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Showing 1 - 200 of 354 Journals sorted alphabetically
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advances in Human Biology     Open Access   (Followers: 2)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 6)
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.269, h-index: 10)
African J. of Trauma     Open Access  
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)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 8)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, SJR: 0.408, h-index: 15)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.308, h-index: 14)
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: 7, SJR: 0.441, h-index: 10)
Annals of Saudi Medicine     Open Access   (SJR: 0.24, h-index: 29)
Annals of Thoracic Medicine     Open Access   (Followers: 4, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15, SJR: 0.148, h-index: 5)
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access  
Archives of Intl. Surgery     Open Access   (Followers: 10)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 6)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 3)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.879, h-index: 49)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 2, SJR: 0.362, h-index: 10)
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  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Cancer Translational Medicine     Open Access   (Followers: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 1)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 12, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.339, h-index: 19)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.131, h-index: 4)
Dental Research J.     Open Access   (Followers: 10)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 5, SJR: 0.205, h-index: 22)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1)
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: 0.121, h-index: 3)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access  
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 Orthopaedic J.     Open Access  
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.473, h-index: 8)
Environmental Disease     Open Access   (Followers: 2)
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.496, h-index: 11)
European J. of General Dentistry     Open Access   (Followers: 1)
European J. of Prosthodontics     Open Access   (Followers: 3)
European J. of Psychology and Educational Studies     Open Access   (Followers: 8)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 4, SJR: 1.227, h-index: 12)
Global J. of Transfusion Medicine     Open Access   (Followers: 2)
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
IJS Short Reports     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: 8, SJR: 0.302, h-index: 13)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.618, h-index: 16)
Indian J. of Critical Care Medicine     Open Access   (Followers: 2, SJR: 0.307, h-index: 16)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.243, h-index: 24)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.448, h-index: 16)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 3, SJR: 0.563, h-index: 29)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.292, h-index: 9)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.53, h-index: 34)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.716, h-index: 60)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.207, h-index: 31)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 2, SJR: 0.233, h-index: 12)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.213, h-index: 5)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 4, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 5, SJR: 0.536, h-index: 34)
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: 9, SJR: 0.393, h-index: 15)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.218, h-index: 5)
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: 0.35, h-index: 12)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 1, SJR: 0.285, h-index: 22)
Indian J. of Pharmacology     Open Access   (SJR: 0.347, h-index: 44)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.303, h-index: 13)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.496, h-index: 15)
Indian J. of Psychological Medicine     Open Access   (Followers: 1, SJR: 0.344, h-index: 9)
Indian J. of Public Health     Open Access   (Followers: 1, SJR: 0.444, h-index: 17)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4, SJR: 0.253, h-index: 14)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.169, h-index: 7)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.313, h-index: 9)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.366, h-index: 16)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Industrial Psychiatry J.     Open Access   (Followers: 2)
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 Critical Illness and Injury Science     Open Access   (Followers: 1)
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: 4, SJR: 0.229, h-index: 13)
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: 7)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.239, h-index: 4)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
Intl. J. of Oral Health Sciences     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: 0.523, h-index: 15)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 7, SJR: 0.611, h-index: 9)
Intl. J. of Trichology     Open Access   (SJR: 0.37, h-index: 10)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 3)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 4, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access  
J. of Association of Chest Physicians     Open Access   (Followers: 2)
J. of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
J. of Cancer Research and Therapeutics     Open Access   (Followers: 4, SJR: 0.359, h-index: 21)
J. of Carcinogenesis     Open Access   (Followers: 1, SJR: 1.152, h-index: 26)
J. of Cardiothoracic Trauma     Open Access  
J. of Cardiovascular Disease Research     Open Access   (Followers: 3, SJR: 0.351, h-index: 13)
J. of Cardiovascular Echography     Open Access   (SJR: 0.134, h-index: 2)
J. of Cleft Lip Palate and Craniofacial Anomalies     Open Access   (Followers: 2)
J. of Clinical and Preventive Cardiology     Open Access   (Followers: 1)
J. of Clinical Imaging Science     Open Access   (Followers: 1, SJR: 0.277, h-index: 8)
J. of Clinical Neonatology     Open Access   (Followers: 1)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 2)
J. of Clinical Sciences     Open Access  
J. of Conservative Dentistry     Open Access   (Followers: 4, SJR: 0.532, h-index: 10)
J. of Craniovertebral Junction and Spine     Open Access   (Followers: 4, SJR: 0.199, h-index: 9)
J. of Current Medical Research and Practice     Open Access  
J. of Current Research in Scientific Medicine     Open Access  
J. of Cutaneous and Aesthetic Surgery     Open Access   (Followers: 1)
J. of Cytology     Open Access   (Followers: 1, SJR: 0.274, h-index: 9)
J. of Dental and Allied Sciences     Open Access   (Followers: 1)
J. of Dental Implants     Open Access   (Followers: 7)
J. of Dental Lasers     Open Access   (Followers: 2)
J. of Dental Research and Review     Open Access   (Followers: 1)
J. of Digestive Endoscopy     Open Access   (Followers: 3)
J. of Dr. NTR University of Health Sciences     Open Access  
J. of Earth, Environment and Health Sciences     Open Access   (Followers: 1)
J. of Education and Ethics in Dentistry     Open Access   (Followers: 5)
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J. of Emergencies, Trauma and Shock     Open Access   (Followers: 9, SJR: 0.353, h-index: 14)
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Journal Cover Anesthesia : Essays and Researches
  [8 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0259-1162 - ISSN (Online) 2229-7685
   Published by Medknow Publishers Homepage  [354 journals]
  • Anesthesiologist in cardiac catheterization laboratories; the roles and
           goals!! a postgraduate educational review

    • Authors: Akshaya N Shetti, Shivanand L Karigar, Rachita G Mustilwar, D Roshan Singh, Kusha Nag
      Pages: 811 - 815
      Abstract: Akshaya N Shetti, Shivanand L Karigar, Rachita G Mustilwar, D Roshan Singh, Kusha Nag
      Anesthesia: Essays and Researches 2017 11(4):811-815
      It is not uncommon to see in developing and underdeveloped countries, where the anesthesiologist who is untrained in cardiac specialty takes care of cardiac catheterization centers. The service in cardiac catheterization laboratories (CCL) in developed countries and some of the developing countries is mainly provided by the cardiac anesthesiologists. The scenario is not same in some part of developing countries or in underdeveloped countries which are mainly due to increase in number of CCL (catheterization laboratory) when compared to the number of cardiac anesthesiologists working outside the operation theater. It is also important for training the postgraduate in this field as to make them capable and competitive in managing such cases during emergency situation as it may save the life of a patient. Many a times, CCL is built as per the need of cardiologist ignoring the basic needs of cardiac anesthesiologist. It is important to note that anesthesiologist should be competent enough to provide complete, integrated anesthetic care outside the operation theater with available resources. It is challenging for the anesthesiologist to provide sedation or general anesthesia in such critical area where he/she will be dealing with life-threatening situations. In the modern era, the interventional techniques are advancing and treating complex heart diseases is more often. Days are not far where the CCL procedures may reduce the requirement of major surgeries. A careful and dedicated approach by the anesthesiologist with thorough knowledge and skills decreases morbidity and mortality rate. This article helps both cardiac and noncardiac anesthesiologists to improve their knowledge and to approach the patient systematically.
      Citation: Anesthesia: Essays and Researches 2017 11(4):811-815
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.186866
      Issue No: Vol. 11, No. 4 (2017)
       
  • Application of discharge criteria for home readiness using bispectral and
           supraglottic airway devices in day-care surgery without using muscle
           relaxants

    • Authors: Joginder Pal Attri, Manjit Singh, Hemchandra Bhatt, Kamal Jyoti, Harjinder Kaur
      Pages: 816 - 820
      Abstract: Joginder Pal Attri, Manjit Singh, Hemchandra Bhatt, Kamal Jyoti, Harjinder Kaur
      Anesthesia: Essays and Researches 2017 11(4):816-820
      Introduction: The availability of rapid and short-acting intravenous and volatile anesthetics has facilitated early recovery that is why nowadays ambulatory surgery is becoming more common. If the criteria used to discharge patients from the Postanesthesia Care Unit (PACU) are met in the operating room (OR), it would be appropriate to consider bypassing the PACU and transferring the patient directly to the step-down unit. This process is known as “fast-tracking” after ambulatory surgery. Aims: To compare hemodynamic characteristics and recovery profile as per fast-track criteria (FTC) of recovery and postanesthesia discharge scoring system (PADSS) between sevoflurane and desflurane. Materials and Methods: One hundred American Society of Anesthesiologists Class I–II patients aged 20–50 years were randomly divided into two groups. Following anesthesia induction with injection propofol and injection dexmedetomidine airway was secured with i-gel, Group D (n = 50) received desflurane + dexmedetomidine + O2 + N2O and Group S (n = 50) received sevoflurane in place of desflurane. Emergence time was noted and FTC was evaluated in the OR, Score >12 is considered as shifting criteria for ambulatory surgery unit (ASU). PADSS was noted in ASU at an interval of 15 min for 3 h and Score >9 is considered as ready to discharge home. Results: Response to pain, verbal commands, and spontaneous eye opening in Group D was shorter than that in Group S (P = 0.001). Mean time to achieve FTC score >12 was 15 min in both the groups. Eighty-six percent of patients were ready to go home between 60 and 90 min using PADSS. Conclusion: We concluded that early recovery is faster for desflurane, and there is no difference in ready to go home time between desflurane and sevoflurane.
      Citation: Anesthesia: Essays and Researches 2017 11(4):816-820
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_20_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Preemptive epidural analgesia for postoperative pain relief revisited:
           Comparison of combination of buprenorphine and neostigmine with
           combination of buprenorphine and ketamine in lower abdominal surgeries, a
           double-blind randomized trial

    • Authors: Sanjay Choubey, Raj Bahadur Singh
      Pages: 821 - 827
      Abstract: Sanjay Choubey, Raj Bahadur Singh
      Anesthesia: Essays and Researches 2017 11(4):821-827
      Context: Postoperative pain relief provides subjective comfort to patient in addition to blunting of autonomic and somatic reflex responses to pain, subsequently enhancing restoration of function by allowing the patient to breathe, cough, and move easily. Aims: The aim is to evaluate and compare the effects of neostigmine + buprenorphine and ketamine + buprenorphine for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under general anesthesia (GA). Settings and Design: A double-blind randomized trial. Subjects and Methods: A total of 60 American Society of Anesthesiologists physical status Classes I and II patients undergoing abdominal surgeries under GA were taken up for the study. They were randomly allocated into two groups, Group A and Group B of thirty patients each. Preemptive epidural analgesia for postoperative pain relief was provided by a combination of neostigmine 1 μg/kg + buprenorphine 2 μg/kg in Group A patients and ketamine 1 mg/kg + buprenorphine 2 μg/kg in Group B patients after induction of GA but before surgical incision. Postoperatively, vital parameters, pain score, requirement of top up doses, and side effects in the two groups were observed and recorded at 2, 4, 6, 10, 18, and 22 h. Statistical Analysis Used: Mean values within each of the Group A and Group B were compared using one-way analysis of variance (one-way ANOVA). Mean values between Group A and Group B were compared using double analysis of variance (two-way ANOVA). Results: Group A patients had a significant analgesia (visual analog scale [VAS] pain scores reduced significantly from 54.6 ± 6.3 at 2 h to 8.1 ± 8.9 at 22 h postoperatively). Group B patients had significant analgesia too (VAS pain scores reduced significantly from 36 ± 12.5 at 2 h to 5.3 ± 10.9 at 22 h postoperatively). There was however no significant difference between the two groups with respect to the degree of postoperative analgesia on comparison of VAS scores, effect on vital parameters, and incidence of side effects. Conclusions: Either of the two combinations, neostigmine 1 μg/kg + buprenorphine μg/kg or ketamine 1 mg/kg + buprenorphine 2 μg/kg can be safely used for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under GA.
      Citation: Anesthesia: Essays and Researches 2017 11(4):821-827
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_64_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of dexmedetomidine and midazolam for sedation in mechanically
           ventilated patients guided by bispectral index and sedation-agitation
           scale

    • Authors: Manoj Tripathi, Virendra Kumar, Mahendra B Kalashetty, Deepak Malviya, Prateek Singh Bais, Om Prakash Sanjeev
      Pages: 828 - 833
      Abstract: Manoj Tripathi, Virendra Kumar, Mahendra B Kalashetty, Deepak Malviya, Prateek Singh Bais, Om Prakash Sanjeev
      Anesthesia: Essays and Researches 2017 11(4):828-833
      Background: Mechanical ventilation and sedation are inextricably linked components of critical care that represent, what we do for the patients during their vulnerable course in Intensive Care Unit (ICU). Aims: The aim of this study is to compare the efficacy and safety of midazolam and dexmedetomidine in patients on mechanical ventilator with the help of Bispectral Index (BIS) monitoring and correlation of BIS with Sedation-Agitation Scale (SAS). Settings and Design: Prospective, observational, and comparative study. Materials and Methods: In this study, recruited patients were allocated into two groups of 14 patients each. Group A and Group B patients received injection dexmedetomidine and injection Midazolam, respectively. Hemodynamic parameters, time of extubation, duration of mechanical ventilation, and mortality were compared between two groups. Statistical Analysis: Mean and the standard deviation were calculated. Test of analysis between two groups was performed using unpaired t-test. We applied correlation technique, that is, Pearson product-moment correlation coefficient (r) to assess the correlation between BIS and SAS. It varies from + 1–0 to −1. Results: Heart rate and blood pressure were more stable and less in Group A than Group B. Duration of mechanical ventilation was found extremely significant between Group A (77.86 ± 5.71 h) and Group B (95.64 ± 17.00 h) (P = 0.001). There was significant difference found in the time of extubation between Group A (21 ± 6.44 h) and Group B (30.4 ± 10.62 h) P = 0.008. Conclusion: It is concluded in this study that sedation with dexmedetomidine resulted in quick extubation and decreased the duration of mechanical ventilation in comparison to midazolam in ICU patients. There was found moderate to high correlation between BIS index and SAS.
      Citation: Anesthesia: Essays and Researches 2017 11(4):828-833
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_48_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • To evaluate the efficacy of intravenous infusion of dexmedetomidine as
           premedication in attenuating the rise of intraocular pressure caused by
           succinylcholine in patients undergoing rapid sequence induction for
           general anesthesia: A randomized study

