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  Citation statistics : Table of Contents
   2013| October-December  | Volume 29 | Issue 4  
    Online since October 1, 2013

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Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy
Vasanth Rao Kadam
October-December 2013, 29(4):550-552
DOI:10.4103/0970-9185.119148  PMID:24249997
The quadratus lumborum (QL) block as a postoperative analgesic method following abdominal surgery has been described by Blanco for superficial surgeries but not used for major laparotomy. This ipsilateral QL block had low pain scores and opioid use on day one with sensory block upto T8-L1. The options of various volume used and pros and cons are discussed.
  59 13,413 2,400
A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study
Vidhi Mahendru, Anurag Tewari, Sunil Katyal, Anju Grewal, M Rupinder Singh, Roohi Katyal
October-December 2013, 29(4):496-502
DOI:10.4103/0970-9185.119151  PMID:24249987
Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is a new neuraxial adjuvant gaining popularity. Aim: The purpose of this study was to compare the onset, duration of sensory and motor block, hemodynamic effects, postoperative analgesia, and adverse effects of dexmedetomidine, clonidine, and fentanyl used intrathecally with hyperbaric 0.5% bupivacaine for spinal anesthesia. Settings and Design: The study was conducted in prospective, double blind manner. It included 120 American Society of Anesthesiology (ASA) class I and II patients undergoing lower limb surgery under spinal anesthesia after approval from hospital ethics committee with written and informed consent of patients. Materials and Methods: The patients were randomly allocated into four groups (30 patients each). Group BS received 12.5 mg hyperbaric bupivacaine with normal saline, group BF received 12.5 mg bupivacaine with 25 g fentanyl, group BC received 12.5 mg of bupivacaine supplemented 30 g clonidine, and group BD received 12.5 mg bupivacaine plus 5 g dexmedetomidine. The onset time to reach peak sensory and motor level, the regression time of sensory and motor block, hemodynamic changes, and side effects were recorded. Results: Patients in Group BD had significantly longer sensory and motor block times than patients in Groups BC, BF, and BS with Groups BC and BF having comparable duration of sensory and motor block. The mean time of two segment sensory block regression was 147 ± 21 min in Group BD, 117 ± 22 in Group BC, 119 ± 23 in Group BF, and 102 ± 17 in Group BS (P < 0.0001). The regression time of motor block to reach modified Bromage zero (0) was 275 ± 25, 199 ± 26, 196 ± 27, 161 ± 20 in Group BD, BC, BF, and BS, respectively (P < 0.0001). The onset times to reach T8 dermatome and modified Bromage 3 motor block were not significantly different between the groups. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic. Conclusions: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand of rescue analgesics in 24 h as compared to clonidine, fentanyl, or lone bupivacaine.
  36 40,255 3,044
Clinical profile of levobupivacaine in regional anesthesia: A systematic review
Sukhminder Jit Singh Bajwa, Jasleen Kaur
October-December 2013, 29(4):530-539
DOI:10.4103/0970-9185.119172  PMID:24249993
The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (−)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence.
