for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Medknow Publishers   (Total: 429 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 429 Journals sorted alphabetically
Acta Medica Intl.     Open Access   (SJR: 0.101, CiteScore: 0)
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advanced Biomedical Research     Open Access  
Advances in Human Biology     Open Access   (Followers: 3)
Advances in Skeletal Muscle Function Assessment     Open Access  
African J. for Infertility and Assisted Conception     Open Access  
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.25, CiteScore: 1)
African J. of Trauma     Open Access   (Followers: 1)
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Alexandria J. of Pediatrics     Open Access  
Ancient Science of Life     Open Access   (Followers: 5)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.258, CiteScore: 1)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, SJR: 0.308, CiteScore: 1)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.434, CiteScore: 1)
Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery     Open Access  
Annals of Indian Psychiatry     Open Access  
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 9, SJR: 0.352, CiteScore: 1)
Annals of Saudi Medicine     Open Access   (SJR: 0.238, CiteScore: 1)
Annals of Thoracic Medicine     Open Access   (Followers: 6, SJR: 0.524, CiteScore: 1)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 13, SJR: 0.152, CiteScore: 0)
Annals of Tropical Pathology     Open Access  
Apollo Medicine     Open Access  
APOS Trends in Orthodontics     Open Access  
Arab J. of Interventional Radiology     Open Access  
Archives of Cardiovascular Imaging     Open Access   (Followers: 1, SJR: 0.187, CiteScore: 0)
Archives of Intl. Surgery     Open Access   (Followers: 10, SJR: 0.302, CiteScore: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Pharmacy Practice     Open Access   (Followers: 6, SJR: 0.102, CiteScore: 0)
Archives of Trauma Research     Open Access   (Followers: 3, SJR: 0.37, CiteScore: 2)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 4)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.856, CiteScore: 2)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 1, SJR: 0.35, CiteScore: 1)
Asian Pacific J. of Reproduction     Open Access   (SJR: 0.227, CiteScore: 1)
Asian Pacific J. of Tropical Biomedicine     Open Access   (Followers: 2, SJR: 0.491, CiteScore: 2)
Asian Pacific J. of Tropical Medicine     Open Access   (Followers: 1, SJR: 0.561, CiteScore: 2)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
Biomedical and Biotechnology Research J.     Open Access  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Canadian J. of Rural Medicine     Full-text available via subscription   (SJR: 0.202, CiteScore: 0)
Cancer Translational Medicine     Open Access   (Followers: 2)
Cardiology Plus     Open Access  
Chinese Medical J.     Open Access   (Followers: 10, SJR: 0.52, CiteScore: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Cancer Investigation J.     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 2)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access  
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 10, SJR: 0.811, CiteScore: 2)
Contemporary Clinical Dentistry     Open Access   (Followers: 4, SJR: 0.353, CiteScore: 1)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.543, CiteScore: 1)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.152, CiteScore: 0)
Dental Research J.     Open Access   (Followers: 11, SJR: 0.416, CiteScore: 1)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 6, SJR: 0.242, CiteScore: 0)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1, SJR: 1.799, CiteScore: 2)
Egyptian J. of Chest Diseases and Tuberculosis     Open Access   (Followers: 3, SJR: 0.155, CiteScore: 0)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access   (Followers: 1)
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.127, CiteScore: 0)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access   (Followers: 1)
Egyptian J. of Otolaryngology     Open Access   (Followers: 2)
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Nursing J.     Open Access  
Egyptian Orthopaedic J.     Open Access   (Followers: 2)
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.822, CiteScore: 2)
Environmental Disease     Open Access   (Followers: 3)
Eurasian J. of Pulmonology     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.749, CiteScore: 2)
European J. of General Dentistry     Open Access   (Followers: 1, SJR: 0.12, CiteScore: 0)
European J. of Prosthodontics     Open Access   (Followers: 3)
European J. of Psychology and Educational Studies     Open Access   (Followers: 11, SJR: 0.113, CiteScore: 0)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.112, CiteScore: 0)
Genome Integrity     Open Access   (Followers: 3, SJR: 0.153, CiteScore: 0)
Glioma     Open Access  
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Gynecology and Minimally Invasive Therapy     Open Access   (SJR: 0.311, CiteScore: 1)
Hamdan Medical J.     Open Access  
Heart and Mind     Open Access  
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
Ibnosina J. of Medicine and Biomedical Sciences     Open Access  
IJS Short Reports     Open Access  
Imam J. of Applied Sciences     Open Access  
Indian Anaesthetists Forum     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 7, SJR: 0.478, CiteScore: 1)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (Followers: 1, SJR: 0.361, CiteScore: 1)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.37, CiteScore: 1)
Indian J. of Critical Care Medicine     Open Access   (Followers: 3, SJR: 0.604, CiteScore: 1)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.266, CiteScore: 1)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.468, CiteScore: 1)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 4, SJR: 0.445, CiteScore: 1)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1, SJR: 0.791, CiteScore: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4, SJR: 0.568, CiteScore: 1)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.425, CiteScore: 1)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.503, CiteScore: 1)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.656, CiteScore: 1)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.102, CiteScore: 0)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 2, SJR: 0.347, CiteScore: 1)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.23, CiteScore: 0)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 3, SJR: 0.225, CiteScore: 1)
Indian J. of Ophthalmology     Open Access   (Followers: 4, SJR: 0.498, CiteScore: 1)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 8, SJR: 0.392, CiteScore: 1)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.199, CiteScore: 0)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 1)
Indian J. of Palliative Care     Open Access   (Followers: 5, SJR: 0.454, CiteScore: 1)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 2, SJR: 0.276, CiteScore: 1)
Indian J. of Pharmacology     Open Access   (SJR: 0.412, CiteScore: 1)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.311, CiteScore: 0)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.408, CiteScore: 1)
Indian J. of Psychological Medicine     Open Access   (SJR: 0.368, CiteScore: 1)
Indian J. of Public Health     Open Access   (Followers: 1)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Respiratory Care     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.119, CiteScore: 0)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.34, CiteScore: 0)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Transplantation     Open Access  
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.434, CiteScore: 1)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Indian Spine J.     Open Access  
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intervention     Open Access   (Followers: 1)
Intl. Archives of Health Sciences     Open Access  
Intl. J. of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Clinicopathological Correlation     Open Access  
Intl. J. of Community Dentistry     Open Access  
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1, SJR: 0.192, CiteScore: 0)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 4)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 3, SJR: 0.142, CiteScore: 0)
Intl. J. of Growth Factors and Stem Cells in Dentistry     Open Access  
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 3)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 3)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 6)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.535, CiteScore: 1)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4, SJR: 0.17, CiteScore: 0)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 2)
Intl. J. of Orofacial Biology     Open Access   (Followers: 1)
Intl. J. of Orofacial Research     Open Access   (Followers: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access  
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 1)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.623, CiteScore: 1)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 5, SJR: 0.653, CiteScore: 1)
Intl. J. of the Cardiovascular Academy     Open Access   (SJR: 0.105, CiteScore: 0)
Intl. J. of Trichology     Open Access   (SJR: 0.4, CiteScore: 1)
Intl. J. of Yoga     Open Access   (Followers: 14)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 5)

        1 2 3 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover
Anesthesia : Essays and Researches
Number of Followers: 10  

  This is an Open Access Journal Open Access journal
ISSN (Print) 0259-1162 - ISSN (Online) 2229-7685
Published by Medknow Publishers Homepage  [429 journals]
  • Anesthetic considerations for carotid endarterectomy: A postgraduate
           educational review

    • Authors: Ahmed Yousef A Al Sultan, Abdulrahman Mawadh A Alsubhi
      Pages: 1 - 6
      Abstract: Ahmed Yousef A Al Sultan, Abdulrahman Mawadh A Alsubhi
      Anesthesia: Essays and Researches 2018 12(1):1-6
      Carotid endarterectomy (CEA) has shown a significant benefit in preventing ipsilateral stroke when it is compared to conservative management. Surgical morbidity and mortality must be kept to a minimum to achieve this benefit. Neurological status of the CEA patients can be monitored easily during regional anesthesia depending on the awake testing (neurocognitive assessment) method of the CEA patients. In addition, specific parameters can help us to monitor and to predict the neurological status of the CEA patients during the procedures such as regional cerebral oxygen saturation (rSO2) and middle cerebral artery velocity (MCAv) changes. We conducted a computerized literature search involving humans, published in English until December 2017, and indexed through Medical Databases; MEDLINE/PubMed, EMBASE, and Web of Science. We reviewed articles performed for prospective and other types of studies related to CEA procedures and techniques which can predict patient's status during the procedure. Searching relevant articles and discussing the results to allow meaningful rate comparison, and to conclude a result view which benefits the CEA patients and the medical staff during the CEA procedures. In total, studies observed cerebral rSO2and MCAv have significant value during CEA procedures. Patients with neurological symptoms during the procedures showed changes of cerebral rSO2and MCAv more than the patients without neurological symptoms. Mentioned parameters (cerebral rSO2and MCAv) showed significant increasing right after the procedure. Mostly, CEA surgeries under local anesthesia were observed, for monitoring patients' consciousness status and comparing it to patients who undergo general anesthesia, to view the reliability of these techniques during CEA procedures, and to predict and avoid intraoperative neurological symptoms.
      Citation: Anesthesia: Essays and Researches 2018 12(1):1-6
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_217_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • The role of nonpharmacological methods in attenuation of pain due to
           peripheral venous cannulation: A randomized controlled study

    • Authors: Archana Shivashankar, KB Nalini, Prapti Rath
      Pages: 7 - 10
      Abstract: Archana Shivashankar, KB Nalini, Prapti Rath
      Anesthesia: Essays and Researches 2018 12(1):7-10
      Background: Establishing an intravenous access is indispensable for safe administration of anesthesia. Most of the times, it is executed without any analgesia although the pain associated with this procedure is quite agonizing to the patients. Aims: This study aims to evaluate the role of 3 different nonpharmacological measures such as Valsalva maneuver, flash of light, and distraction method in attenuation of pain during venous cannulation. Design: A clinical randomized controlled study. Materials and Methods: Two hundred patients of either sex, aged between 18 and 65 years, posted for elective surgery were enrolled in this study. Patients were randomly allocated into four groups, Group C-control, Group V (valsalva) - blew into sphygmomanometer raising the mercury column up to 30 mm of Hg, Group D (distraction) - pressed a rubber ball and Group L (light) - photographed with a flash of light before venous cannulation. During the process of cannulation, patients were observed and questioned, and pain was graded using a 4- point scale. After the cannulation, pain during the procedure was also assessed using visual analog scale (VAS) score. Data analysis was done using SPSS statistical package version 17. Results: A significant reduction in the incidence of pain was noted in distraction group 36% as compared to 44% in Group L, 46% in Group V, and 100% in the control group. The severity of pain as assessed by 4-point score was significantly lowest in Group D (0.26 ± 0.53) as compared to other three groups (Group V and L = 0.54 ± 0.16, Group C = 1.64 ± 0.6, P < 0.001). Mean VAS score was significantly low in Group D (0.6 ± 1.11) and Group L (0.54 ± 1.06) as compared to Group V (1.26 ± 1.76) and Group C (5.0 ± 1.21, P < 0.001). Conclusion: We conclude that distraction can be considered as a diligent, reasonable, and simple method to attenuate procedural pain during peripheral venous cannulation.
      Citation: Anesthesia: Essays and Researches 2018 12(1):7-10
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_172_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Hemodynamic responses and safety of sedation following premedication with
           dexmedetomidine and fentanyl during fiberoptic-assisted intubation in
           patients with predicted difficult airway

    • Authors: Sunil Rajan, Rittick Talukdar, Pulak Tosh, Jerry Paul, Bindu K Vasu, Lakshmi Kumar
      Pages: 11 - 15
      Abstract: Sunil Rajan, Rittick Talukdar, Pulak Tosh, Jerry Paul, Bindu K Vasu, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):11-15
      Background: Awake fiberoptic intubation (AFOI) is the gold standard for the management of predicted difficult airway, and inappropriate sedation is a major cause leading to its failure. Aims: The primary objective was to compare the heart rate (HR) changes that accompany AFOI following sedation with dexmedetomidine and fentanyl. Secondary objectives included comparison of changes in blood pressure, patient comfort, ease of intubation, and degree of sedation. Settings and Designs: This prospective double-blinded randomized study was conducted in a tertiary care institution. Subjects and Methods: Forty patients with anticipated difficult airway requiring AFOI were included in the study. Group A received dexmedetomidine 1 μg/kg whereas Group B received fentanyl 2 μg/kg. After topical anesthesia of the airway, AFOI was performed. Statistical Analysis Used: Fisher's exact test, independent two-sample t-test, and Mann–Whitney U-test were used as applicable. Results: The hemodynamic parameters were comparable in both the groups except at 1 min postintubation when fentanyl group had significantly higher HR. There were lower alertness and muscle tone scores in dexmedetomidine group. Total comfort score was significantly higher in fentanyl group. Though more patients in dexmedetomidine group showed that no reaction to intubation and more patients in fentanyl had slight grimacing, the difference was insignificant. The ease of intubation was similar in both the groups. Conclusion: Though dexmedetomidine1 μg/kg and fentanyl 2 μg/kg premedication results in comparable hemodynamics and ease of intubation, in view of enhanced patient comfort, dexmedetomidine premedication is advantageous in patients with anticipated difficult airway undergoing AFOI.
      Citation: Anesthesia: Essays and Researches 2018 12(1):11-15
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_176_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Ultrasound-guided combined fascial plane blocks as an intervention for
           pain management after laparoscopic cholecystectomy: A randomized control
           study

    • Authors: Seshadri Ramkiran, Mathews Jacob, Manish Honwad, Desiraju Vivekanand, Mathangi Krishnakumar, Seema Patrikar
      Pages: 16 - 23
      Abstract: Seshadri Ramkiran, Mathews Jacob, Manish Honwad, Desiraju Vivekanand, Mathangi Krishnakumar, Seema Patrikar
      Anesthesia: Essays and Researches 2018 12(1):16-23
      Background: Pain associated with laparoscopic cholecystectomy is most severe during the first 24 h and the port sites are the most painful. Recent multimodal approaches target incisional pain instead of visceral pain which has led to the emergence of abdominal fascial plane blocks. This study embraces a novel combination of two independently effective fascial plane blocks, namely rectus sheath block and subcostal transversus abdominis plane (TAP) block to alleviate postoperative pain. Study Objective: The aim is to evaluate the effectiveness of the combination of rectus sheath block and subcostal TAP block, to compare its efficacy with that of subcostal TAP block alone and with conventional port site infiltration (PSI) in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Methodology: This prospective, randomized control, pilot study included 61 patients scheduled for elective laparoscopic cholecystectomy and distributed among three groups, namely Group 1: Combined subcostal TAP block with rectus sheath block (n = 20); Group 2: Oblique subcostal TAP block alone (n = 21); and Group 3: PSI group as an active control (n = 20). Results: Combined group had significantly lower pain scores, higher satisfaction scores, and reduced rescue analgesia both in early and late postoperative periods than the conventional PSI group. Conclusion: Ultrasound-guided combined fascial plane blocks is a novel intervention in pain management of patients undergoing laparoscopic cholecystectomy and should become the standard of care.
      Citation: Anesthesia: Essays and Researches 2018 12(1):16-23
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_157_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Simple predictor of minute ventilation: Holliday-Segar revisited