    • Authors: Raj Bahadur Singh, Sanjay Choubey, Saurabh Mishra
      Pages: 834 - 841
      Abstract: Raj Bahadur Singh, Sanjay Choubey, Saurabh Mishra
      Anesthesia: Essays and Researches 2017 11(4):834-841
      Context: Laryngoscopy and intubation performed during RSI lead to choroidal blood volume increase and an eventual rise in intraocular pressure (IOP). Use of succinylcholine (SCh) causes an undesirable rise in IOP which is further aggravated by laryngoscopy and endotracheal intubation. Dexmedetomidine is a highly selective centrally acting α2adrenergic agonist that has IOP lowering properties. Aims: This study aims to evaluate the efficacy of intravenous (i.v.) infusion of dexmedetomidine (0.5 μg/kg) as premedication in attenuating the rise of IOP and adverse effect if any caused by SCh in patients undergoing RSI for general anesthesia. Settings and Design: This was a double-blind, randomized trial. Subjects and Methods: Sixty adult patients in the age group of 20–50 years scheduled for elective surgeries under general anesthesia. Group I (dexmedetomidine group) (n = 30) received i.v. infusion of dexmedetomidine (0.5 μg/kg) and Group II (control group) (n = 30) received i.v. infusion of 50 ml normal saline as premedication Statistical Analysis Used: The analysis was done using Statistical Package for Social Sciences Version 15.0 statistical Analysis Software. Results: It was observed that Group I (dexmedetomidine group) had a better attenuating effect over the increases in IOP in patients undergoing RSI for general anesthesia using SCh. An increase in IOP was seen in Group II (control group) patients with RSI. Conclusions: The findings in the present study indicate that i.v. dexmedetomidine effectively attenuates the increases in IOP with an additional advantage of control on hemodynamic responses following RSI.
      Citation: Anesthesia: Essays and Researches 2017 11(4):834-841
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_100_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and
           retention in young doctors joining postgraduation program

    • Authors: Vidhu Bhatnagar, Urvashi Tandon, Kavitha Jinjil, Deepak Dwivedi, S Kiran, Rohit Verma
      Pages: 842 - 846
      Abstract: Vidhu Bhatnagar, Urvashi Tandon, Kavitha Jinjil, Deepak Dwivedi, S Kiran, Rohit Verma
      Anesthesia: Essays and Researches 2017 11(4):842-846
      Background: High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. Aims: The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. Design: The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. Methods: A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical Analysis: Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. Results: The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. Conclusion: The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.
      Citation: Anesthesia: Essays and Researches 2017 11(4):842-846
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_239_16
      Issue No: Vol. 11, No. 4 (2017)
       
  • To Compare the effects of different doses of dexmedetomidine on
           intrathecal bupivacaine in infraumbilical surgeries: A prospective,
           randomized, double-blind clinical study

    • Authors: Shashikala Thuraganur Kapinegowda, Tejesh Channasandra Anandswamy, Vijaya Hanumanthappa Narayanappa, Sachin Kumar, Prashant Hatti
      Pages: 847 - 853
      Abstract: Shashikala Thuraganur Kapinegowda, Tejesh Channasandra Anandswamy, Vijaya Hanumanthappa Narayanappa, Sachin Kumar, Prashant Hatti
      Anesthesia: Essays and Researches 2017 11(4):847-853
      Introduction: Spinal anesthesia is preferred technique of choice in infraumbalical surgeries. Limitation of this technique is shorter duration of analgesia, so various adjuvants have been used with intrathecal bupivacaine such as fentanyl, clonidine, and dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonist. The aim of our study was to know the effect of different doses of dexmedetomidine on intrathecal bupivacaine. Materials and Methods: The prospective, randomized, double-blind study was conducted in tertiary health care center, on ninety patients of the American Society of Anesthesiology Class I and II, of age group 18–60 years of either sex. They were randomly allocated into three groups. Group BD5 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 5 μg (0.5 ml), Group BD10 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 10 μg (0.5 ml), Group BD15 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 15 μg (0.5 ml) administered intarthecally. The onset and maximum level of sensory block, time to reach maximum level of sensory block, time of two-segment sensory regression, the total duration analgesia, time of rescue analgesia, onset and duration of motor block and heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and oxygen saturation were recorded at various intervals. Moreover, any adverse effects such as bradycardia, hypotension, nausea, vomiting, and sedation were recorded. Results: The onset time of sensory block in Group D5-2.76 ± 1.32, Group D10-2.45 ± 1.50, and Group D15-1.86±0.93, which is statistically significant (P = 0.025). The time taken for two-segment sensory regression Group D5-96.66 ± 33.67, Group D10-116.80 ± 36.27, and Group D15 120.96 ± 30.24, (P = 0.014). The time taken for complete sensory recovery in Group D5-319.83 ± 61.41, Group D10-336.13 ± 61.38, and Group D15-415.20 ± 96.6, which is statistically highly significant (P = 0.000). Time for rescue analgesia in Group D5-377.46 ± 60.05, in Group D10-401.60 ± 61.11, and in Group D15-517.96 ± 97.30, which is statistically highly significant (P < 0.000). Conclusion: We concluded that there was decrease in onset of sensory and motor blockade with the prolongation of duration of anesthesia and analgesia in a dose-dependent manner.
      Citation: Anesthesia: Essays and Researches 2017 11(4):847-853
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_257_16
      Issue No: Vol. 11, No. 4 (2017)
       
  • Efficacy of oral transmucosal fentanyl citrate for premedication in
           patients for surgery under general anesthesia

    • Authors: Raj Bahadur Singh, Sanjay Choubey, Ria Mehra
      Pages: 854 - 858
      Abstract: Raj Bahadur Singh, Sanjay Choubey, Ria Mehra
      Anesthesia: Essays and Researches 2017 11(4):854-858
      Background: Oral transmucosal fentanyl citrate (OTFC), a water soluble salt when mixed in saliva is 80% nonionized; making it the only opioid suitable for transmucosal absorption. OTFC has rapid onset of action (3–5 min) with peak effect at 20–40 min and total duration of activity is 2–3 h. Aims: This study aims to determine the efficacy of OTFC as premedicant in patients scheduled for surgery under general anesthesia (GA) and to assess the effects of OTFC on anxiety, sedation. Settings and Design: A prospective randomized study. Subjects and Methods: Patients between 21 and 60 years of age in American Society of Anesthesiologists physical status Classes I and II scheduled for elective surgery under GA were randomly assigned to three groups of 30 each: OTFC, placebo, and control. Mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) along with anxiety and sedation scores were recorded as baseline and upon entering the operation theater. Adverse effects were also recorded. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences Version 15.0 Statistical Analysis Software. Results: No significant differences were found in MAP, HR, RR, or SpO2among the groups. OTFC group demonstrated significantly higher levels of anxiolysis than the control group (P < 0.05). No significant difference in sedation score was found. No remarkable adverse effects were observed. Conclusions: OTFC is an effective anxiolytic in adult with minimal risks and side effects. It is readily acceptable by the patients in its given form.
      Citation: Anesthesia: Essays and Researches 2017 11(4):854-858
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_106_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • “Comparison of nalbuphine hydrochloride and fentanyl as an adjuvant
           to bupivacaine for spinal anesthesia in lower abdominal surgeries:”
           A randomized, double-blind study

    • Authors: Umesh N Prabhakaraiah, Archana B Narayanappa, Shivakumar Gurulingaswamy, Krishna Kempegowda, Kiran A Vijaynagar, Nagarajaiah B Hanumantharayappa, Diwakar S Ramegowda
      Pages: 859 - 863
      Abstract: Umesh N Prabhakaraiah, Archana B Narayanappa, Shivakumar Gurulingaswamy, Krishna Kempegowda, Kiran A Vijaynagar, Nagarajaiah B Hanumantharayappa, Diwakar S Ramegowda
      Anesthesia: Essays and Researches 2017 11(4):859-863
      Background and Aims: Opioids have been favored as adjuvants to local anesthetics during spinal anesthesia. Nalbuphine, a μ-receptor antagonist and ĸ-receptor agonist, seems to be a suitable adjuvant to local anesthetics. The aim of this study was to compare postoperative analgesia and adverse effects of nalbuphine and fentanyl when used as an adjuvant to hyperbaric bupivacaine during spinal anesthesia. Materials and Methods: Sixty patients belonging to the American Society of Anesthesiologists Physical Status I and II were randomly allocated into two groups of thirty each. Patients in bupivacaine nalbuphine group (Group BN) received 0.8 mg (0.3 ml) of nalbuphine with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine diluted to 3 ml and bupivacaine-fentanyl group (Group BF) received 25 μg (0.5 ml) of fentanyl with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine. Patients were assessed for hemodynamic changes, sensory and motor block, early postoperative analgesia, and adverse effects. Results: Onset, duration of sensory and motor block, and duration of effective analgesia were comparable between both groups. Postoperative visual analog scale score was 4.8 ± 1.12 in Group BN, and in Group BF, it was 3.86 ± 1.04 which was statistically highly significant (P = 0.0007). The number of patients demanding rescue analgesia in early postoperative period was 18 (60.0%) in Group BN and 7 (23.33%) in Group BF which was statistically significant (P = 0.004). Conclusion: Fentanyl was more efficient than nalbuphine in providing early postoperative analgesia when used as an adjuvant to hyperbaric bupivacaine.
      Citation: Anesthesia: Essays and Researches 2017 11(4):859-863
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_40_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Effect of clonidine as adjuvant in thoracic paravertebral block for
           patients undergoing breast cancer surgery: A prospective, randomized,
           placebo-controlled, double-blind study

    • Authors: Nairita Mayur, Anjan Das, Hirak Biswas, Subinay Chhaule, Surajit Chattopadhyay, Tapobrata Mitra, Sandip Roybasunia, Subrata Kumar Mandal
      Pages: 864 - 870
      Abstract: Nairita Mayur, Anjan Das, Hirak Biswas, Subinay Chhaule, Surajit Chattopadhyay, Tapobrata Mitra, Sandip Roybasunia, Subrata Kumar Mandal
      Anesthesia: Essays and Researches 2017 11(4):864-870
      Background and Aims: Postoperative pain after breast cancer surgery is unavoidable. Thoracic paravertebral block (TPVB), a locoregional anesthetic technique, has been proven successful for postoperative pain management in different thoracic surgical procedures, such as thoracotomy, breast cancer surgeries. Clonidine, an adjuvant, in TPVB may enhance the quality and prolong the duration of analgesia. This prospective study was to evaluate the effectiveness of clonidine; administered with TPVB; in addition to conventional local anesthetic solution. Materials and Methods: Fifty-two patients (25–55 years) scheduled for breast cancer surgery under general anesthesia were randomly divided into Group A (n = 26) receiving preoperative TPVB at T3with clonidine added to local anesthesia solution and Group B (n = 26) receiving identical TPVB with local anesthesia but without any adjuvant. This was followed by balanced general anesthesia. A visual analog scale was used to assess pain postoperatively up to 48 h. Meantime to administration of the first dose of rescue analgesic was noted. Total dose of fentanyl consumption, hemodynamic parameters, and side effects were all recorded for each patient. Results: The dosage of fentanyl required in the intraoperative period was significantly lower in Group A. Mean time to administration of rescue analgesic was found to be significantly longer in clonidine group. Hemodynamics and side effects were quite comparable among two groups. Conclusion: Clonidine as adjuvant in TPVB provided profound analgesia for up to 48 h postoperatively for patients undergoing breast cancer surgery without any appreciable side effects.
      Citation: Anesthesia: Essays and Researches 2017 11(4):864-870
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_162_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • A retrospective analysis on anesthetic management during rigid
           bronchoscopy in children with foreign body aspiration: Propofol and
           sevoflurane with controlled ventilation

    • Authors: Rashmi Venkatesh Annigeri, Rashmi Suresh Patil
      Pages: 871 - 874
      Abstract: Rashmi Venkatesh Annigeri, Rashmi Suresh Patil
      Anesthesia: Essays and Researches 2017 11(4):871-874
      Background: Bronchoscopic removal of foreign body in the airway is one of the important life-saving procedure and demands skill and expertise on the part of the surgeon and anesthesiologist. Aim: To study the outcome of controlled ventilation during rigid bronchoscopy in children with foreign body aspiration. Materials and Methods: A review of fifty cases of foreign body in the bronchi, from January 2014 to December 2015 was undertaken in Vittal Institute of Child Care Hospital, Dharwad, through patient case records. Patients between 6 months and 14 years were included in the study. Cases of foreign body in the larynx and trachea were excluded. Patients were induced with propofol and maintained on sevoflurane. The parameters observed were bronchoscopy attempts, succinylcholine requirement, episodes of laryngospasm, cough, bronchospasm and spontaneous recovery. Statistical analysis was done by Chi-square test using software OpenEpi version 7.3. Results: Of 45 patients with organic foreign body, 42 (94%) patients required one attempt of bronchoscopy and 3 (6%) patients required two attempts. Five (100%) patients with inorganic foreign body required single attempt (P = 0.66). Forty-three (96%) patients with organic foreign body required two repeat doses of succinylcholine and 2 (4%) patients required three repeat doses. All 5 (100%) patients with inorganic foreign body required two repeat doses (P = 0.7461). Two (4%) patients aspirated with organic foreign body had laryngospasm, and there was no cough or bronchospasm with either patient. Two (4%) patients with organic foreign body required tracheostomy. Inorganic foreign body group of patients had lesser complications. Conclusion: In our study, patients on controlled ventilation had few intraoperative complication and smooth early recovery. Controlled ventilation with relaxation should be preferred for any pediatric bronchoscopies. Eliciting history of type of foreign body helps in planning and management of procedure.
      Citation: Anesthesia: Essays and Researches 2017 11(4):871-874
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_154_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Randomized comparison of isoflurane versus sevoflurane and desflurane for
           maintenance of ambulatory anesthesia

    • Authors: Pranjali Kurhekar, Krishnagopal Vinod, J Shesha Dhiviya Krishna, M Sethuraman Raghuraman
      Pages: 875 - 880
      Abstract: Pranjali Kurhekar, Krishnagopal Vinod, J Shesha Dhiviya Krishna, M Sethuraman Raghuraman
      Anesthesia: Essays and Researches 2017 11(4):875-880
      Background: Ambulatory surgeries demand safe anesthesia with faster recovery which makes it expensive due to the cost of inhalational anesthetic agents such as sevoflurane and desflurane. Isoflurane is inexpensive agent but can cause delayed recovery. The aim of this study was to evaluate cost-benefit ratio of all three agent with respect to recovery and safety profile Materials and Methods: Patients posted for elective ambulatory surgeries were divided into three groups. Suitable size laryngeal mask airway was inserted following induction with propofol and vecuronium. Anesthesia was maintained on low-flow anesthesia with inhalational agent as isoflurane for Group I, sevoflurane for Group II and Group III received desflurane. Patients were monitored for recovery as per modified Aldrete score and as per postanesthesia discharge scoring system for discharge from hospital. Cost analysis was done by Dion's formula. Statistical analysis was done with analysis of variance for recovery profile, Chi-square test for safety profile and Kruskal Wallis test for cost comparison between groups. Results: Patient characteristics and duration of anesthesia were similar in all three groups. Time to eye-opening was significantly less with desflurane than sevoflurane and isoflurane (P = 0.001). Time to home readiness was similar in all three groups (P = 0.451). The incidence of airway irritation, pain, and nausea/vomiting was similar in all three groups. Cost of Group I was statistically lower than other two groups (P = 0.00). Conclusion: Home readiness and safety profile were comparable between agents; the cost involved was the least with isoflurane.
      Citation: Anesthesia: Essays and Researches 2017 11(4):875-880
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_174_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Gastric volume and its relationship to underlying pathology or
           acid-suppressing medication

