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  Citation statistics : Table of Contents
   2016| March  | Volume 60 | Issue 3  
    Online since March 2, 2016

 
 
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SPECIAL ARTICLE
Chronic fluorosis: The disease and its anaesthetic implications
Madhuri S Kurdi
March 2016, 60(3):157-162
DOI:10.4103/0019-5049.177867  PMID:27053777
Chronic fluorosis is a widespread disease-related to the ingestion of high levels of fluoride through water and food. Prolonged ingestion of fluoride adversely affects the teeth, bones and other organs and alters their anatomy and physiology. Fluoride excess is a risk factor in cardiovascular disease and other major diseases, including hypothyroidism, diabetes and obesity. Although anaesthesiologists may be aware of its skeletal and dental manifestations, other systemic manifestations, some of which may impact anaesthetic management are relatively unknown. Keeping this in mind, the topic of chronic fluorosis was hand searched from textbooks, scientific journals and electronically through Google, PubMed and other scientific databases. This article concentrates on the effect of chronic fluorosis on various organ systems, its clinical features, diagnosis and the anaesthetic implications of the disease.
  5 3,612 780
BRIEF COMMUNICATIONS
Reliability of American Society of Anesthesiologists physical status classification
Nicola Parenti, Maria Letizia Bacchi Reggiani, Daniela Percudani, Rita Maria Melotti
March 2016, 60(3):208-214
DOI:10.4103/0019-5049.177875  PMID:27053787
  2 1,797 514
ORIGINAL ARTICLES
The opinion of post graduate students on objective structured clinical examination in Anaesthesiology: A preliminary report
Parul Jindal, Gurjeet Khurana
March 2016, 60(3):168-173
DOI:10.4103/0019-5049.177869  PMID:27053779
Background and Aims: The scenario in medical education is changing with objective structured clinical examination (OSCE) being introduced as an assessment tool. Its successful implementation in anaesthesiology postgraduate evaluation process is still limited. We decided to to evaluate the effectiveness of OSCE and compare it to conventional examinations as formative assessment tools in anaesthesiology. Methods: We conducted a cross-sectional comparative study in defined population of anaesthesiology postgraduate students to evaluate the effectiveness of OSCE as compared to conventional examination as formative assessment tool in anaesthesiology. Thirty-five students appeared for the conventional examination on the 1st day and viva voce on the 2nd day and OSCE on the last day. At the conclusion of the assessment, all the students were asked to respond to the perception evaluation questionnaire. We analysed the perception of OSCE among the students. Results: Results showed a positive perception of the objective structured physical examination (OSCE) as well as structured 9 (25.7%), fair 19 (54.2%) and unbiased 13 (37.1%) with more standardised scoring 9 (25.7%). The students perceived OSCE to be less stressful than other examination. Thirty-one (88.5%) students agreed that OSCE is easier to pass than conventional method and 29 (82.5%) commented that the degree of emotional stress is less in OSCE than traditional methods. Conclusion: OSCE is better evaluation tool when compared to conventional examination.
  2 2,577 487
Magnesium sulphate as an adjuvant to bupivacaine in ultrasound-guided transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under subarachnoid block
Shelly Rana, Ravinder Kumar Verma, Jai Singh, Sudarshan Kumar Chaudhary, Ankita Chandel
March 2016, 60(3):174-179
DOI:10.4103/0019-5049.177879  PMID:27053780
Background and Aims: Transversus abdominis plane (TAP) block has proven to be an effective component of multimodal analgesic regimens for a variety of abdominal procedures. Magnesium sulphate (MgSO4) N-methyl-D-aspartate receptor antagonist has the potential to be an ideal adjuvant in TAP block. We studied the efficacy of MgSO4as an adjuvant to bupivacaine in TAP block in patients scheduled for total abdominal hysterectomy (TAH) under subarachnoid block (SAB). Methods: Sixty-five women belonging to American Society of Anesthesiologists physical status 1 or 2, aged between 35 and 70 years, scheduled for TAH under SAB were recruited. Patients in Group B (n = 32) received 18 mL 0.25% bupivacaine (45 mg) with 2 mL normal saline (NS), whereas those in Group BM (n = 33) received 18 mL 0.25% bupivacaine (45 mg) with 1.5 mL (150 mg) MgSO4and 0.5 mL NS in the ultrasound (USG)-guided TAP block performed on each side after the completion of the surgery under SAB. They were evaluated for pain at 0, 2, 4, 6, 12 and 24 h, time to first rescue analgesic and duration of postoperative analgesia were noted. Results: The post-operative visual analogue scale (VAS) scores were lower in Group BM at 4, 6 and 12 h (P < 0.05). Mean duration of analgesia was significantly prolonged in Group BM with lesser requirement of rescue analgesic (P < 0.05) up to 12 h. Conclusion: MgSO4 (150 mg) as an adjuvant to bupivacaine in USG-guided TAP block reduces post-operative pain scores, prolongs the duration of analgesia and decreases demands for rescue analgesics.
