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   2017| October  | Volume 61 | Issue 10  
    Online since October 12, 2017

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Acute kidney injury following rhabdomyolysis and sepsis after non-poisonous desert monitor bite
Poonam Gupta, Pradeep Kumar Verma
October 2017, 61(10):837-839
DOI:10.4103/ija.IJA_241_17  PMID:29242657
The desert monitor, Varanus griseus, is a species of desert monitor lizard found in North-Western India. They are believed to be non-poisonous. We report a case of Indian desert monitor bite leading to acute renal failure following rhabdomyolysis and severe sepsis. Prompt diagnosis and treatment resulted in the favourable outcome. This is author's intent to highlight the complication that may occur after Indian desert monitor bite.
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The effect of intravenous dextrose administration for prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy: A double-blind, randomised controlled trial
Abolfazl Firouzian, Alieh Zamani Kiasari, Gholamali Godazandeh, Afshin Gholipour Baradari, Abbas Alipour, Arman Taheri, Amir Emami Zeydi, Maryam Montazemi
October 2017, 61(10):803-810
DOI:10.4103/ija.IJA_420_16  PMID:29242652
Background and Aims: Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC. Methods: In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery. Results: There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores (P < 0.05). A low negative correlation coefficient was found (r = −0.394, P < 0.001) between blood glucose levels and nausea scores upon PACU arrival. Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: −0.87, odds ratio = 0.42, 95% confidence interval: 0.28–0.64). Conclusion: Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC.
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Newer airway assessment techniques: A view on their utility
S Bala Bhaskar
October 2017, 61(10):779-781
DOI:10.4103/ija.IJA_625_17  PMID:29242647
  2,855 1,056 -
Dose-reversal effect relationship of three different doses of neostigmine in obese patients: A randomised clinical trial
Satyen Parida, Venkatesan Kausalya, Sandeep Kumar Mishra, Sethuramachandran Adinarayanan
October 2017, 61(10):787-792
DOI:10.4103/ija.IJA_297_17  PMID:29242649
Background and Aims: Previous studies suggest that administration of vecuronium based on total body weight rather than ideal body weight (IBW) in obesity results in overdosing with prolonged recovery times. We hypothesised that larger doses of neostigmine could result in faster recovery in obese patients administered vecuronium based on total body weight. Methods: Forty-five obese American Society of Anesthesiologists' II patients undergoing elective surgery under general anaesthesia were randomised into 3 groups to receive neostigmine 30, 40 and 50 μg/kg. Following induction, patients were paralysed with vecuronium 0.1 mg/kg based on total body weight. Reversal was achieved with neostigmine based on the patient's group, and time to train-of-four (TOF) ratios of 0.5, 0.7 and 0.9 measured. The primary outcome variable was time to achieve TOF ratio >0.9. Results: Neostigmine 50 μg/kg achieved faster recovery to TOF 0.7 than neostigmine 30 and 40 μg/kg. There was no significant difference in recovery times to TOF 0.7 in patients receiving either 30 or 40 μg/kg of neostigmine. However, neostigmine 40 μg/kg attained TOF ratio 0.9 faster than 30 μg/kg. We did not note a significant difference between the 40 and 50 μg/kg dose with regard to recovery of TOF to 0.9. Conclusion: Facilitated recovery from neuromuscular blockade to TOF of 0.7 was faster with neostigmine 50 μg/kg compared to 40 or 30 μg/kg. Recovery to TOF ratio of 0.9 was not significantly different with 40 or 50 μg/kg doses although such time was faster as compared to 30 μg/kg dose.