    • Authors: Carli Wittgrove, Esma Birisci, Jeff Kantor, Abdallah Dalabih
      Pages: 881 - 885
      Abstract: Carli Wittgrove, Esma Birisci, Jeff Kantor, Abdallah Dalabih
      Anesthesia: Essays and Researches 2017 11(4):881-885
      Background: Pulmonary aspiration during sedation is a major concern for sedation providers, making identifying high-risk patients a priority. Gastric fluid volume (GFV), an accepted risk factor for aspiration, has not been well characterized in fasting children. We hypothesized that GFV would increase with gastrointestinal (GI) pathology and decrease with regular acid-suppressor use. Aims: The primary objective was to determine baseline GFV in fasting children. The secondary objectives were to evaluate the effect of GI pathology and regular use of acid-suppressing medications on GFV. Settings and Study Design: This was prospective, observational study. Materials and Methods: We endoscopically aspirated and measured GFV of 212 children fasting for >6 h who were sedated for esophagogastroduodenoscopy (EGD). Inclusion criteria were children up to 21 years of age, with the American Society of Anesthesiologists physical Status I and II presenting for elective EGD. After determining baseline GFV, the effect of GI pathology and effect of regular acid-suppressing medication use on GFV was analyzed. Statistical Analysis: Analysis of variance was used to compare the GFV among ages and pathology and medication groups. Student's t-test was used to compare GFV between genders and also to compare GFV in confounder analyses. Results: For the studied 212 children, average GFV was 0.469 ± 0.448 mL/kg (0–2.663 mL/kg). We found no association between GI pathology and GFV (P = 0.147), or acid-suppressor use and GFV (P = 0.360). Conclusions: Average GFV in this study falls within the range of prior EGD-measured GFV in fasting children. Contrary to our hypothesis, we found no association between pathologies or regular acid-suppressor use on GFV. On the basis of GFV, children with GI disorders or those using acid-suppressors do not appear to pose an increased risk of aspiration. Future studies should discern differences in effects on GFV of immediate preprocedural versus the regular use of acid-suppressing medications.
      Citation: Anesthesia: Essays and Researches 2017 11(4):881-885
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_149_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparative effects of buprenorphine and dexmedetomidine as adjuvants to
           bupivacaine spinal anaesthesia in elderly male patients undergoing
           transurethral resection of prostrate: A randomized prospective study

    • Authors: Navdeep Kaur, Umesh Goneppanavar, Ramkumar Venkateswaran, Sadasivan Shankar Iyer
      Pages: 886 - 891
      Abstract: Navdeep Kaur, Umesh Goneppanavar, Ramkumar Venkateswaran, Sadasivan Shankar Iyer
      Anesthesia: Essays and Researches 2017 11(4):886-891
      Background and Aims: Transurethral resection of the prostate is a commonly performed urological procedure in elderly men with spinal anaesthesia being the technique of choice. Use of low-dose spinal anesthetic drug with adjuvants is desirable. This study compares the sensorimotor effects of addition of buprenorphine or dexmedetomidine to low-dose bupivacaine. Methods: Sixty patients were randomly allocated to three different groups. All received 1.8 mL 0.5% hyperbaric bupivacaine intrathecally. Sterile water (0.2 mL) or buprenorphine (60 μg) or dexmedetomidine (5 μg) was added to control group (Group C), buprenorphine group (Group B), and dexmedetomidine group (Group D), respectively. Time to the first analgesic request was the primary objective, and other objectives included the level of sensory-motor block, time to two-segment regression, time to S1sensory regression and time to complete motor recovery. ANOVA and post hoc test were used for statistical analysis. The value of P < 0.05 was considered statistically significant. Results: All sixty patients completed the study. Postoperative analgesia was not required in the first 24 h in a total of 10 (50%), 12 (60%) and 15 (75%) patients in groups C, B, and D, respectively. Time to S1regression was 130 ± 46 min (Group C), 144 ± 51.3 min (Group B) and 164 ± 55.99 min (Group D), P = 0.117.Time to complete motor recovery was 177 ± 56.9 min (Group C), 236 ± 60 min (Group B) and 234 ± 61.71 min (Group D), P < 0.001. Conclusion: Addition of buprenorphine (60 μg) or dexmedetomidine (5 μg) to intrathecal bupivacaine for transurethral resection prolongs the time to the first analgesic request with comparable recovery profile.
      Citation: Anesthesia: Essays and Researches 2017 11(4):886-891
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_163_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of efficacy of oral versus regional clonidine for postoperative
           analgesia following ilioinguinal/iliohypogastric block in children: A
           prospective, randomized, double-blinded, placebo-controlled study

    • Authors: Arijit Sardar, Ganga Prasad, Mahesh Kumar Arora, Lokesh Kashyap
      Pages: 892 - 897
      Abstract: Arijit Sardar, Ganga Prasad, Mahesh Kumar Arora, Lokesh Kashyap
      Anesthesia: Essays and Researches 2017 11(4):892-897
      Background: Clonidine improves quality and prolongs the duration of analgesia in ilioinguinal/iliohypogastric nerve block when given along with local anesthetic and as well as premedication. The objective of this study was to compare the efficacy of oral and regional clonidine for postoperative analgesia in pediatric population after ilioinguinal/iliohypogastric block. Materials and Methods: Sixty children aged between 1 and 8 years scheduled for elective hernia surgery were randomly allocated to three groups. Group I received oral midazolam and regional bupivacaine, Group II received oral midazolam with oral clonidine and regional bupivacaine, and Group III received oral midazolam and regional clonidine with bupivacaine. Preoperative sedation and separation score and postoperative duration and quality of analgesia, analgesic need, sedation score, and side effects of clonidine were assessed up to 6 h, postoperatively. Results: Duration of analgesia was prolonged in Group II (2.83 ± 2.01 h) and Group III (4.43 ± 2.29 h) compared to Group I (3.98 ± 2.58 h), but the difference was not statistically significant (P = 0.161). Analgesic requirement was comparable between all the groups intraoperatively (P = 0.708) and postoperatively (P = 0.644). Group II had better parental separation (P < 0.001) and sedation score (P < 0.001) compared to Group I and III. Postoperatively, patients of Group II and III were more sedated compared to Group I up to 120 min. Adverse effects of clonidine were equally distributed in all the groups. Conclusion: Both oral and regional clonidine was equally efficacious in prolongation of duration and quality of analgesia. Oral clonidine produces better preoperative sedation and parenteral separation which is an added advantage in pediatric population.
      Citation: Anesthesia: Essays and Researches 2017 11(4):892-897
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_152_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of the intravenous and epidural administration of tumor
           necrosis factor-alpha antagonists in an experimental rat pain model

    • Authors: Serb&#252;lent G&#246;khan Beyaz, Mustafa Erkan &#304;nanmaz, Tolga Erg&#246;nen&#231;, Onur Palab&#305;y&#305;k, Yakup Tomak, Ay&#231;a Ta&#351; Tuna
      Pages: 898 - 901
      Abstract: Serbülent Gökhan Beyaz, Mustafa Erkan İnanmaz, Tolga Ergönenç, Onur Palabıyık, Yakup Tomak, Ayça Taş Tuna
      Anesthesia: Essays and Researches 2017 11(4):898-901
      Introduction: Inflammatory cytokines secreted from the nucleus pulposus are thought to lead to lumbar nerve root compression-like symptoms. Tumor necrosis factor-alpha (TNF-α), an inflammatory cytokine, likely plays an important role in lumbar disc hernia-related leg pain. In this experimental study, we compared the effectiveness of TNF-α antagonists administered through the intravenous or epidural route in lumbar spine pathologies. Materials and Methods: After ethics committee approval had been obtained, 24 Sprague Dawley male rats aged 70–90 days and weighing 250–300 g each were allocated to four groups. In Group I, only the surgical procedure was performed; in Group II, 1 ml of saline solution was administered into the epidural field; in Group III, 10 mg/kg of infliximab was administered into the coccygeal vein; and in Group IV (epidural group), 25 mg of etanercept was administered into the epidural region. Results: When the left leg pull values were analyzed on day 14, whereas there was not a significant difference among the three groups, a decreasing difference was observed in Group IV (P < 0.05). When the 21st and 28th day left leg pull values were compared between groups, the values from Groups II, III, and IV were significantly lower than those of Group I (P < 0.05). Conclusion: The absence of a difference between the baseline values and left leg pull values on days 14, 21, and 28 in Group IV indicates that recovery began on day 21 with the epidural administration of etanercept. There was no difference between intravenous saline administration and intravenous infliximab administration with regard to the start of the recovery. In the present study of rats with discopathy, TNF-α antagonists administered epidurally led to earlier recovery from radiculopathy-related allodynia compared to intravenous administration.
      Citation: Anesthesia: Essays and Researches 2017 11(4):898-901
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_160_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Evaluation of preoperative flupirtine in ambulatory functional endoscopic
           sinus surgery: A prospective, double-blind, randomized controlled trial

    • Authors: Anjan Das, Hirak Biswas, Anindya Mukherjee, Sandip Roy Basunia, Subinay Chhaule, Tapobrata Mitra, Partha Sarathi Halder, Subrata Kumar Mandal
      Pages: 902 - 908
      Abstract: Anjan Das, Hirak Biswas, Anindya Mukherjee, Sandip Roy Basunia, Subinay Chhaule, Tapobrata Mitra, Partha Sarathi Halder, Subrata Kumar Mandal
      Anesthesia: Essays and Researches 2017 11(4):902-908
      Background: Functional endoscopic sinus surgery (FESS) is the mainstay therapeutic management for nasal pathologies. We evaluated flupirtine, a centrally acting analgesic, for producing perfect perioperative conditions in FESS for adults in a day-care setting. Materials and Methods: Sixty-two patients (25–40 years) scheduled for FESS under general anesthesia were randomly divided into Group F (n = 31) receiving preoperative flupirtine (100 mg) and Group C (n = 31) receiving identical-looking placebo capsule per oral 60 min before induction of anesthesia. Perioperative Nasal bleeding and surgeon's satisfaction score during operation; amount and number of patients receiving fentanyl, propofol, and esmolol infusion for analgesia; maintenance of desired bispectral index (BIS) and deliberate hypotension, respectively. Postanesthesia Care Unit (PACU) and hospital stay, hemodynamic parameters, and side effects were all recorded for each patient. Results: Significantly, less number of patients and less dosage of esmolol were required (P = 0.0040 and 0.0001, respectively) in Group F as compared to that in Group C. Again, number of patients requiring fentanyl and dosage of the same drug was significantly lower in Group F. Dose of propofol for the maintenance of BIS was significantly lower in Group F. However, the duration of controlled hypotension was almost similar in both groups. Group F patients suffered significantly less nasal bleeding and surgeon's satisfaction score was also high in this group. Discharge time from PACU and hospital was similar between two groups without any appreciable side effects. Conclusion: Flupirtine as a premedication found to be providing more favorable perioperative hemodynamic conditions, analgesia and thus allowing less nasal bleeding as well as more surgeons' satisfaction score.
      Citation: Anesthesia: Essays and Researches 2017 11(4):902-908
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_60_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Utility of acute normovolemic hemodilution in major surgeries in rural
           area: A prospective comparative study from North India

    • Authors: Sujeet Rai, Satyajeet Verma, Pramod Kumar Yadav, Jawed Ahmad, Harikesh Kumar Yadav
      Pages: 909 - 912
      Abstract: Sujeet Rai, Satyajeet Verma, Pramod Kumar Yadav, Jawed Ahmad, Harikesh Kumar Yadav
      Anesthesia: Essays and Researches 2017 11(4):909-912
      Introduction: Easy availability of autologous blood is difficult in rural areas. Acute normovolemic hemodilution (ANH) has been found to be an effective alternative in major surgeries where we are expecting major blood loss. Patients and Methods: A prospective comparative study was designed to evaluate the utility of ANH patients (patients receiving autologous blood) during major operations done at MRA Medical College Ambedkar Nagar, Uttar Pradesh, India. during from September 2015 to September 2016. A total of 60 patients undergoing major surgeries were randomly assigned into two groups of thirty patients' each. Group I received homologous blood intraoperative only when required. In Group II ANH was initiated to a target hematocrit of 30% after induction of anesthesia. Various parameters such as demographic, biochemical, and hemodynamic were compared. Results: The mean value of blood withdrawn in ANH group was 650.5 ± 228 ml and it was replaced with an equal volume of 6% hydroethyl starch. There was no statistically significant variation in mean hemocrits levels in both the groups at various stages of the study. Hematocrits decreased significantly in both the groups at various stages as compared to preoperative values. The heart rate and mean blood pressure were almost similar and without statistically significant differences in both groups. Surgical blood loss in Group I was 895.29 ± 568.30 ml as compared to 765 ± 506 ml in Group II. The difference was statistically insignificant (P ≥ 0.05). The mean volume of homologous blood transfused in Group I was 850.71 ± 318.29 ml, as compared to nil in Group II which was statistically significant (P < 0.05). Conclusion: It concludes that ANH up to a target hematocrit of 30% is safe and effective in reducing the need for homologous blood in various major surgeries in institutes in rural areas.
      Citation: Anesthesia: Essays and Researches 2017 11(4):909-912
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_86_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of the efficacy and safety of morphine and fentanyl as
           adjuvants to bupivacaine in providing operative anesthesia and
           postoperative analgesia in subumblical surgeries using combined spinal
           epidural technique