  2 3,455 1,082
Effects of irrigation fluid in shoulder arthroscopy
Surbhi Gupta, M Manjuladevi, KS Vasudeva Upadhyaya, AM Kutappa, Rajkumar Amaravathi, J Arpana
March 2016, 60(3):194-198
DOI:10.4103/0019-5049.177866  PMID:27053783
Background and Aims: Extravasation of irrigation fluid used in shoulder arthroscopy can lead to life-threatening airway and systemic complications. This study was conducted to assess the effect of irrigation fluid absorption on measurable anthropometric parameters and to identify whether these parameters predict airway/respiratory compromise. Methods: Thirty six American Society of Anaesthesiologists physical status one or two patients aged 15–60 years undergoing shoulder arthroscopy under general anaesthesia were recruited. Measured variables preoperatively (baseline) and at the end of surgery were neck, chest, midarm and midthigh circumferences, weight, haemoglobin and serum sodium. Temperature, endotracheal tube cuff pressure, airway pressure, duration of surgery, amount of irrigation fluid and intravenous fluid used were also noted. Measured parameters were correlated with the duration of surgery and the amount of irrigation fluid used. Results: Postoperatively, the changes in variables showed a significant increase in the mean values (cm) for neck, chest, midarm and midthigh circumference (mean ± standard deviation: 2.35 ± 1.9, P < 0.001; 2.9 ± 3.88 cm, P < 0.001; 3.28 ± 2.44, P < 0.001 and 0.39 ± 0.71, P = 0.002, respectively) and weight (kg) (1.17 ± 1.24, P < 0.001). The post-operative haemoglobin (g/dL) levels decreased significantly (0.89 ± 1.23, P < 0.001) as compared to the baseline. No significant change was found in the serum sodium levels (P = 0.92). No patient experienced airway/respiratory compromise. Conclusion: Regional and systemic absorption of irrigation fluid in arthroscopic shoulder surgery is reflected in the degree of change in the measured anthropometric variables. However, this change was not significant enough to cause airway/respiratory compromise.
  2 2,003 442
CASE REPORTS
An anaesthesiologist's encounter with purple glove syndrome
B Uma, Anjali Kochhar
March 2016, 60(3):199-201
DOI:10.4103/0019-5049.177864  PMID:27053784
Purple glove syndrome (PGS) is a devastating complication of intravenous (IV) phenytoin administration. Anaesthetic management during the amputation of the limb for such patients is very challenging due to limited clinical experience. A 65-year-old woman developed PGS of left upper extremity after IV administration of phenytoin following generalised tonic-clonic seizures. The condition progressed rapidly leading to gangrene of left hand extending to the mid arm. Amputation was carried out under general anaesthesia with a supraglottic airway device. We discuss the prevention and alternate managements in PGS, which is a rare clinical entity with limited data in the literature.
