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   2010| May-June  | Volume 54 | Issue 3  
    Online since July 10, 2010

 
 
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REVIEW ARTICLE
Medication error in anaesthesia and critical care: A cause for concern
Dilip Kothari, Suman Gupta, Chetan Sharma, Saroj Kothari
May-June 2010, 54(3):187-192
DOI:10.4103/0019-5049.65351  PMID:20885862
Medication error is a major cause of morbidity and mortality in medical profession, and anaesthesia and critical care are no exception to it. Man, medicine, machine and modus operandi are the main contributory factors to it. In this review, incidence, types, risk factors and preventive measures of the medication errors are discussed in detail.
  15,026 1,645 11
CASE REPORTS
Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions
Thrivikrama Padur Tantry, Dinesh Kadam, Pramal Shetty, Sanath Bhandary
May-June 2010, 54(3):235-238
DOI:10.4103/0019-5049.65372  PMID:20885871
Peripheral nerve block (PNB) in anticoagulated patients is controversial and guidelines are not defined. We report two patients with severe cardiac valvular lesions, who underwent emergency surgeries for lower limb. Both the patients were on anticoagulants, warfarin and heparin in one and aspirin and clopidogrel in the other, with abnormal coagulation profile in the former. Combined femoral and sciatic nerve blocks were used as a sole anaesthetic technique. Postoperatively, the patients were evaluated for bleeding complications at the injection site using high-frequency ultrasound probe. Both had uneventful surgery and recovery. A close postoperative monitoring following PNBs in anticoagulated patients is necessary.
  6,707 806 5
CLINICAL INVESTIGATIONS
Caudal ropivacaine-clonidine: A better post-operative analgesic approach
Sukhminder Jit Singh Bajwa, Jasbir Kaur, Sukhwinder Kaur Bajwa, Geetika Bakshi, Kanwalpreet Singh, Aparajita Panda
May-June 2010, 54(3):226-230
DOI:10.4103/0019-5049.65368  PMID:20885869
The aim was to determine qualitative and quantitative aspects of caudal block, haemodynamic effects, and post-operative pain relief of ropivacaine 0.25% versus ropivacaine 0.25% with clonidine for lower abdominal surgeries in paediatric patients. A double-blind study was conducted among 44 paediatric patients in the Department of Anaesthesiology and Intensive Care of our institute. A total of 44 ASA-I paediatric patients between the ages of 1 and 9 years, scheduled for elective hernia surgery, were enrolled in this randomised double-blind study. The caudal block was administered with ropivacaine 0.25% (Group I) and ropivacaine 0.25% and clonidine 2 μg/kg (Group II) after induction with general anaesthesia. Haemodynamic parameters were observed before, during and after the surgical procedure. Post-operative analgesic duration, total dose of rescue analgesia, pain scores and any side effects were looked for and recorded. All the results were tabulated and analysed statistically. The variables in the two groups were compared using the non-parametric tests. For all statistical analyses, the level of significance was P < 0.05. Forty-four patients were enrolled in this study and their data were subjected to statistical analysis: 22 patients in both the groups were comparable with regard to demographic data, haemodynamic parameters and other vitals and were statistically non-significant (P>0.05). The duration of analgesia was significantly prolonged in Group II (P<0.05). The dose requirement for post-operative pain relief was also significantly lesser in Group II. The incidences of side effects were almost comparable and non-significant. A caudal block with 0.25% of isobaric ropivacaine combined with 2 μg/kg of clonidine provides efficient analgesia intra-operatively and prolonged duration of analgesia post-operatively.
  5,691 1,447 10
A comparative study of intrathecal and epidural buprenorphine using combined spinal-epidural technique for caesarean section
Shaloo Ipe, Sara Korula, Sreelatha Varma, Grace Maria George, Saramma P Abraham, Leena Rachel Koshy
May-June 2010, 54(3):205-209
DOI:10.4103/0019-5049.65359  PMID:20885865
Neuraxial opioids provide excellent analgesia intraoperatively and postoperatively while allowing early ambulation of the patient by sparing sympathetic and motor nerves. A prospective, randomised double blind study was conducted involving 90 patients of ASA 1 physical status coming for elective cesarean section to evaluate the analgesic effect of neuraxial buprenorphine. They were allocated into three groups. Spinal local anaesthetic was used as the main stay of anaesthesia for surgery and spinal and epidural analgesia with opioids continued as the main stay for postoperative analgesia. All the groups were given 0.5% Bupivacaine intrathecally for the surgery. Besides this, group I was given 150 mcg Buprenorphine intrathecally and group II and III were given 150 mcg and 300 mcg Buprenorphine respectively, epidurally. In the present study, we observed that 150 mcg of Buprenorphine given intrathecally provided much longer duration of analgesia compared to 150 mcg of Buprenorphine given epidurally. Increasing the epidural dose of Buprenorphine from 150 mcg to 300 mcg proved to produce prolonged analgesia comparable to intrathecal Buprenorphine without compromising patient safety and neonatal outcome. The minor side effects were more with intrathecal Buprenorphine than epidural Buprenorphine. We concluded that 300 mcg of Buprenorphine epidurally is equianalgesic to 150 mcg Buprenorphine intrathecally.