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Recent advances in low temperature sterilization - Moving ahead from Cidex™/ETO to OPA/Ozone: An update
Shagun Bhatia Shah, Ajay Kumar Bhargava
October 2017, 61(10):855-857
DOI:10.4103/ija.IJA_281_17  PMID:29242666
  2,883 446 -
Enhancing airway assessment of patients with head and neck pathology using virtual endoscopy
Imran Ahmad, Oliver Keane, Sarah Muldoon
October 2017, 61(10):782-786
DOI:10.4103/ija.IJA_588_17  PMID:29242648
Studies have demonstrated that poor assessment and planning contribute to airway complications and that current airway assessment strategies have a poor diagnostic accuracy in predicting difficult intubation in the general population. Patients with head and neck pathology are at higher risk for difficulties during airway management and are more likely to need emergency surgical access. Therefore, thorough assessment of this group of patients is mandatory. The addition of virtual endoscopy (VE) to clinical history and computerised tomography imaging has been shown to improve diagnostic accuracy for supraglottic, glottic and infraglottic lesions and has a positive influence in formulating a more cautious and thorough airway management strategy in this high-risk group of patients. This article reviews whether VE can enhance airway assessment in patients with head and neck pathology and help reduce airway complications.
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Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery
Jaya Sharma, Shobha Purohit, Sonali Bhatia, Poonam Kalra, Mamta Sharma, Reema Meena
October 2017, 61(10):811-817
DOI:10.4103/ija.IJA_169_17  PMID:29242653
Background and Aims: Awake fibre-optic intubation (AFOI) is an integral part of anaesthetic management of difficult airways. Conscious sedation is essential to assist AFOI. This study compared two different doses of dexmedetomidine in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation in patients undergoing elective cervical spine surgery with rigid cervical collar in situ. Methods: A randomized, prospective, comparative study design was conducted in sixty patients divided into two groups: Group (L) (n = 30) patients received low dose of dexmedetomidine (0.5 μg/kg) along with airway blocks and Group (H) (n = 30) patients received standard dose of dexmedetomidine (1 μg/kg) along with airway blocks. Both the groups received dexmedetomidine infusion over 10 min followed by airway block. Quantitative data were analysed by applying Student's t-test whereas qualitative data were analysed with Chi-square test. The objectives were to compare patients' Observer's Assessment of Alertness/Sedation scale (OAA/S) as primary outcome and other variables such as endoscopy, intubation condition, tolerance and haemodynamic stability among low and standard doses of dexmedetomidine. Results: Group H had more favourable OAA/S score than that of Group L, but endoscopy and intubation time, patient tolerance, vocal cord and limb movement and satisfaction score did not differ significantly between the groups. There were no significant haemodynamic differences between the two groups. Conclusion: The 0.5 μg/kg dose of dexmedetomidine was found optimal and effective in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation for patients undergoing elective cervical spine surgery.
  2,656 418 -
Comparison of volume control and pressure control ventilation in patients undergoing single level anterior cervical discectomy and fusion surgery
Srilata Moningi, Praveen Kumar Elmati, Prasad Rao, Geetha Kanithi, Dilip Kumar Kulkarni, Gopinath Ramachandran
October 2017, 61(10):818-825
DOI:10.4103/ija.IJA_605_16  PMID:29242654
Background and Aims: Pressure control and volume control ventilation are the most preferred modes of ventilator techniques available in the intraoperative period. The study compared the intraoperative ventilator and blood gas variables of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in patients undergoing single level anterior cervical discectomy and fusion (ACDF). Methods: After obtaining Institutional Ethical Committee approval and informed consent, sixty patients scheduled for single level ACDF surgery performed in supine position under general anaesthesia were included. Group V (30 patients) received VCV and Group P (30 patients) received PCV. The primary objective was oxygenation variable PaO2/FiO2at different points of time i.e. T1–20 min after the institution of the ventilation, T2–20 min after placement of the retractors and T3–20 min after removal of the retractors. The secondary objectives include other arterial blood gas parameters, respiratory and haemodynamic parameters. NCSS version 9 statistical software was used for statistics. Two-way repeated measures for analysis of variance with post hoc Tukey Kramer test was used to analyse continuous variables for both intra- and inter-group comparisons, paired sample t-test for overall comparison and Chi-square test for categorical data. Results: The primary variable PaO2/FiO2was comparable in both groups (P = 0.08). The respiratory variables, PAP and Cdynamwere statistically significant in PCV group compared to VCV (P < 0.05), though clinically insignificant. Other secondary variables were comparable. (P > 0.05) Conclusion: Clinically, both PCV and VCV group appear to be-equally suited ventilator techniques for anterior cervical spine surgery patients.