  1 3,837 483
Takotsubo cardiomyopathy precipitated by negative pressure pulmonary oedema following total thyroidectomy
KS Bharathi, Srinivas Kulkarni, KS Sadananda, CL Gurudatt
March 2016, 60(3):202-205
DOI:10.4103/0019-5049.177872  PMID:27053785
'Takotsubo cardiomyopathy (TCM)' or 'stress cardiomyopathy' is a reversible cardiomyopathy that is precipitated by intense emotional or physical stress. This syndrome is characterised by symptoms mimicking acute coronary syndrome with transient systolic dysfunction associated with regional wall motion abnormalities, which extend beyond a single coronary vascular bed in the absence of obstructive coronary vascular disease. The presentation of TCM and myocardial infarction is similar with sudden onset of chest pain, breathlessness as well as abnormalities in both the electrocardiogram and cardiac enzymes. It is difficult to differentiate between the two until cardiac catheterisation establishes the diagnosis. We report a case of TCM in a post-menopausal female, precipitated by negative pressure pulmonary oedema following total thyroidectomy in whom timely cardiac catheterisation established the diagnosis and influenced the management. Heightened awareness of this unique cardiomyopathy is essential to have a high index of suspicion in at-risk population for the prompt diagnosis of stress-related cardiomyopathy syndromes occurring in the perioperative period.
  1 1,545 345
COMMENTS ON PUBLISHED ARTICLE
Firstborn female offsprings are significantly more common among Indian anaesthesiologists as compared to national child sex ratio
Deepak Gupta
March 2016, 60(3):224-224
DOI:10.4103/0019-5049.177881  PMID:27053793
  1 1,514 320
LETTERS TO EDITOR
Takotsubo cardiomyopathy due to cephalosporin anaphylaxis under general anaesthesia
Soumi Pathak, Mamta Dubey, Nitesh Goel
March 2016, 60(3):215-216
DOI:10.4103/0019-5049.177870  PMID:27053788
  1 1,318 283
ORIGINAL ARTICLES
Effect of breastfeeding on haemodynamics and consumption of propofol and sevoflurane: A state entropy guided comparative study
B Bhaskara, VP Dayananda, Sudheesh Kannan, RS Raghavendra Rao, R Ramachandraiah
March 2016, 60(3):180-186
DOI:10.4103/0019-5049.177865  PMID:27053781
Background and Aims: Unique post-partum endocrine hormone oxytocin secreted during breastfeeding (BF) has amnestic, sedative properties and down-regulates stress responses. This study was done to assess the effect of BF on consumption of propofol, sevoflurane and haemodynamic stability in women. Methods: Study was conducted on 120 women aged 20–30 years of American Society of Anesthesiologists I and II physical status scheduled for tubectomy under general anaesthesia who were randomly allocated to three groups 40 of each; BF, withhold feeding (WF), and non-feeding (NF) groups. All received standard premedication. Heart rate (HR), mean arterial pressure (MAP) and state entropy (SE) values were recorded at regular intervals. All patients were induced with intravenous propofol until the SE levels dropped to 45, and dose of propofol recorded. Airway was secured with laryngeal mask airway and anaesthesia was maintained with sevoflurane in 60% N2O and O2. Sevoflurane concentration was adjusted to maintain SE between 40 and 60. End tidal concentration of sevoflurane and consumption of sevoflurane (ml) was recorded by GE Datex-Ohmeda S/5™ System. Results were analysed by analysis of variance and Chi-square test. Results: Demographic parameters were comparable. Dose of propofol and sevoflurane consumption in group BF was significantly reduced by 20% and 35%, respectively (P < 0.05) compared to group NF. Intra-operative HR and MAP were persistently low in group BF and elevated in group WF (P < 0.05). Conclusion: BF before induction of anaesthesia decreases the consumption of propofol, sevoflurane and maintains the intra-operative haemodynamic stability, whereas withholding BF increases propofol and sevoflurane consumption with intra-operative higher HR and MAP, compared to control group.
  1 1,795 405
Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial
Ban Leong Sng, Sarah Carol Kwok, Deepak Mathur, Farida Ithnin, Clare Newton-Dunn, Pryseley Nkouibert Assam, Rehena Sultana, Alex Tiong Heng Sia
March 2016, 60(3):187-193
DOI:10.4103/0019-5049.177877  PMID:27053782
Background and Aims: Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. Methods: A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction. Results: One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia. Conclusion: There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.
