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   2009| September-October  | Volume 53 | Issue 5  
    Online since March 3, 2010

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Are All Colloids Same? How to Select the Right Colloid?
Sukanya Mitra, Purva Khandelwal
September-October 2009, 53(5):592-607
The administration of intravenous fluids is one of the most common and universal interventions in medicine. Colloids are an alternative to the frequently used crystalloids, with highly variable use depending on a myriad of clinical variables. A colloid is defined as a high molecular weight (MW) substance that largely remains in the intravas­eular compartment, thereby generating an oncotic pressure. Colloids are considered to have a greater intravaseular persistence when compared to crystalloids. All colloids, however, are clearly not the same. Differences in the physi­cochemical properties, pharmacokinetics and safety profile exist amongst various colloids. This review explores the different types of colloids, with their properties and usefulness as well as adverse effects. While all the available colloids are reviewed briefly (e.g., albumin, gelatin, dextran) with respect to their pharmacology, indications, advan­tages and disadvantages, particular emphasis is laid on the hydroxyethyl starches (HES) because of their rising prominence. It is shown that HES differ widely in their physicochemical and pharmacokinetic properties, composition, usefulness, and especially in their adverse effect profiles. The third generation HES (tetrastarches), in particular, seem to offer a unique combination of safety and efficacy. Several issues related to this are discussed in detail. This review of the available clinical data demonstrates that HES should not be regarded as one homogenous group, and data for one product should not be automatically extrapolated to another. Thus, among the synthetic colloids, the tetrastarches appear to offer the best currently available compromise between efficacy, safety profile, and cost. They also appear to be the best suited for use in the intensive care setting. Finally, balanced (rather than saline-based) HES solutions appear promising as a plasma-adapted volume replacement strategy and may further refine the ongoing quest of finding the ideal fluid therapy.
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Complications And Controversies of Regional Anaesthesia: A Review
Anil Agarwal, Kamal Kishore
September-October 2009, 53(5):543-553
Complications of regional anaesthesia has been recognised from very long time. Fortunately serious complica­tion are rare. Safe, effective practice of neuraxial anaesthesia requires a detailed knowledge of potential complica­tions, their incidence and risk factors associated with their occurrence. The incidence of complication were higher for spinal than for epidural anaesthesia. These complications being rare, so existing studies are mainly retrospective, providing information about incidence and their associations but not necessarily demonstrate causality. There are many areas of controversies regarding the usage of regional anaesthesia i.e. in outpatient surgical procedures, epidural test dose, its safety in infected / febrile / immuno compromised patients, / in patients with neurological disorder and in patients receiving anti-coagulants. Recommendations proposed may be acceptable based on the judgment of the responsible anaesthesiologist. The consensus statements are designed to encourage safe and quality patient care but cannot guarantee a specific outcome.
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Tobacco Interventions and Anaesthesia - A Review
Usha Saha
September-October 2009, 53(5):618-627
Tobacco use is the leading preventable agent of death in the world. It is manufactured on a large scale in India and has a huge international market also. Death toll from tobacco use is on the rise. Use of tobacco is also increasing esp. in developing countries, in teenagers& in women, despite government, WHO and intervention by other statutory bodies. Prolonged use of tobacco or its products, as smoke or chew, endows significant risk of developing various diseases. With advances in surgical and anaethesia techniques& prolonged life expectancy, anaesthetist will be faced with management of these patients. Tobacco consumption affects every major organ system of the body; esp. lung, heart and blood vessels. Perioperative smoking cessation can significantly reduce the risk of postoperative complica­tions& duration of hospital stay. Anaesthetist can play an important role in motivating these patients to quit smoking preoperatively by providing brief counselling and nicotine replacement therapy in reluctant quitters. More of concern is the effect of passive smoking (second& third hand smoke) on non smokers. This is a review of tobacco& its products, their health consequences, diseases caused, anaesthetic consider­ations& their role in helping these patients quit smoking Preventing nicotine addiction and improving smoking cessa­tion strategies should be the priority and despite these being only partially successful, strong measures at all levels should he continued& enforced.
  4,656 1,469 -
Challenges in Paediatric Laparoscopic Surgeries
Ruchi Gupta, Saru Singh
September-October 2009, 53(5):560-566
Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular.The anaes­thetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult. The pressure of pnemoperitoneum needs to be kept between 6-12em H 2 O, flow of gas about 0.91, ventilation to be controlled, temperature monitoring being essential, use of atropine as premedicant, intravenous fluid management to be meticulous, induction with sevoflurane preferred as children may not allow i.v.puneture, intraoperative surgical complications being more, one needs to be very vigilant to diagnose and treat it. Using periumbilical area in paediatric age group should be avoided because the umbilical vessels have not imvoluted and can get punctured.Thus careful management in paediatric laparoscopic surgery will assume an important place in paediatric surgery.