    • Authors: Priyankar Kumar Datta, Ajisha Aravindan, Jayanandan E Sreekumar, Ajay Singh, Shambo Guha Roy
      Pages: 24 - 25
      Abstract: Priyankar Kumar Datta, Ajisha Aravindan, Jayanandan E Sreekumar, Ajay Singh, Shambo Guha Roy
      Anesthesia: Essays and Researches 2018 12(1):24-25
      Background: Minute ventilation (MV) and calorific requirement (CR) are both functions of metabolic demand. The Holliday-Segar formula is a weight-based tool for predicting CR. This study was performed to derive an equation, based on the Holliday-Segar formula, for calculating resting MV from body-weight (BW), which is applicable for all age groups. Methods: MV for BW (obtained from Radford normogram) was plotted against CR for BW (as per Holliday-Segar formula), for BWs ranging from neonates to adults. From the scatter plot thus obtained, best-fit line, with the origin as intercept, was drawn. Linear regression analysis was used to obtain R2 coefficient and P value. Results: The plot of MV against CR yields a straight line passing through the origin with a slope = 46.87. R2 value is 0.98886, P < 0.001. Conclusion: MV can be easily and reliably estimated for all age groups from the equation: MV (mL/min) = 47 × CR (kcal/h).
      Citation: Anesthesia: Essays and Researches 2018 12(1):24-25
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_158_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of efficacy of epidural ropivacaine versus bupivacaine for
           postoperative pain relief in total knee replacement surgeries

    • Authors: Sidharth Bhasin, Mridul Dhar, Deepak Kumar Sreevastava, Rajiv Nair, Saurabh Chandrakar
      Pages: 26 - 30
      Abstract: Sidharth Bhasin, Mridul Dhar, Deepak Kumar Sreevastava, Rajiv Nair, Saurabh Chandrakar
      Anesthesia: Essays and Researches 2018 12(1):26-30
      Background: Epidural analgesia has become the standard of care for knee replacement surgeries worldwide. Bupivacaine has been used successfully for many years. Epidural ropivacaine is now being used increasingly and seems to have benefits other than just pain relief, in terms of a better safety profile. Aim: To compare the efficacy of bupivacaine 0.125% (Group B) versus two concentrations of ropivacaine 0.1% (Group R1) and 0.2% (Group R2), in terms of pain scores, requirement of rescue analgesia, related adverse effects, and duration of postoperative (PO) hospital stay. Materials and Methods: A retrospective study was conducted from the acute pain service data of patients who underwent joint replacement surgeries in one or both limbs, over a span of 6 months. Patients were allocated to and analyzed under one of the three groups based on the drug concentration used postoperatively by epidural infusion. Data retrieved were demographic data, daily average visual analog scale (VAS) pain scores, rescue analgesia given, adverse effects, and PO hospital stay days for all three groups. Results: Demographic data were comparable between the three groups. Daily average VAS pain scores on days 1 and 2 were significantly higher in Group R1. Groups B and R2 were comparable. There was significantly more requirement of rescue analgesia in Group R1 on day 1. Day 2 showed no significant difference in rescue analgesic requirement in all three groups. Days of PO hospital stay were significantly higher in Group R1. Adverse effects such as hypotension and delayed motor block were higher in Group B. Conclusion: Ropivacaine 0.2% and bupivacaine 0.125% were equally efficacious in terms of VAS pain scores, rescue analgesic requirement, and duration of PO hospital stay, but ropivacaine had a better safety profile in terms of less hypotension and lesser motor block.
      Citation: Anesthesia: Essays and Researches 2018 12(1):26-30
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_134_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effect of pregabalin premedication on emergence agitation in children
           after sevoflurane anesthesia: A randomized controlled study

    • Authors: Hesham Mohamed Marouf
      Pages: 31 - 35
      Abstract: Hesham Mohamed Marouf
      Anesthesia: Essays and Researches 2018 12(1):31-35
      Background: Emergence agitation (EA) is common in pediatrics after sevoflurane anesthesia. Aims: We intended to study the effect of preoperative pregabalin on EA in pediatrics after sevoflurane anesthesia. Settings and Design: This study design was a prospective randomized controlled double-blinded study. Patients and Methods: Sixty children with American Society of Anesthesiologists physical status Classes I–II, aged 4–10 years, prepared for adenotonsillectomy under sevoflurane anesthesia were randomized to two equal groups (control Group C and pregabalin Group P). Children received either placebo syrup (Group C) or pregabalin syrup 1.5 mg/kg (Group P) ½ h preoperatively. We recorded postoperative EA scale (EAS) (10, 20, and 30 min postoperatively), time to open the eye, time to extubate, postanesthesia care unit (PACU) duration of stay, number of paracetamol doses (15 mg/kg) given (to control postoperative pain), and complications as vomiting and dizziness on discharge. Statistical Analysis Used: Independent sample t-test and Chi-square test were used as appropriate. Results: Pregabalin Group P showed less EAS, less analgesic (paracetamol) requirement, and less vomiting with insignificant effects on time to open the eye or extubation and PACU duration of stay compared to control group. Conclusion: Preoperative pregabalin decreased postoperative EAS, analgesic (paracetamol) requirement, and vomiting in pediatrics after adenotonsillectomy using sevoflurane anesthesia without affecting time to open the eye or extubation and PACU duration of stay.
      Citation: Anesthesia: Essays and Researches 2018 12(1):31-35
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_223_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Perianal block: Is it as good as spinal anesthesia for closed
           hemorrhoidectomies?

    • Authors: Kavitha Jinjil, Deepak Dwivedi, Vidhu Bhatnagar, Rahul K Ray, Swayam Tara
      Pages: 36 - 41
      Abstract: Kavitha Jinjil, Deepak Dwivedi, Vidhu Bhatnagar, Rahul K Ray, Swayam Tara
      Anesthesia: Essays and Researches 2018 12(1):36-41
      Background and Aims: This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal anesthesia (SA) using bupivacaine (heavy) for closed hemorrhoidectomies. Methods: A prospective randomized study was conducted in sixty patients who underwent closed hemorrhoidectomy. Thirty patients of Group A received SA. Thirty patients in Group B received local perianal block. Patients were evaluated for onset of the block, total pain-free period, and time to ambulation. Patient satisfaction in terms of pain during injection and satisfaction with the anesthesia technique was assessed after 2-week telephonically. Data were statistically analyzed using unpaired t-test for the continuous variables and Fischer's exact test for categorical variables. Results: Onset of anesthesia was significantly earlier in Group B, mean (standard deviation [SD]) value being 3.17 (1.28) min as compared to Group A, 6.24 (4.28) min (P = 0.0004). Total pain-free period (mean [SD]) in minute was longer in Group B, 287 (120) min as compared to Group A, 128 (38) min. Time to ambulation was significantly earlier in Group B, 22.83 (29.32) min as compared to Group A 302 (92.41) min. Pain during injection between the two groups was comparable. However, more patients in Group B (60%) were satisfied with the anesthesia technique as compared to Group A (27.5%). Conclusion: Perianal block for hemorrhoidectomy with ropivacaine 0.2% using dexmedetomidine as an adjuvant is an effective and reliable technique which is as effective as SA. It provides prolonged postoperative analgesia and early ambulation.
      Citation: Anesthesia: Essays and Researches 2018 12(1):36-41
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_225_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Ultrasonographic optic nerve sheath diameter as a surrogate measure of
           raised intracranial pressure in severe pregnancy-induced hypertension
           patients

    • Authors: Shiv Kumar Singh, Kiran Bhatia
      Pages: 42 - 46
      Abstract: Shiv Kumar Singh, Kiran Bhatia
      Anesthesia: Essays and Researches 2018 12(1):42-46
      Context: It is a well-known fact that severe pregnancy-induced hypertension (PIH) can be disastrous at times as it can cause a lot of complications to both pregnant women and her baby. Hence, it is always desirable to know the extent of severity by a real-time and easily accessible modality like ultrasound. Aims: The aim of the study was to evaluate the incidence of raised intracranial pressure (ICP) in severe preeclampsia and eclampsia patients using ocular ultrasonography with optic nerve sheath diameter (ONSD) measurement. Settings and Design: This study design was a prospective and clinically controlled blinded observational study. Materials and Methods: After taking necessary permissions from the Institution Ethical Committee, 75 patients were enrolled for the study. However, finally, 25 patients in severe preeclampsia and 24 in eclampsia group were compared with 25 normal term antenatal women. Demographic profiles, hemodynamic parameters, laboratory markers for severity of PIH, and ultrasonographic OSND were measured. Statistical Analysis Used: They were statistically analyzed and compared using one-way ANOVA and Tukey's test. Value of P < 0.05 was considered statistically significant. Results: All the three groups were comparable in terms of age, body weight, gestation age, gestity, and the number of primigravida in each group. There was a significant difference (P < 0.05) in mean levels of hepatic aminotransferase levels and platelet counts between groups. Aspartate transaminase and alanine transaminase levels were much higher in Group II and III as compared to Group I, while platelet levels were lower in study groups indicating increase in severity of PIH. There was also a significant difference for systolic blood pressure and diastolic blood pressure (P < 0.001) as both were significantly higher in study groups. Among severe PIH groups (Group II and III), the difference was comparable. Conclusions: OSND is a surrogate marker for raised ICP in severe PIH patients. It is a rapid, bedside, noninvasive, and readily accessible tool and could be a part of a holistic approach for managing such patients.
      Citation: Anesthesia: Essays and Researches 2018 12(1):42-46
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_218_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • A comparative study of botulinum toxin: A with triamcinolone compared to
           triamcinolone alone in the treatment of osteoarthritis of knee

    • Authors: Divya Shukla, Smitha K Sreedhar, Virendra Rastogi
      Pages: 47 - 49
      Abstract: Divya Shukla, Smitha K Sreedhar, Virendra Rastogi
      Anesthesia: Essays and Researches 2018 12(1):47-49
      Introduction: This study compares the efficacy in terms of pain relief and complications of intra-articular Botulinum toxin-A (BoNT-A) with intra-articular Triamcinolone versus Triamcinolone alone in the treatment of osteoarthritic knee pain of severe grade. If effective, BoNT-A may help in reducing the long term adverse effects due to prolonged analgesic consumption and reduce/delay requirement of knee replacement surgeries. Materials and Methods: In this prospective study, 30 patients of either sex, aged between 40 to 60 years with physical status ASA classes I or II suffering from knee joint osteoarthritis with knee pain and functional impairment were divided into 2 groups: The OA patients which received Botulinum toxin-A with Triamcinolone (Group A) & OA patients which received only Triamcinolone (Group B). Only patients with advanced OA of the knee; radiographically verified with a Joint space <2 mm were included. The efficacy of pain relief in the 2 groups were compared using Visual analog score (VAS) and Oxford knee Score and followed upto 6 months. Results and Conclusions: On comparing the VAS Score during the follow up period, there was a significant difference between groups A and B upto 3 months. During post treatment follow up, there was significant difference in pain relief as measured by the Oxford Knee score from 4 weeks to 6 months, where Group A patients fared much better in terms of pain relief than group B with a highly significant value of P=<0.001 during the time period of 6 weeks to 6 months. The study shows that the use intra-articular Botulinum toxin-A with steroid is far superior to intra-articular steroid alone in terms of pain relief as well as functional outcome.
      Citation: Anesthesia: Essays and Researches 2018 12(1):47-49
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_210_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of ultrasound with peripheral nerve stimulator guided technique
           for supraclavicular block in upper limb surgeries: A randomized controlled
           trial

    • Authors: Vinu Mervick Alfred, Gnanasekaran Srinivasan, Mamie Zachariah
      Pages: 50 - 54
      Abstract: Vinu Mervick Alfred, Gnanasekaran Srinivasan, Mamie Zachariah
      Anesthesia: Essays and Researches 2018 12(1):50-54
      Background: The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin. Aims: The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications. Settings and Design: Prospective, randomized controlled study. Subject and Methods: Sixty patients aged above 18 years scheduled for elective upper limb surgery were randomly allocated into two groups. Group A patients received supraclavicular brachial plexus block under ultrasound guidance and in Group B patients, PNS was used. In both groups, local anesthetic mixture consisting of 15 ml of 0.5% bupivacaine and 10 ml of 2% lignocaine with 1:200,000 adrenaline were used. Statistical Analysis: Independent t-test used to compare mean between groups; Chi-square test for categorical variables. Results: The procedure time was shorter with USG (11.57 ± 2.75 min) compared to PNS (21.73 ± 4.84). The onset time of sensory block (12.83 ± 3.64 min vs. 16 ± 3.57 min) and onset of motor block (23 ± 4.27 min vs. 27 ± 3.85 min) were significantly shorter in Group A compared to Group B (P < 0.05). The duration of sensory block was significantly prolonged in Group A (8.00 ± 0.891 h) compared to Group B (7.25 ± 1.418 h). None of the patients in either groups developed any complications. Conclusion: The ultrasound-guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique.
      Citation: Anesthesia: Essays and Researches 2018 12(1):50-54
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_211_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • The role of bolus injection of saline with arm elevation on rocuronium
           onset time: A randomized control study

    • Authors: Malavika Kulkarni, LS Chuchendra, PJ Bhavya
      Pages: 55 - 59
      Abstract: Malavika Kulkarni, LS Chuchendra, PJ Bhavya
      Anesthesia: Essays and Researches 2018 12(1):55-59
      Background: The onset time of neuromuscular blockade is a crucial time associated with the risk of hypoxia and pulmonary aspiration. Various strategies have been undertaken to shorten this onset time. Therefore, we investigated the effects of bolus of 20 ml saline followed by limb elevation after administration of rocuronium in a dose of 0.6 mg/kg to study the onset time. Methodology: Thirty patients were randomly allocated to the bolus saline group or control group. General anesthesia was induced and maintained with fentanyl and propofol. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by 20 ml saline bolus and limb elevation in the study group compared to administration of 0.6 mg/kg in a running drip only in the control. Onset of neuromuscular block was assessed by acceleromyography at the adductor pollicis muscle with train-of-four stimulation. Results: The lag time was shorter in bolus group (34 s median) than in control group (45 s median), P < 0.017. The onset time was shorter in bolus group (55 s median) than in control group (110 s median), P < 0.001. The T1 recovery to 25% was longer in bolus group (42 min median) than in control group (39 min median) which was statistically not significant. Conclusion: Rocuronium 0.6 mg/kg IV followed by bolus 20 ml saline and concomitant limb elevation resulted in shorter lag time, faster onset of neuromuscular blockade, good intubating conditions without prolonging clinical duration of action when compared to the control.
      Citation: Anesthesia: Essays and Researches 2018 12(1):55-59
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_212_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of three different concentrations of levobupivacaine for
           epidural labor analgesia: Clinical effect and pharmacokinetic profile