  1 2,111 515
RESPONSE OF AUTHOR TO COMMENTS
Anaesthesia practice and reproductive outcomes: Facts unveiled
Amrutha Bindu Nagella, M Ravishankar, VR Hemanth Kumar
March 2016, 60(3):225-225
DOI:10.4103/0019-5049.177883  PMID:27053794
  1 1,315 270
Lung ultrasound: A potential tool to detect lobar atelectasis
Swapnil Y Parab, Jigeeshu V Divatia
March 2016, 60(3):228-228
DOI:10.4103/0019-5049.177874  PMID:27053796
  1 1,421 349
New approach to treat an old problem: Mannitol for post-dural puncture headache
Mohammed Meesam Rizvi, Raj Bahadur Singh, Rajnikant Tripathi
March 2016, 60(3):229-230
DOI:10.4103/0019-5049.177878  PMID:27053797
  1 1,698 449
BRIEF COMMUNICATIONS
Anaesthetic management in a case of concurrent hypertrophic cardiomyopathy and constrictive pericarditis: Are there special concerns?
Prachi Kar, Ramachandran Gopinath, Padmaja Durga, RV Kumar
March 2016, 60(3):206-208
DOI:10.4103/0019-5049.177868  PMID:27053786
  - 2,011 410
COMMENTS ON PUBLISHED ARTICLE
”A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries”
Nieves Gloria Alvarez Diaz
March 2016, 60(3):226-227
DOI:10.4103/0019-5049.177880  PMID:27053795
  - 1,282 253
EDITORIAL
'Broken-heart syndrome'… Be aware..
Mahesh Vakamudi
March 2016, 60(3):155-156
DOI:10.4103/0019-5049.177863  PMID:27053776
  - 2,314 875
LETTERS TO EDITOR
Wilms tumour with intracardiac extension - multimodal approach to a challenging case
Mallie Abraham, Mathai Samuel, Mohan Mathew
March 2016, 60(3):216-218
DOI:10.4103/0019-5049.177884  PMID:27053789
  - 1,376 292
Elastomeric balloon pump: Use of triway to fill!
Abinash Patro, Vansh Priya, Rameez Riaz, Sanjay Dhiraaj
March 2016, 60(3):218-219
DOI:10.4103/0019-5049.177882  PMID:27053790
  - 1,775 266
Wire guided fibreoptic retrograde intubation in a case of glottic mass
Anity Singh Dhanyee, Rahul Pillai, Raj Sahajanandan
March 2016, 60(3):219-221
DOI:10.4103/0019-5049.177876  PMID:27053791
  - 1,310 278
Epidural clonidine for the anaesthetic management for diagnostic procedure
Sangeeta Agarwal Bansal, Yogesh Tilkar, Sanjeevani Karmalkar
March 2016, 60(3):221-223
DOI:10.4103/0019-5049.177873  PMID:27053792
  - 1,206 242
ORIGINAL ARTICLES
Polyurethane cuffed versus conventional endotracheal tubes: Effect on ventilator-associated pneumonia rates and length of Intensive Care Unit stay
P Suhas, Pankaj Kundra, Anusha Cherian
March 2016, 60(3):163-167
DOI:10.4103/0019-5049.177871  PMID:27053778
Background and Aims: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality among patients in the Intensive Care Units (ICUs) and results in added healthcare costs. One of the methods of preventing VAP is to use polyurethane (PU)-cuffed endotracheal tube (ETT). This study compares the incidence of VAP and length of ICU stay in patients intubated with conventional polyvinyl chloride (PVC) ETT and PU-cuffed ETT. Methods: Eighty post-laparotomy patients who were mechanically ventilated for >48 h in the ICU were included in this randomised controlled trial. Patients with moderate to severe pre-existing lung conditions were excluded from the study. Patients in group PVC (n = 40) were intubated with conventional PVC-cuffed ETT and those in group PU (n = 40) with PU-cuffed ETT. VAP was defined as a Clinical Pulmonary Infection Score of >6 with a positive quantitative endotracheal culture in patients on ventilator for >48 h. Results: Overall VAP rates were 23.75%. Thirteen (32.5%) patients in group PVC and six (15%) patients in group PU developed VAP. ICU stay was significantly lesser in patients intubated with PU-cuffed ETT (group PU) (median, 6 days; range: 4–8.5) compared to patients intubated with conventional ETT (group PVC) (median, 8; range: 6–11). Conclusion: No statistically significant reduction in the incidence of VAP could be found between the groups. The length of ICU stay was significantly lesser with the use of ultra thin PU-cuffed ETTs.
  - 2,872 574