    • Authors: Owais Mushtaq Shah, Kharat Mohammad Bhat
      Pages: 913 - 920
      Abstract: Owais Mushtaq Shah, Kharat Mohammad Bhat
      Anesthesia: Essays and Researches 2017 11(4):913-920
      Introduction: The combined spinal epidural (CSE) technique involves intentional subarachnoid blockade and epidural catheter placement during the same procedure to combine their individual best features, to reduce the total drug dosage and avoid their respective disadvantages. The addition of opioids to local anesthetics (bupivacaine) for CSE anesthesia (CSEA) is increasingly common to enhance the block. Neuraxial fentanyl is more potent and has shorter duration of action than morphine which provides prolonged anesthesia and analgesia, however at the cost of increased incidence of adverse effects like delayed respiratory depression. Aims and Objectives: The aim is to compare the efficacy and safety of morphine and fentanyl as adjuvants to bupivacaine in subumblical surgeries using CSE technique. The characteristics of sensory and motor block, intergroup variations in pain, cardiorespiratory parameters, and adverse effects were compared between the two groups. Materials and Methods: A total of 60 patients belonging to physical status American Society of Anesthesiologists Classes I and II, aged 18–60 years were randomized into two groups: Group A (n = 30) received intrathecal 0.5% heavy bupivacaine 12.5 mg and morphine 2.85 μg/kg; Epidural Anesthetic bolus (when required/T11Regression) 8 ml 0.25% isobaric bupivacaine and 0.04 mg/kg morphine; Epidural Analgesic bolus (postoperative visual analog scale [VAS] score >30) 5 ml 0.125% isobaric bupivacaine and 0.04 mg/kg morphine and Group B (n = 30) received intrathecal 0.5% heavy bupivacaine 12.5 mg and fentanyl 0.35 μg/kg; Epidural Anesthetic bolus (when required/T11Regression) 8 ml 0.25% isobaric bupivacaine and 0.7 μg/kg fentanyl; Epidural Analgesic bolus (postoperative VAS score >30) 5 ml 0.125% isobaric bupivacaine and 0.7 μg/kg fentanyl. Results and Conclusion: Group A had significantly prolonged two segment regression time, T11 regression time, lower mean VAS score, prolonged effective analgesia, and required lesser number of epidural boluses in 24 h as compared to Group B (P < 0.001). There were no significant differences between the groups considering onset of sensory block, duration of motor block, median maximum sensory block level achieved after spinal component (T6), median highest sensory block level achieved after epidural anesthetic bolus (T7-4seg enhancement after regression to T11), cardiorespiratory parameters and adverse effects. None of the patients had respiratory depression nor was there any failure of spinal/epidural component of CSEA. Thus, addition of morphine to bupivacaine in CSEA produced prolonged effective anesthesia and postoperative analgesia compared to addition of fentanyl to bupivacaine without producing undue adverse effects.
      Citation: Anesthesia: Essays and Researches 2017 11(4):913-920
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_99_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • A comparative study of dexmedetomidine and diltiazem for attenuating
           pressor responses to laryngoscopy and endotracheal intubation: A
           double-blind, randomized study

    • Authors: Raj Bahadur Singh, Shivendu Ojha, Sanjay Choubey
      Pages: 921 - 929
      Abstract: Raj Bahadur Singh, Shivendu Ojha, Sanjay Choubey
      Anesthesia: Essays and Researches 2017 11(4):921-929
      Context: Endotracheal intubation has been suggested to be one of the most invasive stimuli in anesthesia, particularly during induction and after tracheal intubation. The present study aims to evaluate the efficacy of dexmedetomidine as compared to diltiazem on hemodynamic response to laryngoscopy and intubation. Aims: To assess and compare the hemodynamic response of dexmedetomidine as compared to diltiazem in patients undergoing laryngoscopy and intubation and rate and type of side effects of the drugs if any. Settings and Design: This study design was a prospective, randomized, and double-blind trial. Subjects and Methods: The patients were randomly allocated into three groups: Group I (control), Group II (dexmedetomidine), and Group III (diltiazem) of 45 patients each. Group I (n = 45): 0.9% NaCl 10 ml was given to the patients over 10 min before intubation in Group I (control). Group II (n = 45): injection dexmedetomidine (0.5 μg/kg) in 10 ml normal saline was given to the patients over 10 min before intubation. Group III (n = 45): injection diltiazem (0.3 mg/kg) in 10 ml normal saline was given to the patients over 10 min before intubation. Statistical Analysis Used: The data so collected were subjected to statistical analysis using Statistical Package for the Social Sciences version 15.0. Results: Mean percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) following intubation was 17.90%, 19.96%, and 19.04%, respectively, in control group, 9.04%, 6.32%, and 7.53%, respectively, in dexmedetomidine group, and 12.30%, 10.32%, and 11.14%, respectively, in diltiazem groups. Statistically, there was a significant difference in postintubation SBP, DBP, and MAP of the three groups (P < 0.001). Dexmedetomidine at a dose of 0.5 μg/kg showed to have a better attenuation of pressor response as compared to diltiazem at a dose of 0.3 μg/kg. Conclusions: Both dexmedetomidine and diltiazem were safe and effective in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation; however, between two trial drugs, dexmedetomidine had a better response.
      Citation: Anesthesia: Essays and Researches 2017 11(4):921-929
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_101_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of I-gel versus endotracheal tube in patients undergoing
           elective cesarean section: A prospective randomized control study

    • Authors: Manohar Panneer, Saravana Babu, Prakash Murugaiyan
      Pages: 930 - 933
      Abstract: Manohar Panneer, Saravana Babu, Prakash Murugaiyan
      Anesthesia: Essays and Researches 2017 11(4):930-933
      Background and Aim: Physiological changes during pregnancy and the sympatho adrenalstimulation during larynoscopy and intubation leads to evaluation of safe devices to secure airway during cesarean section under general anesthesia. I-gel, recently emerging effective supra glottic device found safe during general anesthesia in cesarean section. Aim of the study is to compare the hemodynamic disturbances and airway related complications of I-gel and Endotracheal tube in patients undergoing cesarean section under general anesthesia. Material and Methods: Eighty ASA II pregnant patients posted for elective LSCS were randomly divided into two groups of 40 each (n = 40). According to the group they were inserted either I-gel (Group I) or ETT (Group E). Insertion time, ease of intubation, hemodynamics during insertion and Extubation, airway related complications like sore throat, blood on the device, dysphagia, regurgitation, nausea, vomiting, aspiration and laryngospasm were noted and compared. Statistical analysis was done by using unpaired t test, chi square test and fisher's test. P value of <0.05 was considered as significant. Results: The demographic parameters, ease of insertion, insertion times and adequacy of ventilation were comparable between the groups (P > 0.05). 8 out of 40 patients in Group E had difficult intubation (P < 0.01). More than 20% of rise in MAP and HR were found during intubation and Extubation in Group E (40 out of 40 patients) which was statistically significant when compared to Group I (P < 0.001).Post operative sore throat significantly high in Group E (30 out of 40) (P < 0.001) when compared to Group I (4 out of 40). Conclusion: Easier insertion with less hemodynamic disturbances and very low incidence of sore throat I-gel found to be safer device to secure the airway in patients undergoing LSCS under general anesthesia.
      Citation: Anesthesia: Essays and Researches 2017 11(4):930-933
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_32_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • A comparative study of postoperative analgesia provided by
           ultrasound-guided transversus abdominis plane block using two
           concentrations of bupivacaine in patients undergoing inguinal hernia
           repair

    • Authors: Rajesh Prabhu, Dewan Roshan Singh, N Krishnaveni
      Pages: 934 - 939
      Abstract: Rajesh Prabhu, Dewan Roshan Singh, N Krishnaveni
      Anesthesia: Essays and Researches 2017 11(4):934-939
      Background: Pain after open inguinal hernia surgery can be moderate to severe and is known to prolong hospital stay and delay return to normal daily activities. Settings: A randomized controlled trial conducted in the Department of Anesthesiology in a tertiary care hospital. Aims and Objectives: To compare the efficacy of postoperative analgesia provided by equal volumes of 0.125% and 0.25% bupivacaine administered in an ultrasound (US)-guided transversus abdominis plane (TAP) block in patients undergoing unilateral inguinal hernia repair. Materials and Methods: After obtaining Institutional Ethics Committee approval and informed consent, sixty patients posted for inguinal hernia repair were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups; Group 0.125 received 20 ml of 0.125% bupivacaine and Group 0.25 received 20 ml of 0.25% bupivacaine through US-guided TAP block at the end of surgery. Visual analog scale (VAS) scores and duration of analgesia were recorded. Results: There was no significant difference in the VAS scores among both groups. The duration of analgesia provided by 0.25% bupivacaine was significantly longer than that provided by 0.125% (Group 0.125 - 355.67 ± 118.88 min and Group 0.25 - 635.73 ± 195.58 min; P < 0.05). No complications were noted in both groups. Conclusion: The duration of analgesia provided by 0.25% bupivacaine was significantly longer than that provided by 0.125% bupivacaine through US-guided TAP block in inguinal hernia repair.
      Citation: Anesthesia: Essays and Researches 2017 11(4):934-939
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_84_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of local wound infiltration with ropivacaine alone or
           ropivacaine plus dexmedetomidine for postoperative pain relief after lower
           segment cesarean section

    • Authors: Shaman Bhardwaj, Sumeet Devgan, Dinesh Sood, Sunil Katyal
      Pages: 940 - 945
      Abstract: Shaman Bhardwaj, Sumeet Devgan, Dinesh Sood, Sunil Katyal
      Anesthesia: Essays and Researches 2017 11(4):940-945
      Context: Dexmedetomidine, α2-adrenergic agonist, when coadministered with local anesthetics, improves the speed of onset, duration of analgesia and decreases the dose of local anesthetic used. Aims: The aim of this study was to compare the efficacy of local subcutaneous wound infiltration of ropivacaine alone with ropivacaine plus dexmedetomidine for postoperative pain relief following lower segment cesarean section (LSCS). Subjects and Methods: The study was a prospective, randomized control, double-blind study. Sixty female patients belonging to physical status American Society of Anesthesiologists Grade I or II scheduled for LSCS under spinal anesthesia were randomly allocated into two groups of thirty patients each. Group A: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) diluted with normal saline to 40 ml. Group B: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) plus dexmedetomidine (1.5 μg/kg) of the body weight diluted with normal saline to 40 ml. Standard spinal anesthesia technique was used and LSCS was conducted. The allocated drug was administered by local subcutaneous wound infiltration before closure of the skin. In postoperative period, pain was assessed using visual analog scale (VAS) over a period of 24 h, time of giving first rescue analgesic consumption, mean analgesic consumption, patient satisfaction, and incidence of side effects in 24 h postoperative period was noted. Statistical Analysis Used: All observations were tabulated and statistically analyzed using Chi-square test and unpaired t-test. Results: A total number of patients requiring rescue analgesic, mean VAS each time rescue analgesic was given, and the mean analgesic required in 24 h postoperative period was lesser in Group B than in Group A. Conclusions: Dexmedetomidine added to ropivacaine for the surgical wound infiltration significantly reduces postoperative pain and rescue analgesic consumption in patients undergoing LSCS. No serious adverse effects were noted.
      Citation: Anesthesia: Essays and Researches 2017 11(4):940-945
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_14_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Clinical study to determine the efficacy of clonidine as an adjuvant to
           intrathecal bupivacaine in patients undergoing cesarean section

    • Authors: Basavaraj Kallapur, DN Ravikumar, Safiya Imtiaz Shaikh, M Marutheesh
      Pages: 946 - 951
      Abstract: Basavaraj Kallapur, DN Ravikumar, Safiya Imtiaz Shaikh, M Marutheesh
      Anesthesia: Essays and Researches 2017 11(4):946-951
      Introduction: Spinal anesthesia with bupivacaine is associated with hypotension and inadequate postoperative analgesia. The addition of clonidine as an adjuvant to intrathecal bupivacaine is beneficial in reducing the dose of the local anesthetic and also provides prolonged postoperative analgesia. Methodology: One hundred and five American Society of Anesthesiologists physical status Classes 1 and 2 parturient women undergoing elective cesarean section were randomly divided into three groups. Patients in Group C (control) received 2 ml of 0.5% of heavy bupivacaine (10 mg) with 0.5 ml of 0.9% saline to a total volume of 2.5 ml, those in Group H (high dose of bupivacaine) received 2 ml of 0.5% of heavy bupivacaine (10 mg) with 1 μg/kg of clonidine and 0.9% saline to make a total volume of 2.5 ml, and those in Group L (low dose of bupivacaine) received 1.5 ml of 0.5% of heavy bupivacaine (7.5 mg) with 1 μg/kg clonidine and 0.9% saline to make a total volume of 2.5 ml. Patients were observed for onset and duration of sensory and motor block and for postoperative analgesia. Results: Patients who received clonidine as adjuvant had effective prolonged postoperative analgesia (Group H – 480 ± 40 min, Group L – 480 ± 34 min) as compared to control group (180 ± 19 min). Conclusion: The dose of intrathecal bupivacaine 0.5% was effectively reduced to 7.5 mg by adding 1 μg/kg of clonidine as adjuvant in patients undergoing elective cesarean section.
      Citation: Anesthesia: Essays and Researches 2017 11(4):946-951
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_49_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Intrathecal hyperbaric bupivacaine with varying doses of buprenorphine for
           postoperative analgesia after cesarean section: A comparative study

    • Authors: Rashmi Ravindran, Binu Sajid, Konnanath Thekkethil Ramadas, Indu Susheela
      Pages: 952 - 957
      Abstract: Rashmi Ravindran, Binu Sajid, Konnanath Thekkethil Ramadas, Indu Susheela
      Anesthesia: Essays and Researches 2017 11(4):952-957
      Background: Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia. Aim: The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section. Setting and Design: Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block. Materials and Methods: Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any. Statistical Analysis: Unpaired t-test and Chi-square test were used. Results: Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed. Conclusion: Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.
      Citation: Anesthesia: Essays and Researches 2017 11(4):952-957
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_82_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • ProSeal laryngeal mask airway versus cuffed endotracheal tube for
           laparoscopic surgical procedures under general anesthesia: A random
           comparative study

    • Authors: Suchita Shailesh Parikh, Shivam Bipin Parekh, Chaula Doshi, Varsha Vyas
      Pages: 958 - 963
      Abstract: Suchita Shailesh Parikh, Shivam Bipin Parekh, Chaula Doshi, Varsha Vyas
      Anesthesia: Essays and Researches 2017 11(4):958-963
      Context: The Proseal LMA(PLMA), which has been designed especially for positive pressure ventilation and protection against aspiration can act as an alternative to Endotracheal Tube (ETT) as an effective airway device for patients undergoing elective Laparoscopic surgeries. Aims: To compare the efficacy and safety of PLMA with ETT in patients undergoing Laparoscopic surgeries under general anaesthesia. Settings and Design: A prospective, randomized study was conducted in a tertiary care teaching hospital with 60 patients of ASA grade I/II undergoing elective Laparoscopic surgery under general anaesthesia .Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the PLMA group (Group S) and to the ETT group (Group C) Heart rate (HR), mean blood pressure (MAP), ETCO2values, intraoperative complications such as regurgitation- aspiration, and Postoperative complications such as nausea or vomiting, throat soreness and oral injuries were monitored. Results: There was no difference demographically. Insertion success rate was 100% for both the groups. The mean increase in HR was seen all throughout the duration of the surgery to 8 % above the baseline in Group C and to 3% above the baseline in Group S. On comparing the MAP in Group C, there was a increased by 2.5% to 78.300 ± 14.2615 mmHg as compared to an increase by 5% to 76.233 ± 6.2072 mmHg in Group S. EtCO2 showed a rise in both groups after pneumoperitoneum, which returned to baseline values after completion of surgery. Gastric aspirate values showed no difference in each group. Post op complications were seen mainly in Group C with statistical significance. Conclusions: A properly positioned PLMA is a suitable and safe alternative to ETT for airway management in adequately fasted, adult patients undergoing elective Laparoscopic surgeries.
      Citation: Anesthesia: Essays and Researches 2017 11(4):958-963
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_97_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • To compare the effect of two different doses of dexmedetomidine on the
           attenuation of airway and pressor response during tracheostomy tube change
           in traumatic brain injury patients