    • Authors: Ahmed Mostafa El-Shaarawy, Mohamed S Asfour, Doaa A Rashwan, Mahmoud M Amer, Shahira F El-Menshawe, Mohammed H Elkomy
      Pages: 60 - 66
      Abstract: Ahmed Mostafa El-Shaarawy, Mohamed S Asfour, Doaa A Rashwan, Mahmoud M Amer, Shahira F El-Menshawe, Mohammed H Elkomy
      Anesthesia: Essays and Researches 2018 12(1):60-66
      Background: The aim is to compare the clinical effect of three different concentrations of levobupivacaine (0.25%, 0.125%, and 0.0625%) on the sensory and motor block characteristics and mode of delivery during epidural labor analgesia. We also studied the pharmacokinetic profile of the three concentrations during labor. Materials and Methods: Sixty pregnant females undergoing normal vaginal delivery under epidural analgesia were divided into three groups according to the concentration of levobupivacaine used. All parturients received an epidural bolus dose of 15 ml of the desired concentration followed by a continuous infusion of the same concentration at 10 mL/h, each combined with fentanyl 2 μg/mL. Sensory block was assessed by the visual analog score (VAS), whereas motor block was evaluated by the Bromage score. Assessments were performed every 5 min in the first 20 min after initiation of epidural analgesia and then at 30 min interval. The incidence of instrumental delivery and cesarean section was also recorded. The total plasma concentrations of levobupivacaine were determined before the start of epidural analgesia, 5 and 10 min after starting the infusion, at infusion stop time, and 3–8 h after infusion termination. Results: The VAS was significantly lower with levobupivacaine concentrations of 0.25% and 0.125% than 0.0625%. Motor block in the form of Bromage score 1 was observed in 39% of parturients receiving levobupivacaine 0.25% of which 43% were converted to cesarean delivery. No motor block was observed with the other two concentrations. Levobupivacaine peak plasma concentrations increased with increasing the concentration of the local anesthetic. There was no difference in other pharmacokinetic parameters between the three groups. Conclusion: levobupivacaine concentration of 0.125% is superior to other concentrations for epidural labor analgesia as it provides adequate analgesia without motor affection which reflects in a lower incidence of instrumental delivery or cesarean section.
      Citation: Anesthesia: Essays and Researches 2018 12(1):60-66
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_145_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Intraocular pressure changes during laparoscopic surgery in Trendelenburg
           position in patients anesthetized with propofol-based total intravenous
           anesthesia compared to sevoflurane anesthesia: A comparative study

    • Authors: Gagandeep Kaur, Mamta Sharma, Poonam Kalra, Shobha Purohit, Kanchan Chauhan
      Pages: 67 - 72
      Abstract: Gagandeep Kaur, Mamta Sharma, Poonam Kalra, Shobha Purohit, Kanchan Chauhan
      Anesthesia: Essays and Researches 2018 12(1):67-72
      Background: Intraocular pressure (IOP) is increased during laparoscopic surgery with Trendelenburg position and may contribute to deleterious effects on optic nerve in susceptible patients. Aims: The primary objective of this study is to compare the effects of propofol-based total intravenous anesthesia (TIVA) with those of sevoflurane anesthesia on IOP in patients undergoing lower abdominal laparoscopic surgery in Trendelenburg position. Secondary objectives are to compare hemodynamic changes, mean arterial pressure (MAP), end-tidal CO2, and peak inspiratory pressure changes. Materials and Methods: Sixty patients with physical status American Society of Anesthesiologists classes I and II were randomly allocated in two groups: Group A (propofol) and Group B (sevoflurane). IOP along with other parameters was measured at seven points including baseline (T0), 5 min after induction (T1), 5 min after CO2pneumoperitoneum in supine position (T2), 30 min after CO2pneumoperitoneum with Trendelenburg position (T3), 5 min after returning to supine position (T4), 5 min after CO2desufflation (T5), and 5 min after extubation (T6). Results: The change in IOP was different between the two groups. Maximum rise in IOP was seen at T3, and mean ± standard deviation IOP was 15.5 ± 0.9 mmHg and 19.8 ± 1.2 mmHg in Group A and Group B, respectively (P < 0.01). In Group A (propofol), IOP remained almost equal to the baseline value at T3 and the IOP difference was 0.3 ± 0.9 mmHg less than baseline (statistically insignificant, P > 0.05), while in Group B (sevoflurane), IOP increased significantly at T3 and the difference was 4.0 ± 1.2 mmHg (P < 0.001). The IOP was significantly greater (P < 0.01) from T2 to T6 in sevoflurane group than propofol group. Conclusion: Propofol-based TIVA is more effective than inhalational anesthesia with sevoflurane in attenuating the increase in IOP during laparoscopic surgery requiring CO2pneumoperitoneum with Trendelenburg position.
      Citation: Anesthesia: Essays and Researches 2018 12(1):67-72
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_177_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of inhalational vital capacity induction with sevoflurane to
           intravenous induction with propofol for insertion of laryngeal mask airway
           in adults: A randomized study

    • Authors: Vinaya Udaybhaskar, Amol Singam, Himanshu Dodeja, Karuna Taksande
      Pages: 73 - 79
      Abstract: Vinaya Udaybhaskar, Amol Singam, Himanshu Dodeja, Karuna Taksande
      Anesthesia: Essays and Researches 2018 12(1):73-79
      Background: Since the development of laryngeal mask airway (LMA) by Dr. Brain, it is extensively used for airway management; satisfactory insertion of LMA requires administration of an induction agent and suppression of airway reflexes. Among intravenous agents, propofol has been the drug of choice in view of better safety profile, relaxation and depression of upper airway reflexes. Sevoflurane on the other hand, with pleasant odor, nonirritating to the airways and with bronchodilator property are best among the volatile induction agents. While it is true both propofol and sevoflurane have their merits, still both have certain limitations. We aimed to compare the quality and ease of LMA insertion, hemodynamic changes, and complications with inhalation of 8% sevoflurane vital capacity breath and propofol. Materials and Methods: A prospective randomized study of 100 American Society of Anaesthesiologists' Class I and II patients was conducted equal distribution among two groups with 50 each undergoing gynecological procedures under general anesthesia. Group P received injection propofol and Group S received sevoflurane. At the end point of induction, the LMA insertion was attempted. Scoring systems were used to grade the conditions for insertion of the LMA. Induction characteristics, hemodynamic changes, and complications were assessed. Results: Sevoflurane took a longer time for induction and jaw relaxation than propofol. There was no statistically significant difference between the two groups, with respect to LMA insertion time, and conditions. Apnea time was more in propofol group. Fall in heart rate and mean blood pressure was more in propofol. Conclusion: Propofol is associated with faster induction while sevoflurane is associated with good hemodynamic stability.
      Citation: Anesthesia: Essays and Researches 2018 12(1):73-79
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_193_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of postoperative analgesic efficacy of wound site infiltration
           and ultrasound-guided transversus abdominis plane block with 0.5%
           ropivacaine in lower abdominal surgeries under spinal anesthesia

    • Authors: N Pratheeba, R Remadevi, I Joseph Raajesh, V Bhavani, DK Tripathy, R Ravindra Bhat
      Pages: 80 - 84
      Abstract: N Pratheeba, R Remadevi, I Joseph Raajesh, V Bhavani, DK Tripathy, R Ravindra Bhat
      Anesthesia: Essays and Researches 2018 12(1):80-84
      Context: Optimization and providing excellent quality of postoperative analgesia after total abdominal hysterectomy is a determinant factor of better clinical outcome, increases patient satisfaction, and allows early mobilization of the patient. Aims: The aim of this study is to compare the postoperative analgesic efficacy of wound site infiltration (WSI) and ultrasound-guided transversus abdominis plane block (TAPB) with 0.5% ropivacaine in lower abdominal surgeries under spinal anesthesia. Settings and Design: This was a randomized controlled study. Subjects and Methods: One hundred and ten patients undergoing lower abdominal surgeries were randomly allocated to two groups (WSI and TAP) of 55 patients in each. At the end of the surgical procedure, 2.5 mg/kg of the drug ropivacaine 0.5% was administered by an anesthesiologist through either of the routes of study. Visual analog score (VAS) assessment was done at every 30 min, for 1½ h, every 2 for 24 h postoperatively. Injection diclofenac sodium 75 mg intramuscularly was given whenever VAS was >3 as rescue analgesic. Statistical Analysis Used: Epi Info 7.0 version software for Windows was used. All analyses were performed using Kolmogorov–Smirnov test. Mann–Whitney test was applied to detect the difference between the two groups. P < 0.05 was considered statistically significant. Results: Postoperative VAS scores in Group TAP were significantly reduced at 30 min, 1st h, 1 h 30 min, 2, 4, 6, 8, 10, 12, 18, and 24 h (P < 0.001). The total doses of rescue analgesics administered were also low in the Group TAP (1.41 ± 0.538) with P < 0.0001 in comparison to Group WSI (2.24 ± 0.637) with P < 0.001. Conclusions: The quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries. Both WSI and USG TAPB are effective in providing postoperative analgesia as a part of multimodal analgesia in lower abdominal surgeries. However, in our study the quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries.
      Citation: Anesthesia: Essays and Researches 2018 12(1):80-84
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_201_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effect of esmolol and diltiazem infusions on hemodynamic response to
           pneumoperitoneum on laparoscopic simple nephrectomy: A randomized
           controlled trial

    • Authors: Alka Verma, Divya Srivastava, Mekhala Paul, Arindam Chatterjee, Abhilash Chandra
      Pages: 85 - 91
      Abstract: Alka Verma, Divya Srivastava, Mekhala Paul, Arindam Chatterjee, Abhilash Chandra
      Anesthesia: Essays and Researches 2018 12(1):85-91
      Background: Several studies have been conducted in search of appropriate drugs to attenuate hemodynamic responses in laparoscopic cholecystectomy, but till date, no such study has been conducted on patients undergoing laparoscopic nephrectomy. Aim: The study was designed to assess the effect of esmolol and diltiazem infusions on hemodynamic changes during routine laparoscopic transperitoneal simple nephrectomy. Settings and Design: A prospective double-blinded randomized control trial. Subjects and Methods: A total of 120 nonhypertensive patients of the American Society of Anesthesiologists physical Status I and II aged 20–60 years about to undergo laparoscopic nephrectomy were enrolled for the study after obtaining Institute Ethical committee approval. The patients were randomly allocated to one of the three groups. Group I (control group) received 10 ml normal saline intravenously (i.v.) before induction of anesthesia, followed by continuous infusion 10–20 ml/h. Group II (esmolol group) received i.v. esmolol 1 mg/kg diluted in 10 ml similarly, followed by continuous infusion of 10–20 ml/h (5–10 μg/kg/min). Group III (diltiazem group) received i.v. diltiazem 0.2 mg/kg diluted in 10 ml before induction of anesthesia, followed by continuous infusion at 10–20 ml/h (0.08–1.25) μg/kg/min. After completion of surgery, all the infusions were stopped. Data recording were done for changes in hemodynamics throughout the surgery. Statistical Analysis: was done using Chi-square test for categorical data and one-way ANOVA for continuous data. Tukey (“honestly significant difference”) post hoc test was applied for intra- and inter-group comparison in cases where ANOVA was significant. P < 0.05 is considered statistically significant. Results: All hemodynamic data: Heart rate (HR), systolic, diastolic, and mean arterial pressure were observed to be significantly higher (P < 0.001) from baseline in control group at the time of creation of pneumoperitoneum, till 20 min thereafter. The values were comparable to baseline in both esmolol and diltiazem group. On intergroup comparison, the patients in esmolol group had significantly lower HR and blood pressures than in diltiazem group at the creation of pneumoperitoneum and at extubation (P < 0.05). Mean dose of esmolol and diltiazem used were 7.25 ± 1.33 μg/kg/min and 1.14 ± 0.77 μg/kg/min, respectively. Conclusion: Both esmolol and diltiazem infusion provide stable intraoperative hemodynamics and protection against stress response triggered by pneumoperitoneum in patients undergoing laparoscopic transperitoneal nephrectomy.
      Citation: Anesthesia: Essays and Researches 2018 12(1):85-91
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_203_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Norepinephrine versus ephedrine to maintain arterial blood pressure during
           spinal anesthesia for cesarean delivery: A prospective double-blinded
           trial

    • Authors: Ali Mohamed Ali Elnabtity, Mohamed Foad Selim
      Pages: 92 - 97
      Abstract: Ali Mohamed Ali Elnabtity, Mohamed Foad Selim
      Anesthesia: Essays and Researches 2018 12(1):92-97
      Background: Ephedrine was conventionally regarded as the first-choice drug to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, due to its stimulant activity on α- and β-adrenergic receptors. Norepinephrine is a weak β-adrenergic and potent α-adrenergic receptor agonist. Therefore, it may be suitable for maintaining blood pressure with less chronotropic effects compared to ephedrine. Patients and Methods: One hundred and forty healthy patients having cesarean delivery under spinal anesthesia were randomized to Group N (n = 61) who received a prophylactic bolus of norepinephrine 5 μg intravenous (i.v.) at the time of intrathecal block or Group E (n = 61) who received a prophylactic bolus of i.v. ephedrine 10 mg. Rescue i.v. bolus interventions of norepinephrine 5 μg or ephedrine 10 mg were given as required to maintain systolic blood pressure. Maternal and fetal hemodynamic variables, Apgar score, and number of boluses of vasopressors used were recorded. Results: The numbers of maternal hypotension and hypertension episodes and the frequency of bradycardia and tachycardia were significantly lower in Group N compared with Group E (P = 0.02, 0.003, 0.0002, and 0.008, respectively). The number of boluses of vasopressors used was also lower in Group N (P = 0.005). Uterine artery pulsatility index was lower in Group N compared to Group E (P = 0.01) when measured 5 min after spinal anesthesia. Moreover, it was higher at 5 min in Group E when compared with the baseline readings in the same group (P = 0.001). Conclusions: Norepinephrine is a suitable and potent drug to counterbalance the hemodynamic effects of spinal anesthesia during cesarean delivery.
      Citation: Anesthesia: Essays and Researches 2018 12(1):92-97
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_204_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparative study between propofol and dexmedetomidine for conscious
           sedation in patients undergoing outpatient colonoscopy

