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   2019| May  | Volume 63 | Issue 5  
    Online since May 13, 2019

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Chronic pain following thoracotomy for lung surgeries: It's risk factors, prevalence, and impact on quality of life - A retrospective study
Prachi Kar, K Durga Sudheshna, Durga Padmaja, Archana Pathy, Ramachandran Gopinath
May 2019, 63(5):368-374
DOI:10.4103/ija.IJA_42_19  PMID:31142880
Background and Aims: Chronic post thoracotomy pain (CPTP) is a nagging complication and can affect quality of life (QOL). Studies conducted across globe have found a wide variability in the risk factors predisposing to chronic pain following thoracotomy. As no study on CPTP is available from India, we aim to detect the prevalence of CPTP, assess the predisposing factors implicated in its causation and study the impact of CPTP on QOL. Methods: After obtaining clearance from Institutional ethics committee, medical records of patients who underwent open posterolateral thoracotomy between January 2012 and December 2015 were reviewed. Data on perioperative variables, address, and contact number were collected from the patient records. All patients were mailed the Telugu translation of medical outcome study short form -36(MOS-SF-36) QOL questionnaire and were contacted telephonically to enquire about presence of CPTP and QOL. A univariate analysis was done to assess factors associated with CPTP and a multivariate logistic regression analysis was done subsequently to identify independent risk factors of CPTP. QOL indices were compared between those patients who suffered from CPTP and those who did not. Results: The prevalence of pain in our study was 40.86% (85/208). The factors implicated in the causation of CPTP were diabetes mellitus, preoperative pain, rib resection, and duration of chest tube drainage with odds ratio of 9.8, 2.6, 6.7, and 1.03, respectively. The health-related QOL showed poor scores in all domains in patients suffering from CPTP. Conclusion: The prevalence of CPTP was high. It significantly impacts health-related QOL.
  3,741 286 -
How to design a questionnaire
Sandhya Yaddanapudi, LN Yaddanapudi
May 2019, 63(5):335-337
DOI:10.4103/ija.IJA_334_19  PMID:31142875
  3,223 772 -
Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block
Nibedita Pani, Sidharth S Routray, Soveena Pani, Soumyakanta Mallik, Santiswaroop Pattnaik, Amit Pradhan
May 2019, 63(5):382-387
DOI:10.4103/ija.IJA_65_19  PMID:31142882
Background and Aims: Shoulder arthroscopic surgeries can produce intense post-operative pain. Inter-scalene block (ISB) provides good analgesia after shoulder surgery, but concerns over its associated risks have prompted the search for alternatives. Shoulder block (SHB), which includes suprascapular block along with axillary nerve (AN) block, was recently proposed as an alternative to ISB, but evidence of its efficacy is conflicting. The aim of our study was to compare SHB with ISB in shoulder surgery for post-operative analgesia. Methods: A total of 76 patients scheduled for shoulder arthroscopic surgery were equally divided into 2 groups of 38 patients each: ISB group and SHB group. Both the nerve blocks were achieved by using ultrasound and a nerve stimulator. Visual analogue scale (VAS) scores were evaluated at 1, 4, 6, 12 and 24 h post-operatively. The time to first analgesia request, total analgesic requirement for 24 h post-operatively, patient satisfaction and any complications were recorded. Results: SHB provided equivalent analgesia to ISB in terms of post-operative VAS scores. Time to first analgesic request was 6.2 ± 1.3 h in ISB group and 5.9 ± 1.2 h in SHB group, which was not statistically significant. Complications like subjective dyspnoea and weakness of arm were significantly higher in ISB group compared to SHB group. Patient satisfaction scores were also significantly higher in SHB group compared to ISB group. Conclusion: SHB is as effective as ISB for post-operative pain relief and with fewer complications due to selective blockade of suprascapular and axillary nerves.