  31 21,695 3,563
Brachial plexus block: Comparison of two different doses of clonidine added to bupivacaine
Santvana Kohli, Manpreet Kaur, Sangeeta Sahoo, Homay Vajifdar, Pramod Kohli
October-December 2013, 29(4):491-495
DOI:10.4103/0970-9185.119147  PMID:24249986
Background: The role of clonidine as an adjuvant to local anesthetic agents in brachial plexus block (BPB) has been extensively studied. However, till date there has been no consensus about the ideal dose of clonidine for this purpose. This study was carried out to evaluate two doses of clonidine-1 and 2 g/kg, added to 0.5% bupivacaine, with regard to onset and duration of sensorimotor blockade, hemodynamic effects, postoperative analgesia, and adverse effects. Materials and Methods: Sixty adult patients undergoing upper limb surgeries were randomly allocated into two groups. Thirty patients received 1 g/kg clonidine (group I) and the rest received 2 g/kg clonidine (group II) added to 30 mL of 0.5% bupivacaine through nerve stimulator-guided supraclavicular BPB. The onset and duration of sensorimotor blockade, hemodynamic variables, duration of analgesia, level of sedation, and adverse effects was assessed. Results: The onset of sensorimotor block was earlier in group II (9.9 ± 4.1 min for sensory block and 13.2 ± 6.7 min for motor block) than in group I (15.9 ± 6.8 min for sensory block and 18.5 ± 7.8 min for motor block). The duration of analgesia was also prolonged in patients receiving the higher dose (21.0 ± 2.96 h vs. 14.9 ± 3.0 h). Although hemodynamics remained comparable in both the groups, incidence of hypotension and bradycardia was higher in group II as compared to group I. The sedation was clinically and statistically more in group II patients (43% vs. 17%). Conclusion: Higher dose of clonidine in BPB hastens the onset, prolongs the duration of sensorimotor blockade and postoperative analgesia without significant hemodynamic alterations. It also causes more sedation, which although ensures patient comfort in most cases, but might be undesirable in certain situations.
  17 4,990 737
Preemptive analgesia with ketamine for laparoscopic cholecystectomy
Harsimran Singh, Sandeep Kundra, Rupinder M Singh, Anju Grewal, Tej K Kaul, Dinesh Sood
October-December 2013, 29(4):478-484
DOI:10.4103/0970-9185.119141  PMID:24249984
Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.
  16 5,654 1,170
Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital
Aliya Ahmed, Naveed Latif, Robyna Khan
October-December 2013, 29(4):472-477
DOI:10.4103/0970-9185.119137  PMID:24249983
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries were included. Post-operative analgesic strategy, co-analgesics used, pain and sedation scores, motor block, nausea and vomiting were recorded and patient satisfaction was determined. Results: Data was collected on 100 patients. Epidural analgesia was used in 61, patient controlled intravenous analgesia (PCIA) in 25 and opioid infusion in 14 patients. Multimodal analgesia was employed in 98 patients. The level of epidural was between L1-L3 in 31, T10-L1 in 20 and T8-T10 in 10 patients. Pethidine was used in 80% of patients receiving PCIA. Patients with epidurals at T8-T10 had lower pain scores. Fifteen patients had motor block, 73% of which were with epidural at L1-L3. Fourteen patients complained of nausea. Ninety nine out of 100 patients were satisfied with their analgesia. Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS) and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
  14 6,654 1,071
Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy
Pankaj Kundra, Ramesh Varadharajan, Kotteeswaran Yuvaraj, Stalin Vinayagam
October-December 2013, 29(4):459-464
DOI:10.4103/0970-9185.119133  PMID:24249981
Background: Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy. Materials and Methods: A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge. Results: Lung functions decreased on 1 st post-operative day and returned to baseline value by 4 th post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group. Conclusion: To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.
  13 8,130 1,052
Pre-operative pain sensitivity: A prediction of post-operative outcome in the obstetric population
Luana Mifsud Buhagiar, Olivia A Cassar, Mark P Brincat, George G Buttigieg, Anthony Serracino Inglott, Maurice Zarb Adami, Lilian M Azzopardi
October-December 2013, 29(4):465-471
DOI:10.4103/0970-9185.119135  PMID:24249982
Context: Experimental assessments can determine pain threshold and tolerance, which mirror sensitivity to pain. This, in turn, influences the post-operative experience. Aims: The study intended to evaluate whether the pre-operative pressure and electrical pain tests can predict pain and opioid requirement following cesarean delivery. Settings and Design: Research was conducted on females scheduled for cesarean section at a tertiary care hospital of the state. Twenty women were enrolled, after obtaining written informed consent. Materials and Methods: Pain assessment was performed on the eve of cesarean sections using three devices: PainMatcher; determined electrical pain threshold while the algometers PainTest FPN100 (manual) and PainTest FPX 25 (digital) evaluated pressure pain threshold and tolerance. Post-operative pain relief included intravenous morphine administered by patient-controlled analgesia, diclofenac (100 mg, every 12 h, rectally, enforced) and paracetamol (1000 mg, every 4-6 h, orally, on patient request). Pain scores were reported on numerical rating scales at specified time intervals. Statistical Analysis Used: Correlational and regression statistics were computed using IBM SPSS Statistics 21 software (IBM Corporation, USA). Results: A significant correlation was observed between morphine requirement and: (1) electrical pain threshold (r = -0.45, P = 0.025), (2) pressure pain threshold (r = -0.41 P = 0.036) and (3) pressure pain tolerance (r = -0.44, P = 0.026) measured by the digital algometer. The parsimonious regression model for morphine requirement consisted of electrical pain threshold (r2 = 0.20, P = 0.049). The dose of morphine consumed within 48 h of surgery decreases by 0.9 mg for every unit increment in electrical pain threshold. Conclusions: The predictive power of pain sensitivity assessments, particularly electrical pain threshold, may portend post-cesarean outcomes, including opioid requirements.