    • Authors: Harish Karanth, Sumesh Murali, Reshma Koteshwar, Vasanth Shetty, Karunakara Adappa
      Pages: 98 - 102
      Abstract: Harish Karanth, Sumesh Murali, Reshma Koteshwar, Vasanth Shetty, Karunakara Adappa
      Anesthesia: Essays and Researches 2018 12(1):98-102
      Introduction: Colonoscopy is a mildly painful procedure requiring conscious sedation. Though propofol is a widely used anesthetic agent in day-care procedures due to its rapid onset and quick recovery has a drawback of requiring resuscitation maneuvers more often than the conventional methods. Dexmedetomidine, a newly introduced, highly selective α2-adrenergic receptor agonist possessing hypnotic, sedative, anxiolytic, sympatholytic, and analgesic properties with impressive safety margin, needs to be explored for use in conscious sedation for colonoscopy procedure among South Indian population. Materials and Methods: A prospective randomized comparative study was conducted on patients aged between 25 and 60 years with the American Society of Anesthesiologist physical status classes I and II posted for colonoscopy under monitored anesthesia care. Study group was randomly divided into two groups and administered propofol and dexmedetomidine. The primary outcome variable was assessments of sedation scores between the two groups. Secondary outcome variables were pain score assessments, hemodynamic comparisons, and adverse events among the two groups. Appropriate statistical tests were applied to compare the findings. Results: After comparisons between the two groups, we found that patients on dexmedetomidine had similar sedation score as that of patients on propofol. However, there was a significantly higher incidence of systemic hypotension. Requirement of rescue analgesia and adverse events and other hemodynamic fluctuation were similar in both the groups. Conclusion: We conclude that dexmedetomidine has similar efficacy as propofol for conscious sedation required during colonoscopy. Occurrence of systolic hypotension was, however, significantly more among the group receiving dexmedetomidine.
      Citation: Anesthesia: Essays and Researches 2018 12(1):98-102
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_206_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Postoperative analgesia with epidural dexmedetomidine compared with
           clonidine following total abdominal hysterectomies: A prospective
           double-blind randomized trial

    • Authors: Sunil Chiruvella, Balaji Donthu, Srinivasa Rao Nallam, Dora Babu Salla
      Pages: 103 - 108
      Abstract: Sunil Chiruvella, Balaji Donthu, Srinivasa Rao Nallam, Dora Babu Salla
      Anesthesia: Essays and Researches 2018 12(1):103-108
      Background and Aims: Anesthesia for total abdominal hysterectomies is not only concerned with relieving pain during intraoperative period but also during the postoperative period. We compared clonidine and dexmedetomidine as an adjuvant to levobupivacaine for epidural analgesia with respect to onset and duration of sensory block, duration of analgesia, and adverse effects. Materials and Methods: A total of 80 individuals between the age of 45 and 65 years of American Society of Anesthesiologists (ASA) physical status Classes I and II who underwent total abdominal hysterectomies were randomly allocated into two groups, comprising 40 patients in each group. Group LC received 10 ml of 0.125% levobupivacaine and 2 μg/kg of clonidine while Group LD received 10 ml of 0.125% levobupivacaine and 1 μg/kg of dexmedetomidine through the epidural catheter. Onset of analgesia, time of peak effect, duration of analgesia, cardiorespiratory parameters, side effects, and need of rescue intravenous (IV) analgesics were observed. The data analysis was carried out with Z-test and Chi-square test. Results: The demographic profile and ASA physical classes were comparable between the groups. Group LD had early onset, early peak effect, prolonged duration, and stable cardiorespiratory parameters when compared with Group LC. Less number of patients (42.5%) in Group LD required IV rescue analgesics when compared to Group LC (70%) and was statistically significant. The side effects' profile was also comparable. Conclusion: Dexmedetomidine is a better neuraxial adjuvant compared with clonidine for providing early onset and prolonged postoperative analgesia and stable cardiorespiratory parameters.
      Citation: Anesthesia: Essays and Researches 2018 12(1):103-108
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_207_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of magnesium sulfate and dexmedetomidine as an adjuvant to 0.5%
           ropivacaine in infraclavicular brachial plexus block

    • Authors: Mohamed M Abu Elyazed, Mona M Mogahed
      Pages: 109 - 115
      Abstract: Mohamed M Abu Elyazed, Mona M Mogahed
      Anesthesia: Essays and Researches 2018 12(1):109-115
      Background: Magnesium sulfate and dexmedetomidine were used as adjuvants to local anesthesia to improve the quality of regional anesthesia. Aims: The aim of this study is to evaluate and compare the effects of magnesium sulfate and dexmedetomidine when added to ropivacaine on the quality of infraclavicular brachial plexus block (BPB). Settings and Design: This was a prospective randomized double-blinded controlled study. Patients and Methods: A total of 105 adult patients undergoing surgery in hands, wrist, and forearm using infraclavicular BPB were randomly assigned into three groups. Ultrasound-guided infraclavicular BPB was performed using 35 ml ropivacaine 0.5% diluted with 4 ml normal saline 0.9%. Magnesium sulfate 150 mg and dexmedetomidine 100 μg were added in the magnesium sulfate group and dexmedetomidine group, respectively. Duration of analgesia, onset times and durations of sensory block (SB) and motor block (MB), patient's satisfaction, and complications were recorded. Statistical Analysis: Statistical software SPSS 16 was used for statistical analysis. Results: Dexmedetomidine and magnesium sulfate provided longer duration of analgesia and lesser consumption of postoperative rescue analgesia than the control group (P = 0. 000); dexmedetomidine provided the longest duration of analgesia versus control and magnesium sulfate groups (P = 0.000). Dexmedetomidine provided the quickest onset times and the longest durations of both SB and MB than control and magnesium sulfate groups (P = 0.000). Dexmedetomidine group had higher incidences of bradycardia and hypotension. Conclusions: Magnesium sulfate or dexmedetomidine is a useful adjuvant to ropivacaine for infraclavicular BPB in lengthening the duration of analgesia. Dexmedetomidine provided quicker onset and longer duration of both SB and MB and longer duration of analgesia with lesser consumption of postoperative rescue analgesia; however, it showed a higher incidence of intraoperative hypotension and bradycardia than magnesium sulfate.
      Citation: Anesthesia: Essays and Researches 2018 12(1):109-115
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_70_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Postoperative cognitive dysfunction in Indian patients undergoing total
           knee replacement under spinal anesthesia

    • Authors: Praful Kilaru, A Ramachandra Reddy, Maryada Venketeshwar Reddy, Brijesh Kidiyoor, Vinay Mathew Joseph, Annapareddy Venkata Gurava Reddy
      Pages: 116 - 118
      Abstract: Praful Kilaru, A Ramachandra Reddy, Maryada Venketeshwar Reddy, Brijesh Kidiyoor, Vinay Mathew Joseph, Annapareddy Venkata Gurava Reddy
      Anesthesia: Essays and Researches 2018 12(1):116-118
      Introduction: Total knee replacement is a common surgical procedure in the elderly. The number of surgeries has increased owing to the increasing life expectancy of the population and better functional outcomes postsurgery. Postoperative cognitive dysfunction (POCD) is an identified entity postsurgery in elderly but most of the studies have been on patients undergoing cardiac and other nonorthopaedic surgeries. The studies have shown variable incidence due to selection bias. We studied the incidence and probable predictive factors of POCD in elderly Indian population undergoing total knee replacement under spinal anesthesia. Materials and Methods: We designed a prospective, observational study at a single center including patients above 60 years of age undergoing total knee replacement under spinal anesthesia. Preoperative mini-mental scale examination, electrolytes, urea and creatinine levels were recorded. Postoperatively, mini mental scale evaluation (MMSE) was done 2 days postsurgery, at 3 months, 6 months, and 1 year follow-up. Laboratory values postoperatively were recorded. Results: The average preoperative MMSE was 27 and declined to 25.4 on second postoperative day the value increased to 25.9, 26.6, and 27 at 3 months, 6 months, and 1-year follow-up, respectively. Sixty-three out of 600 patients developed POCD at second postoperative day. Forty-three patients showed recovery in subsequent visits and 20 patients had persistent dysfunction at the end of 1 year. Electrolyte imbalance, oxygen saturation, and age over 80 years were factors that showed statistically significant difference in multiple comparison analysis. Conclusion: In our study, we have found POCD to be a definitive entity which can cause short- and long-term cognitive defect in elderly Indian population undergoing total knee replacement and electrolyte imbalance, age, and oxygen saturation were the significant factors in the patients who developed POCD.
      Citation: Anesthesia: Essays and Researches 2018 12(1):116-118
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_178_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of the laryngeal mask airways: Laryngeal mask airway-classic
           and laryngeal mask airway-proseal in children

    • Authors: Chetan B Bhat, Kiran A Honnannavar, Mallanna B Police Patil, Mahantesh S Mudakanagoudar
      Pages: 119 - 123
      Abstract: Chetan B Bhat, Kiran A Honnannavar, Mallanna B Police Patil, Mahantesh S Mudakanagoudar
      Anesthesia: Essays and Researches 2018 12(1):119-123
      Introduction: In the past 25 years with the development of various supraglottic airway devices, the armamentarium for airway management has increased. In our study, the laryngeal mask airway (LMA)-ProSeal is compared with the LMA-Classic with respect to as follows: (a) Ease of insertion and number of insertion attempts, (b) Device positional stability and possible oropharyngeal leak, (c) Airway trauma, and (d) Hemodynamic changes; in children aged 3–15 years undergoing elective surgery under general anesthesia, hypothesizing that these would be different. Materials and Methods: Sixty consecutive American Society of Anesthesiologists Physical Status Classes I and II children aged 3–15 years and weighing 5–45 kg undergoing elective surgery in the supine position were randomized for airway management with the LMA-Classic or LMA-ProSeal. Results: Size of the LMA used in both LMA-Classic and LMA-ProSeal was 1.5, 2, and 2.5 and was statistically nonsignificant. There was no difference between LMA-Classic and LMA-ProSeal with regard to ease of insertion, number of attempts for insertion, device positional stability, airway trauma and hemodynamic changes. Conclusions: The complications of usage of the LMA are minimal and similar in both the devices. The LMA-ProSeal has advantages over LMA-classic such as the placement of gastric tube, adequate ventilation, and oxygenation without any gastric distension.
      Citation: Anesthesia: Essays and Researches 2018 12(1):119-123
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_191_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of upper lip bite test and ratio of height to thyromental
           distance with other airway assessment tests for predicting difficult
           endotracheal intubation

    • Authors: D Shobha, Maitri Adiga, D Devika Rani, Sudheesh Kannan, SS Nethra
      Pages: 124 - 129
      Abstract: D Shobha, Maitri Adiga, D Devika Rani, Sudheesh Kannan, SS Nethra
      Anesthesia: Essays and Researches 2018 12(1):124-129
      Background and Aims: Unanticipated difficult intubation or the failed intubation in operating room and in emergency department is an imperative source of anesthesia-related patient's mortality. The aim of this study is to compare the predictive value of upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) with other commonly used preoperative airway assessment tests for predicting difficult intubation in Indian population. Materials and Methods: In this prospective, single-blinded observational study, 260 adult patients of either sex, belonging to American Society of Anesthesiologists physical Status I and II undergoing elective surgical procedure under general anesthesia were included in the study. ULBT, RHTMD, inter-incisor gap, modified Mallampati grade, horizontal length of the mandible, head and neck movements, sternomental distance, and TMD were assessed preoperatively and correlated with Cormack and Lehane's grading during laryngoscopy under anesthesia. Statistical analysis was done by Chi-square and Fisher's exact test. Results: ULBT and RHTMD had highest sensitivity (66.7% and 63.3%), specificity (99.1% and 89.6%), positive predictive value (90.9% and 44.2%), and negative predictive value (96.9% and 95.0%), respectively, when compared to other parameters in predicting difficult airway. Conclusion: ULBT and RHTMD may be used as a simple bedside airway assessment tools for prediction of difficult intubation.
      Citation: Anesthesia: Essays and Researches 2018 12(1):124-129
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_195_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of prophylactic intravenous magnesium sulfate with tramadol for
           postspinal shivering in elective cesarean section: A placebo controlled
           randomized double-blind pilot study

    • Authors: Roopa Sachidananda, K Basavaraj, Safiya I Shaikh, G Umesh, Triveni Bhat, B Arpitha
      Pages: 130 - 134
      Abstract: Roopa Sachidananda, K Basavaraj, Safiya I Shaikh, G Umesh, Triveni Bhat, B Arpitha
      Anesthesia: Essays and Researches 2018 12(1):130-134
      Background and Aims: Cesarean sections are performed mostly under spinal anesthesia. Shivering is one of the distressing complications. The aim of the study was to compare the efficacy of intravenous (i.v) magnesium sulfate and tramadol with placebo (normal saline) on postspinal shivering in elective cesarean section when used as prophylaxis. Methods: One hundred and thirty-five pregnant women between 18 and 35 years age, belonging to the American Society of Anesthesiologists' physical Status II, undergoing elective cesarean section under spinal anesthesia were enrolled into the study. Patients belonging to Group C (control group, n = 45) received isotonic saline 100 mL i.v, Group T (tramadol group, n = 45) received tramadol 0.5 mg/kg in 100 mL isotonic saline i.v, whereas those in Group M (magnesium sulfate group, n = 45) received magnesium sulfate 30 mg/kg in 100 mL isotonic saline i.v after administering spinal anesthesia. Incidence and grades of shivering were noted. Data were analyzed using one-way ANOVA test and Chi-square test. Results: The incidence of shivering in Group C, Group T, and Group M were 67.5%, 43.9%, and 39%, respectively. The incidence of shivering in Group M and Group T was significantly low when compared to Group C (P = 0.008; P = 0.026), whereas there was no statistically significant difference between Groups T and M (P = 0.654). Conclusion: Magnesium sulfate and tramadol significantly reduce the incidence of shivering compared to placebo when used as prophylaxis in pregnant women undergoing cesarean section under spinal anesthesia. Magnesium sulfate reduces the severity of the shivering.
      Citation: Anesthesia: Essays and Researches 2018 12(1):130-134
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_196_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Supraclavicular brachial plexus block: Comparison of varying doses of
           nalbuphine combined with levobupivacaine: A prospective, double-blind,
           randomized trial

    • Authors: Sunil Chiruvella, Suresh Kumar Konkyana, Srinivasa Rao Nallam, Gokul Sateesh
      Pages: 135 - 139
      Abstract: Sunil Chiruvella, Suresh Kumar Konkyana, Srinivasa Rao Nallam, Gokul Sateesh
      Anesthesia: Essays and Researches 2018 12(1):135-139
      Background and Aims: The ideal dose of nalbuphine for brachial plexus block (BPB) is a matter of debate. This study was carried out to evaluate 5 mg or 10 mg of nalbuphine added to 0.375% levobupivacaine, with regard to the duration of analgesia. Our study also sought to assess the onset and duration of sensorimotor blockade, hemodynamic effects, sedation, and adverse effects. Materials and Methods: One hundred adult patients undergoing upper-limb surgeries under supraclavicular BPB were randomly allocated into two groups. Group LN5 received 29 ml of 0.375% levobupivacaine plus 5 mg of nalbuphine diluted in 1 ml of normal saline. Group LN10 received 29 ml of 0.375% levobupivacaine plus 10 mg of nalbuphine diluted in 1 ml of normal saline. Onset and duration of sensorimotor blockade, hemodynamic variables, duration of analgesia, and adverse effects were recorded. The data were analyzed with Students t-test and Chi-square test. Results: Onset of sensory block and motor block was 10.57 ± 3.5 and 17.16 ± 1.3 min, respectively, in Group LN5, while it was 8.64 ± 1.7 and 14.3 ± 1.2 min, respectively, in Group LN10. The duration of analgesia was significantly prolonged in Group LN10 compared to Group LN5 (833.55 ± 141.6 vs. 698.44 ± 138.6 min; P = 0.001). Postoperative visual analog scale value at 24 h was significantly lower in Group LN10 (P < 0.05). Conclusion: A higher dose of nalbuphine in BPB hastens the onset, and prolongs the duration of sensorimotor blockade and analgesia, without any significant side effects.
      Citation: Anesthesia: Essays and Researches 2018 12(1):135-139
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_197_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effect of C-MAC video laryngoscope-aided intubations using D-blade on
           incidence and severity of postoperative sore throat

