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SPECIAL ARTICLE |
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Pyrexia: An update on importance in clinical practice |
p. 207 |
Ragi Jain, Deepesh Saxena DOI:10.4103/0019-5049.154996 PMID:25937645Pyrexic patients are usually attended with some scepticism by anaesthesiologists. Main reasons are the absence of comprehensible guidelines pertaining to anaesthesia in such patients and the presence of innumerable aetiologies of pyrexia. This article has tried to fill the existing void in the medical literature regarding anaesthesia in a patient with pyrexia. The article aims to discuss common and relevant causes of pyrexia, their pathophysiology in anaesthetic perspective, and the subsequent anaesthetic management, though a detailed discourse on all the entities causing pyrexia is beyond the scope of this article. This article will also touch upon the thermoregulatory alterations during anaesthesia. The literature search was performed manually using text and reference books, peer-reviewed journals, online and offline and through internet search engines Google, PubMed and Medline databases, using search terms 'perioperative pyrexia or fever, anaesthesia and thermoregulation'. Articles from 1980 to 2013 in English language were selected. |
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CLINICAL INVESTIGATIONS |
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Clinical evaluation of nares-vocal cord distance and its correlation with various external body parameters |
p. 212 |
Bhuwan Sareen, Anu Kapur, Sanjay Kumar Gupta, Parul Bansal Sareen, Hitesh Nischal DOI:10.4103/0019-5049.154997 PMID:25937646Background and Aims: The optimal visualisation of vocal cords during fibreoptic intubation may be utilised for the nares-vocal cord distance (NVD) estimation. The present study was conducted to measure NVD and to correlate with various external body parameters. Methods: This study was conducted on 50 males and 50 females. We measured NVD and analysed its relationship with height, nares to tragus of ear distance (NED), nares to angle of mandible distance (NMD), sternal length (SL), thyro-mental distance (TMD), sterno-mental distance (SMD) and arm span (AS). Results: The mean NVD of the males was 18.5 ± 1.5 cm, and that of the females was 15.9 ± 1.1 cm. The relationship between the NVD and body height (males P = 0.001, r = 0.463, females P = 0.000, r = 0.555), SL (males P = 0.000, r = 0.463, females P < 0.000, r = 0.801) or AS (males P = 0.000, r = 0.561, females P = 0.000, r = 0.499) showed a significant correlation but NED, NMD, TMD, SMD did not. After combining male and female groups, (n = 100), the correlation of NVD with external body parameters is as follows SL (r = 0.887), height (r = 0.791), AS (r = 0.769), weight (r = 0.531), SMD (r = 0.466), NED (r = 0.459), NMD (r = 0.391), TMD (r = 0.379). Conclusion: The relationship of NVD to external body parameters had strong correlation in all parameters in the combined group; whereas when gender was taken into consideration NVD correlated significantly only with SL, height and AS. |
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Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea |
p. 216 |
Melveetil S Sreejit, Venkateswaran Ramkumar DOI:10.4103/0019-5049.154998 PMID:25937647Background and Aims: Induction of general anaesthesia per se as also the use of 100% oxygen during induction of anaesthesia, results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. We aimed to assess the effect of application of a continuous positive airway pressure (CPAP) of 5 cm H 2 O during pre-oxygenation and induction of anaesthesia on the period of apnoea before the occurrence of clinically significant desaturation. Methods: In this prospective, randomised, and double-blind study, 40 patients posted for elective surgery were enrolled. Duration of apnoea was measured as the time from the administration of succinylcholine hydrochloride to the time when oxygen saturation fell to 93%. Student's t-test was used for comparing the duration of apnoea. Results: The safe duration of apnoea was found to be significantly longer in patients receiving CPAP of 5 cm H 2 O (Group P; n = 16) compared to the group receiving no CPAP (Group Z; n = 20), that is, 496.56 ± 71.68 s versus 273.00 ± 69.31 s (P < 0.001). Conclusion: The application of CPAP of 5 cm H 2 O using a Mapleson "A" circuit with a fixed positive end-expiratory pressure device during 5 min of pre-oxygenation with 100% oxygen prior to the induction of anaesthesia provides a clearly longer duration of apnoea before clinically significant arterial desaturation occurs. |
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Comparison of ramosetron with ondansetron for the prevention of post-operative nausea and vomiting in high-risk patients |
p. 222 |
Sandip Agarkar, Aparna S Chatterjee DOI:10.4103/0019-5049.154999 PMID:25937648Background and Aims: Post-operative nausea and vomiting (PONV) has an 80% incidence in high-risk patients. This is despite the availability of several antiemetic drugs. Selective 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists are considered first-line for prophylaxis, ondansetron being the most commonly used agent. Ramosetron, another selective 5-HT 3 receptor antagonist, is more potent and longer acting than ondansetron. This study was conducted to evaluate the antiemetic efficacy of ramosetron in comparison with ondansetron in patients at a high risk of PONV. Methods: This was a prospective randomised double-blind study carried out over a 6-month period in which 206 patients with at least two risk factors for PONV were randomised to receive ramosetron 0.3 mg or ondansetron 8 mg, 30 min before the end of surgery. The incidence of PONV, severity of nausea and need for rescue antiemetic were recorded over the next 24 h. Primary outcome was the incidence of PONV. Secondary outcomes included severity of nausea and need for rescue. The data were analysed using the Predictive Analytics Software (PASW, version 18: Chicago, IL, USA). Results: The incidence of PONV was found to be 35% in the ramosetron group as opposed to 43.7% in the ondansetron group (P = 0.199). Need for rescue antiemetic was 23.3% in the ramosetron group and 32% in the ondansetron group (P = 0.156) in the 24 h following surgery. Conclusion: Ramosetron 0.3 mg and ondansetron 8 mg were equally effective in reducing the incidence of PONV in high risk patients. |