  3,230 551 -
Optimised reversal without train-of-four monitoring versus reversal using quantitative train-of-four monitoring: An equivalence study
Ardyan Wardhana, Juni Kurniawaty, Yusmein Uyun
May 2019, 63(5):361-367
DOI:10.4103/ija.IJA_94_19  PMID:31142879
Background and Aims: Less residual paralysis in recovery room was demonstrated when train-of-four (TOF) monitoring was applied. The aim of this study was to know whether optimisation of neostigmine reversal without TOF monitoring was equivalent to reversal using TOF monitoring. Methods: Seventy two patients, aged 18–60 years, undergoing elective surgery under general anaesthesia (sevoflurane and rocuronium) with intubation were randomised into two interventions: an optimised neostigmine reversal strategy without TOF monitoring (group A, n = 36) and a neostigmine reversal strategy using quantitative TOF monitoring (group B, n = 36). Per-protocol analysis was performed to compare incidence of residual paralysis in the recovery room between the two groups. Results: Six residual paralyses occurred in group A in the recovery room, whereas one case occurred in group B. The equivalence test showed that the 95% confidence interval of this study was outside the range of equivalence margin (15%). The absolute difference was 13.9%: standard error (SE) =0.068 (P = 0.107; 95% confidence interval (CI): 1%, 27.2%). No subjects had TOF ratio <0.70 in the recovery room. The TOF ratio in the recovery room did not differ between the two groups (mean difference: −2.58; P = 0.05; 95% CI: −5.20, 0.29). One respiratory adverse event occurred in this study. Conclusion: An optimised reversal strategy without TOF monitoring is not equivalent to a reversal strategy based on quantitative TOF monitoring. TOF monitoring should be used whenever applicable, although neostigmine is optimised.
  3,197 533 -
Comparison of ultrasound-guided transversus abdominis plane (TAP) block versus local infiltration during paediatric laparoscopic surgeries
Priyanka P Karnik, Nandini M Dave, Harick B Shah, Ketan Kulkarni
May 2019, 63(5):356-360
DOI:10.4103/ija.IJA_89_18  PMID:31142878
Background and Aims: The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries. Methods: After ethics committee approval and informed consent, 92 children aged 2–12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5–10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively. Results: The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0–2.5) vs 2 (3–4); P = 0.011], 30 min [1.5 (0–3) vs 3 (2–5);P < 0.001], 1 h [1.5 (0–2) vs 2 (2–3);P < 0.001] and 2 h [2 (0–2) vs 2 (1.5–2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group (P < 0.001). Conclusion: TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.
  2,788 539 -
Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review
SB Shah, U Hariharan, R Chawla
May 2019, 63(5):338-349
DOI:10.4103/0019-5049.258058  PMID:31142876
Integrating perioperative medicine with anaesthesia is the need of the hour. Evolution of a new superspeciality called perioperative anaesthesia can improve surgical outcomes by quality perioperative care and guarantee imminent escalation of influence and power for anaesthesiologists. All original peer-reviewed manuscripts pertaining to surgery-specific perioperative surgical home models involving preoperative, intraoperative and postoperative initiatives spanning the past 5 years have been reviewed using PubMed and Google Scholar. Whether the perioperative surgical home model is feasible or still a distant dream in the Indian perspective has been analysed.
  2,866 437 -
A prospective survey on knowledge, attitude and current practices of pre-operative fasting amongst anaesthesiologists: A nationwide survey
Pratibha Panjiar, Anjali Kochhar, Homay Vajifdar, Kharat Bhat
May 2019, 63(5):350-355
DOI:10.4103/ija.IJA_50_19  PMID:31142877
Background and Aims: Pre-operative fasting is a routine practice to minimise the risk of pulmonary aspiration. The leading societies of anaesthesia have adopted more liberal fasting guidelines to avoid the adverse effect of prolonged fasting. This survey was conducted to assess the knowledge, attitude and current practice of fasting guidelines among Indian anaesthesiologists and to analyse the reasons for non-compliance of these guidelines. Methods: A questionnaire consisted of 11 questions was distributed via 'Survey Monkey' software to 621 anaesthesiologists who attended the annual conference of the Indian Society of Anaesthesiologists held in Ludhiana, in 2016. American Society of Anaesthesiologists (ASA) practice guidelines for fasting were the standard of assessment. Results: The response rate to the survey was 52%. Of the respondents, 69% described correctly the practice guidelines to pre-operative fasting. Only seven percent respondents were aware of the benefits of liberalised fasting. More than 2/3rd of the respondents advised fasting as per ASA guidelines during pre-anaesthetic check-up (PAC). However, only about 50% respondents confirmed that these guidelines are actually followed in their institution. Not having control on scheduling of cases in operation theatre and poor knowledge of ward nurses and surgeons were the common reasons for non-compliance of these guidelines. Twenty four percent respondents did not use routinely any drug for aspiration prophylaxis. Conclusion: Majority of the respondents were aware of the ASA fasting guidelines. However, the implementation of the guidelines and knowledge regarding benefits of liberalised fasting is poor among respondents.