  2,254 386 -
Perioperative sildenafil therapy for children with ventricular septal defects and associated pulmonary hypertension undergoing corrective surgery: A randomised clinical trial
Sidharth Bhasin, Pooja Gogia, Rajeev Nair, Tapan Kumar Sahoo
October 2017, 61(10):798-802
DOI:10.4103/ija.IJA_210_17  PMID:29242651
Background and Aims: Sildenafil is known to reduce pulmonary artery pressure but its role in the perioperative period has not been well studied. We aimed to evaluate the efficacy of sildenafil in controlling post-operative pulmonary hypertension in children with pulmonary hypertension undergoing surgeries for correction of ventricular septal defect. Methods: The patients were divided randomly into two groups of thirty each. Group 1 (placebo) received pre-operative placebo and post-operative sildenafil (0.5mg/kg every 6 hrs) while Group 2 (sildenafil) received pre- and post-operative sildenafil (0.5mg/kg every 6 hrs) Results: In the Group 1, systolic pulmonary artery pressure reduced from 81.63 (±12.1) mmHg preoperatively to 79.26 (±11.29) mmHg pre-cardiopulmonary bypass (CPB) and 56.76 (±11) mmHg (with 10 minutes post-CPB), whereas in Group 2, it reduced from 83.3 (±12.1) before surgery to 68.9 (±11.3) mmHg pre-CPB and after CPB, to 42.2 (±7.6) mmHg (P = 0.001). The mean pulmonary artery pressure decreased from 60.63 (±10.5) mmHg to 42.13 (±8.3) mmHg in the Group 1 whereas it reduced from 54.36 (±10) mmHg to 31.36 (±6.5) mmHg in Group 2 (P = 0.001). The reductions in pulmonary artery/aortic ratio and Intensive Care Unit stay were statistically significant No adverse effects were recorded. Conclusion: The use of perioperative sildenafil has a statistically significant reduction in the mean pulmonary artery pressure without any adverse effects.
  2,115 398 -
Quadratus lumborum block for post-operative pain relief in patient with Prune belly syndrome
Chitra Garg, Sangeeta Khanna, Yatin Mehta
October 2017, 61(10):840-842
DOI:10.4103/ija.IJA_246_17  PMID:29242658
Abdominal field blocks are commonly used as part of multimodal analgesia for post-operative pain relief in patients undergoing abdominal surgery. Conventionally, transversus abdominis plane block is used, but has the disadvantage of limited spread only to T10–T12 segments, providing only partial pain relief. The new quadratus lumborum (QL) block has the advantage of providing wider sensory block from T6 to L1 and thus has an evolving role in opioid-free anaesthesia. Opioid-induced cough depression, urinary retention, and drowsiness can be problematic in patients with Prune belly syndrome, who have deficient abdominal muscles and myriad of genitourinary problems. We report a case of a young male with Prune belly syndrome, who had a pain-free post-operative period after high inguinal orchidectomy with unilateral QL block.