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Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery |
p. 228 |
Lakshmi Kumar, Yamini Sivani Kanneganti, Sunil Rajan DOI:10.4103/0019-5049.155000 PMID:25937649Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT) targeting cardiac index (CI) and oxygen extraction ratio (O 2 ER) on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III) undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT), in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU) and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05). The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05). There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days) or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days) between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation. |
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Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation  |
p. 234 |
Usha Shukla, T Prabhakar, Kiran Malhotra, Dheeraj Srivastava, Kriti Malhotra DOI:10.4103/0019-5049.155001 PMID:25937650Background and Aims: Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy. Methods: A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (n = 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's t-test and Chi-square test (level of significance P = 0.05). Results: VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B. Conclusion: Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol. |
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CASE REPORT |
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Management of tracheomalacia in an infant with Tetralogy of Fallot |
p. 240 |
Santoshi Kurada, Ranjith B Karthekeyan, Mahesh Vakamudi, Periyasamy Thangavelu DOI:10.4103/0019-5049.155002 PMID:25937651Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1-2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful. |
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BRIEF COMMUNICATIONS |
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Anaesthetic management for drainage of frontoparietal abscess in a patient of uncorrected Tetralogy of Fallot  |
p. 244 |
Anjana S Wajekar, Anita N Shetty, Shrikanta P Oak, Ruchi A Jain DOI:10.4103/0019-5049.155003 PMID:25937652 |
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Prone position ventilation in Acute Respiratory Distress Syndrome: An overview of the evidences  |
p. 246 |
Sumita P Agrawal, Akhil D Goel DOI:10.4103/0019-5049.155004 PMID:25937653 |
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Anaesthetic management of a patient with anti-NMDA receptor encephalitis |
p. 248 |
Mohammed Aslam Shaikh, Tasneem Dhansura, Shweta Gandhi, Tarana Shaikh DOI:10.4103/0019-5049.155005 PMID:25937654 |
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Immune-mediated thrombocytopaenia secondary to pulmonary tuberculosis: Diagnostic and therapeutic dilemma |
p. 250 |
J Shashibhushan, H Bala Subramanya, N Sunil Kumar, Malappa Poojari DOI:10.4103/0019-5049.155006 PMID:25937655 |
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LETTERS TO EDITOR |
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Emergency tracheal intubation through intubating laryngeal mask airway in patients with stereotactic frame in situ |
p. 253 |
Lakshmi N Kurnutala, Sudhakar Kinthala, D Padmaja DOI:10.4103/0019-5049.155007 PMID:25937656 |
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Cardiac arrest from tramadol and fentanyl combination |
p. 254 |
Shalini Nair, Tony Thomson Chandy DOI:10.4103/0019-5049.155008 PMID:25937657 |
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Our encounter with left superior vena cava |
p. 255 |
Abhijit S Nair, Venugopal Kulkarni, Sunjoy Verma, Ravikiran Mudunuri DOI:10.4103/0019-5049.155009 PMID:25937658 |
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Bilateral asymptomatic pneumothorax in early post-operative period |
p. 257 |
Abdelmalek Ghimouz, Claude Lentschener, Laure Bonnet, Philippe Goater DOI:10.4103/0019-5049.155010 PMID:25937659 |
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Anaesthetic in the garb of a propellant |
p. 258 |
Shagun Bhatia Shah, Uma Hariharan, Ajay Kumar Bhargava DOI:10.4103/0019-5049.155011 PMID:25937660 |
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New approach to treat an old problem: Mannitol for post dural puncture headache! |
p. 260 |
MM Rizvi, Raj Bahadur Singh, RK Tripathi, Sister Immaculate DOI:10.4103/0019-5049.155012 PMID:25937661 |
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Prevention of migration of endotracheal tubes used for aided nasogastric tube placement in anaesthetized patients |
p. 261 |
Rachel Maria Gomes, Praveen P Raj, Saravana S Kumar, Chinnusamy Palanivelu DOI:10.4103/0019-5049.155013 PMID:25937662 |
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COMMENTS ON PUBLISHED ARTICLE |
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Transfusion practices in trauma |
p. 263 |
Sonal Rastogi DOI:10.4103/0019-5049.155014 PMID:25937663 |
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RESPONSE TO COMMENTS |
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Transfusion practices in trauma |
p. 264 |
V Trichur Ramakrishnan, Srihari Cattamanchi DOI:10.4103/0019-5049.155015 PMID:25937664 |
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COMMENTS ON PUBLISHED ARTICLE |
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Blood transfusion practices in liver transplantation |
p. 266 |
Jyotirmoy Das, Sangeeta Khanna, Sudhir Kumar, Yatin Mehta DOI:10.4103/0019-5049.155016 PMID:25937665 |
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ERRATUM |
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Survey of supraglottic airway devices usage in anaesthetic practice in South Indian State: Erratum |
p. 268 |
DOI:10.4103/0019-5049.155017 PMID:25937666 |
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