  2,705 524 -
Development and validation of a questionnaire for a survey on perioperative fasting practices in India
Pradeep A Dongare, S Bala Bhaskar, SS Harsoor, M Kalaivani, Rakesh Garg, K Sudheesh, Umesh Goneppanavar
May 2019, 63(5):394-399
DOI:10.4103/ija.IJA_118_19  PMID:31142884
Background and Aims: Perioperative fasting guidelines have been published and updated to standardise practices. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. We detail and discuss herewith the content validity of the questionnaire developed for the survey. Methods: Thirty-six questions related to perioperative fasting practices were framed based on the collected evidence and relevance to regional diet and concerns. Subsequently, an information sheet was prepared and sent to 10 experts to grade each question. The responses were tabulated, and item-wise content validity index (I-CVI), scale-wise content validity index (S-CVI) and modified kappa statistic were calculated in Microsoft Excel sheet. Results: Seven of the 10 experts completed the assessment and grading as per the instructions provided and submitted a completed proforma. S-CVI for relevance, simplicity, clarity and ambiguity was 0.72, 0.86, 0.72 and 0.72, respectively. S-CVI/average or average congruency percentagewas 0.95, 0.97, 0.95 and 0.95 for relevance, simplicity, clarity and ambiguity, respectively. Question 2 received an I-CVI of 0.71 in terms of clarity and question 23 received an I-CVI of 0.71. They were modified as persuggestions of the experts. Conclusion: We conclude that our questionnaire designed to ascertain the preoperative fasting practices for a surveymet the content validity criteria both by qualitative and quantitative analyses.
  2,329 305 -
Hemi-diaphragmatic paresis following extrafascial versus conventional intrafascial approach for interscalene brachial plexus block: A double-blind randomised, controlled trial
Basavaraja Ayyanagouda, Vinod Hosalli, Prableen Kaur, Uday Ambi, SY Hulkund
May 2019, 63(5):375-381
DOI:10.4103/ija.IJA_69_19  PMID:31142881
Background and Aims: Hemidiaphragmatic paresis occurs in almost all patients undergoing interscalene block for proximal upper limb surgeries. This study tested hypothesis that ultrasound-guided extrafascial approach of interscalene block under nerve stimulator guidance reduces incidence of hemidiaphragmatic paresis in comparison to intrafascial approach by achieving same degree of anaesthesia and analgesia. Methods: Sixty patients undergoing proximal upper limb surgeries were randomised to receive an ultrasound-guided interscalene brachial plexus block (ISB) with the aid of nerve stimulator for surgical anaesthesia and analgesia using 20 mL 0.5% ropivacaine by extrafascial (Group E) or intrafascial (Group I) approach. The incidence of hemidiaphragmatic paresis was measured by M-mode ultrasound before and 30 min after the procedure. Secondary outcomes such as respiratory functions (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate) were measured, and complications were recorded and compared. The statistics was obtained using SPSS Version 19. Levene's test and paired and unpaired t-test were used. P value <0.05 was considered significant. Results: The incidence of hemidiaphragmatic paresis was 17% and 46% in Group E and Group I, respectively (P < 0.0001). All other respiratory outcomes were preserved in Group E compared with Group I. Conclusion: Ultrasound-guided ISB with the aid of nerve stimulator through extrafascial approach reduces the incidence of hemidiaphragmatic paresis and also reduces respiratory function impairment when compared with intrafascial approach.
  2,046 357 -
Maffucci syndrome and anaesthesia: Case report
B Naveen Naik, John Sujith, Kamal Kajal
May 2019, 63(5):400-402
DOI:10.4103/ija.IJA_779_18  PMID:31142885
Maffucci syndrome is an extremely rare, sporadic, and nonhereditary disease characterized by enchondromatosis, bony abnormalities, and vascular malformations. We report a successful anaesthetic management of an adult patient with Maffucci syndrome scheduled for surgical excision of parathyroid adenoma, who had numerous enchondromas, haemangiomas, and skeletal deformities involving different parts of the body and posing significant challenge during positioning, securing intravenous access, and insertion of endotracheal tube. Awareness about this syndrome is of paramount importance because similar patients may be encountered with increasing frequency for incidental or corrective surgeries.