  1,923 316 -
Single bolus dose of epidural magnesium prolongs the duration of analgesia in cardiac patients undergoing vascular surgeries
Amarja Sachin Nagre, Nagesh Jambure
October 2017, 61(10):832-836
DOI:10.4103/ija.IJA_396_16  PMID:29242656
Background and Aims: Magnesium, a physiological antagonist of calcium and N-methyl-d-aspartate, has a role in the prevention of pain in patients undergoing surgery for peripheral vascular diseases with cardiac comorbidities such as ischaemic heart disease and coronary artery disease. The objective of our study was assessment of effects of epidural magnesium in cardiac patients undergoing vascular surgery. Methods: Sixty patients of either sex American Society of Anesthesiologists physical status III undergoing surgeries for peripheral vascular diseases were enrolled. The control group had 30 patients who received levobupivacaine 0.25% 10 ml with fentanyl 50 μg while 30 patients in study group received levobupivacaine 0.25% 10 ml with fentanyl 50 μg and magnesium 100 mg. The primary outcome was duration of analgesia. Sedation score, pain assessment using visual analogue scale (VAS), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR) and fentanyl consumption were also recorded. Statistical analyses were performed using Minitab 15 statistical software. Results: Both groups were similar demographically and with respect to baseline HR, SBP, DBP and RR. In the study group, compared to the control group, duration of analgesia was 4.17 ± 1.07 h versus 1.55 ± 0.47 h (P < 0.01), sedation score were\ better (P = 0.003) and the VAS scores was lower (P < 0.01). sConclusion: Epidural magnesium, added to levobupivacaine and fentanyl as a single bolus dose effectively prolongs the duration of analgesia in high-risk cardiac patients undergoing peripheral vascular surgery.
  1,901 303 -
Pectoralis block for breast surgery: A surgical concern?
Sumitra G Bakshi, Nupur Karan, Vani Parmar
October 2017, 61(10):851-852
DOI:10.4103/ija.IJA_455_17  PMID:29242663
  1,860 342 -
Infusion dose requirement of rocuronium in patients on phenytoin therapy – A prospective comparative study
Veena Sheshadri, Arathi Radhakrishnan, Kusuma Halemani, Venkatesh H Keshavan
October 2017, 61(10):793-797
DOI:10.4103/ija.IJA_218_17  PMID:29242650
Background and Aims: Patients with intracranial tumour are usually on anticonvulsants. Patients on phenytoin therapy demonstrate rapid metabolism of nondepolarising muscle relaxants secondary to enzyme induction. Infusion dose requirement of rocuronium in such patients has been sparingly studied. We studied the continuous infusion dose requirement of rocuronium bromide in patients on phenytoin therapy and its correlation with serum levels of phenytoin. Methods: Seventy-five patients scheduled for supratentorial tumour surgery were included in the study. Patients not on phenytoin were taken as control. The primary outcome variable studied was the infusion dose requirement of rocuronium in patients on phenytoin. Based on pre-operative serum phenytoin levels, study group patients were divided into two groups: sub-therapeutic level group (phenytoin level <10 μg/mL) and therapeutic level group (phenytoin level >10 μg/mL). Following anaesthesia induction, rocuronium bromide 0.6 mg/kg was administered to achieve tracheal intubation. Rocuronium infusion was titrated to maintain zero response on the train-of-four response. Results: Demographic data were comparable. Patients receiving phenytoin required higher infusion dose compared to the control group (0.429 ± 0.2 mg/kg/h vs. 0.265 ± 0.15 mg/kg/h, P < 0.001). The serum phenytoin level had no correlation to infusion dose requirement of rocuronium (0.429 ± 0.205 mg/kg/h vs. 0.429 ± 0.265 mg/kg/h (P = 0.815). The recovery was faster in the phenytoin group compared to the control group. Haowever, it was not clinically significant. Conclusion: The infusion dose requirement of rocuronium bromide in patients on phenytoin is higher and the serum levels of phenytoin does not influence the dose required.
