sumalatha, Ravichandra Ramesh Dodawad, Sandeep Pandarpurkar, Parashuram R Jajee
January 2016, 60(1):25-29
DOI:10.4103/0019-5049.174810  PMID:26962251
Background and Aims: Propofol is widely used for induction of anaesthesia, although the pain during its injection remains a concern for all anaesthesiologists. A number of techniques have been adopted to minimise propofol-induced pain. Various 5-hydroxytryptamine-3 antagonists have shown to reduce propofol-induced pain. Hence, this placebo-controlled study was conducted to compare the efficacy of ondansetron, ramosetron and lignocaine in terms of attenuation of propofol-induced pain during induction of anaesthesia. Methods: Hundred and fifty adult patients, aged 18–60 years, posted for various elective surgical procedures under general anaesthesia were randomly assigned to three groups of 50 each. Group R received 0.3 mg of ramosetron, Group L received 0.5 mg/kg of 2% lignocaine and Group O received 4 mg of ondansetron. After intravenous (IV) pre-treatment of study drug, manual occlusion of venous drainage was done at mid-arm with the help of an assistant for 1 min. This was followed by administration of propofol (1%) after release of venous occlusion. Pain was assessed with a four-point scale. Unpaired Student's t-test and Chi-square test/Fisher's exact test were used to analyse results. Results: The overall incidence and intensity of pain were significantly less in Groups L and R compared to Group O (P ≤ 0.001). The incidence of mild to moderate pain in Groups O, R and L was 56%, 26% and 20%, respectively. The incidence of score '0' (no pain) was significantly higher in Group L (76%) and Group R (72%) than Group O (34%) (P < 0.001). Conclusion: Pre-treatment with IV ramosetron 0.3 mg is equally effective as 0.5 mg/kg of 2% lignocaine in preventing propofol-induced pain and both were better than ondansetron.
  - 2,973 786
Excerpts from the President's inaugural address during ISACON 2015, on 28 December 2015 at Jaipur. Indian Society of Anaesthesiologists: Past, present and future
SS Harsoor
January 2016, 60(1):10-11
  - 1,020 233
From the desk of the New President
AS Kameswara Rao
January 2016, 60(1):8-9
  - 1,006 231
Preoperative cardiovascular investigations in liver transplant candidate: An update
Lalit Sehgal, Piyush Srivastava, Chandra Kant Pandey, Amit Jha
January 2016, 60(1):12-18
DOI:10.4103/0019-5049.174870  PMID:26962249
Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation. Identifying candidates at the highest risk of postoperative cardiovascular complications is the cornerstone for optimizing the outcome. Ischaemic heart disease contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients of ESLD usually demonstrate increased cardiac output, compromised ventricular response to stress, low systemic vascular resistance and occasionally bradycardia. Despite various recommendations for preoperative evaluation of cardiovascular disease in liver transplant candidates, a considerable controversy on screening methodology persists. This review critically focuses on the rapidly expanding body of evidence for diagnosis and risk stratification of cardiovascular disorder in liver transplant candidates.
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