  13 3,792 546
Regional anesthesia in patients with pregnancy induced hypertension
Saravanan P Ankichetty, Ki Jinn Chin, Vincent W Chan, Raj Sahajanandan, Hungling Tan, Anju Grewal, Anahi Perlas
October-December 2013, 29(4):435-444
DOI:10.4103/0970-9185.119108  PMID:24249977
Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.
  11 13,936 2,960
Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty
Gabriela R Lauretti, Claudia C F Righeti, Anita L Mattos
October-December 2013, 29(4):503-508
DOI:10.4103/0970-9185.119155  PMID:24249988
Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT) ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml). The control group (CG) received saline as IT test drug. The morphine group (MG) received IT 200 g morphine, the ketorolac group (KG) IT 2 mg ketorolac and the morphine-ketorolac group (MKG) 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P < 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively). Both groups were longer when compared to the CG (170 ± 13 min) (P < 0.01). The MG and KG had lesser ketoprofen consumption compared to the CG (P < 0.05). The time to first rescue analgesic was longer to the MKG (926 ± 222 min) (15 h) compared to CG (P < 0.001) and to the MG and the KG (P < 0.01). MKG displayed lesser ketoprofen consumption compared to MG and KG (P < 0.05) and to the CG (P < 0.02). Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.
  10 2,706 545
Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient
Lipi Mishra, Nibedita Pani, Debasis Mishra, Nupur Patel
October-December 2013, 29(4):540-542
DOI:10.4103/0970-9185.119140  PMID:24249994
Although transversus abdominis plane (TAP) block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was used as a sole anesthetic technique. TAP block can be considered as an anesthetic technique for abdominal surgery in moribund patients.
  6 4,792 630
Intrathecal sufentanil or fentanyl as adjuvants to low dose bupivacaine in endoscopic urological procedures
Shikha Gupta, Supriya Sampley, Suneet Kathuria, Sunil Katyal
October-December 2013, 29(4):509-515
DOI:10.4103/0970-9185.119158  PMID:24249989
Context: Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia. Aim: The aim of this study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures. Settings and Design: Prospective, randomized, double-blind study. Materials and Methods: A total of 90 elective endoscopic urological surgery patients, 40-80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 g (Group B) or fentanyl 25 g (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia. Statistical analysis used: Analysis of variance and Chi-square test. Results: The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post-operative analgesic was significantly delayed in Group B patients. Conclusions: Spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.