    • Authors: Pulak Tosh, Dilesh Kadapamannil, Sunil Rajan, Naina Narayani, Lakshmi Kumar
      Pages: 140 - 144
      Abstract: Pulak Tosh, Dilesh Kadapamannil, Sunil Rajan, Naina Narayani, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):140-144
      Background: Video laryngoscope-aided intubations require less force to align oral, pharyngeal, and laryngeal planes to visualize the glottis opening during intubation. Aim: The primary objective of the study was to assess the incidence and severity of postoperative sore throat (POST) in patients who were intubated with C-MAC video laryngoscope using D-blade versus traditional Macintosh laryngoscope. Settings and Design: This prospective, randomized, open label study was conducted in a tertiary care institution. Subjects and Methods: A total of 130 patients undergoing short elective laparoscopic surgeries lasting <2 h were recruited. All patients received general anesthesia as per a standardized protocol. Laryngoscopy was performed using traditional Macintosh laryngoscope in Group M and with Storz® C-MAC video laryngoscope using D-Blade in Group V. The endotracheal tube cuff pressure was maintained at 20–22 cm of H2O intraoperatively. Statistical Analysis Used: Pearson's Chi-square test, Fisher's exact test, and Independent sample t-test were used in this study. Results: As compared to Group M, number of patients who had POST, hoarseness of voice, and cough was significantly low in Group V at 2, 6, 12, and 24 h. Severity, as well as the incidence of all these symptoms, showed a downward trend in both groups with time. Significantly more number of patients in Group M required rescue therapy for POST (44.6% as compared to 7.7%, P < 0.001). Conclusion: C-MAC video laryngoscope-aided intubations using D-blade significantly reduced the incidence and severity of POST, hoarseness of voice, and cough following orotracheal intubation as compared to use of traditional Macintosh laryngoscope.
      Citation: Anesthesia: Essays and Researches 2018 12(1):140-144
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_182_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Epidural volume extension with saline in combined spinal–epidural
           anesthesia for hip surgeries using low dose of intrathecal hyperbaric
           bupivacaine

    • Authors: Rajiv Singh Bhandari, Rohan Bhatia, Sanjay Agrawal
      Pages: 145 - 148
      Abstract: Rajiv Singh Bhandari, Rohan Bhatia, Sanjay Agrawal
      Anesthesia: Essays and Researches 2018 12(1):145-148
      Background and Aims: The aim of the study was to evaluate the effectiveness of epidural volume extension (EVE) technique in terms of sensory and motor block characteristics along with hemodynamic parameters as a part of combined spinal–epidural anesthesia (CSEA). Materials and Methods: A total of 60 patients undergoing hip surgeries were assigned to one of the two groups containing 30 patients each. Group I (the CSE–EVE group) patients were anesthetized using CSE with EVE and Group II (the CSE group) patients were anesthetized using CSE without EVE, using the same technique and low dose of intrathecal hyperbaric bupivacaine. Sensory block characteristics were recorded using pinprick method, whereas motor blockade was assessed by modified Bromage scale. Results: There was a statistically significant difference between the two groups regarding the level of maximum sensory block (P < 0.001), as Group I showed sensory block level extending to up to T4, whereas in Group II, it was limited to below T6. Time required for maximum sensory blockade was faster in Group I, ranging from 7 to 12 min (mean ± standard deviation [SD]: 9.83 ± 1.72), whereas in Group II, it ranged from 9 to 15 min (mean ± SD: 12.33 ± 1.83; P < 0.001). Two-segment regression was faster in Group II, ranging from 50 to 70 min (mean ± SD: 60.0 ± 6.30), whereas in Group I, it ranged from 80 to 105 min (mean ± SD: 89.67 ± 8.19; P < 0.001). The time required to reach the maximum motor block was faster in Group I, ranging from 2 to 4 min (mean ± SD: 2.67 ± 0.84), whereas in Group II, the time ranged from 2 to 6 min (mean ± SD: 3.50 ± 1.31; P < 0.001). Conclusion: CSEA with EVE is associated with early onset of sensory and motor blockade, high level of sensory block, and longer time of two-segment regression while maintaining hemodynamic stability due to decreased dose of intrathecal local anesthetic.
      Citation: Anesthesia: Essays and Researches 2018 12(1):145-148
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_189_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Impact of targeted preoperative optimization on clinical outcome in
           emergency abdominal surgeries: A prospective randomized trial

    • Authors: Ashish Sethi, Miltan Debbarma, Neeraj Narang, Anudeep Saxena, Mamta Mahobia, Gaurav Singh Tomar
      Pages: 149 - 154
      Abstract: Ashish Sethi, Miltan Debbarma, Neeraj Narang, Anudeep Saxena, Mamta Mahobia, Gaurav Singh Tomar
      Anesthesia: Essays and Researches 2018 12(1):149-154
      Background: Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. Aims: The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured. Settings/Design: It is a prospective, randomized, double-blind controlled study in hospital setting. Materials and Methods: One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared. Statistical Analysis: Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t-test was applied. Results: The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group (P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group (P = 0.007). Furthermore, a significant decline in death rate was noted in case group as compared to control group (P = 0.03). Conclusion: Goal-directed optimized patients with perforation peritonitis were discharged early as compared to control group with significantly lesser mortality as compared with randomly optimized patients in the perioperative period.
      Citation: Anesthesia: Essays and Researches 2018 12(1):149-154
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_190_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Does restrictive fluid strategy during robotic pelvic surgeries obtund
           intraoperative rise in intraocular pressure?

    • Authors: Pulak Tosh, Saritha Valsala Krishnankutty, Sunil Rajan, Hema Muraleedharan Nair, Nitu Puthanveettil, Lakshmi Kumar
      Pages: 155 - 158
      Abstract: Pulak Tosh, Saritha Valsala Krishnankutty, Sunil Rajan, Hema Muraleedharan Nair, Nitu Puthanveettil, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):155-158
      Background: Robotic pelvic surgeries require steep Trendelenburg position which may result in rise in intraocular pressure (IOP). Aim: The aim of this study was to compare the changes that occur in IOP during robotic pelvic surgeries in steep Trendelenburg position with a restrictive intravenous fluid administration. Settings and Design: This prospective observational study was conducted in a tertiary care institution. Subjects and Methods: Twenty consenting patients scheduled for pelvic robotic gynecological surgeries were enrolled. All patients received general anesthesia following a standardized protocol. IOP was measured before induction of anesthesia, immediately after induction and intubation, at the end of surgery immediately after making the patient supine and immediately after extubation. Ringer's lactate was administered intravenously at a rate of 4 mL/kg/h targeting a mean arterial pressure of >65 mmHg and urine output of >0.5 mL/kg/h. Statistical Analysis Used: Paired t-test was used in this study. Results: There was a fall in IOP soon after induction from baseline which was not significant. Immediately, following intubation, there was a significant rise in IOP. At the end of surgery, though IOP remained high, it was not statistically significant. However, following extubation, IOP rose further and the difference from the baseline became statistically significant. Although there was a moderate increase in peak airway pressure and highest EtCO2levels during Trendelenburg from baseline values, the differences were statistically insignificant. Conclusion: During robotic pelvic surgeries, adopting a restrictive intravenous fluid strategy with the maintenance of normal end-tidal carbon dioxide levels could abate effects of steep Trendelenburg position on IOP.
      Citation: Anesthesia: Essays and Researches 2018 12(1):155-158
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_144_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effects of intravenous and inhaled nebulized lignocaine on the hemodynamic
           

    • Authors: Abolfazl Jokar, Maryam Babaei, Sahar Pourmatin, Majid Taheri, Amir Almasi-Hashiani, Arash Yazdanbakhsh
      Pages: 159 - 164
      Abstract: Abolfazl Jokar, Maryam Babaei, Sahar Pourmatin, Majid Taheri, Amir Almasi-Hashiani, Arash Yazdanbakhsh
      Anesthesia: Essays and Researches 2018 12(1):159-164
      Background: Endotracheal intubation is one of the most common measures in the Intensive Care Unit (ICU) which plays an important role in airway management of the critically ill patients. Aims: The study aimed to evaluate the effects of lignocaine spray on hemodynamic response of endotracheal intubation patients. Settings and Design: This study is a randomized clinical trial on a study population comprising patients admitted to the ICU. Subjects and Methods: The patients were divided into three groups using a permuted block randomization. In Group 1, inhaled nebulized lignocaine 4% (75.0 mg/kg) was sprayed around the patients' epiglottis and larynx. In Group 2, intravenous (IV) lignocaine 2% (75.0/mg/kg) was injected. No lignocaine was prescribed for or administered to the control group. One and four minutes after intubation, the patients' hemodynamic and vital signs were measured. Statistical Analysis Used: Data analysis was run using Stata 13 software through repeated measure ANOVA tests. Results: Although the mean arterial blood pressure (MAP) of Group 1 (inhaled nebulized lignocaine) was smaller than that of Group 2 (IV lignocaine), there was no significant difference between the two groups. Both groups' MAPs were significantly different from that of the control group. As for the average number of pulses, a significant difference was observed between the inhaled and IV lignocaine groups; hence, the average number of pulses in Group 1 (inhalation) was lower than that of Group 2 (IV injection). Conclusion: As blood pressure is considered to be normal under 140/90 and may not entail any hemodynamic complications, it can be concluded that inhaled nebulized lignocaine can control the hemodynamic changes of intubation more effectively than IV lignocaine.
      Citation: Anesthesia: Essays and Researches 2018 12(1):159-164
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_75_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Hemodynamic, airway pressure, and capnometric changes and perioperative
           outcome in pediatric laparoscopic inguinal herniorrhaphy: A comparison
           with open inguinal herniorrhaphy

    • Authors: Jyoti Garg, Suniti Kale, Nikki Sabharwal, Deepak Bagga, Anoop Raj Gogia
      Pages: 165 - 169
      Abstract: Jyoti Garg, Suniti Kale, Nikki Sabharwal, Deepak Bagga, Anoop Raj Gogia
      Anesthesia: Essays and Researches 2018 12(1):165-169
      Background: Laparoscopic procedures which are now established in pediatric population as well exposes the child to supplemental cardiorespiratory changes due to increase in intraabdominal pressure (IAP) and hypercarbia. Aims: This study aims to analyze the effects of pneumoperitoneum and postural modifications on cardiorespiratory system (primary outcome) during pediatric laparoscopic herniorrhaphy (LH) and its comparison with open herniorrhaphy (OH) and assessment of overall perioperative outcome (secondary outcome). Settings and Design: A prospective, observational study conducted in a tertiary care hospital. Materials and Methods: Fifty children undergoing either LH (n = 25) or OH (n = 25) were included in the study. Anesthetic procedure was standardized. Parameters monitored were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressures (MAP), electrocardiogram lead-II, end-tidal CO2(ETCO2), airway pressures PPeak, PPlateau, PMean, pulse oximetry, IAP, minute ventilation/respiratory rate alterations. Statistical Analysis Used: Student's t-test and Chi-square test were applied to compare different variables between the two groups. Intragroup analysis was done using the analysis of variance test. Results: The HR was comparable in both groups. The rise in SBP, DBP, and MAP was 9% (102.88 ± 6.91–121.32 ± 6.63), 19% (60.88 ± 4.94–77.00 ± 9.75), and 14.8% (73.92 ± 4.65–90.40 ± 8.42), respectively, in group LH. The rise in peak, plateau, and mean airway pressures was 19.4% (14.20 ± 2.00–18.00 ± 2.54), 20.1% (13.32 ± 1.89–16.89 ± 2.60), and 16.1% (6.20 ± 1.00–7.47 ± 0.96), respectively, in group LH. ETCO2showed a maximum rise of 19.4% (34.52 ± 3.61–41.21 ± 3.99) in group LH. In laparoscopic group, recurrence was seen in 3 patients. Conclusions: We found significant hemodynamic, airway pressure, and capnometric changes during pediatric LH with comparable perioperative outcome among the two groups.
      Citation: Anesthesia: Essays and Researches 2018 12(1):165-169
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_112_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of intranasal dexmedetomidine compared to midazolam as a
           premedication in pediatrics with congenital heart disease undergoing
           cardiac catheterization

    • Authors: Medhat M Messeha, Gamal Zakaria El-Morsy
      Pages: 170 - 175
      Abstract: Medhat M Messeha, Gamal Zakaria El-Morsy
      Anesthesia: Essays and Researches 2018 12(1):170-175
      Background: The intranasal route is a reliable way to administer preanesthetics and sedatives to children. The aim of this study was to compare the anxiolytic and sedative effect of intranasal dexmedetomidine and midazolam as a premedication in pediatrics with simple congenital heart disease undergoing cardiac catheterization. Patients and Methods: Sixty children 3–6 years old of either sex with simple congenital heart disease undergoing cardiac catheterization were randomly allocated into two groups: Dexmedetomidine group who received intranasal dexmedetomidine (0.1 μg/kg) and midazolam group who received intranasal midazolam (0.2 mg/kg) 30 min before induction. Heart rate, mean arterial blood pressure, and oxygen saturation were monitored up to 30 min after drug administration. The sedation score, anxiety score, and child-parent separation score were recorded until the child taken to the operating room. The postoperative agitation score was also observed. Results and Conclusion: The premedication of children with intranasal dexmedetomidine attained satisfactory and significant sedation and lower anxiety level with better parental separation than those who received intranasal midazolam.
      Citation: Anesthesia: Essays and Researches 2018 12(1):170-175
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_119_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of dexamethasone and buprenorphine as adjuvant in
           ultrasound-guided brachial plexus blocks: A randomized controlled trial