    • Authors: Abdul Alim Khan, Neeraj Kumar, Yashpal Singh, Atul Kumar Singh, Sharad Kumar Mathur
      Pages: 964 - 968
      Abstract: Abdul Alim Khan, Neeraj Kumar, Yashpal Singh, Atul Kumar Singh, Sharad Kumar Mathur
      Anesthesia: Essays and Researches 2017 11(4):964-968
      Background: Tracheostomy tube (TT) change is the common procedure in trauma Intensive Care Unit (ICU) and almost always associated with cough reflex, increase in blood pressure, and heart rate. Dexmedetomidine (DEX) is a selective α2-adrenergic receptor agonist well studied for the prevention of pressor response during laryngoscopy and extubation, but literature on prevention of pressor response during TT change is lacking. Aims: The aim of this study is to compare two doses (0.5 and 1.0 μg/kg) of DEX for prevention of cough and pressor response during TT change in traumatic brain injury patients. Settings and Design: Prospective randomized, double-blind trial. Materials and Methods: Sixty tracheostomized traumatic brain injury patients in ICU scheduled for TT change were randomized to two equal groups: Group A to receive DEX 0.5 μg/kg and Group B to receive DEX 1.0 μg/kg. Calculated dose of studied drug was given by infusion pump over 10 min after dilution in 50 ml. Hemodynamic parameters, cough reflex, and adverse event were recorded and statistically analyzed. Statistical Analysis: Statistical analysis was done with nonpaired (two tailed, independent) Student's t-test for continuous data. Demographic data were compared using Pearson's χ2 test. P < 0.05 was considered to be statistically significant. Results: Both doses of DEX were able to attenuate the hemodynamic response of tracheal stimulation and cough reflex. Cough reflex was better controlled with 1.0 μg/kg dose but associated with increased incidence of hypotension and bradycardia. Conclusions: We conclude that 0.5 μg/kg dose provides desired attenuation of hemodynamic response during TT change without any significant adverse events.
      Citation: Anesthesia: Essays and Researches 2017 11(4):964-968
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_103_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • The influence of two different doses of magnesium sulfate on intraocular
           pressure variations after injection of succinylcholine and endotracheal
           intubation: A prospective, randomized, parallel three-arm, double-blind,
           placebo-controlled clinical trial

    • Authors: Hany Mahmoud Yassin, Ahmed Tohamy Abdel Moneim, Ahmed Sherin Mostafa Bayoumy, Hasan Metwally Bayoumy, Sameh Galal Taher
      Pages: 969 - 975
      Abstract: Hany Mahmoud Yassin, Ahmed Tohamy Abdel Moneim, Ahmed Sherin Mostafa Bayoumy, Hasan Metwally Bayoumy, Sameh Galal Taher
      Anesthesia: Essays and Researches 2017 11(4):969-975
      Background The use of succinylcholine for rapid sequence induction in patients with open globe injuries may be detrimental to the eye. Aim: The aim of this study is to determine if the premedication with magnesium sulfate (MgSO4) could attenuate the increase in intraocular pressure (IOP) associated with succinylcholine injection and intubation. Setting: Operation theaters in a tertiary care University Hospital between December 2014 and July 215. Design: This was a prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial. Participants: One hundred and thirteen patients' physical status ASA Classes I and II underwent elective cataract surgery under general anesthesia. Patients and Methods: These patients allocated into three groups: Group C (control group) received 100 ml normal saline, Group M1 received 30 mg/kg MgSO4in 100 ml normal saline, and Group M2 received 50 mg/kg MgSO4in 100 ml normal saline. IOP, mean arterial pressure (MAP), and heart rate (HR) reported at 5-time points related to study drug administration. In addition, any adverse effects related to MgSO4were recorded. Intragroup and between-groups differences were examined by analysis of variance test. Results: We noticed a significant decrease in IOP in M1 (n = 38) and M2 (n = 37) groups as compared with C group (n = 38) after study drugs infusion, 2 and 5 min after intubation, P < 0.001. While the difference between M1 and M2 groups was insignificant, P = 0.296 and P = 0.647, respectively. There was a significant decrease in MAP and HR in M1 and M2 groups as compared with C group 2 and 5 min after intubation, P = 0.01. While the difference between M1 and M2 groups was insignificant, P = 1. Conclusion: MgSO4 30 mg/kg as well as 50 mg/kg effectively prevented the rise in IOP, MAP, and HR associated with rapid sequence induction by succinylcholine and endotracheal intubation.
      Citation: Anesthesia: Essays and Researches 2017 11(4):969-975
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_35_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Transversus abdominis plane block versus ilioinguinal/iliohypogastric
           nerve block with wound infiltration for postoperative analgesia in
           inguinal hernia surgery: A randomized clinical trial

    • Authors: Chinthavali Sujatha, Mamie Zachariah, RV Ranjan, Sagiev Koshy George, TR Ramachandran, Anil Radhakrishna Pillai
      Pages: 976 - 980
      Abstract: Chinthavali Sujatha, Mamie Zachariah, RV Ranjan, Sagiev Koshy George, TR Ramachandran, Anil Radhakrishna Pillai
      Anesthesia: Essays and Researches 2017 11(4):976-980
      Background: Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair. Aim: The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery. Settings and Design: This was a randomized clinical trial performed in a tertiary care hospital. Materials and Methods: Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance , Group T received 20 ml of 0.25% ropivacaine – TAP block and Group I received 10 ml of 0.25% ropivacaine – IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain. Statistical Analysis: Statistical comparisons were performed using Student's t-test and Chi-square test. Results: Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block. Conclusion: As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.
      Citation: Anesthesia: Essays and Researches 2017 11(4):976-980
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_33_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Effect of locally administered dexmedetomidine as adjuvant to
           levobupivacaine in supraclavicular brachial plexus block: Double-blind
           controlled study

    • Authors: Bikash Bisui, Swastika Samanta, Sumanta Ghoshmaulik, Amit Banerjee, Tirtha R Ghosh, Suman Sarkar
      Pages: 981 - 986
      Abstract: Bikash Bisui, Swastika Samanta, Sumanta Ghoshmaulik, Amit Banerjee, Tirtha R Ghosh, Suman Sarkar
      Anesthesia: Essays and Researches 2017 11(4):981-986
      Context: Brachial plexus block is effective with good postoperative analgesia in upper limb surgery has gained importance as it safe, low cost, and maintains stable hemodynamics intraoperatively. To decrease the onset time and prolong the duration of nerve block bicarbonate, opioids (morphine, fentanyl, etc.), sympathomimetic agents (epinephrine, phenylephrine, etc.), α-2 agonists (clonidine and dexmedetomidine), calcium channel blocker (verapamil), magnesium sulfate, etc., were studied with local anesthetics and their isomers. For their sedative, analgesic, perioperative sympatholytic, and cardiovascular stabilizing effects with reduced anesthetic requirements, α-2 adrenergic receptor agonists, such as more potent and highly selective dexmedetomidine, have been the focus of interest for regional anesthesia. Intravenous dexmedetomidine infusion resulted in significant opioid-sparing effects as well as a decrease in inhalational anesthetic requirements. Animal studies proved that dexmedetomidine enhances sensory and motor blockade along with increased duration of analgesia. In humans, dexmedetomidine has also shown to prolong the duration of block and postoperative analgesia when added to local anesthetic in various regional blocks. Bupivacaine, the widely used local anesthetic in regional anesthesia, is available in a commercial preparation as a racemic mixture (50:50) of its two enantiomers: levobupivacaine, S (−) isomer and dextrobupivacaine, R (+) isomer. Severe central nervous system and cardiovascular adverse reactions reported in the literature after inadvertent intravascular injection or intravenous regional anesthesia have been linked to the R (+) isomer of bupivacaine. The levorotatory isomers were shown to have a safer pharmacological profile with less cardiac and neurotoxic adverse effects. The decreased toxicity of levobupivacaine is attributed to its faster protein binding rate. The pure S (−) enantiomers of bupivacaine, i.e., ropivacaine and levobupivacaine were thus introduced into the clinical anesthesia practice. Such an increased usage mandates the documentation of evidence-based literature with regard to risk and safety concerns as well as clinical issues related to levobupivacaine. This study is designed to assess the efficacy of adding dexmedetomidine to levobupivacaine during placement of supraclavicular brachial plexus blockade. Materials and Methods: This prospective observational double-blinded study was conducted over a 1-year period among randomly selected seventy (n = 35) American Society of Anesthesiologists Classes I and II patients of ages between 18 and 60 years of both sexes scheduled to undergo upper limb surgery. With nerve locator, levobupivacaine (0.5%) 28 ml and 2 ml normal saline for Group L and levobupivacaine (0.5%) 28 ml and 0.75 μg/kg dexmedetomidine made up a solution of 2 ml, for Group D, a total 30 ml will be injected locally, in both the groups. Onset and duration of sensory and motor block will be assessed. Results and Discussion: One patient in Group L and two patients in Group D failed to achieve block within 30 min. Those three patients were then excluded from the analysis. Hence, the analysis was done by taking 34 patients in Group L and 33 patients in Group D. Onset of sensory and motor block was earlier in Group D (12.03 ± 0.85 and 13.58 ± 0.97) than Group L (14.32 ± 1.15 and 15 ± 0.98), and the difference is statistically significant (P < 0.0001). Duration of sensory and motor block was longer in Group D (563.94 ± 15.60 and 495.15 ± 10.34) than Group L (368.53 ± 9.89 and 321.47 ± 7.84), and the difference is also statistically significant (P < 0.0001). Duration of analgesia was longer in Group D (672.12 ± 11.39) than Group L (506.47 ± 9.497), and the difference is statistically significant (P < 0.0001). Heart rate and mean arterial pressure were well maintained within the presumed range of significant variation, i.e., 20% from baseline, though at some point of time, intergroup comparison was statistically significant. Visual analog scale score compared at the time for administration of rescue analgesic between the groups come out to be statistically significant. Conclusion: Addition of 0.75 μg/kg dexmedetomidine to 0.5% levobupivacaine for supraclavicular plexus block shortens sensory and motor block onset time and extends sensory block, motor block, and analgesia duration.
      Citation: Anesthesia: Essays and Researches 2017 11(4):981-986
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_55_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • A comparison of intrathecal dexmedetomidine and neostigmine as adjuvant to
           ropivacaine for lower limb surgeries: A double-blind randomized controlled
           study

    • Authors: Ashutosh Kumar Singh, Abhyuday Kumar, Ashok Kumar, Braj Kishore Prasad, Pradeep Kumar Tiwary, Ranjeet Kumar
      Pages: 987 - 992
      Abstract: Ashutosh Kumar Singh, Abhyuday Kumar, Ashok Kumar, Braj Kishore Prasad, Pradeep Kumar Tiwary, Ranjeet Kumar
      Anesthesia: Essays and Researches 2017 11(4):987-992
      Objective: The primary objective of this study was to compare the analgesic effects of intrathecal ropivacaine with or without neostigmine or dexmedetomidine in lower limb surgeries. Secondary objectives were to study the characteristics of block, duration of analgesia, postoperative analgesic requirement, and associated side effects. Materials and Methods: Seventy-five patients posted for elective orthopedic lower limb surgeries under spinal anesthesia were randomly divided into three equal groups to receive intrathecal ropivacaine 0.5% alone (Group R), with adjuvant 5 μg dexmedetomidine (Group R + D) or 50 μg neostigmine (Group R + N). Time to achieve T10 sensory block, time to 2-segment regression, duration of regression to L4, maximum modified Bromage score and duration of analgesia were noted. The incidences of adverse events such as nausea, vomiting, hypotension, bradycardia, desaturation, shivering, and itching were also noted. Statistical analysis was performed using two sample t-test for normally distributed variables and Pearson's Chi-squared test for categorical data. The level of significance was set as P < 0.05. Results: Quality of motor and sensory blockage was significantly better in both Group R + D and Group R + N than Group R. Mean time to achieve T10 sensory block was lowest, time taken in regression of block by 2-segments and duration of regression to L4 was longest in Group R + D and was significant when compared to other groups. Adverse effects such as nausea and vomiting were highest in Group R + N and was statistically significant as compared to other groups. Conclusions: Dexmedetomidine is a better intrathecal adjuvant emerged as compared to neostigmine due to faster onset of anesthesia, better intra- and post-operative analgesia and prolonged duration of motor and sensory blockade without significant increase in adverse effects.
      Citation: Anesthesia: Essays and Researches 2017 11(4):987-992
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_62_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of enhancement of analgesic effect of intrathecal neostigmine
           by intrathecal clonidine and transdermal nitroglycerin patch on
           bupivacaine spinal anesthesia

    • Authors: Mathew V Mammen, Manoj Tripathi, Harish C Chandola, Amit Tyagi, Prateek Singh Bais, Om Prakash Sanjeev
      Pages: 993 - 997
      Abstract: Mathew V Mammen, Manoj Tripathi, Harish C Chandola, Amit Tyagi, Prateek Singh Bais, Om Prakash Sanjeev
      Anesthesia: Essays and Researches 2017 11(4):993-997
      Background: Relief of pain is very important goal intraoperatively and postoperatively. Neostigmine has been used successfully intrathecally with other agents such as clonidine and opioids for pain relief. Aims: This study aims to compare and evaluate the efficacy and safety of combining intrathecal (IT) neostigmine with IT clonidine and transdermal nitroglycerin (tNTG) patch for the relief of pain in patients after surgery. Settings and Design: This was a randomized, prospective, and comparative study Materials and Methods: In this study, recruited patients were randomly allocated into three groups. Groups I, II, and III received intrathecally 25 μg of neostigmine + 15 mg hyperbaric 0.5% bupivacaine, 25 μg of neostigmine + 25 μg clonidine + 15 mg hyperbaric 0.5% bupivacaine, and 25 μg of neostigmine + tNTG patch (3 cm × 5 cm, 5 mg/24 h) +15 mg hyperbaric 0.5% bupivacaine, respectively. Heart rate, mean arterial pressure, analgesic properties, and complications were assessed and compared among groups. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by ANOVA, then P value was calculated. Results: Duration of analgesia was significantly longer in Group III in comparison to Group II (7.142 ± 1.81 vs. 4.408 ± 0.813 h) and was significantly longer in Group II in comparison to Group I (4.408 ± 0.813 vs. 2.583 ± 0.493 h). Analgesic requirement was significantly less in Group III in comparison to Group II (1.9 ± 0.76 vs. 2.5 ± 0.51) and was significantly less in Group II in comparison to Group I (2.5 ± 0.51 vs. 3.1 ± 0.48). Sedation score was found significantly high in Group II than other groups. Conclusion: Both IT clonidine and tNTG patch with bupivacaine + neostigmine spinal anesthesia were found effective in pain control. Results were found better with tNTG patch.
      Citation: Anesthesia: Essays and Researches 2017 11(4):993-997
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_68_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam
           combination on sedation and safety during awake fiberoptic intubation: A
           randomized comparative study