  4 4,190 610
Comparison between lornoxicam quick-release and parecoxib for post-operative analgesia after laparoscopic cholecystectomy: A prospective randomized, placebo-controlled trial
Irene Kouroukli, Vasilios Zompolas, Vasiliki Tsekoura, Ioannis Papazoglou, Antonis Louizos, Venetiana Panaretou
October-December 2013, 29(4):485-490
DOI:10.4103/0970-9185.119144  PMID:24249985
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are valuable for post-operative pain as they reduce the use of opioids. Cyclooxygenase-2 inhibitors and traditional NSAIDs can be used. This is a prospective, randomized, placebo-controlled trial to study the efficacy and the safety of the oral administration of lornoxicam quick release tablets versus intravenously administered parecoxib for the management of pain after laparoscopic cholecystectomy (LC). Materials and Methods: One hundred and eight patients, American Society of Anesthesiologists I-II, were randomized to either group A (n = 36): Lornoxicam quick-release 8 mg PO, group B (n = 36): Parecoxib 40 mg intravenous (IV) or group C (n = 36) placebo, for post-operative analgesia, 30 min before the operation and 12 and 24 h post-operatively. All patients received a standard dose of meperidine 1 mg/kg intramuscularly before the incision and post-operatively as rescue analgesia, when visual analog scale (VAS) pain score was >4. Pain at rest and on movement was assessed at 20 min, 3, 6, 12, 18 and 24 h post-operatively. Total meperidine administration and adverse events were also recorded. Results: There were significantly lower VAS pain scores at 20 min, 3, 6, 12 and 18 h at rest or with movement in the lornoxicam quick release and parecoxib groups compared with the placebo group. The number of patients requiring rescue analgesia (meperidine) was significantly higher in the placebo group (P = 0.001). The average dose of meperidine administered was significantly higher in the placebo group, both at 20 min (P = 0.013/0.007) and 24 h (P = 0.037/0.023) post-operatively. VAS scores and meperidine requirements were similar in patients who received lornoxicam or parecoxib. Conclusions: Parecoxib 40 mg IV and lornoxicam quick-release 8 mg PO every 12 h are equivalent adjuvant analgesics with a greater efficacy than placebo for post-operative analgesia in patients undergoing LC.
  4 2,819 471
Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery
Rakhee Goyal, Shivinder Singh, Ashfak Bangi, Satyen Kumar Singh
October-December 2013, 29(4):543-546
DOI:10.4103/0970-9185.119142  PMID:24249995
The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger's syndrome, 2-Tetralogy of Fallot). The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation.This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.
  3 4,010 1,029
Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy
Ferhan Khan, Sampathila Padmanabha, Manjula Shantaram, M Aravind
October-December 2013, 29(4):578-579
DOI:10.4103/0970-9185.119171  PMID:24250015
  3 2,181 370
Efficacy of tramadol in preventing postoperative shivering using thiopentone or propofol as induction agent: A randomized controlled trial
Beena Yousuf, Khalid Samad, Hameed Ullah, Muhammad Q Hoda
October-December 2013, 29(4):521-525
DOI:10.4103/0970-9185.119166  PMID:24249991
Background: Postoperative shivering (POS) is a common and distressing experience occurring in up to 60% patients postoperatively. This study was designed to compare the efficacy of tramadol in preventing POS when used with two different induction agent, propofol or thiopentone. Materials and Methods: One hundred and twenty-four ASA I and II adult patients, aged between 18-60 years, undergoing general anesthesia of intermediate duration (60-240 min) for orthopedic, gynecological, and general surgical procedures were randomly divided to receive either thiopentone or propofol as induction agent. Each group was further subdivided (31 patients in each group) to receive either tramadol or saline 15 min before wound closure. Presence of POS after extubation till discharge from post anesthesia care unit (PACU) was recorded at six different time intervals. Results: The highest incidence of POS was observed in thiopentone-saline (TS) group 77.4%, while the lowest (12.9%) was in propofol-tramadol (PT) group (P < 0.001). Total number of shivering episodes was 122 out of which, 35 (28.7%) were of grade 2 and 3 (significant shivering) requiring treatment. The incidence of significant shivering was similar to the episodes of POS, highest in TS group and lowest being in PT group (P < 0.05). Conclusion: The prophylactic use of tramadol in a dose of 1 mg/kg with propofol as an induction agent significantly reduces the incidence of POS in patients recovering from general anesthesia of intermediate duration.
  3 4,931 667
Spontaneous central vein thrombosis in a patient with activated protein C resistance and dengue infection: An association or causation?
