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EDITORIAL |
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Shoulder arthroscopy and complications: Can we afford to relax?  |
p. 335 |
S Bala Bhaskar, M Manjuladevi DOI:10.4103/0019-5049.158729 PMID:26195827 |
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SPECIAL ARTICLE |
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Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations |
p. 338 |
Tomas Vymazal DOI:10.4103/0019-5049.158731 PMID:26195828For 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. |
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CLINICAL INVESTIGATIONS |
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Effect of peri-operative intravenous infusion of lignocaine on haemodynamic responses to intubation, extubation and post-operative analgesia  |
p. 342 |
Shruti Jain, Rashid M Khan DOI:10.4103/0019-5049.158733 PMID:26195829Background 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. |
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Comparison of electroencephalogram entropy versus loss of verbal response to determine the requirement of propofol for induction of general anaesthesia |
p. 348 |
Akasapu Karunakara Rao, Indira Gurajala, Ramachandran Gopinath DOI:10.4103/0019-5049.158738 PMID:26195830Background 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. |
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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 |
p. 353 |
Srinivasa Rao Nallam, Sudheer Dara DOI:10.4103/0019-5049.158739 PMID:26195831Background 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. |
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Is dexmedetomidine better than propofol and fentanyl combination in minor day care procedures? A prospective randomised double-blind study  |
p. 359 |
Gaurav Singh Tomar, Farhat Singh, S Ganguly, Neeraj Gaur DOI:10.4103/0019-5049.158740 PMID:26195832Background 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. |
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Change in neck circumference after shoulder arthroscopy: An observational study |
p. 365 |
Shrividya Chellam, Sheetal Chiplonkar, Ketaki Pathak DOI:10.4103/0019-5049.158742 PMID:26195833Background 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. |
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EVIDENCE-BASED DATA |
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Introducing a teaching module to impart communication skills in the learning anaesthesiologists |
p. 369 |
Vaijayanti Nitin Gadre, Kalpana V Kelkar, Vidya S Kelkar, Maya A Jamkar DOI:10.4103/0019-5049.158744 PMID:26195834Background 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. |
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BRIEF COMMUNICATIONS |
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Prolonged post spinal anaesthesia paralysis |
p. 376 |
Kartik Syal, Ajay Sood, Rashmi Bhatt, Hitesh Gupta DOI:10.4103/0019-5049.158757 PMID:26195835 |
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Perioperative management of combined surgery for phaeochromocytoma and double outlet right ventricle: A rare combination |
p. 378 |
Sambhunath Das, Sanjay Kumar, Mridupaban Nath, Amar P Bhalla DOI:10.4103/0019-5049.158759 PMID:26195836 |
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Cerebral vasospasm after selective amygdalohippocampectomy |
p. 380 |
Ashish Chakravarty, Saurabh Anand DOI:10.4103/0019-5049.158763 PMID:26195837 |
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Reversible cause of intra operative hypoxia in an aspirated patient |
p. 382 |
Amar Nandhakumar, Suresh Jayabalan, Nandhakumar Subramaniyan DOI:10.4103/0019-5049.158769 PMID:26195838 |
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LETTERS TO EDITOR |
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Inside preview of procuring narcotic license |
p. 385 |
Gurkaran Kaur, Gurpreet Kaur, Sukhminder Singh Bajwa DOI:10.4103/0019-5049.158771 PMID:26195839 |
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Laparoscopic adrenalectomy in a post-pneumonectomy state |
p. 386 |
Abhijit Nair, Venogopal Kulkarni, Gopi Macherla, Sunjoy Verma DOI:10.4103/0019-5049.158773 PMID:26195840 |
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Acute Compartment Syndrome of the forearm in a patient undergoing coronary artery bypass surgery |
p. 387 |
Lalit Raj Garg, Sanjay Chhabra, Gopal Krishan Singla, Sunil Lakhwani DOI:10.4103/0019-5049.158775 PMID:26195841 |
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Massive subcutaneous emphysema following laparoscopic nephroureterectomy: An unusual presentation |
p. 389 |
Suman Saini, Nidhi Agrawal DOI:10.4103/0019-5049.158777 PMID:26195842 |
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Marble bone disease and the Anaesthesiologist |
p. 390 |
Ashima Sharma, G Poojitha Reddy, W Sreedhar Reddy, Gopinath Ramchandran DOI:10.4103/0019-5049.158779 PMID:26195843 |
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Hyperacute onset of Guillain Barre Syndrome in the immediate postpartum period following Caesarean section under spinal anaesthesia |
p. 391 |
Byrappa Vinay, Bansal Sonia, Varadarajan Bhadrinarayan DOI:10.4103/0019-5049.158782 PMID:26195844 |
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Unexpected intra-operative bleeding due to Hermansky-Pudlak Syndrome |
p. 393 |
Mustafa Ozgur, Bahar Yilmaz DOI:10.4103/0019-5049.158784 PMID:26195845 |
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Ultrasound guided Transversus Abdominis Plane block through surgical wound |
p. 394 |
Sunil Rajan, Jerry Paul, Lakshmi Kumar DOI:10.4103/0019-5049.158786 PMID:26195846 |
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A home brewed low cost cuff inflator and pressure monitor |
p. 395 |
Pavan Dhulkhed, Sunil Khyadi, Amit Kadam, Vithal K Dhulkhed DOI:10.4103/0019-5049.158793 PMID:26195847 |
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