    • Authors: Prasanna Vadhanan, Narendren Ganesh, M I Hussain Ahmed
      Pages: 176 - 179
      Abstract: Prasanna Vadhanan, Narendren Ganesh, M I Hussain Ahmed
      Anesthesia: Essays and Researches 2018 12(1):176-179
      Introduction: Effective postoperative analgesia is imperative for orthopedic surgeries to enhance recovery and facilitate early ambulation. Various additives have been used as adjuvants with local anesthetics in peripheral nerve blocks to provide postoperative analgesia. The aim of this study is to compare the duration of postoperative analgesia with buprenorphine and dexamethasone when administered as an adjuvant during ultrasound-guided brachial plexus blocks. Methodology: Sixty adult patients undergoing various upper arm surgeries were recruited for the study after acquiring ethics committee clearance. They were randomized into two groups of thirty; Group B was given ultrasound-guided supraclavicular block with 10 ml 2% lignocaine with adrenaline and 15 ml 0.5% bupivacaine and 4 mg dexamethasone as adjuvant. Group B was given the same amount of local anesthetics with 0.3 mg buprenorphine as the adjuvant. The duration of postoperative analgesia and incidence of adverse events if any were noted. Results: Both groups were comparable in demographics, time for onset of sensory, and motor block. The duration of postoperative analgesia was 17.4 ± 3.4 h in the buprenorphine group and 18 ± 3.49 h in the dexamethasone group. None of the patients had significant adverse effects. A single dose of buprenorphine and dexamethasone administered perineurally can provide significant postoperative analgesia for upper limb surgeries.
      Citation: Anesthesia: Essays and Researches 2018 12(1):176-179
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_129_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Attenuation of hemodynamic response to tracheal extubation: A comparative
           study between esmolol and labetalol

    • Authors: HS Prajwal Patel, MR Shashank, BT Shivaramu
      Pages: 180 - 185
      Abstract: HS Prajwal Patel, MR Shashank, BT Shivaramu
      Anesthesia: Essays and Researches 2018 12(1):180-185
      Background and Aims: Cardiovascular stress response to extubation can result in elevated heart rate (HR) and mean arterial blood pressures which can be detrimental in high-risk patients. Settings and Design: The objective of this study is to compare the esmolol and labetalol efficacy in attenuating hemodynamic response to tracheal extubation. Materials and Methods: Sixty patients scheduled for elective surgical procedures were selected randomly and divided into two groups of thirty each. Group I - esmolol 1.5 mg/kg and Group II - labetalol 0.25 mg/kg were administered 2 min before extubation after following a standard perioperative anesthetic management. Hemodynamic parameters recorded include HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) at baseline, reversal, study drug, 1 min after study drug, extubation, and at 1, 2, 3, 4, 5, and 15 min postextubation. Statistical Analysis: Student's t-test and analysis of variance have been used to find the significance of study parameters between groups of patients. P <0.05 was considered statistically significant. Results: Both esmolol and labetalol obtunded extubation response throughout the extubation and postextubation period. At extubation and immediately postextubation at 1st and 2nd min, there was statistical significance (P < 0.05) in SBP, DBP, and MAP which showed esmolol was better than labetalol. Whereas labetalol was more efficient in controlling HR at 5th and 15th min postextubation having statistical significance. Conclusions: Both esmolol and labetalol attenuated hemodynamic response. Esmolol was more efficient than labetalol at extubation and immediately postextubation. If patient has tachycardia at extubation, labetalol is preferred. If patient has raised blood pressure, then esmolol is a good option in blunting the response.
      Citation: Anesthesia: Essays and Researches 2018 12(1):180-185
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_130_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Incidence of postspinal headache and low backache following the median and
           paramedian approaches in spinal anesthesia

    • Authors: Balwinderjit Singh, Amartej Singh Sohal, Iqbal Singh, Subash Goyal, Prabhjot Kaur, Joginder Pal Attri
      Pages: 186 - 189
      Abstract: Balwinderjit Singh, Amartej Singh Sohal, Iqbal Singh, Subash Goyal, Prabhjot Kaur, Joginder Pal Attri
      Anesthesia: Essays and Researches 2018 12(1):186-189
      Background and Aims: Postspinal headache and low backache are common complaints following spinal anesthesia which regresses spontaneously but sometimes becomes very troublesome for the patient as well as for the anesthesiologists. The aim of this study was to evaluate the incidence of postspinal headache and low backache after spinal anesthesia in lower abdominal surgery. Materials and Methods: One hundred patients of 18–60 years of age group with patients physical status the American Society of Anesthesiologists Class I or II after due consent divided into equal numbers of two groups: median (M) approach and paramedian (P) approach scheduled for lower abdominal surgery. Group M (50 patients) received spinal by median approach while in Group P (50 patients) received spinal by paramedian approach. The incidence of postspinal headache and low backache was observed in each group. All the patients were observed up to 7 days postoperatively. Data collected was analyzed statistically by SPSS (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) and Chi-square test, and P < 0.05 considered as statistically significant. Results: Postspinal headache was observed to be 4% in paramedian approach and 20% in median approach group. Backache incidence recorded in both the groups was 2% and 10%, respectively. P value calculated statistically was < 0.05 and hence statistically significant in paramedian approach in respect of incidence of both postspinal headache and backache. Conclusion: Incidence of postspinal headache and low backache is less in paramedian approach than in median approach.
      Citation: Anesthesia: Essays and Researches 2018 12(1):186-189
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_139_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of intravenous bolus and infusion of dexmedetomidine on
           characteristics of subarachnoid block

    • Authors: Tripti Vatsalya, Chandrakant Waikar, Madhurima Singh
      Pages: 190 - 193
      Abstract: Tripti Vatsalya, Chandrakant Waikar, Madhurima Singh
      Anesthesia: Essays and Researches 2018 12(1):190-193
      Aims: Dexmedetomidine is very dynamic drug, used for analgesia, sedation, blunting the laryngoscopic responses and as adjuvants in regional anesthesia. Studies have shown that intravenous (iv) dexmedetomidine given during spinal anesthesia increases the quality of subarachnoid block (SAB). In this study, we compare the two iv regimen of dexmedetomidine on analgesic effect of spinal anesthesia. One is bolus dose of dexmedetomidine and other is infusion during the surgery, both given after induction of spinal anesthesia. Subjects and Methods: Sixty American Society of Anesthesiologists I and II patients scheduled to undergo surgeries under SAB were randomly allocated into two groups namely B and I. After SAB with 3.0 ml of bupivacaine 0.5% heavy, Group B received 0.5 μg/kg of dexmedetomidine bolus over 15 min, Group I received 0.5 μg/kg/h of dexmedetomidine infusion until the end of surgery. Statistical Analysis Used: All parametric data were statistically analyzed using Student's t-test and nonparametric data analyzed using Chi-square test and Fischer exact test as appropriate. P < 0.05 was considered as statistically significant. Statistical analysis was performed using the SPSS. Results: Time to reach desired level T10was quick in Group B compared to Group I. Regression of sensory and motor was prolonged in Group I compared to Group B. Total duration of analgesia was significantly prolonged in Group I 230.39 ± 16.20 compared to Group B 196.01 ± 14.32 and the difference is statistically significant (P = 0.0001). Both groups had Ramsay sedation score of 3 which lasted for 45 min in Group B while it was maintained in Group I. Side effects profile of both groups was comparable with few incidence of bradycardia and hypotension in both groups requiring treatment. Conclusions: We conclude that the continuous infusion of dexmedetomidine after SAB results in prolonged analgesia than just a bolus dose. Therefore, we suggest use of the maintenance dose of iv dexmedetomidine after SAB for prolonging the duration and achieving adequate sedation
      Citation: Anesthesia: Essays and Researches 2018 12(1):190-193
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_111_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Ease of intubation with C-MAC videolaryngoscope: Use of 60° angled
           styletted endotracheal tube versus intubation over bougie

    • Authors: Pulak Tosh, Sunil Rajan, Lakshmi Kumar
      Pages: 194 - 198
      Abstract: Pulak Tosh, Sunil Rajan, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):194-198
      Background: Although videolaryngoscopes improve glottic visualization, their actual usefulness in intubation is not yet established. Aims: The primary objective was to compare the ease of oral intubation with the use of 60° angled styletted endotracheal tube versus that performed over bougie inserted under videolaryngoscopic guidance. The secondary objectives were assessment of incidence of airway loss, hemodynamic changes, and time and number of attempts at intubation. Settings and Design: This prospective randomized study was conducted in a tertiary care institution. Patients and Methods: Seventy surgical patients requiring oral intubation were randomly allotted to Group S or Group B. Laryngoscopy was performed with Storz® C-MAC videolaryngoscope using D-Blade. In Group S, patients were intubated with a 60° angled stylletted endotracheal tube. In Group B, a bougie was introduced into the trachea and endotracheal tube was railroaded over the bougie. Statistical Analysis Used: Chi-square test and independent sample t-test were used as applicable. Results: The ease of intubation was significantly more in patients of Group S as compared to Group B (88.6% vs. 25.7%, respectively, P < 0.001) with significantly shorter intubation time (16.97 ± 7.91 vs. 77.43 ± 35.55 s, respectively, P < 0.001). The requirement of more than one attempt at intubation was significantly higher in Group B [57.1% vs. 5.7% P < 0.001, respectively]. Group B showed a significantly high mean arterial pressure at 1 and 3 min following intubation with no significant change in heart rate. Conclusion: Use of 60° angled styletted endotracheal tube resulted in easier and faster intubation as compared to intubation over a bougie when used with C-MAC videolaryngoscope.
      Citation: Anesthesia: Essays and Researches 2018 12(1):194-198
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_121_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Predictors and outcomes of postoperative pulmonary complications following
           abdominal surgery in a South Indian population

    • Authors: Lakshmi Kumar, Keerthi N Satheesan, Sunil Rajan, Bindu K Vasu, Jerry Paul
      Pages: 199 - 205
      Abstract: Lakshmi Kumar, Keerthi N Satheesan, Sunil Rajan, Bindu K Vasu, Jerry Paul
      Anesthesia: Essays and Researches 2018 12(1):199-205
      Background: Postoperative pulmonary complications (PPC) following abdominal surgery are associated with increased morbidity and poorer outcomes. We prospectively examined risk factors associated with the development of PPC in patients undergoing abdominal surgery. Aims: The primary outcome was to determine the association of predefined risk factors in the prediction of PPC after abdominal surgery. Secondary outcomes were evaluation of outcomes of PPC. Setting and Design: This was a prospective study conducted in the gastrosurgical and urological units of a tertiary care referral hospital in patients undergoing abdominal surgery over a period of 6 months (November 2015–April 2016). Materials and Methods: Relevant preoperative and intraoperative variables were recorded by the anesthesiologist in a pro forma provided. Postoperatively, data from the Intensive Care Unit (ICU) were collected from data sheets. PPC were defined according to preset criteria and outcomes of the patients including ICU stay, hospital stay, and mortality were noted. Statistical Analysis: Chi-square test was used to find the association of risk factors of PPC. Mann–Whitney test was used for continuous variables and McNemar's test for postoperative respiratory variables. A final regression analysis was performed with factors with significant association (P < 0.1) Results: One hundred and fifty patients were included, and 24 patients (16%) developed PPC as defined by our criteria. Emergency surgery (44.4% of PPC) and cardiac comorbidity (23.9% of PPC) were significant associations for pulmonary complications. The length of ICU and hospital stay (LOICU, LOHS) and mortality were higher in the group with pulmonary complications (P < 0.001). Conclusions: Emergent surgery and cardiac comorbidities were independent predictors for the development of PPC. PPC are associated with increased LOHS, LOICU stay, and mortality.
      Citation: Anesthesia: Essays and Researches 2018 12(1):199-205
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_69_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Pressure-controlled volume guaranteed mode improves respiratory dynamics
           

    • Authors: Apoorwa Kothari, Deepa Baskaran
      Pages: 206 - 212
      Abstract: Apoorwa Kothari, Deepa Baskaran
      Anesthesia: Essays and Researches 2018 12(1):206-212
      Background: Pneumoperitoneum and altered positioning 1in laparoscopic cholecystectomy predispose to alterations in cardiorespiratory physiology. We compared the effects of volume controlled, pressure controlled, and the newly introduced pressure controlled-volume guaranteed ventilation (PCV-VG) modes of ventilation on respiratory mechanics and oxygenation during laparoscopic cholecystectomy. Materials and Methods: Seventy-five physical status American Society of Anesthesiologists Classes I and II patients with normal lungs undergoing laparoscopic cholecystectomy were randomly allocated to receive volume controlled ventilation (VCV), pressure-controlled ventilation (PCV), or PCV-VG modes of ventilation during general anesthesia. In all modes of ventilation, the tidal volume was set at 8 mL/kg, and respiratory rate was set at 12 breaths/min with inspired oxygen of 0.4. After pneumoperitoneum, respiratory rate was adjusted to maintain an end-tidal carbon dioxide between 32 and 37 mm Hg. The peak airway pressures, compliance, the mean airway pressures, oxygen saturation, end tidal carbon dioxide and hemodynamics were recorded at the time of intubation (T1), 15 min after pneumoperitoneum (T2) and after desufflation (T3) and were compared.. Arterial oxygen tension, arterial carbon dioxide tension at T2 and T3 were compared. Results: PCV-VG and PCV mode resulted in lower peak airway pressures than VCV (23.04 ± 3.43, 24.52 ± 2.79, and 27.24 ± 2.37 cm of water, respectively, P = 0.001). Compliance was better preserved in the pressure mediated modes than VCV (fall from baseline was 42%, 29%, and 30% in VCV, PCV, and PCV-VG). The arterial to end-tidal carbon dioxide gradient was lower in PCV-VG and PCV compared to VCV. No difference in oxygenation and hemodynamics were observed. Conclusion: PCV and PCV-VG modes are superior to VCV mode in providing adequate oxygenation at lower peak inspiratory pressures.
      Citation: Anesthesia: Essays and Researches 2018 12(1):206-212
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_96_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Evaluation of the hemodynamic response of intravenous clonidine versus
           ropivacaine scalp block to insertion of scalp pins in neurosurgical
           patients

    • Authors: Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
      Pages: 213 - 217
      Abstract: Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
      Anesthesia: Essays and Researches 2018 12(1):213-217
      Background: The application of the skull-pin head-holder, used to stabilize the head during neurosurgical procedures, produces an intense nociceptive stimulus and results in abrupt increases in blood pressure and cerebral blood flow under general anesthesia. Different anesthetic and pharmacologic techniques, including local anesthetics, narcotics, antihypertensives, and deepening of anesthesia with inhalation anesthetics, have been used to blunt this deleterious effect with variable success. Aim: To compare the analgesic and hemodynamic effects of ropivacaine scalp block, and intravenous (IV) clonidine in attenuating the hemodynamic response to the scalp pin insertion in neurosurgical patients. Settings and Design: A comparative two group's clinical study of 64 patients undergoing elective craniotomy in Department of Anaesthesiology, Bangalore Medical College and Research Institute. Methodology: Sixty-four patients were allocated into any one of two groups of 32 patients each, by means of computer-generated randomization: (1) Group S: Patients receiving scalp block with injected ropivacaine 0.25% 30 ml. (2) Group C: Patients receiving 2 μg/kg IV clonidine. Statistical Methods: Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean ± standard deviation (minimum–maximum) and results on categorical measurements are presented in number (%). Significance is assessed at 5% level of significance. Results: Increase in heart rate and blood pressure during pin insertion was attenuated by clonidine hydrochloride (P < 0.001). The number of patients who required more fentanyl and propofol to stabilize the hypertensive response were more in control group than clonidine group. Conclusion: IV clonidine maximally attenuated the hemodynamic response to application of head pins in a dose of 2 μg/kg compared to ropivacaine scalp block, thus maintaining intracranial pressure for neurosurgical anesthesia.
      Citation: Anesthesia: Essays and Researches 2018 12(1):213-217
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/0259-1162.194572
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparative study of efficacy of preoperative nalbuphine hydrochloride and
           pentazocine lactate on hemodynamic response to tracheal intubation and
           postoperative analgesia