Tanmoy Ghatak, Ratender K Singh, Arvind K Baronia
October-December 2013, 29(4):547-549
DOI:10.4103/0970-9185.119145  PMID:24249996
Spontaneous central vein thrombosis is a rare and potentially fatal condition in critical care setting. Activated protein C resistance due to homozygous factor V Leiden mutation is an exceptional cause of central venous thrombosis. We recently treated a healthy female student who presented with acute febrile illness, septic shock, and encephalopathy. Neck ultrasonography (USG) prior to an attempt of right internal jugular vein (IJV) cannulation revealed non compressibility of the vein along with absence of venous blood flow. Right IJV and subclavian vein thrombus was confirmed subsequently in USG Doppler by radiologist. Radiological evidence of distal pulmonary artery embolism in pulmonary angiography was also evident. Further investigations demonstrated homozygous Factor V Leiden mutation and activated factor C resistance and Dengue IgM positivity in our patient. Intravenous heparin followed by oral vitamin K anticoagulants (OVKA) aided in her recovery. Spontaneous intravascular thrombosis with activated protein C resistance and the relationship of acute Dengue infection were explored in our report.
  2 2,313 341
Anesthetic management of a case of GAPO syndrome for craniosynostosis surgery
Vivek Bharati Sharma, Mihir Prakash Pandia, Parameswar Pankaj Kumar Raut
October-December 2013, 29(4):580-581
DOI:10.4103/0970-9185.119174  PMID:24250016
  2 1,625 272
Use of transversus abdominis plane block as an anesthetic technique in a high risk patient for abdominal wall surgery
Samina Ismail, Muhammad Rizwan Khan, Sana Urooj
October-December 2013, 29(4):581-582
DOI:10.4103/0970-9185.119176  PMID:24250017
  2 2,118 322
Ivabradine in sepsis
Abhijit S Nair, T V S Gopal
October-December 2013, 29(4):570-571
DOI:10.4103/0970-9185.119154  PMID:24250010
  2 2,615 506
Post-operative severe hypokalemia mimicking myocardial ischemia
Preet Mohinder Singh, Lokesh Kashyap
October-December 2013, 29(4):567-568
DOI:10.4103/0970-9185.119146  PMID:24250008
  2 1,653 245
Measurement of consumption of sevoflurane for short pediatric anesthetic procedures: Comparison between dion's method and dragger algorithm
Preet Mohinder Singh, Anjan Trikha, Renu Sinha, Anuradha Borle
October-December 2013, 29(4):516-520
DOI:10.4103/0970-9185.119160  PMID:24249990
Background: The most common drugs used in an operating room are the "Inhalation agents" for maintenance of anesthesia yet their measurement methods during the procedure are not well-validated. Conventional methods of measuring the vaporizer weight after each use suffers from practical limitations of high error and time constraints. Aims: We compared two alternative methods available (Dion's method and Drager Inc. patent protocol) for their degree of concordance and correlation in real-time consumption of sevoflurane for pediatric procedures. Methodology: One hundred pediatric patients scheduled for ophthalmological examination under anesthesia were included in the study. Anesthesia was induced and maintained using sevoflurane with oxygen and nitrous oxide (1:1) on Primus workstation (Drager Inc., Germany). Total sevoflurane consumed for each procedure was calculated using Dion's equation and the values obtained from Drager Primus were noted and compared. Results: Both methods showed a very strong correlation (0.895 [P < 0.001]). Dion's method underestimated consumption by 2.59 ml with limits of agreement between 5.188 ml and −0.008 ml. Both test results showed a strong correlation, but poor concordance. Conclusions: Dion's method strongly correlates with Drager protocol although concordance between the two methods for measuring anesthetic gas consumption is poor. Dion's method underestimates the consumption and with slight modification addressing this underestimation, it can be electronically incorporated in other workstations to overcome limitations of real-time measurement of inhalation agent consumption.