  1,929 291 -
A curious case of intravenous cannula
Prateek , Pranav Bansal, Pranshi Jain, Himani Tak
May 2019, 63(5):416-417
DOI:10.4103/ija.IJA_837_18  PMID:31142892
  1,856 306 -
Effect of immobilised cervical spine on oropharyngeal sealing pressure with Ambu AuraGain™ Supraglottic airway: A randomised crossover trial
Duraiyarassu Uthaman, Suman Lata Gupta, Sandeep Kumar Mishra, Satyen Parida, Prasanna Udupi Bidkar, Muthupillai Senthilnathan
May 2019, 63(5):388-393
DOI:10.4103/ija.IJA_787_18  PMID:31142883
Background and Aims: Ambu® AuraGain™ laryngeal airway (AuraGain) is one of the newer supraglottic airway device introduced in 2014. Cervical spine stabilisation with hard cervical collar makes insertion of supraglottic airways and tracheal intubation difficult. This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure (OSP) and fibreoptic view of the glottis (Brimacombe score) in airways secured with the AuraGain. Methods: The study was a randomised crossover trial. Thirty five ASA 1-3 patients undergoing elective surgery under general anaesthesia were recruited for the study. In each patient AuraGain was inserted twice in a crossover manner once with and once without a hard cervical collar in situ, with the sequence of insertion randomised. During each insertion of AuraGain the OSP, fibreoptic view of the glottis, insertion parameters, ventilator data and complications were noted. Results: The mean OSPs in both the groups were similar with no significant difference (29.6 ± 3.7 cmH2O without collar and 30.1 ± 3.1 cmH2O with collar [P = 0.310]). The fibreoptic view of glottis was also similar in both groups. The insertion with collar was more difficult than without collar. The number of attempts for successful insertion was same in both the groups. The time taken for appropriate placement of LMA was significantly prolonged in patients with collar. Conclusions: We conclude that the Ambu AuraGain can be used to provide effective ventilation in patients whose cervical spine is immobilised with a hard cervical collar.
  1,565 223 -
Opioid-free anaesthesia in children with severe mandibular hypoplasia and TMJ ankylosis with sleep apnoea for mandibular distraction osteogenesis
Anju R Bhalotra, Rohit Balyan, Gunjan Manchanda, Shefali Singh
May 2019, 63(5):412-414
DOI:10.4103/ija.IJA_698_18  PMID:31142890
  1,371 244 -
Bilateral diaphragmatic palsy in a parturient for emergency Caesarean delivery – What are our concerns?
Ramya Ravi, Srinivasan Swaminathan, Muthapillai Senthilnathan, Varun Prasad Rajendran
May 2019, 63(5):417-418
DOI:10.4103/ija.IJA_840_18  PMID:31142893
  1,402 184 -
Airway management in a patient of Crouzon syndrome for maxillo-facial reconstructive surgery: Role of point-of-care ultrasonography
Debendra K Tripathy, Mridul Dhar, G Hari Haran, Udit Chauhan
May 2019, 63(5):409-410
DOI:10.4103/ija.IJA_864_18  PMID:31142888
  1,374 210 -
Inadvertent intravenous transverse abdominis plane block (TAP) bolus dose-case report and anatomy of epigastric vessels in relation to TAP block
Vasanth Rao Kadam, Rana Abdullah
May 2019, 63(5):406-408
DOI:10.4103/ija.IJA_146_19  PMID:31142887
  1,376 188 -
Asymptomatic tension pneumothorax in a child
Neeraj Kumar, Abhyuday Kumar, Amarjeet Kumar, Amit Kumar Sinha, Sanjeev Kumar
May 2019, 63(5):411-412
DOI:10.4103/ija.IJA_881_18  PMID:31142889
  1,371 182 -
WEI nasal jet tube during monitored anaesthesia care for removal of oesophageal foreign body for a patient with fragile cardiopulmonary function
Yuantao Hou, Hansheng Liang, Huafeng Wei, Yi Feng
May 2019, 63(5):403-405
DOI:10.4103/ija.IJA_880_18  PMID:31142886
This manuscript reports a case of foreign body removal surgery and anaesthesia of an elderly patient with a challenging airway and fragile cardiopulmonary function. WEI Nasal Jet Tube (WNJ) was used to sustain sufficient oxygenation without interfering with the gastroscopy operation. Because the device could be well tolerated by the patient, it was beneficial to maintain circulation stability as well. This case was a considerable anaesthetic challenge, as the anaesthesia depth for the patient was difficult to manage.
  1,320 195 -
Pressure infusion bag----“One size fits all” positioning tool for central venous access and brachial plexus blocks: A novel yet effective technique
Bhavna Hooda, Shalendra Singh, S Kiran, Deepak Dwivedi
May 2019, 63(5):414-415
DOI:10.4103/ija.IJA_802_18  PMID:31142891
  1,305 179 -
Looped suction catheter in an i-gel™; something to worry about or much ado about nothing?
B Naveen Naik, Venkata Ganesh, Vikas Saini, Tanvir Samra
May 2019, 63(5):420-421
DOI:10.4103/ija.IJA_804_18  PMID:31142895
  1,244 165 -
Airway management of hypopharyngeal stricture: An out of the box method
Amit Goyal, Anand Sharma, Kumari Pallavi
May 2019, 63(5):419-420
DOI:10.4103/ija.IJA_844_18  PMID:31142894
  1,109 172 -