  1,691 326 -
Evaluation of the role of dexmedetomidine in improvement of the analgesic profile of thoracic paravertebral block in thoracic surgeries: A randomised prospective clinical trial
Mohamed Elsayed Hassan, Essam Mahran
October 2017, 61(10):826-831
DOI:10.4103/ija.IJA_221_17  PMID:29242655
Background and Aims: Thoracic paravertebral block (TPB) is one of the effective methods for management of post-operative pain in thoracic surgeries. The aim of the study was to evaluate effectiveness of addition of dexmedetomidine to paravertebral block with bupivacaine in improving the postoperative pain relief and pulmonary functions in patients undergoing thoracic surgeries. Methods: A prospective randomized double-blinded study was performed on forty patients scheduled for thoracic surgery. A paravertebral catheter was secured under ultrasound guidance preoperatively for all patients. Group B (n = 20) received a bolus dose of 0.25% bupivacaine at 0.3 mL/kg followed by continuous infusion of 0.125% bupivacaine 0.1 mL/kg/h. Group (BD) received a bolus dose of 0.25% bupivacaine + dexmedetomidine 1 μg/kg at 0.3 mL/kg followed by continuous infusion of dexmedetomidine 0.2 μg/kg/h + 0.125% bupivacaine 0.1 mL/kg/h. Anaesthesia technique was standardized for all patients. Postoperatively, all patients were assessed during first 24 hours for intraoperative fentanyl and post-operative morphine requirements, Visual Analogue Scores (VAS) scores at rest and during cough, and postoperative pulmonary functions. Results: Post-operative morphine consumption in the first 24 hours and intraoperative fentanyl requirement were significantly less in group BD (2.95 ± 1.986 mg, 80.75 ± 31.551μg respectively) compared to group B (9.85 ± 3.468 mg, 186 ± 39.683 μg respectively). Group BD showed less VAS scores during cough and better postoperative pulmonary functions (P < 0.05). Conclusion: Addition of dexmedetomidine to paravertebral bupivacaine in patients undergoing thoracic surgeries provides more effective analgesia with improvement in post-operative pulmonary functions.
  1,699 310 -
The baffling issues of Brugada electrocardiogram pattern for anaesthesiologist!
MC Rajesh, Sushma Kondi, EK Ramdas
October 2017, 61(10):857-859
DOI:10.4103/ija.IJA_459_17  PMID:29242667
  1,516 261 -
Changes in respiratory mechanics during extraperitoneal insufflation in inguinal hernia surgery
Bimla Sharma, Alok Kumar, Nitin Sethi, Jayashree Sood, Savitar Malhotra, Rathindra Sarangi
October 2017, 61(10):843-845
DOI:10.4103/ija.IJA_139_17  PMID:29242659
  1,423 255 -
Unfavourable outcome after uneventful anaesthesia and surgery in a child with Hurler syndrome
Renu Sinha, Kanil Ranjith Kumar, Rahul Kumar Anand, Bikash Ranjan Ray
October 2017, 61(10):853-855
DOI:10.4103/ija.IJA_392_17  PMID:29242665
  1,340 214 -
Newer design, newer problems: Unusual complication with Limb-O anaesthesia circuit
Chitra Rajeswari Thangaswamy, Patel Roushan, Lal Pooja, Guru Krishnakumar, Lenin Babu Elakkumanan
October 2017, 61(10):848-849
DOI:10.4103/ija.IJA_287_17  PMID:29242661
  1,324 218 -
Nil per oral instructions in chronic tobacco chewers: Are they enough?
Amit Rastogi, Supriya , Sandeep Sahu, Rudrashish Haldar
October 2017, 61(10):849-850
DOI:10.4103/ija.IJA_262_17  PMID:29242662
  1,188 218 -
Radiological images through an anaesthesiologists' looking glass: Airway management in cervical lipomatosis in an infant
Ketan Sakharam Kulkarni, Priyanka Pradeep Karnik, Nandini M Dave, Barkha Agrawal
October 2017, 61(10):846-847
DOI:10.4103/ija.IJA_678_16  PMID:29242660
  1,149 170 -
Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block
Saipriya Tewari, Sanjay Dhiraaj, Vertika Sachan, Tanvi Bhargava, Alka Verma
October 2017, 61(10):852-853
DOI:10.4103/ija.IJA_435_17  PMID:29242664
  1,079 186 -