  2 3,539 485
Pseudothrombocytopenia in perioperative patient: A significant laboratory artifact
Subramanian Senthilkumaran, Ritesh G Menezes, Narendra Nath Jena, Ponniah Thirumalaikolundusubramanian
October-December 2013, 29(4):553-554
DOI:10.4103/0970-9185.119152  PMID:24249998
Pseudothrombocytopenia secondary to ethylenediaminetetra-acetic acid induced platelet aggregation observed in a healthy perioperative male patient is reported in order to create awareness among anesthesiologist and laboratory personnel. The mechanisms for such changes have been highlighted.
  1 2,458 332
Predicting post - operative pain: Still a long way to go!
Anjan Trikha, Preet Mohinder Singh
October-December 2013, 29(4):433-434
DOI:10.4103/0970-9185.119105  PMID:24249976
  1 2,267 1,733
Airway management plan in patients with difficult airways having regional anesthesia
Neeraj Saxena
October-December 2013, 29(4):558-560
DOI:10.4103/0970-9185.119106  PMID:24250001
  1 1,517 378
A useful mnemonic for pre-anesthetic assessment
VR Hemanth Kumar, Ashish Saraogi, S Parthasarathy, M Ravishankar
October-December 2013, 29(4):560-561
DOI:10.4103/0970-9185.119127  PMID:24250002
  1 15,170 1,607
Waxing and waning tracheal tube obstruction: A diagnostic dilemma!
Ajay Kumar, Parul Mullick
October-December 2013, 29(4):562-563
DOI:10.4103/0970-9185.119132  PMID:24250004
  1 1,505 249
Difficult tracheostomy in a case of difficult mask ventilation and difficult intubation?
Mritunjay Kumar, Abhishek Khanna, Shalini Verma, Amit Jha, Shiba Aggarwal
October-December 2013, 29(4):576-577
DOI:10.4103/0970-9185.119168  PMID:24250014
  1 1,756 315
Radiographic evidence of unilateral epidural anesthesia
Uma Srivastava, Sathiyanarayanan Pilendran, Yogita Dwivedi, Vinay Shukla
October-December 2013, 29(4):571-572
DOI:10.4103/0970-9185.119159  PMID:24250011
  1 1,569 291
Post-operative refractory hypotension due to right heart compression by hepatic cysts in a patient with autosomal dominant polycystic kidney disease
Tanmoy Ghatak, Afzal Azim, Arun Sharma, Samir Mahindra
October-December 2013, 29(4):572-574
DOI:10.4103/0970-9185.119163  PMID:24250012
  1 1,614 244
Perioperative management of a patient with hemophilia A and crigler-najjar syndrome
Debesh Bhoi, Lokesh Kashyap
October-December 2013, 29(4):582-584
DOI:10.4103/0970-9185.119177  PMID:24250018
  1 2,908 385
Caffeine for the prevention of postoperative nausea and vomiting
Richard A Steinbrook, Frances Garfield, Stacey H Batista, Richard D Urman
October-December 2013, 29(4):526-529
DOI:10.4103/0970-9185.119170  PMID:24249992
Context: Postoperative nausea and vomiting (PONV) is common after ambulatory surgery performed under general anesthesia. Anecdotal evidence suggests that caffeine may be useful in preventing PONV. Aims: The aim of the study was to determine efficacy of intravenous (IV) caffeine given prior to surgery is effective prophylaxis against PONV. Settings and Design: We conducted a prospective, randomized, double-blind, placebo-controlled study. Subject and Methods: Patients at moderate or high risk of PONV were randomized to receive IV caffeine (500 mg) or saline placebo during general anesthesia; all patients received dexamethasone and dolasetron. Statistical analysis: Statistical comparisons were tested using bivariable linear and logistic regression for each outcome and then adjusted for high/low risk. Results: Nausea in the postanesthesia care unit (PACU) was more common in the caffeine (16 of 62 patients) than the placebo group (seven of 69; P = 0.02). There were no significant differences in the use of rescue antiemetics in the PACU, in the incidence of nausea or vomiting over 24 h postoperatively, nor in other outcomes (headache, fatigue, or overall satisfaction) either in the PACU or at 24 h; time-to-discharge was similar for both groups. Conclusion: Caffeine was not effective in the prevention of PONV or headache, and did not improve time-to-discharge or patient satisfaction.