  5,169 951 6
Lateral approach for supraclavicular brachial plexus block
DK Sahu, Anjana Sahu
May-June 2010, 54(3):215-218
DOI:10.4103/0019-5049.65364  PMID:20885867
A lateral approach described by Volker Hempel and Dr. Dilip Kotharihas been further studied, evaluated and described in detail in the present study. The aim of this study was to evaluate lateral approach of supraclavicular brachial plexus block, mainly in terms of successes rate and complication rate. The study was conducted in secondary level hospital and tertiary level hospital from 2004 to 2008. It was a prospective nonrandomized open-level study. Eighty-two patients of both sexes, aged between 18 and 65 years with ASA Grade I and II scheduled to undergo elective major surgery of the upper limb below the midarm, were selected for this new lateral approach of brachial plexus block. The onset and duration of sensory and motor block, any complications and need for supplement anaesthesia were observed. Success and complication rate were calculated in percentage. Average onset and duration of sensory and motor block was calculated as mean SD and percentage. Out of 82 patients, 75 (92%) have got successful block with no significant complication in any case.
  5,118 970 3
SPECIAL ARTICLES
Tight bag
S Parthasarathy, M Ravishankar
May-June 2010, 54(3):193-198
DOI:10.4103/0019-5049.65354  PMID:20885863
Tight bag is a clinical situation where excessive pressure needs to be applied to a reservoir bag of a breathing system to an intubated patient, which may or may not produce satisfactory ventilation. The various clinical scenarios and the appropriate steps for its prevention are described.
  4,623 1,464 -
HISTORY
Dr. (Miss) Rupa Bai Furdoonji: World's first qualified lady anaesthetist
Narayana Ala, K Bharathi, PKJP Subhaktha, Manohar Gundeti, A Ramachari
May-June 2010, 54(3):259-261
DOI:10.4103/0019-5049.65371  PMID:20885878
  5,133 544 -
CLINICAL INVESTIGATIONS
Comparative evaluation of ASA classification and ACE-27 index as morbidity scoring systems in oncosurgeries
Mary Thomas, Nebu Abraham George, Balagopal Prabhakar Gowri, Preethi Sara George, Paul Sebastian
May-June 2010, 54(3):219-225
DOI:10.4103/0019-5049.65366  PMID:20885868
The primary intention of the study was to find out whether Adult Comorbidity Evaluation Index (ACE-27) was better than the American Society of Anaesthesiologists' (ASA) risk classification system in predicting postoperative morbidity in head and neck oncosurgery. Another goal was to identify other risk factors for complications which are not included in these indexes. Univariate and multivariate analyses were performed on 250 patients to determine the impact of seven variables on morbidity-ACE-27 grade, ASA class, age, sex, duration of anaesthesia, chemotherapy and radiotherapy. In univariate analysis ACE-27 index, ASA score, duration of anaesthesia, radiotherapy and chemotherapy were significant. As both comorbidity scales were significant in univariate analysis they were analyzed together and separately in multivariate analysis to illustrate their individual strength. In the first multivariate analysis (excluding ACE-27 grade) ASA class, duration of anaesthesia, radiotherapy and chemotherapy were significant. The positive predictive value (PPV) of this model to predict morbidity was 60.86% and negative predictive value (NPV) was 77.9%. The sensitivity was 75% and specificity 62.2%. In the second multivariate analysis (excluding ASA class) ACE-27 grade, duration of anaesthesia and radiotherapy were significant. The PPV of this model to predict morbidity was 62.1% and NPV was 76.5%. The sensitivity was 61.6% and specificity 70.9%. In the third multivariate analysis which included both ACE-27 grade and ASA class only ASA class, duration of anaesthesia, radiotherapy and chemotherapy remained significant. In conclusion, ACE-27 grade and ASA class were reliable predictors of major complications but ASA class had more impact on complications than ACE-27 grade.