    • Authors: Abida Yousuf, Basharat Ahad, Aabid Hussain Mir, Abdul Waheed Mir, Juvera Gul Wani, Sheikh Quyoom Hussain
      Pages: 998 - 1003
      Abstract: Abida Yousuf, Basharat Ahad, Aabid Hussain Mir, Abdul Waheed Mir, Juvera Gul Wani, Sheikh Quyoom Hussain
      Anesthesia: Essays and Researches 2017 11(4):998-1003
      Background: Awake fiberoptic intubation (AFOI) is a recommended technique for anticipated difficult airway. An ideal regime should provide patient comfort, cooperation, amnesia, hemodynamic stability, and blunt airway reflexes and maintain a patent airway with spontaneous ventilation. The aim of our study was to compare intubation conditions between dexmedetomidine and fentanyl–midazolam combination during AFOI. Methods: This prospective, randomized study was conducted on a total of sixty patients of the American Society of Anesthesiologists physical status I and II of either sex, in the age group of 18–60 years having predicted difficult intubation undergoing elective surgeries and the patients were allocated to two groups of thirty patients each. After premedication and topicalization of airways, dexmedetomidine group (Group I, n = 30) received dexmedetomidine 1 μg/kg over 10 min and midazolam–fentanyl group (Group II, n = 30) received fentanyl 2 μg/kg plus midazolam 0.02 mg/kg over 10 min. Adequacy of intubation condition was evaluated by cough score and postintubation score. Incidence of desaturation, hemodynamic changes, and sedation using Ramsay sedation scale were noted and compared between two groups. Results: The demographic characteristics were comparable in the two groups (P > 0.05). The mean Ramsay sedation score in Group I was 3.13 ± 0.937 and Group II was 3.16 ± 0.949, and the comparison between two groups was statistically insignificant (P = 0.891). Cough scores and postintubation scores were favorable in dexmedetomidine group than midazolam–fentanyl group and were statistically significant with P < 0.001 and 0.0001, respectively. Group I also showed better hemodynamics and less episodes of desaturation than Group II. Conclusions: Dexmedetomidine is more effective than midazolam–fentanyl during AFOI, as it provides better intubation condition, hemodynamic stability, and preservation of airway and spontaneous ventilation.
      Citation: Anesthesia: Essays and Researches 2017 11(4):998-1003
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_150_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Effect of intravenous magnesium sulfate on the minimum alveolar
           concentrations of desflurane using bispectral index monitoring: A
           prospective randomized double-blind controlled study

    • Authors: Mohd Rameez Riaz, Vikram Mahajan, Sadaf Syed, Riyaz Ahmad
      Pages: 1004 - 1008
      Abstract: Mohd Rameez Riaz, Vikram Mahajan, Sadaf Syed, Riyaz Ahmad
      Anesthesia: Essays and Researches 2017 11(4):1004-1008
      Background: Magnesium sulfate has been implicated to influence the minimum alveolar concentration (MAC) of various volatile anesthetics, but its effect on desflurane remains unanswered so far. Aim: To study the effect of perioperative intravenous magnesium sulfate on MAC of desflurane using bispectral index (BIS) monitoring. Settings: Operating room of a tertiary care hospital. Design: A prospective, randomized, controlled, double-blind clinical trial. Methods: Sixty American Society of Anesthesiologists Physical Status I/II patients aged 18–65 years and scheduled for breast conservative surgeries were randomized into three groups of 20 each. Control group (Group 1) was administered 100 ml normal saline (NS) as bolus followed by NS infusion. Magnesium (Mg) was administered as bolus of 40 mg/kg in 100 ml NS followed by NS infusion in Group 2 and as bolus of 40 mg/kg followed by infusion of 10 mg/kg/h of Mg in NS in Group 3. Anesthesia was induced with propofol, fentanyl, and atracurium. Dial setting of desflurane was adjusted to target a BIS of 45–55. Time from cessation of desflurane to beginning of spontaneous movement, time taken to respond to verbal commands, time of extubation, and time taken to reach BIS value of 70 were recorded. Statistical Analysis: Statistics was done using SPSS program using ANOVA and the Chi-square test for variables and a P < 0.05 was taken to indicate a significant difference. Results: No significant difference was present in MAC, end-tidal desflurane, and cumulative consumption of morphine. Recovery was similar in Group 2 and Group 3, but time to eye opening (P = 0.011), time to respond to verbal commands (P < 0.001), and time to extubate (P < 0.001) were significantly delayed when compared with patients in Group 1. Hemodynamic changes were comparable among three groups. Conclusions: From this study, we conclude that MACs of desflurane using BIS as a guide remains unaffected by perioperative infusion of magnesium sulfate.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1004-1008
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_123_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of analgesic efficacy of caudal dexamethasone with intravenous
           dexamethasone as an adjuvant to caudal block in pediatric patients
           undergoing urogenital surgeries

    • Authors: Dhanashree H Dongare, Seema S Karhade
      Pages: 1009 - 1012
      Abstract: Dhanashree H Dongare, Seema S Karhade
      Anesthesia: Essays and Researches 2017 11(4):1009-1012
      Context: Caudal block is one of the most common regional anesthetic techniques employed in pediatric urogenital surgeries. Adjuvants play an important role to improve postoperative analgesia. Aims: The aim of this study was to evaluate the analgesic effect of dexamethasone when given systemically as against caudally as an adjuvant to caudal block. Subjects and Methods: In this randomized controlled study, sixty American Society of Anesthesiologists Physical Status I and II patients aged 3–6 years were randomly allocated into two groups of thirty each. Group D received caudal block with local anesthetic solution and 0.1 mg/kg injection dexamethasone. Group I received a caudal block with local anesthetic solution. They received intravenous injection dexamethasone 0.1 mg/kg after the block. Both the groups were compared for the duration of postoperative analgesia and analgesic requirement. Statistical Analysis Used: Statistical analysis was done with unpaired t-test and Chi-square test as was appropriate. Results: Group D showed a significant prolongation of postoperative analgesia (626.33 ± 59.39 min) as compared to Group I (194.67 ± 27.76 min). Similarly, requirement of analgesic was reduced on 1st postoperative day in group receiving caudal dexamethasone. Conclusions: Dexamethasone significantly prolongs the duration of postoperative analgesia of a caudal block when given caudally than when given intravenously.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1009-1012
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_143_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Does pulmonary artery systolic pressure as estimated by transthoracic
           echocardiography alter the effect of positive end-expiratory pressure on
           arterial blood gases and hemodynamics in morbidly obese patients?

    • Authors: Dipti Saxena, Priyank Singh, Atul Dixit, Bipin Arya, Mohit Bhandari, Sadhana Sanwatsarkar
      Pages: 1013 - 1017
      Abstract: Dipti Saxena, Priyank Singh, Atul Dixit, Bipin Arya, Mohit Bhandari, Sadhana Sanwatsarkar
      Anesthesia: Essays and Researches 2017 11(4):1013-1017
      Background: Positive end-expiratory pressure (PEEP) at the time of induction increases oxygenation by preventing lung atelectasis. However, PEEP may not prove beneficial in all cases. Factors affecting the action of PEEP have not been elucidated well and remain controversial. Pulmonary vasculature has direct bearing on the action of PEEP as has been proven in the previous studies. Thus, this prospective study was planned to evaluate the action of PEEP on the basis of pulmonary artery systolic pressure (PASP) which is noninvasive and easily measured by transthoracic echocardiography. Materials and Methods: Seventy morbidly obese patients, the American Society of Anesthesiologists Grade II, or III, aged 20–65 years with body mass index >40 kg/m2 , scheduled for elective laparoscopic bariatric surgery were included. Patients who denied consent, those undergoing emergency and/or open surgery and those requiring >2 attempts for intubation were excluded from the study. Ten patients had to be excluded. Thus, a total of sixty patients participated in the study. Thirty patients received no PEEP at the time of induction while other thirty patients were given a PEEP of 10 cm of H2O. Serial ABG samples were taken preoperatively, at the time of intubation, 5 min after intubation, and 10 min after intubation. Patients were then divided into four groups on the basis of PASP value of ≤30 mm Hg with and without PEEP or >30 mm Hg with and without PEEP. Primary Outcome: The primary outcome was the effect of PEEP of 10 cm of H2 O on ABG and hemodynamics in morbidly obese patients. Secondary Outcome: The secondary outcome was the effect of PASP on the action of PEEP in morbidly obese patients undergoing laparoscopic surgery. Results: Patients having PASP of >30 mm Hg had significant improvement in oxygenation on PEEP application (270.11 ± 119.26 mm Hg) as compared to those without PEEP (157.57 ± 109.29 mm Hg) just after intubation. The increase in oxygenation remained significant at all time intervals. Patients with PASP ≤30 mm Hg did not show significant improvement in oxygenation with PEEP application (177.09 ± 85.85 mm Hg as compared to 226.27 ± 92.42 mm Hg without PEEP). Hemodynamic parameters did not show statistically significant alterations. Conclusion: Morbidly obese patients who have PASP >30 mm Hg benefit most from the PEEP. Thus, PASP which is an easily measurable noninvasive parameter can be used as a criterion for selecting patients who benefit from PEEP application.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1013-1017
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_73_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Short-term outcome of patients with infective endocarditis: A
           single-center prospective study

    • Authors: Kianoush Saberi, Mehrdad Salehi, Ali Reza Bakhshandeh, Shahnaz Sharifi, Mehrzad Rahmanian, Roya Sattarzadeh, Anahita Tavoosi
      Pages: 1018 - 1021
      Abstract: Kianoush Saberi, Mehrdad Salehi, Ali Reza Bakhshandeh, Shahnaz Sharifi, Mehrzad Rahmanian, Roya Sattarzadeh, Anahita Tavoosi
      Anesthesia: Essays and Researches 2017 11(4):1018-1021
      Objectives: To investigate the short-term outcome of patients with infective endocarditis (IE). Patients and Methods: We analyzed data from 42 patients with active endocarditis which underwent different cardiac surgeries. An active endocarditis was considered due to urine analysis and/or blood culture and acute inflammation Gram stains of sample tissue and/or blood culture and acute inflammation Gram stains of sample tissue. Design: Collecting data of 42 patients prospectively. Setting: University hospital single center. Participants: Patients with IE from July 2014 to June 2016. Interventions: None. Measurement and Main Results: We collected data of 42 patients in Imam Hospital which is a university-based 1700-bed center. Twelve patients experienced a redo operation; in which, 2 of them have had the second redo. Five patients underwent an aortic valve replacement operation, 2 mitral valve repair, and only one patient had experienced a subaortic web resection. Seven cases were addict; in which, 5 of them were intravenous abusers. There was 1 porphyric patient which suffered from pethidine reliability. Most of our cases underwent Bentall or tricuspid valve repair operation, and multivalve operation was more scarce. Conclusions: We have presented the therapeutic strategies and outcome of patients with IE and evaluated their short-term outcome.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1018-1021
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_66_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparison of three different concentrations 0.2%, 0.5%, and
           0.75% epidural ropivacaine for postoperative analgesia in lower limb
           orthopedic surgery

    • Authors: Amitesh Pathak, Neeraj Yadav, Sati Nath Mohanty, Ekta Ratnani, Om Prakash Sanjeev
      Pages: 1022 - 1025
      Abstract: Amitesh Pathak, Neeraj Yadav, Sati Nath Mohanty, Ekta Ratnani, Om Prakash Sanjeev
      Anesthesia: Essays and Researches 2017 11(4):1022-1025
      Introduction: Ropivacaine has been studied previously and holds promise as an agent that offers a safe, efficacious, and better recovery profile than other conventional agents such as bupivacaine. The aim of the present study was to compare the safety and efficacy of equal volume of different concentration of ropivacaine for epidural analgesia in patients undergoing major lower limb orthopedic surgery. Subjects and Methods: One hundred and fifty adult patients were randomized into three groups to receive single dose of equal volume of ropivacaine through epidural route in concentrations of 0.2%, 0.5%, and 0.75%, respectively. All the groups received equal dose of ropivacaine of same concentration for subarachnoid block using combined spinal-epidural technique. Results: Modified Bromage Scale and Numeric rating scale was used to assess motor block and analgesia. Data analysis was done using WINDOW SPSS Student Version 17 ANOVA test. Student's t-test was performed for comparison between two groups, and qualitative data were analyzed by applying Chi-square test. Conclusion: 0.5% and 0.75% ropivacaine were sufficient and effective for intrathecal subarachnoid block as well as for postoperative analgesia with epidural use. Shorter duration of motor blockade and analgesia was seen with ropivacaine 0.2%.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1022-1025
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_88_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Postoperative ultrasound guided continuous femoral nerve blockade for
           unilateral total knee arthroplasty: A comparison of 0.125% bupivacaine
           and 0.2% ropivacaine

    • Authors: Sruthi C Babu, Gokuldas Menon, Bindu K Vasu, Mathew George, Jai Thilak, Sundaram Iyer
      Pages: 1026 - 1029
      Abstract: Sruthi C Babu, Gokuldas Menon, Bindu K Vasu, Mathew George, Jai Thilak, Sundaram Iyer
      Anesthesia: Essays and Researches 2017 11(4):1026-1029
      Context: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. Aims: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. Settings and Design: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. Subjects and Methods: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. Statistical Analysis: Student's t-test and Chi-square test were applied. Results: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. Conclusion: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1026-1029
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_155_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Effect of two different doses of dexmedetomidine on stress response in
           laparoscopic pyeloplasty: A randomized prospective controlled study

    • Authors: Rafat Shamim, Shashi Srivastava, Amit Rastogi, Kamal Kishore, Aneesh Srivastava
      Pages: 1030 - 1034
      Abstract: Rafat Shamim, Shashi Srivastava, Amit Rastogi, Kamal Kishore, Aneesh Srivastava
      Anesthesia: Essays and Researches 2017 11(4):1030-1034
      Background: Clonidine, opioids, β-blockers, and dexmedetomidine have been tried to attenuate stress responses during laparoscopic surgery. We evaluated the efficacy of dexmedetomidine in two different doses in attenuating stress responses on patients undergoing laparoscopic pyeloplasty. Subjects and Methods: Ninety patients were assigned to one of the three groups: Group A, Group B, and Group C. Group B received dexmedetomidine 1 mcg/kg as loading dose, followed by 0.7 mcg/kg/h for maintenance; Group C received dexmedetomidine 0.7 mcg/kg as a loading dose, followed by 0.5 mcg/kg/h for maintenance. Group A received normal saline. Stress responses were assessed by the variations in heart rate (HR), mean arterial pressure (MAP), blood glucose levels, and serum cortisol levels. One-way analysis of variance test was applied. Multiple comparisons between groups were done with post hoc Bonferroni test. Results: The HR and MAP were found to be higher in Group A. The difference was statistically significant (P < 0.05) during intubation, carbon dioxide insufflation, and extubation when compared with Groups B and C. Blood glucose levels at postintubation and at extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. Serum cortisol levels at postintubation, during midsurgery, and 2 h after extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. However, HR, MAP, blood glucose levels, and serum cortisol levels were similar in dexmedetomidine groups. Conclusions: Dexmedetomidine decreases stress response and provides good condition for maintenance of anesthesia. Dexmedetomidine when used in lower dose in Group C decreases stress response comparable to higher dose in Group B.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1030-1034
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_153_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Comparative study of clonidine with ropivacaine versus ropivacaine alone
           in epidural anesthesia for lower limb orthopedic surgery