  1 3,026 533
Anesthesia for a patient of acromesomelic dysplasia with associated hydrocephalus, Arnold Chiari malformation and syringomyelia
Rudrashish Haldar, Prakhar Gyanesh, Sukhen Samanta
October-December 2013, 29(4):555-557
DOI:10.4103/0970-9185.119153  PMID:24249999
Acromesomelic dysplasias are autosomal recessive osteochondrodysplasias. Acromesomelic dysplasia Maroteaux-type (AMDM), also known as St Helena dysplasia, is of two types: The classical and the mild variety. About 50 cases of AMDM have been reported till date, most of them being the classical variety. There is scarcity of literature on anesthesia for such patients. We are reporting a case of general anesthetic management of AMDM, associated with hydrocephalus, Arnold Chiari malformation type-1 and syringomyelia. The patient was a 10-year-old short-statured boy who presented with symptomatic thoracic kyphoscoliosis, gibbus deformity and back pain. On examination, there was no neurological deficit. Radiology revealed thoracic kyphoscoliosis, mild ventriculomegaly and upper cervical syringomyelia. The patient underwent posterior fossa decompression in the prone position under general anesthesia. We will discuss the anesthetic considerations for such patients and review the pertinent literature.
  - 3,137 407
Perioperative care in perforation peritonitis: Where do we stand?
Rakesh Garg
October-December 2013, 29(4):454-456
  - 4,336 758
Clinical perspective on statistical equivalence
Basavana G Goudra, Preet Mohinder Singh
October-December 2013, 29(4):457-458
  - 1,820 271
If you don't peep, you may shriek! Ultrasound for regional anesthesia in preeclampsia
Mian Ahmad, Ashish C Sinha
October-December 2013, 29(4):431-432
DOI:10.4103/0970-9185.119103  PMID:24249975
  - 2,439 9,608
Medimorph anesthesia apparatus
T Vemmer
October-December 2013, 29(4):558-558
DOI:10.4103/0970-9185.119104  PMID:24250000
  - 1,453 247
Management of intraoperative hiccups with intravenous promethazine
Smita Prakash, N Sitalakshmi
October-December 2013, 29(4):561-562
DOI:10.4103/0970-9185.119131  PMID:24250003
  - 5,418 402
Cardiac arrest associated with ranitidine and ondansetron combination in day care gynecologic surgery
Vinit K Srivastava, Parineeta Jaisawal, Sanjay Agrawal, Diwakar Kumar
October-December 2013, 29(4):563-564
DOI:10.4103/0970-9185.119136  PMID:24250005
  - 4,284 454
Patent ductus arteriosus ligation: Do not take it easy
Bhuvana Vijayakanthi, Minati Choudhury, Milind P Hote, Usha Kiran
October-December 2013, 29(4):564-566
DOI:10.4103/0970-9185.119138  PMID:24250006
  - 5,104 546
Difficult airway rescued by a gamjee
Samridhi Nanda, Sandeep Kumar, Sumit Kumar, Chandni Sinha
October-December 2013, 29(4):566-567
DOI:10.4103/0970-9185.119143  PMID:24250007
  - 2,060 298
Undiagnosed bladder pheochromocytoma: An anesthetic challenge
Sonal S Khatavkar, Deepak M Raje, Chaula M Doshi, Shubha N Mohite, Ashish V Dhande
October-December 2013, 29(4):574-576
DOI:10.4103/0970-9185.119165  PMID:24250013
  - 1,705 301
Anesthetic management in a patient with papillion lefevre syndrome
Prakash Sharma, Ashvini Kumar
October-December 2013, 29(4):568-570
DOI:10.4103/0970-9185.119150  PMID:24250009
  - 1,339 208
Anesthetic management for patients with perforation peritonitis
Kiran Sharma, Mritunjay Kumar, Upma Bhatia Batra
October-December 2013, 29(4):445-453
DOI:10.4103/0970-9185.119128  PMID:24249978
Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential.
  - 6,424 1,607