    • Authors: Namrata Natraj Sadafule, Seema Shripad Karhade
      Pages: 218 - 222
      Abstract: Namrata Natraj Sadafule, Seema Shripad Karhade
      Anesthesia: Essays and Researches 2018 12(1):218-222
      Background: For General anaesthesia perioperative administration of opioids are choice of drugs to attenuate intubation response and to provide good intraoperative and postoperative analgesia. Mixed agonist-antagonist opioids produces powerful analgesia without undesirable side effects. Aim: Aim of present study to compare efficacy of Nalbuphine and Pentazocine on hemodynamic response to tracheal intubation and postoperative analgesia. Settings: Present study carried out in operation theater. Design: This is prospective randomized double blind controlled trial. Material and Methods: Patients of ASA physical status I and II, age 20-60 years undergoing abdominal surgical procedure of 1-2 hour duration were randomly divided into two groups of 30 patients each (Group N) receiving nalbuphine 0.3 mg.kg-1 and (Group P) receiving pentazocine 0.6 mg.kg-1 intravenously before induction. Baseline vital parameters were noted and then noted till 15 minutes after intubation to see hemodynamic response. Time of rescue analgesia required was noted postoperatively. Stastical Analysis: Chi-square test, paired and unpaired t-test were used for statistical analysis. Results: There is rise in heart rate, blood pressure after intubation in both groups but rise was more with Pentazocine as compared to Nalbuphine (P < 0.05). Postoperatively within 30 minutes 60% of patient from Pentazocine group require rescue analgesia compare to only 16.60% of patient of Nalbuphine group (P = 0.05) which is highly significant. Conclusion: Nalbuphine is potent mixed opioid analgesic which can be used for attenuation of pressor response of tracheal intubation and for perioperative analgesia with minimal side effects.
      Citation: Anesthesia: Essays and Researches 2018 12(1):218-222
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_168_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Postoperative cardiac surgery outcomes in a statin-native population

    • Authors: Sameh Aboulnaga, Ahmed Mahfouz, Hesham A Ewila, Alejandro Kohn Tuli, Rajvir Singh, Amr S Omar, Abdulaziz Al Khualifi
      Pages: 223 - 228
      Abstract: Sameh Aboulnaga, Ahmed Mahfouz, Hesham A Ewila, Alejandro Kohn Tuli, Rajvir Singh, Amr S Omar, Abdulaziz Al Khualifi
      Anesthesia: Essays and Researches 2018 12(1):223-228
      Background: Statin utilization had been associated with improved survival after cardiac surgery. We aim to study whether perioperative treatment with statin could be associated with increased postoperative complications. Design: This was a retrospective, descriptive, single-center study. Settings: We analyzed morbidity after cardiac surgery as well as the outcome related to statin therapy in a tertiary cardiac center. Patients: A total of 202 consecutive patients were enrolled over 1 year after cardiac surgery. Intervention: Patients were divided into two groups; Group I – statin users and Group II – nonusers. Measurements: Measurements were baseline and follow-up laboratory markers for muscular injury including cardiac muscle and hepatic injuries and renal injuries. Results: The incidence of rhabdomyolysis and elevation of liver enzymes did not differ between both groups. Postoperative atrial fibrillation was significantly lower in the statin group (P = 0.02). In addition, peak cardiac troponin and creatine kinase-MB did not differ significantly in the statin group. Statin-treated group had significant lower length of mechanical ventilation, and length of stay in the Intensive Care Unit and hospital (P = 0.036, 0.04, and 0.027, respectively). Conclusions: Therapy with statin before cardiac surgeries was not associated with high incidence of adverse events.
      Citation: Anesthesia: Essays and Researches 2018 12(1):223-228
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_229_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effects of preoxygenation with tidal volume breathing followed by apneic
           oxygenation with and without continuous positive airway pressure on
           duration of safe apnea time and arterial blood gases

    • Authors: Sunil Rajan, Nandhini Joseph, Pulak Tosh, Jerry Paul, Lakshmi Kumar
      Pages: 229 - 233
      Abstract: Sunil Rajan, Nandhini Joseph, Pulak Tosh, Jerry Paul, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):229-233
      Background: Application of continuous positive airway pressure (CPAP) helps to recruit collapsed areas of the lung, which improves the oxygen reserve. Aim of the Study: To compare the time to desaturate to 90% during apnea following preoxygenation and apneic ventilation with tidal volume breathing for 3 min with and without the application of CPAP. Settings and Design: This prospective randomized study was conducted in a tertiary care institution. Subjects and Methods: Twenty adult surgical patients were allocated into two groups. Group C patients were preoxygenated with 100% oxygen with CPAP of 20 cm H2O for 3 min. Group P patients were preoxygenated for 3 min without CPAP. In Group C, apneic oxygenation was initiated following induction and neuromuscular blockade with CPAP of 20 cm H2O. In Group P, no CPAP was applied. The study was terminated when the patient desaturated to 90%. Statistical Analysis Used: Chi-square test and Mann–Whitney test. Results: Group C had a significantly longer apnea time as compared to Group P (816.00 ± 30.98 vs. 348.00 ± 122.64 s). Three patients in Group P desaturated to <90% by 3 min and the remaining soon after 6 min. No patient in Group C desaturated till 12 min of apnea. PaO2was significantly higher in Group C at 3 and 6 min of apnea. At 3 and 6 min, Group P had significantly lower saturation as compared to Group C. Conclusion: Preoxygenation with CPAP significantly delayed desaturation during apnea with significantly higher arterial partial pressure of oxygen as compared to preoxygenation without CPAP.
      Citation: Anesthesia: Essays and Researches 2018 12(1):229-233
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_219_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Effect of dexamethasone on characteristics of supraclavicular nerve block
           with bupivacaine and ropivacaine: A prospective, double-blind, randomized
           control trial

    • Authors: Deeksha Bindal, Neeraj Narang, Rekha Mahindra, Himanshu Gupta, Jyotsna Kubre, Anudeep Saxena
      Pages: 234 - 239
      Abstract: Deeksha Bindal, Neeraj Narang, Rekha Mahindra, Himanshu Gupta, Jyotsna Kubre, Anudeep Saxena
      Anesthesia: Essays and Researches 2018 12(1):234-239
      Background: Dexamethasone as an adjuvant to bupivacaine and ropivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, comparison of effect of dexamethasone (8 mg) when added to these two local anesthetics has not been well studied. This study was conducted to compare analgesic efficacy of dexamethasone as adjuvant to bupivacaine and ropivacaine in SCBP block. Subjects and Methods: Nerve stimulator-guided SCBP block was given to 120 patients, randomly assigned to one of four groups: (n = 30 in each group) Group B, BD, R, and RD received 30 ml (0.5%) bupivacaine + 2 ml saline, 30 ml (0.5%) bupivacaine + dexamethasone 8 mg, 30 ml (0.5%) ropivacaine + 2 ml saline, and 30 ml (0.5%) ropivacaine + dexamethasone 8 mg, respectively. Time for request of the first rescue analgesic, 24-h analgesic consumption, and different block characteristics were assessed. Student's t-test, Chi-square test, ANOVA were used for statistical analysis. Results: Dexamethasone significantly prolonged time for request of the first rescue analgesic of both ropivacaine (1211.83 ± 32.86 vs. 283.17 ± 7.71 min){ p R, RD < 0.001} and bupivacaine (1205.17 ± 34.32 vs. 364.67 ± 16.50 min) {p B, BD < 0.001}. 24-h requirement for rescue analgesics was more in Groups B and R when compared to Groups BD and RD. The increase in duration of analgesia was more when Groups R and RD (928.66 min) were compared than Groups B and BD (840.5 min). Similar results were seen with onset times and duration of sensory and motor block. Conclusion: The addition of dexamethasone to bupivacaine and ropivacaine in SCBP block prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block, with the effect being stronger with ropivacaine.
      Citation: Anesthesia: Essays and Researches 2018 12(1):234-239
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_2_18
      Issue No: Vol. 12, No. 1 (2018)
       
  • Clonidine as an adjuvant to caudal epidural ropivacaine for lumbosacral
           spine surgeries

    • Authors: Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
      Pages: 240 - 245
      Abstract: Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
      Anesthesia: Essays and Researches 2018 12(1):240-245
      Background: Caudal epidural analgesia is a proven technique for providing analgesia for spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilization. Objective: The objective of this study is to compare the effect of adding 1 μg/kg of clonidine to injection ropivacaine 0.2% with respect to duration of analgesia, hemodynamic effects, and associated side effects. Methodology: In this prospective double-blind study, a total of 60 patients undergoing lumbosacral spine surgery were randomized to receive 25 cc caudal epidural injection of either injection ropivacaine 0.2% (Group R, n = 30) or a mixture of injection ropivacaine 0.2% and injection clonidine 1 μg/kg (Group RD, n = 30) under general anesthesia after the patient was positioned prone for surgery. Visual analog scale (VAS) scores, heart rate, blood pressures, and time to rescue analgesia and sedation score were recorded at regular intervals for the first 24 h. Results: Mean VAS scores were significantly lower in the RC Group for up to 12 h following the caudal block. The time to first rescue analgesic was prolonged in the RC group compared to the R Group, and it was statistically significant. No clinically significant hemodynamic changes were noted in either of the groups. No other side effects were seen in both the groups. Conclusion: These results suggest that injection clonidine is an effective additive to injection ropivacaine for caudal epidural analgesia in lumbosacral spine surgeries.
      Citation: Anesthesia: Essays and Researches 2018 12(1):240-245
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_215_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of arterial oxygenation and acid-base balance with the use of
           transnasal humidified rapid-insufflation ventilatory exchange versus tidal
           volume breathing with continuous positive airway pressure for
           preoxygenation and apneic ventilation

    • Authors: Nandhini Joseph, Sunil Rajan, Pulak Tosh, Dilesh Kadapamannil, Lakshmi Kumar
      Pages: 246 - 250
      Abstract: Nandhini Joseph, Sunil Rajan, Pulak Tosh, Dilesh Kadapamannil, Lakshmi Kumar
      Anesthesia: Essays and Researches 2018 12(1):246-250
      Background: Preoxygenation and apneic ventilation prolong apnea time without desaturation. Aims: The primary objective of this study is to compare arterial oxygenation during the periods of apnea following preoxygenation and apneic ventilation with tidal volume breathing for 3 min with continuous positive airway pressure (CPAP) versus with transnasal humidified rapid-insufflation ventilatory exchange (THRIVE). Settings and Designs: This prospective randomized study was conducted in 20 adult patients at a tertiary care institution. Subjects and Methods: Group C patients (n = 10) were preoxygenated with 100% oxygen using a face mask at a rate of 6 L/min for 3 min with CPAP of 15 cm of H2O. In Group H, oxygen was administered using THRIVE at 30 L/min for 3 min. Apneic ventilation was given in Group C with 10 L/min oxygen with CPAP of 15 cm H2O and in Group H with THRIVE at 60 L/min. The endpoint was desaturation to 90% or maximum duration of 12 min. Statistical Analysis Used: Chi-square test and Mann–Whitney test. Results: Both groups tolerated apnea for 12 min without desaturation. PaO2in Group C was significantly higher than Group H from 3 min of apnea to 12 min. The PaCO2was significantly lower in Group C from 6 min. The pH was comparable in both groups except at 12 min with Group H having significantly lower pH. Conclusion: Tidal volume breathing with CPAP resulted in significantly higher arterial oxygen levels than THRIVE, though both modalities were equally effective in prolonging apnea time without desaturation up to 12 min. Group C showed an added advantage of lower PaCO2with less acidemia.
      Citation: Anesthesia: Essays and Researches 2018 12(1):246-250
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_13_18
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in
           infraumbilical surgeries under spinal anesthesia

    • Authors: Amar Parkash Kataria, Vishal Jarewal, Rajan Kumar, Ankush Kashyap
      Pages: 251 - 255
      Abstract: Amar Parkash Kataria, Vishal Jarewal, Rajan Kumar, Ankush Kashyap
      Anesthesia: Essays and Researches 2018 12(1):251-255
      Introduction: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h. Materials and Methods: A prospective, randomized study was carried out which included 60 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability. Results: The mean duration of sensory block in Group L was 199.50 ± 7.96 min while in Group LD was 340.20 ± 11.78 min. All the differences were statistically highly significant between the two groups (P < 0.001). Mean duration of motor block in Group L and LD was 150.83 ± 9.17 min and 190.20 ± 9.61 min, respectively. Both the differences were highly significant (P < 0.001). Conclusion: It is concluded that Group LD has early-onset and prolonged duration of sensory and motor block and longer duration of postoperative analgesia than Group L.
      Citation: Anesthesia: Essays and Researches 2018 12(1):251-255
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_227_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Magnesium sulfate as a preemptive adjuvant to levobupivacaine for
           postoperative analgesia in lower abdominal and pelvic surgeries under
           epidural anesthesia (randomized controlled trial)

    • Authors: Heba Omar
      Pages: 256 - 261
      Abstract: Heba Omar
      Anesthesia: Essays and Researches 2018 12(1):256-261
      Background: Magnesium (Mg) has been evaluated as an adjuvant to local anesthetics for prolongation of postoperative epidural and intrathecal analgesia but not with epidural levobupivacaine in lower abdominal surgeries. Aim of the Study: The aim of the study was to evaluate the preemptive analgesic effect of Mg added to epidural levobupivacaine anesthesia in infraumbilical abdominal surgeries. Settings and Design: This study design was a prospective randomized controlled trial. Patients and Methods: Two groups, each with fifty patients undergoing lower abdominal and pelvic surgeries with epidural anesthesia. Group M received 15 ml of a mixture of 14 ml levobupivacaine 0.5%, 0.5 ml magnesium sulfate 10% (50 mg), and 0.5 ml 0.9 NaCl at induction. Group L received 15 ml of 14 ml levobupivacaine 0.5% and 1 ml 0.9 NaCl at induction. Then, continuous infusion was used as 5 ml/h of the specific mixture of each group till the end of the surgery. Statistical Analysis: Chi-square test, unpaired t-test or Mann–Whitney, and Wilcoxon sign rank test were used. Results: No statistically significant difference between the two groups regarding intraoperative hemodynamics (P > 0.05). Sensory and motor block onset was significantly shorter in Group M (14.5 [±1.51] and 12.42 [±1.69]) compared to Group L (19.86 [±1.39] and 19.34 [±1.62]) (P = 0.001). Group M showed lower visual analog scale (VAS) pain score compared to Group L from the 2nd to the 5th h postoperatively. Time for first analgesic dose was longer in Group M (294.98 [±21.67]) compared to Group L (153.96 [±10.04]) (P = 0.001). Conclusions: Preoperative and intraoperative epidural Mg infusion with levobupivacaine resulted in prolonged postoperative analgesia and lower VAS.
      Citation: Anesthesia: Essays and Researches 2018 12(1):256-261
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_194_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Comparison of esmolol and dexmedetomidine for suppression of hemodynamic
           response to laryngoscopy and endotracheal intubation in adult patients
           undergoing elective general surgery: A prospective, randomized controlled
           double-blinded study