  3,852 617 7
SPECIAL ARTICLES
Telemedicine and anaesthesia
Veena Chatrath, Joginder Pal Attri, Raman Chatrath
May-June 2010, 54(3):199-204
DOI:10.4103/0019-5049.65357  PMID:20885864
Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article.
  3,426 963 8
CASE REPORTS
Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient
Surekha S Patil, Shonali C Pawar, VM Divekar, Rochana G Bakhshi
May-June 2010, 54(3):249-254
DOI:10.4103/0019-5049.65377  PMID:20885876
A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial), a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation.
  3,571 714 1
CLINICAL INVESTIGATIONS
Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus
Vikas Trehan, Uma Srivastava, Aditya Kumar, Surekha Saxena, Chandra Shekhar Singh, Ankit Darolia
May-June 2010, 54(3):210-214
DOI:10.4103/0019-5049.65362  PMID:20885866
The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular) regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30) or medial clavicular approach (group M, n = 30) with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4), discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05). More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L). Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.
  3,359 813 2
CASE REPORTS
Indoxacarb poisoning: A rare presentation as methemoglobinaemia
Roopam Chhabra, Ishwar Singh, Mansi Tandon, Ram Babu
May-June 2010, 54(3):239-241
DOI:10.4103/0019-5049.65373  PMID:20885872
Indoxacarb is a broad-spectrum non-organophosphorus oxidiazine insecticide widely used in farming. Once absorbed it acts on sodium channels and blocks the flow of sodium ions. We report a case of indoxacarb poisoning in a farmer following suicidal consumption, manifested as unconsciousness, cyanosis and stationary SpO 2 values. Methemoglobinaemia was suspected on clinical presentation which was successfully managed with inj. methylene blue and other symptomatic and supportive treatment.
  3,668 434 3
CLINICAL INVESTIGATIONS
Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia
Poonam S Ghodki, Shalini P Sardesai, Shalini K Thombre
May-June 2010, 54(3):231-234
DOI:10.4103/0019-5049.65370  PMID:20885870
Sixty ASA grade I/II patients scheduled for elective short laparoscopic procedures under spinal anaesthesia were divided into two groups of 30 each. The first group (group C) received 3.5 ml of hyperbaric bupivacaine with 30 mcg of clonidine. The second group (group B) received plain bupivacaine 3.5 ml. Till date, the limiting factor for use of spinal anaesthesia for laparoscopy was patient's discomfort due to shoulder tip pain. From our study it can be concluded that bupivacaine along with clonidine in low doses provides good sedation and analgesia in intraoperative and post-operative period and at the same time abolishes shoulder tip pain during laparoscopic procedures. In addition, no significant changes in haemodynamics occur with the low dose of clonidine used.
  3,051 659 3
CASE REPORTS
Anaesthetic management of difficult airway due to retropharyngeal abscess
Manjula Sudhakar Rao, YK Linga Raju, PN Vishwanathan
May-June 2010, 54(3):246-248
DOI:10.4103/0019-5049.65376  PMID:20885875
A one-and-half-year old girl weighing 7.5 kg presented with a history of neck swelling, difficulty in swallowing and breathing. She was posted for incision and drainage on an emergency basis. Diagnosis was confirmed by neck X-ray and computed tomography scan as retropharyngeal abscess. Here we present the successful anaesthetic management of this child at JSS Medical College Hospital, Mysore.
  3,044 627 -
MEDICOLEGAL ARTICLE
Thiopentone - Medicolegal views
AL Meenakshi Sundaram
May-June 2010, 54(3):275-277
  2,373 430 -
EDITORIAL
Critical incident reporting and learning system: The black pearls
SS Harsoor
May-June 2010, 54(3):185-186
DOI:10.4103/0019-5049.65348  PMID:20885861
  2,002 472 -
CASE REPORTS
Fatal thyrocardiac event
Samit Kumar Khutia, Bhaskar Roy, Mohan Chandra Mandal, Sabyasachi Das
May-June 2010, 54(3):255-258
DOI:10.4103/0019-5049.65374  PMID:20885877
Atrial fibrillation occurs frequently (2-20%) in chronic hyperthyroidism patients. Poorly treated thyrotoxic patients may present with a life-threatening cerebrovascular accident giving little scope to revert the situation. At times, it is difficult to make a patient euthyroid with conventional management. The definitive treatment of choice is 131 I, radioiodine. An adjusted dose of an oral anticoagulant is highly efficacious for the prevention of all types of strokes. Timely intervention by a skilled airway manager with right instruments is the key to success in airway management. A 50-year-old thyrotoxic, semiconscious male presented with a sudden onset of haemiplegia. He had chronic AF, a huge thyroid swelling with gross tracheal deviation and dilated cardiomyopathy. A CT scan showed infarction in the left middle cerebral artery territory. After initial improvement with conservative management, patient's condition deteriorated in the next 48 h. Repeat CT scan showed increase in the infarct size with haemorrhage and midline shift. Finally, he died despite all resuscitative measures.