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Anaesthesia for Fetal Surgeries
Kirti N Saxena
September-October 2009, 53(5):554-559
The concept of the fetus as a patient has evolved from prenatal diagnosis and serial observation of fetuses with anatomical abnormalities.. Surgical intervention is considered when a fetus presents with a congenital lesion that can compromise or disturb vital function or cause severe postnatal morbidity. Hydronephrosis, saccrococcygeal ter­atoma, hydrocephalus, meningomyelocoele and diaphragmatic hernia are some of the defects that can be diagnosed by imaging and are amenable to intervention. The combination of underdeveloped organ function and usually life-threatening congenital malformation places the fetus at a considerable risk. Fetal surgery also leads to enhanced surgical and anaesthetic risk in the mother including haemon - hage, infection, airway difficulties and amniotic fluid embolism. There are 3 basic types of surgical interventions: 1.Ex utero intrapartum treatment(EHIT), 2.Midgestation open procedures, 3.Minimally invasive midgestation procedures. These procedures require many manipulations and moni­toring in both the mother and the unborn fetus.
  3,913 1,888 -
Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery
Usha Kiran, Neeti Makhija
September-October 2009, 53(5):582-591
Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implanta­tion and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i) In a surgical patient with a history of percu­taneous coronary intervention (PCI) and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii) Consider all patents with a recent stent implan­tation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii) Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision.
  3,456 1,218 -
Fibromyalgia and Myofascial Pain Syndrome - A Dilemma
HC Chandola, Arunangshu Chakraborty
September-October 2009, 53(5):575-581
Pain and fatigue associated to the musculoskeletal system are among the leading causes of patients to visit their physicians and nearly one-third of such patients suffer from fibromyalgia. Fibromyalgia syndrome (FMS) is a chronic debilitating disorder characterized by widespread pain with tenderness in specific areas, leading to fatigue, headache and sleep disorder. Myofaseial Pain Syndrome (NIPS), is also a localized musculoskeletal pain producing condition whose diagnostic and management criteria differ from FMS but still considered by many only a subtype of FMS.Till date no exact cause has been held responsible for these painful conditions, therefore treatment of these disorders is always a challenge. The therapies are not precise but multimodal including pharmacological and alternative ap­proaches. This article describes the existing knowledge pertaining to these conditions in regard of causative factors diagnosis and management.
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Transoesophageal Echocardiography Related Complications
SK Mathur, Pooja Singh
September-October 2009, 53(5):567-574
The application of transesophageal echocardiography (TEE ) has been continuously increasing over past several decades. It is usually considered a very safe diagnostic and monitoring device. Though the complications are rare, but these complications must be known to the operators performing TEE. The goal of this article is to encapsulate the potential complications associated with TEE. The complications are primarily related to gastro intestinal, cardiovascular and respiratory systems along with some miscellaneous problems related to probe insertion, drugs and inexperience of the operator. Strategies for the prevention of these complications are also analyzed in order to avoid the risk.
  2,907 767 -
Current Status of Obstetric Anaesthesia: Improving Satisfaction and Safety
J Sudharma Ranasinghe, David Birnbach
September-October 2009, 53(5):608-616
The Centers for Disease Control and Prevention (CDC) reported in 2003 that although the maternal mortal­ity rate has decreased by 99% since 1900, there has been no further decrease in the last two decades [1] . A more recent report indicates a rate of 11.8 per 100,000 live births [2] , although anaesthesia-related maternal mortality and morbidity has considerably decreased over the lastfew decades. Despite the growing complexity of problems and increasing challenges such as pre-existing maternal disease, obesity, and the increasing age of pregnant mothers, anaesthesia related maternal mortality is extremely rare in the developed world. The current safety has been achievedthrough changes in training, service, technical advances and multidisciplinary approach to care. The rates of general anaesthesia for cesarean delivery have decreased and neuraxial anaesthetics have become the most commonly used techniques. Neuraxial techniques are largely safe and effective, but potential complications, though rare, can be severe.
  2,707 779 -
The Future of Anaesthetic Pharmacology
YK Batra
September-October 2009, 53(5):533-536
  2,075 509 -
Drug Errors in Anaesthesiology
Rajnish Kumar Jain, Sarika Katiyar
September-October 2009, 53(5):539-542
Medication errors are a leading cause of morbidity and mortality in hospitalized patients. The incidence of these drug errors during anaesthesia is not certain. They impose a considerable financial burden to health care systems apart from the patient losses. Common causes of these errors and their prevention is discussed.
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Message from the Editor
Pramila Bajaj
September-October 2009, 53(5):537-538
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