    • Authors: Sandeep Sharma, Om Prakash Suthar, ML Tak, Abhilasha Thanvi, Naveen Paliwal, Rakesh Karnawat
      Pages: 262 - 266
      Abstract: Sandeep Sharma, Om Prakash Suthar, ML Tak, Abhilasha Thanvi, Naveen Paliwal, Rakesh Karnawat
      Anesthesia: Essays and Researches 2018 12(1):262-266
      Context: Laryngoscopy and endotracheal intubation lead to strong sympathetic response which may precipitate arrhythmias, myocardial ischemia and cerebrovascular accidents in patients with preexisting cardiovascular disease. Aims: This study was aimed to compare the effect of dexmedetomidine and esmolol on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery under general anesthesia. Settings and Design: This was a prospective, randomized controlled double-blinded study. Materials and Methods: A total of ninety patients were selected and randomized into three groups of thirty patients each: Group C received infusion of 20 mL 0.9% normal saline (NS) over 10 min, Group D received infusion of dexmedetomidine 1 μg/kg diluted in 20 mL NS over 10 min, and Group E received infusion of esmolol 1.5 mg/kg diluted in 20 mL NS over 10 min. Three minutes after the completion of infusion, patients were induced with general anesthesia. Baseline parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and rate pressure product (RPP) were recorded before administration of study drugs and at 1, 3, 5, 7, and 10 min after intubation. Statistical Analysis Used: One-way ANOVA was used for comparison among the groups and unpaired t-test was used for comparison within the groups along with Tukey's test for post test analysis. Results: Mean HR, SBP, DBP, MAP, and RPP values remained significantly lower in Group D than that of Group C and Group E at all time intervals up to 10 min after intubation. Conclusions: Both dexmedetomidine and esmolol suppressed the hemodynamic response to intubation when compared to control group, but dexmedetomidine is more effective than esmolol in maintaining hemodynamic stability following laryngoscopy and intubation.
      Citation: Anesthesia: Essays and Researches 2018 12(1):262-266
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_226_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • An unusual case of a parturient with uncorrected pentalogy of Fallot
           presenting for elective cesarean section delivery of twins

    • Authors: Ying Ci Ho, Sek Koon Boey, Abey Matthew Varughese Mathews, Hooi Geok See, Nian Chih Hwang
      Pages: 267 - 270
      Abstract: Ying Ci Ho, Sek Koon Boey, Abey Matthew Varughese Mathews, Hooi Geok See, Nian Chih Hwang
      Anesthesia: Essays and Researches 2018 12(1):267-270
      We present a 31-year-old primigravida with uncorrected pentalogy of Fallot, pregnant with monochorionic-diamniotic twins, undergoing elective lower segment cesarean section at 36 weeks gestation. Preoperative workup included a transthoracic echocardiogram which revealed a large ventricular septal defect of 1.8 cm with bidirectional shunting, a moderate size atrial septal defect of 1.8 cm with predominant left-to-right shunting, an overriding aorta, moderate right ventricular hypertrophy, and severe pulmonary valve stenosis. Notably, the patient was acyanotic with normal effort tolerance. Preoperative preparation involved the input of cardiologists and obstetric and cardiothoracic anesthetists. Issues such as the use of extracorporeal membrane oxygenation and cardiopulmonary support in the event of cardiac failure were discussed. Autotransfusion postdelivery was also addressed, and plans made for therapeutic venesection should need to arise. Intraoperatively, the planned anesthetic technique was slow and titrated combined spinal–epidural. However, a general anesthetic technique with rapid sequence induction was used in view of extreme patient anxiety. Intravenous induction was performed with ketamine and etomidate, followed by paralysis with succinylcholine. Anesthesia was maintained with desflurane on a mixture of air and oxygen. Phenylephrine infusion was titrated according to the patient's blood pressure and systemic vascular resistance. The uterotonic of choice was duratocin given as a slow bolus, followed by a 4-h infusion of oxytocin. The patient was put in a head-up position to prevent venous air embolism and to decrease autotransfusion to central circulation. Postoperatively, she was extubated and sent to the Intensive Care Unit for continuous monitoring with FloTrac®.
      Citation: Anesthesia: Essays and Researches 2018 12(1):267-270
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_126_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Anesthesia in a child with newly diagnosed hypertrophic cardiomyopathy for
           placement of implantable cardioverter defibrillator

    • Authors: Rajnish Kumar, Bibha Kumari
      Pages: 271 - 272
      Abstract: Rajnish Kumar, Bibha Kumari
      Anesthesia: Essays and Researches 2018 12(1):271-272
      Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease usually characterized by asymmetric ventricular septal hypertrophy. HCM is an important cause of sudden cardiac death in adolescents and young adults. We are presenting a case report, ten years boy came in emergency with sudden loss of consciousness (witness cardiac arrest). Child was revived after cardiopulmonary resuscitation and send to coronary care unit. Echocardiography findings were suggestive of HCM. There was history of sudden death of her mother and maternal uncle. After stabilization ICD was implanted under total intravenous anesthesia. Post procedure his hospital stay was uneventful.
      Citation: Anesthesia: Essays and Researches 2018 12(1):271-272
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_208_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Subarachnoid block a safe choice for cesarean section in neurofibromatosis
           patient with severe kyphoscoliosis

    • Authors: Ibrahim Demir, Ebru Tarik&#231;i Kili&#231;, Mehmet Salim Akdemir
      Pages: 273 - 275
      Abstract: Ibrahim Demir, Ebru Tarikçi Kiliç, Mehmet Salim Akdemir
      Anesthesia: Essays and Researches 2018 12(1):273-275
      Neurofibromatosis type 1 (NF1) is an autosomal-dominant neuroectodermal hereditary disorder, in which spinal skeletal deformities are one of the manifestations. Pectus carinatum, temporomandibular joint dysfunction, and kyphoscoliosis can be seen with this genetic disorder which can lead to cardiorespiratory system problems and can cause difficulty in airway management. We present the anesthetic management of a NF1 patient with a sharp thoracolumbar dystrophic kyphoscoliosis who have been posted for emergency cesarean section as a result of fetal distress. The operation was successfully performed with subarachnoid block. This case highlights the anesthetic challenges and the significance of early planning anesthetic technique.
      Citation: Anesthesia: Essays and Researches 2018 12(1):273-275
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_222_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Anesthetic management in pediatric patient for percutaneous endoscopic
           gastrostomy with mitochondrial myopathy: Leigh syndrome

    • Authors: Ebru Tarikci Kilic, Nelgin Gerenli, Mehmet Salim Akdemir, Necmi Onur Tastan, Egemen Atag
      Pages: 276 - 278
      Abstract: Ebru Tarikci Kilic, Nelgin Gerenli, Mehmet Salim Akdemir, Necmi Onur Tastan, Egemen Atag
      Anesthesia: Essays and Researches 2018 12(1):276-278
      Leigh syndrome (LS) is a rare disease mainly affecting the central nervous system due to the abnormalities of mitochondrial energy generation and seen in early childhood with progressive loss of movement, mental abilities, seizures, nystagmus, ophthalmoparesis, optic atrophy, ataxia, dystonia, or respiratory failure. Anesthesia and surgery exacerbate the risks of aspiration, wheezing, and breathing difficulties. Tracheal irritability can be stimulated with the efforts of intubation. We report the anesthetic management of a rare case of an 11-year-old boy with a severe form of LS for percutaneous endoscopic gastrostomy insertion. The patient was closely monitored during the procedure and the postoperative period. Carefully chosen anesthetic agents, good pain control, and close monitoring are essential.
      Citation: Anesthesia: Essays and Researches 2018 12(1):276-278
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_200_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Transient receptor potential channels as blood biomarkers for pain
           characteristics in patients with chronic pain

    • Authors: Norihiko Sukenaga, Munetaka Hirose
      Pages: 279 - 281
      Abstract: Norihiko Sukenaga, Munetaka Hirose
      Anesthesia: Essays and Researches 2018 12(1):279-281
      Transient receptor potential (TRP) channels play key roles for the transition from acute to chronic postoperative pain after surgery. To evaluate TRP channels in the peripheral blood cells as blood biomarkers for chronic pain, we collected blood samples for genome-wide assays of the mRNA expression and assessed pain intensity and the number of pain symptoms in 13 patients with chronic pain. There was a significant association between increases in the number of pain symptoms and increases in the TRP vanilloid 1 (TRPV1) expression. Decreases in the TRP ankyrin 1 (TRPA1) expression, however, tended to increase the number of pain symptoms. There was likely an inverse relationship for TRPV1 and TRPA1 expressions with regard to the number of pain symptoms in chronic pain patients.
      Citation: Anesthesia: Essays and Researches 2018 12(1):279-281
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_179_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Temporomandibular joint ankylosis: “A pediatric difficult airway
           management”

    • Authors: Anoop Sharma, Deepak Dwivedi, Ram Murti Sharma
      Pages: 282 - 284
      Abstract: Anoop Sharma, Deepak Dwivedi, Ram Murti Sharma
      Anesthesia: Essays and Researches 2018 12(1):282-284
      Intubating a pediatric patient with temporomandibular joint ankylosis is a daunting task, and it becomes more challenging with limited mouth opening. Fiberoptic nasotracheal intubation technique is considered a gold standard. We describe an improvised technique of securing airway in the absence of appropriate-sized fiberoptic scope. The endotracheal tube inserted in the left nostril for maintaining depth of anesthesia was advanced under vision by the fiberoptic scope inserted into the right nostril, and with external laryngeal manipulation, the airway was secured with no complications.
      Citation: Anesthesia: Essays and Researches 2018 12(1):282-284
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_122_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Cardiopulmonary arrest and pneumoencephaly developing after epidural
           oxygen-ozone mixture therapy

    • Authors: Serbulent Gokhan Beyaz, Cafer Alta&#351;, Havva Sayhan
      Pages: 285 - 287
      Abstract: Serbulent Gokhan Beyaz, Cafer Altaş, Havva Sayhan
      Anesthesia: Essays and Researches 2018 12(1):285-287
      Pain treatment can comprise a combination of pharmacological, interventional, surgical, physical, psycological methods. Interventional procedures, particularly minimally invasive percutaneous therapies, have been widely used in recent years. Corticosteroid, hyperbaric saline or oxygen-ozone therapy is a safe procedure for patients in whom pain cannot be relieved by epidural adhesiolysis or other treatments. Complication related to oxygen-ozone therapy have been reported rarely in lumbar sciatalgia. Herein, we present a patient who developed cardiopulmonary arrest and pneumoencephaly as a rare but life-threatening complication of oxygen-ozone therapy, for epidural lysis, applied to the epidural space due to low back pain.
      Citation: Anesthesia: Essays and Researches 2018 12(1):285-287
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_142_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • I-gel™ may be the device of choice for controlled ventilation in
           patients with hemophilia undergoing abdominal laparoscopic surgery

    • Authors: Sreyashi Sen, Koel Mitra, Shanta Ganguli, Sudakshina Mukherji
      Pages: 288 - 290
      Abstract: Sreyashi Sen, Koel Mitra, Shanta Ganguli, Sudakshina Mukherji
      Anesthesia: Essays and Researches 2018 12(1):288-290
      Haemophilia is an inherited bleeding disorder with variable deficiency of Factor VIII in the plasma and is characterised by bleeding into joints, muscles and tissues either spontaneously or in response to trivial trauma. Perioperative care requires multidisciplinary involvement. Perioperative management involves the risk of excessive bleeding from surgical site as well as spontaneous bleeding into the brain in response to surgical stress in patients with previous history of intracerebral haemorrhage. Airway management of such patients during anaesthetic intervention is a challenge and entails the risk of life threatening haemorrhage into the airway. The I gel Supraglottic airway device may be best suited for the purpose considering its soft elastomeric non-inflatable cuff, ease of insertion, availability of gastric suction port and minimal leak fraction on controlled ventilation. The I Gel may be solution to avoiding airway instrumentation in patients with bleeding disorders. It may be an alternative to endotracheal intubation in patients with Haemophilia undergoing surgery.
      Citation: Anesthesia: Essays and Researches 2018 12(1):288-290
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/0259-1162.172336
      Issue No: Vol. 12, No. 1 (2018)
       
  • Anosmia after caudal epidural steroid injection

    • Authors: Ayhan Kaydu, Ebru Tarik&#231;i Kili&#231;, Erhan G&#246;k&#231;ek, Cem Kivilcim Ka&#231;ar
      Pages: 291 - 293
      Abstract: Ayhan Kaydu, Ebru Tarikçi Kiliç, Erhan Gökçek, Cem Kivilcim Kaçar
      Anesthesia: Essays and Researches 2018 12(1):291-293
      There are no reports for anosmia after caudal epidural steroid injections (CESIs). General anesthesia is among the reasons, but the reports up to date are extremely limited. There are no identifiable factors contributing to anosmia after epidural injection, so it is worth discussing. We present the case of a 50-year-old woman with no previous history of any sensory deficits. She experienced anosmia after CESI that had been performed due to her chronic low back pain and lasted for 4 months. Clinical and imaging studies did not reveal any pathology. After 4 months, the olfactory dysfunction demonstrated a significant improvement. Disorders of the olfactory system are unknown after regional anesthesia. The onset of the dysfunction in correlation with the imaging findings may indicate that anesthetics can affect the olfactory dysfunction. Further studies are needed.
      Citation: Anesthesia: Essays and Researches 2018 12(1):291-293
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_14_18
      Issue No: Vol. 12, No. 1 (2018)
       
  • Zero oxygen saturation in pulse oximeter: Need for clinical correlation

    • Authors: Chitra Rajeswari Thangaswamy
      Pages: 294 - 294
      Abstract: Chitra Rajeswari Thangaswamy
      Anesthesia: Essays and Researches 2018 12(1):294-294

      Citation: Anesthesia: Essays and Researches 2018 12(1):294-294
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/aer.AER_53_17
      Issue No: Vol. 12, No. 1 (2018)
       
  • Erratum: Intrathecal Hyperbaric Bupivacaine with Varying Doses of
           Buprenorphine for Postoperative Analgesia after Cesarean Section: A
           Comparative Study

    • Pages: 295 - 295
      Abstract:
      Anesthesia: Essays and Researches 2018 12(1):295-295

      Citation: Anesthesia: Essays and Researches 2018 12(1):295-295
      PubDate: Fri,9 Mar 2018
      DOI: 10.4103/0259-1162.226944
      Issue No: Vol. 12, No. 1 (2018)
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.224.56.126
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-