    • Authors: Mahendra Singh, Amitesh Pathak, Aamir laique Khan, Amit Srivastava, Devendra Negi
      Pages: 1035 - 1039
      Abstract: Mahendra Singh, Amitesh Pathak, Aamir laique Khan, Amit Srivastava, Devendra Negi
      Anesthesia: Essays and Researches 2017 11(4):1035-1039
      Background: Epidural anesthesia has been well established as a safe and effective technique not only for perioperative anesthesia but also for postoperative analgesia. Various adjuvants have been added to local anesthetic agent in an effort to prolong this duration. Aims: The aim of this study was to compare and evaluate the anesthesia and analgesic property of ropivacaine to its combination with clonidine for lower limb orthopedic surgery under epidural. Materials and Methods: In a prospective, randomized, double-blind study, eighty adult patients undergoing lower limb surgeries received either 0.75% ropivacaine or 75 μg clonidine with 0.75% ropivacaine through epidural route. Patients were compared for hemodynamic variability, quality of motor and sensory block, intra- and post-operative analgesia, and the side effects associated. Statistical Analysis: Data analysis was done by Student's paired t-test, Chi-square test, and Mann–Whitney test. P < 0.05 was considered statistically significant. Results: The time taken for onset of the motor as well as the sensory block was significantly shorter in ropivacaine with clonidine group as compared to ropivacaine alone group. Mean duration of analgesia was significantly higher in patients who received clonidine as an adjunct (P < 0.001). There was no significant difference observed in the incidence of hemodynamic changes or side effects. Conclusion: The study demonstrated that use of clonidine as an adjuvant to ropivacaine through epidural route provides a hemodynamically stable, faster, and prolonged epidural block and a longer analgesic effect as compared to ropivacaine alone.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1035-1039
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_67_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Effects of dexmedetomidine on intraoperative hemodynamics and propofol
           requirement in patients undergoing laparoscopic cholecystectomy

    • Authors: Avneesh Khare, Satya Prakash Sharma, Mangi Lal Deganwa, Mamta Sharma, Nitesh Gill
      Pages: 1040 - 1045
      Abstract: Avneesh Khare, Satya Prakash Sharma, Mangi Lal Deganwa, Mamta Sharma, Nitesh Gill
      Anesthesia: Essays and Researches 2017 11(4):1040-1045
      Background: Despite multiple benefits, laparoscopic surgery always poses anesthetic challenge due to significant alteration of hemodynamics. Various pharmacological agents have been used for the same with variable response. Dexmedetomidine, in addition to sympatholytic effect, diminishes intraoperative requirement of anesthetics including propofol. The present study was conducted to evaluate the effects of intravenous dexmedetomidine on intraoperative hemodynamics and propofol requirement using bispectral index (BIS) in laparoscopic cholecystectomy. Methods: Forty patients undergoing laparoscopic cholecystectomy were randomly allocated to receive either dexmedetomidine (Group A; n = 20) or normal saline (Group B; n = 20). In Group A, dexmedetomidine was loaded (1 μg/kg) before anesthesia induction and infused (0.6 μg/kg/h) during surgery. Anesthesia was induced with propofol, and maintenance infusion rate was adjusted to a BIS of 55–60 in both groups. Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline and at various time points from loading of drugs to just after tracheal extubation. All infusions were stopped with removal of scope from abdominal cavity. Recovery time (time from end of all infusions to BIS = 80) and extubation time (time from end of all infusions to extubation) were noted. Results: After intubation, MAP and HR values in Group A were significantly lower than Group B at various time points of study. To achieve similar BIS values, significantly low doses of propofol were required in Group A during induction and intraoperatively. Doses were reduced by 36% and 31%, respectively. Mean recovery time and mean extubation time in Group A were also significantly less. Conclusion: During propofol-based anesthesia for laparoscopic cholecystectomy, dexmedetomidine provides stable intraoperative hemodynamics and reduces propofol requirement for induction as well as maintenance, without compromising recovery profile.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1040-1045
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_107_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Optimal dose of dexmedetomidine retrobulbar anesthesia during
           phacoemulsification cataract surgery

    • Authors: Ahmed Ahmed Nagy, Saber Hamed El-Sayd, Ahmed Abdelaziz Ahmed, Ghada Zin-Eldin Rajab
      Pages: 1046 - 1050
      Abstract: Ahmed Ahmed Nagy, Saber Hamed El-Sayd, Ahmed Abdelaziz Ahmed, Ghada Zin-Eldin Rajab
      Anesthesia: Essays and Researches 2017 11(4):1046-1050
      Background: The cataract surgery anesthesia should be to make the procedure as safe and as satisfactory as possible for all concerned. The recent progress in anesthesia and surgery now allow cataract extraction to be done with minimal physiological changes to the patient. We aimed in the study to compare between two different doses of dexmedetomidine combined with lidocaine and bupivacaine during retrobulbar anesthesia for cataract extraction by phacoemulsification. Materials and Methods: This study was done on forty patients with cataract. The patients were enrolled in two groups: Group (A):Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.25 μg/kg of dexmedetomidine and Group (B): Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.5 μg/kg of dexmedetomidine. Results: The globe anesthesia duration, globe, and lid akinesia were significantly longer in the Group B than in the Group A (P < 0.05). Intraocular pressure decreased through the first 15 min after anesthesia in the two groups, and the changes were not significant between the two groups but highly significant in every group when compared to its baseline reading. As regards the conscious level in the two groups, there was a significant difference (P < 0.001). Group A is higher regarding score 2 and 3, and Group B higher in score 4. Conclusions: We concluded that dexmedetomidine 0.25 μg/kg, when added to retrobulbar block for cataract surgery, will significantly increase the duration of retrobulbar block and improve both the surgeon and the patient satisfaction.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1046-1050
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_116_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Low-dose succinylcholine to facilitate laryngeal mask airway insertion: A
           comparison of two doses

    • Authors: Leah R George, Raj Sahajanandan, Sarah Ninan
      Pages: 1051 - 1056
      Abstract: Leah R George, Raj Sahajanandan, Sarah Ninan
      Anesthesia: Essays and Researches 2017 11(4):1051-1056
      Background and Aims: Around the world, the use of the laryngeal mask airway (LMA) is becoming more common for different surgeries accounting for it being the dominant choice of airway in numerous surgeries. Although propofol is known to blunt the laryngeal reflexes often patient movement, coughing, and gagging occur on insertion. This study aims to identify the optimum dose of succinylcholine required to facilitate LMA insertion comparing placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. Further objectives were to compare (a) the overall insertion conditions of the LMA, (b) the number of insertion attempts, (c) the amount of propofol consumption, and (d) the hemodynamics in the three groups. Setting and Design: This is a prospective, double-blinded, randomized control trial of 283 patients randomized into three groups-placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. It was done in the day case theatres of a tertiary hospital in Southern India. Subjects and Methods: Patients were induced with 2 mg/kg of propofol, after 2 μg/kg of fentanyl. The study drug was given after loss of consciousness. After 60 s, a classic LMA was inserted by the standard method by a single investigator. Jaw relaxation, coughing, gagging, movement, laryngospasm, ease of insertion, number of attempts, propofol usage, and hemodynamics were assessed. Statistical Analysis: Statistical methods used were analysis of variance with Bonferroni's t-test, Chi-square test, and Fisher's test. P < 0.05 was considered statistically significant. Results: Jaw relaxation was significantly better in the 0.25 mg/kg succinylcholine group. There was no significant difference in coughing and gagging in the groups, but patient movement was more in the placebo group. Two patients in the placebo group experienced partial laryngospasm. Overall insertion conditions were significantly better in the 0.25 mg/kg group compared to the other two groups. Propofol consumption was significantly more in the placebo group. Conclusions: The study concludes that 0.25 mg/kg succinylcholine facilitates insertion of the LMA.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1051-1056
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_98_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Efficacy and safety of using air versus alkalinized 2% lignocaine for
           inflating endotracheal tube cuff and its pressure effects on incidence of
           postoperative coughing and sore throat

    • Authors: Pallavi Gaur, Pravin Ubale, Prashant Khadanga
      Pages: 1057 - 1063
      Abstract: Pallavi Gaur, Pravin Ubale, Prashant Khadanga
      Anesthesia: Essays and Researches 2017 11(4):1057-1063
      Background and Objective: We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Materials and Methods: This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18–65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N2O-O2mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups (P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group (P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1057-1063
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_85_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Dexmedetomidine versus magnesium sulfate in anesthesia for cochlear
           implantation surgery in pediatric patients

    • Authors: Passaint Fahim Hassan, Amany Hassan Saleh
      Pages: 1064 - 1069
      Abstract: Passaint Fahim Hassan, Amany Hassan Saleh
      Anesthesia: Essays and Researches 2017 11(4):1064-1069
      Context: Cochlear implantation surgery represents a great advance in ENT surgeries. Special anesthetic managements were required to provide bloodless surgical field and monitoring of the facial nerve. Aims: We aimed to compare both dexmedetomidine and magnesium sulfate as regards their efficacy in inducing deliberate hypotension and providing better quality of the surgical field during cochlear implantation in pediatrics. Settings and Design: Prospective, randomized double-blinded study. Subjects and Methods: Forty-six pediatric patients aging 1.5–2.5 years of either sex with American Society of Anesthesiologists physical status classes I and II were randomized into dexmedetomidine (D) group (n = 23) and magnesium sulfate (M) group (n = 23). In the D group, after induction of anesthesia but before the surgery, a bolus dose of 0.4 μg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.4 μg/kg/h until the end of surgery. In M group, after induction of anesthesia but before the surgery, magnesium sulfate 10% (50 mg/kg) was given slowly, then continuous infusion by a rate of 10 mg/kg/h during the whole surgery. Intraoperative hemodynamics, quality of surgical field, fentanyl consumption, blood loss, operative time, FLACC pain scores, and adverse effects were compared in both groups. Statistical Analysis Used: Data were presented as mean ± standard deviation, ranges, numbers, and percentages as appropriate. Comparison of demographic data and time of surgery was done by Student's t-test. Two-way analysis of variance with correction for repeated measurements was used for heart rate and blood pressure comparison. Mann–Whitney U-test was used for nonparametric measurements. Results: Surgical field score and blood loss were better in D group than M group. Fentanyl consumption was less in D group than M group. Heart rate and mean atrial blood pressure were lower in D group except in the initial times than M group.Conclusions: In our study, both drugs were effective in achieving hypotensive anesthesia in pediatrics; however, dexmedetomidine proved to have superior effect on the surgical field and blood loss compared to magnesium sulfate with no intra- and post-operative complications for cochlear implantation surgery.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1064-1069
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_72_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Intravenous dexmedetomidine infusion compared with that of fentanyl in
           patients undergoing arthroscopic shoulder surgery under general anesthesia
           

    • Authors: Mona Hossam Eldin Abdel Hamid
      Pages: 1070 - 1074
      Abstract: Mona Hossam Eldin Abdel Hamid
      Anesthesia: Essays and Researches 2017 11(4):1070-1074
      Background: Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile. Aim: The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. Patients and Methods: A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h. Measurements: Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU , MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU. Results: This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction. Conclusion: Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1070-1074
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_148_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Role of oral prednisolone in the management of postdural puncture headache
           after spinal anesthesia in urological patients

    • Authors: Sunana Gupta, Nandita Mehta, Arti Mahajan, Mohd Reidwan Dar, Neeraj Gupta
      Pages: 1075 - 1078
      Abstract: Sunana Gupta, Nandita Mehta, Arti Mahajan, Mohd Reidwan Dar, Neeraj Gupta
      Anesthesia: Essays and Researches 2017 11(4):1075-1078
      Background and Aims: Postdural puncture headache (PDPH) is a frequently encountered complication of spinal anesthesia and may be associated with significant morbidity in some patients. Parenteral corticosteroids have been used in the management of PDPH both prophylactically and after the occurrence of headache. The aim of this study was to evaluate the effect of oral prednisolone in the management of PDPH after spinal anesthesia in urological patients. Materials and Methods: Sixty adult patients who developed PDPH after spinal anesthesia for urological surgeries were randomly allocated to two groups. Group C patients (n = 30) were managed conservatively, and Group P patients (n = 30) were given 20 mg of oral prednisolone for 4 days in addition to the conventional treatment. The intensity of headache was measured using visual analog scale (VAS). VAS score was taken just before the start of treatment (0 h) and at 12, 24, 48, 72, and 96 h after the start of treatment. Statistical Analysis: Statistical analysis was performed using Statistical Packages for Social Science version 19 (SPSS, Inc., Chicago, IL, USA). Results: There was no statistically significant difference in the VAS score in patients before the start of treatment (0 h) and at 12 h after the start of treatment. The VAS scores were less and statistically significant in Group P at 24, 48, 72 and 96 h after the start of treatment (P < 0.05). Conclusion: The use of oral prednisolone is effective in reducing the severity and duration of PDPH.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1075-1078
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.183565
      Issue No: Vol. 11, No. 4 (2017)
       
  • A comparison of dexmedetomidine and clonidine in attenuating the
           hemodynamic responses at various surgical stages in patients undergoing
           elective transnasal transsphenoidal resection of pituitary tumors