  2,056 405 -
Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly
Sriram Sabade, Anand Vagrali, Sharan Patil, Praveen Kalligudd, Vithal Dhulked, MD Dixit, Mohan Gan, A Dayal
May-June 2010, 54(3):242-245
DOI:10.4103/0019-5049.65375  PMID:20885873
Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD) is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum), atrial septal defect (ASD) and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10 th postoperative day.
  2,018 404 -
LETTERS TO EDITOR
Parenteral nutrition: Few more facts
Preety Mittal Roy, Vijaya Pant, Jyotirmoy Das
May-June 2010, 54(3):272-272
DOI:10.4103/0019-5049.65365  PMID:20885889
  1,743 559 -
Capnography-guided awake nasal intubation in a 4-month infant with Pierre Robin syndrome
Rajeev Sharma
May-June 2010, 54(3):262-262
DOI:10.4103/0019-5049.65349  PMID:20885879
  1,733 455 -
Unusual presentation of hypocalcaemia in a peri-operative period-cause unknown
Rachna Wadhwa, Seema Kalra
May-June 2010, 54(3):270-271
DOI:10.4103/0019-5049.65363  PMID:20885888
  1,892 287 -
How is that? Knotting of a peripherally inserted central venous catheter
Gnanamuthu Birla Roy, Ajit A Cheriyan, Manbha L Rymbai
May-June 2010, 54(3):272-274
DOI:10.4103/0019-5049.65367  PMID:20885890
  1,782 326 2
Management of a patient with Huntington's disease under spinal anaesthesia
Sanjeev Janardan Juwarkar, Chitra Sanjeev Juwarkar
May-June 2010, 54(3):263-264
DOI:10.4103/0019-5049.65352  PMID:20885880
  1,812 287 -
Indigenous device for in circuit delivery of bronchodilator drugs through MDI
Balkar Singh, Nishkarsh Gupta, Bishnu Prasad Panigrahi, Deep Arora, Pradip Govil, Shibani Das, Manish Singh, Raj Tobin
May-June 2010, 54(3):264-265
DOI:10.4103/0019-5049.65353  PMID:20885882
  1,724 268 -
Utility of BIS for sedation management during monitored anaesthesia care
Satyen Parida
May-June 2010, 54(3):263-263
DOI:10.4103/0019-5049.65350  PMID:20885881
  1,598 385 -
Use of suction catheter as an aid to intubation in emergency situation of intraoral bleeding
Mohammad Aseem, Urmila Palaria, Umesh Kumar Bhadani
May-June 2010, 54(3):267-268
DOI:10.4103/0019-5049.65358  PMID:20885885
  1,537 337 1
Oculocardiac reflex during endoscopic transsphenoidal removal of pituitary adenoma
Tumul Choudhury, Hemanshu Prabhakar, Gyaninder Pal Singh, Ashish Bindra
May-June 2010, 54(3):269-270
DOI:10.4103/0019-5049.65361  PMID:20885887
  1,459 353 1
Centenarians: Hip fractures and peripheral lower limb nerve blocks
Anand Rampure V Rao, Aneesh Lakshmanan, Anita Ajith, Sudheendra M Rao
May-June 2010, 54(3):268-269
DOI:10.4103/0019-5049.65360  PMID:20885886
  1,457 341 -
Boneless occiput and awake fibreoptic intubation in lateral position
Keshav Goyal, Girija P Rath, Tumul Chowdhury, Charu Mahajan
May-June 2010, 54(3):265-266
DOI:10.4103/0019-5049.65355  PMID:20885883
  1,490 296 -
OBITUARY
Dr. Ashok Jain
N Tandon
May-June 2010, 54(3):258-258
  1,523 207 -
LETTERS TO EDITOR
Indigenous neonatal facemask
Lalit Kumar Raiger
May-June 2010, 54(3):266-267
DOI:10.4103/0019-5049.65356  PMID:20885884
  1,315 270 -
CORRIGENDUM
Corrigendum

May-June 2010, 54(3):245-245
PMID:20885874
  1,036 223 -