    • Authors: Summaira Jan, Zulfiqar Ali, Yasir Nisar, Imtiaz Ahmad Naqash, Syed Amer Zahoor, Shabir Ahmad Langoo, Khan Azhar
      Pages: 1079 - 1083
      Abstract: Summaira Jan, Zulfiqar Ali, Yasir Nisar, Imtiaz Ahmad Naqash, Syed Amer Zahoor, Shabir Ahmad Langoo, Khan Azhar
      Anesthesia: Essays and Researches 2017 11(4):1079-1083
      Background: Transsphenoidal approach to pituitary tumors is a commonly performed procedure with the advantage of a rapid midline access to the sella with minimal complications. It may be associated with wide fluctuations in hemodynamic parameters due to intense noxious stimulus at various stages of the surgery. As duration of the surgery is short and the patients have nasal packs, it is prudent to use an anesthestic technique with an early predictable recovery. Materials and Methods: A total of 60 patients of either sex between 18 and 65 years of age, belonging to the American Society of Anesthesiologists I and II who were undergoing elective transnasal transsphenoidal pituitary surgery were chosen for this study. Patients were randomly allocated into two groups, Group C (clonidine) and Group D (dexmedetomidine), with each group consisting of 30 patients. Patients in Group C received 200 μg tablet of clonidine and those in Group D received a pantoprazole tablet as placebo at the same time. Patients in the Group D received an intravenous infusion of dexmedetomidine diluted in 50 ml saline (200 μg in 50 ml saline) 10 min before induction and patients in Group C received 0.9% normal saline (50 ml) as placebo. The hemodynamic variables (heart rate, mean arterial pressure) were noted at various stages of the surgery. Statistical analysis of the data was performed. Results: A total of 60 patients were recruited. The mean age, sex, weight and duration of surgery among the two groups were comparable (P > 0.05). Both dexmedetomidine and clonidine failed to blunt the increase in hemodynamic responses (heart rate and blood pressure) during intubation, nasal packing, speculum insertion and extubation. However when the hemodynamic response was compared between the patients receiving dexmedetomidine and clonidine it was seen that patients who received dexmedetomidine had a lesser increase in heart rate and blood pressure (P < 0.05) when compared to clonidine. Conclusions: A continuous intravenous infusion of dexmedetomidine as compared to oral clonidine improved hemodynamic stability in patients undergoing transnasal transsphenoidal resection of pituitary tumors.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1079-1083
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.194575
      Issue No: Vol. 11, No. 4 (2017)
       
  • Securing a difficult airway: Tracheal intubation achieved after deliberate
           placement of an endotracheal tube in esophagus: A new approach

    • Authors: Vanilla Chopra, Nandita Mehta, Mohd Reidwan Dar
      Pages: 1084 - 1087
      Abstract: Vanilla Chopra, Nandita Mehta, Mohd Reidwan Dar
      Anesthesia: Essays and Researches 2017 11(4):1084-1087
      Enlarged thyroid gland with retrosternal extension has an increased incidence of difficult intubation, and it poses real airway challenge for the anesthesiologists. Here, we present a case of successful management of a difficult airway in a female patient of enlarged thyroid gland, planned for open reduction and internal fixation of the upper end of humerus. Endotracheal intubation was achieved after deliberate insertion of an endotracheal tube in esophagus. The patient was extubated over a ventilating bougie, with uneventful postoperative course.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1084-1087
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.184611
      Issue No: Vol. 11, No. 4 (2017)
       
  • Postoperative chylothorax of unclear etiology in a patient with
           right-sided subclavian central venous catheter placement

    • Authors: Samie Asghar, Faisal Shamim
      Pages: 1088 - 1090
      Abstract: Samie Asghar, Faisal Shamim
      Anesthesia: Essays and Researches 2017 11(4):1088-1090
      A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1088-1090
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_54_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • GuideWire migrating into murphy's eye of endotracheal tube: An unusual
           complication of percutaneous dilational tracheostomy

    • Authors: Rohini Arora, Sandeep Kumar, Sumit Sachan
      Pages: 1091 - 1093
      Abstract: Rohini Arora, Sandeep Kumar, Sumit Sachan
      Anesthesia: Essays and Researches 2017 11(4):1091-1093
      Percutaneous dilational tracheostomy (PDT) is a frequently carried out bedside procedure in a critical care setting. It is usually performed under fiberoptic endoscopic guidance. Studies with PDT performed with endoscopic guidance have reported lower complication rates than studies performed with “blind” PDT. We report a case where PDT was performed without endoscopic assistance and the j-shaped guidewire got stuck in the Murphy's eye of endotracheal tube causing difficulty in railroading of tracheostomy tube (TT).
      Citation: Anesthesia: Essays and Researches 2017 11(4):1091-1093
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_45_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Anesthetic issues and difficult airway management in a case of
           grisel&#39;s syndrome

    • Authors: Ajit Gupta, Jay Prakash, Pawan Kumar, Niraj Narain Singh
      Pages: 1094 - 1096
      Abstract: Ajit Gupta, Jay Prakash, Pawan Kumar, Niraj Narain Singh
      Anesthesia: Essays and Researches 2017 11(4):1094-1096
      Grisel's syndrome is a nontraumatic subluxation of atlanto-axial joint which is associated with inflammatory conditions of head and neck and occurs primarily in children. Anesthetic management is such cases constitute a multitude of challenges, especially related to the airway management. We presented here a case of 16-year-old male child weighing 23 kg, came to our hospital for the treatment of torticollis who was previously treated with intravenous antibiotics for rhinopharyngitis and diagnosed as a case of Grisel's syndrome. The child was operated on for unilateral resection of sternocleidomastoid muscle under general anesthesia. This case report pertains to the successful airway and anesthetic management in the background of difficult airway.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1094-1096
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.180782
      Issue No: Vol. 11, No. 4 (2017)
       
  • Airway considerations in case of a large multinodular goiter

    • Authors: Harpreet Kaur, Amar Parkash Kataria, Magila Muthuramalingapandian, Harjinder Kaur
      Pages: 1097 - 1100
      Abstract: Harpreet Kaur, Amar Parkash Kataria, Magila Muthuramalingapandian, Harjinder Kaur
      Anesthesia: Essays and Researches 2017 11(4):1097-1100
      Patients with large goiters pose a great challenge to the anesthesiologist regarding securing the airway without compromising the safety of the patient. The technique of intubation depends on the choice and expertise of anesthesiologist. Awake fiberoptic intubation (AFOI) is the preferred technique. We present the case of large multinodular goiter with difficult airway in which AFOI was successfully used to secure the airway. Proper assessment, planning, and preparation for airway management should be done preoperatively to ensure patient safety.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1097-1100
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_86_16
      Issue No: Vol. 11, No. 4 (2017)
       
  • Anesthetic management for prolonged incidental surgery in advanced liver
           disease

    • Authors: Riddhi Kundu, Rajeshwari Subramaniam, Arijit Sardar
      Pages: 1101 - 1104
      Abstract: Riddhi Kundu, Rajeshwari Subramaniam, Arijit Sardar
      Anesthesia: Essays and Researches 2017 11(4):1101-1104
      In spite of advances in perioperative management, operative procedures in patients with chronic liver disease pose a significant challenge for the anesthesiologist due to multisystem involvement, high risk of postoperative hepatic decompensation, and mortality. We describe the anesthetic management of an elderly patient with advanced liver disease (model for end-stage liver disease 16) for prolonged abdominal surgery. The use of invasive hemodynamic monitoring, point-of-care biochemical, and hematological surveillance coupled with prompt correction of all abnormalities was responsible for good outcome. The patient's inguinal swellings turned out to be extensions of a large peritoneal mesothelioma, necessitating a large abdominal incision and blood loss. Analgesia was provided by bilateral transversus abdominis plane blocks, which helped to reduce opioid use and rapid extubation.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1101-1104
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_94_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Monitored anesthesia care for the acute ischemic stroke patient with
           end-stage pulmonary disease

    • Authors: Kevin C Lee, Brian C Lee, Steven E Miller
      Pages: 1105 - 1108
      Abstract: Kevin C Lee, Brian C Lee, Steven E Miller
      Anesthesia: Essays and Researches 2017 11(4):1105-1108
      The majority of patients who suffer acute ischemic stroke (AIS) from large vessel occlusion are at a significant risk for disability or death. Because patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO) are therapeutically anticoagulated, intravenous recombinant tissue plasminogen activator is contraindicated. For AIS management, these patients must undergo emergent intra-arterial therapy. Presented is a patient on VA ECMO who subsequently suffered a large vessel embolic stroke requiring emergent surgical intervention. The decision by our anesthetic team to perform the procedure under monitored anesthesia care is discussed.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1105-1108
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_95_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Difficult airway in a case of gross hydrocephalus for shunt surgery

    • Authors: Raghavendra Vagyannavar, Vandna Bharti, Mohammad Hashim
      Pages: 1109 - 1111
      Abstract: Raghavendra Vagyannavar, Vandna Bharti, Mohammad Hashim
      Anesthesia: Essays and Researches 2017 11(4):1109-1111
      Children with gross hydrocephalus for emergency ventriculoperitoneal (VP) shunt present challenges to anesthesiologist due to increase in circumference of head, associated congenital anomalies. Here is a case report of child with gross hydrocephalus with Type 2 Arnold chiari malformation posted for emergency VP shunt placement possessed a difficult airway.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1109-1111
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_201_16
      Issue No: Vol. 11, No. 4 (2017)
       
  • Haemothorax following internal jugular vein cannulation: A rare event

    • Authors: Sanjeev Kumar, Srinarayan, Anand Kumar Jha
      Pages: 1112 - 1114
      Abstract: Sanjeev Kumar, Srinarayan , Anand Kumar Jha
      Anesthesia: Essays and Researches 2017 11(4):1112-1114
      Catheterization of central veins is a routine technique which is widely used in emergency department, operation theater, and intensive care units. Seldinger technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. We describe a case of hemothorax following internal jugular venous cannulation. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1112-1114
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_37_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Anaesthetic implications of severe hyperthyroidism secondary to molar
           pregnancy: A case report and review of literature

    • Authors: Srinivasan Swaminathan, Roshin Ann James, Rashmi Chandran, Reesha Joshi
      Pages: 1115 - 1117
      Abstract: Srinivasan Swaminathan, Roshin Ann James, Rashmi Chandran, Reesha Joshi
      Anesthesia: Essays and Researches 2017 11(4):1115-1117
      Pregnant women with gestational trophoblastic disease have an increased likelihood to develop hyperthyroidism secondary to increased secretion of human chorionic gonadotropin. Most of these cases of hyperthyroidism remain undiagnosed and may present as a thyrotoxic crisis during the perioperative period. Pregnant patients with gestational trophoblastic disease should be always evaluated for hyperthyroidism, and in cases of severe hyperthyroidism, antithyroid treatment should be initiated before evacuation of the mole. Anesthetic management of these cases is challenging in view of the emergency nature of the surgery and potential for thyroid crisis. Spinal anesthesia can be safely administered and has a protective role in preventing thyroid crisis.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1115-1117
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_38_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • A safe regional technique in a high-risk patient: Cervical plexus blockage

    • Authors: Ayhan Kaydu, Ebru Tar&#305;k&#231;&#305; K&#305;l&#305;&#231;, Erhan G&#246;k&#231;ek, Mehmet Salim Akdemir
      Pages: 1118 - 1120
      Abstract: Ayhan Kaydu, Ebru Tarıkçı Kılıç, Erhan Gökçek, Mehmet Salim Akdemir
      Anesthesia: Essays and Researches 2017 11(4):1118-1120
      Regional anesthesia in the form of combined cervical plexus block is gaining popularity as a technique of choice for cervical spine surgeries, especially for urgent ones. An important advantage is that it allows continuous monitoring of patient's neurological status. The success of the block often depends on accurate placement of the local anesthetic. Landmarks for the block are therefore of great importance. In this case, we aimed to present a 74-year-old man with C4–5 odontoid fracture. We planned to perform a unilateral combined cervical plexus block for anterior cervical instrumentation and fusion (ACIF) operation because of his associated high-risk comorbid disorders.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1118-1120
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_135_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Anesthetic management of a patient with dilated cardiomyopathy and
           end-stage renal disease for emergency strangulated hernia repair surgery

    • Authors: Gaurav Sindwani, Aditi Suri, Amit Rastogi
      Pages: 1121 - 1123
      Abstract: Gaurav Sindwani, Aditi Suri, Amit Rastogi
      Anesthesia: Essays and Researches 2017 11(4):1121-1123
      Dilated cardiomyopathy (DCMP) is a myocardial disease associated with dilatation of one or both the ventricles, impaired myocardial contractility, decreased cardiac output, and increased ventricular filling pressures. Patients with end-stage renal disease are dependent on renal replacement therapy to survive and often manifest with a variety of pathological organ dysfunction. We present a case of DCMP and chronic kidney disease posted for emergency reduction of strangulated umbilical hernia under general plus epidural anesthesia.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1121-1123
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_231_16
      Issue No: Vol. 11, No. 4 (2017)
       
  • Resuscitation of a newborn with right hypoplastic heart syndrome: A rare
           confrontation for an anesthesiologist

    • Authors: Prachi Gaurang Kadam, Veena R Shah, Kishori Saikia, Rujal R Patel
      Pages: 1124 - 1125
      Abstract: Prachi Gaurang Kadam, Veena R Shah, Kishori Saikia, Rujal R Patel
      Anesthesia: Essays and Researches 2017 11(4):1124-1125
      According to newborn resuscitation guidelines, all referrals for neonates with suspected or confirmed duct-dependent congenital heart disease are to be discussed with pediatric cardiologist beforehand and are to be transferred immediately under their care for optimal management. However, in case of emergency, when there is not adequate time for preoperative consultations or a multidisciplinary approach, we should be able to manage these patients in the immediate perioperative period to decrease the likelihood of adverse outcome. We herewith describe a case where we as anesthesiologists successfully resuscitated a newborn with right hypoplastic heart in an emergency case of cesarean section till the baby was transferred to level III cardiac institution for further management.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1124-1125
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.194592
      Issue No: Vol. 11, No. 4 (2017)
       
  • Anesthetic management of a parturient with hemolysis, elevated liver
           enzyme levels, and low platelet syndrome complicated by renal
           insufficiency and coagulopathy

    • Authors: Jinguo Wang, Na Wang, Wei Han, Zhanyang Han
      Pages: 1126 - 1128
      Abstract: Jinguo Wang, Na Wang, Wei Han, Zhanyang Han
      Anesthesia: Essays and Researches 2017 11(4):1126-1128
      The objective of this study is to describe the anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) syndrome and renal insufficiency. A 28-year-old female patient, gestational age of 35 weeks, with hypertensive crisis (blood pressure 190/110 mmHg), was admitted for an emergency cesarean section after diagnosis of HELLP syndrome and renal insufficiency. We performed total intravenous general anesthesia with rapid sequence induction. During the surgical procedure, reduced urine output and coagulopathy were detected. After the treatments of transfusion, diuresis, and anticoagulation, the surgery finished uneventfully. The patient was taken to the Intensive Care Unit without extubation and discharged on the 6th postoperative day. This case report revealed a successful anesthetic management applied to a pregnant woman with HELLP syndrome complicated by renal insuffciency and coagulopathy. There are several case reports about HELLP syndrome, but the patient in this paper is complicated with renal insuffciency and coagulopathy which made the treatment diffcult to handle.
      Citation: Anesthesia: Essays and Researches 2017 11(4):1126-1128
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/aer.AER_31_17
      Issue No: Vol. 11, No. 4 (2017)
       
  • Erratum: Anesthesiologist in catheterization laboratory; the roles and
           goals!! a postgraduate educational review

    • Pages: 1129 - 1129
      Abstract:
      Anesthesia: Essays and Researches 2017 11(4):1129-1129

      Citation: Anesthesia: Essays and Researches 2017 11(4):1129-1129
      PubDate: Tue,28 Nov 2017
      DOI: 10.4103/0259-1162.219355
      Issue No: Vol. 11, No. 4 (2017)
       
 
 
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