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Access Statistics 2016 | July-December | Issue 2

 

ORIGINAL ARTICLE
Naina P Dalvi, Narendra Patil

Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:35-40]


ABSTRACT

Introduction: This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanyl-bupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries.

Materials and methods: Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine +0.5 mL (25 µg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine +0.5 mL (25 mg) of tramadol (group T) intrathecally.
Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals.

Results: Sixty patients were randomized to the group F (n=30) and group T (n=30). The duration of sensory blockade was significantly prolonged in group F (314.66±49.25 minutes) as compared to group T (261.66±27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66±40.97 minutes) compared to group T (214.66±26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301±38.75 minutes).
Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients.

Discussion: Fentanyl 25 µg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia.

Keywords: Fentanyl, Intrathecal adjuvant, Postoperative analgesia, Tramadol.

How to cite this article: Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

Source of support: Nil

Conflict of interest: None.

1320

ORIGINAL ARTICLE
Johann Mathew, SK Gvalani

Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:41-44]


ABSTRACT

Background: Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation.

Study design: Prospective observational study.

Materials and methods: About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience.

Statistical analysis used: Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test.

Results: The incidence of difficult intubation determined by the IDS (=5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of =5 gives high false positive for our population.

Keywords: Airway management, Difficult tracheal intubation, Obesity.

How to cite this article: Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

Source of support: Nil

Conflict of interest: None.

712

CASE REPORT
V Sreeram, Pallavi Waghalkar, W Atul, Digambar Sarje

Anesthesia Management of Prolonged Surgery with Duration of 15 Hours for Correction of Post Koch’s Kyphosis

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:73-75]


ABSTRACT

Anesthetic management of post koch’s kyphosis correction of 48 yr old female is discussed.The patient was under anesthesia for long duration of 15 hours which also included Wake up test. After surgery 3 months later patient went home walking. It is emphasized that with good team work between orthopedician, anesthesiologist, chest physician and nursing staff will make it possible to produce excellent outcome in these cases.

Keywords: Anesthesia, Deformity, Koch’s, Kyphosis, Monitoring, Spine, Test, Wakeup.

How to cite this article: Sreeram V, Waghalkar P, Atul W, Sarje D. Anesthesia Management of Prolonged Surgery with Duration of 15 Hours for Correction of Post Koch’s Kyphosis. Res Inno in Anesth 2016;1(2):73-75.

Source of support: Nil

Conflict of interest: None.

572

CASE REPORT
Reena Gautam

Anesthesia Mumps: An Unusual Presentation

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:69-70]


ABSTRACT

Anesthesia mumps is an acute transient swelling of parotid gland following general anesthesia.There are several case reports of anesthesia mumps postoperatively in adults, however there are very few reports in children. Increase in secretions along with improper drainage of saliva causes enlargement of parotid gland. This article lists the various causes implicated for this and the methods to prevent its occurrence. The purpose of this article is to highlight the occurrence of anesthesia mumps in pediatric patient even after a short procedure.

Keywords: Acute transient swelling, Anesthesia mumps, General anesthesia, Parotid gland.

How to cite this article: Gautam R. Anesthesia Mumps: An Unusual Presentation. Res Inno in Anesth 2016;1(2):69-70.

Source of support: Nil

Conflict of interest: None.

495

ORIGINAL ARTICLE
SK Gvalani, L Pradeep

Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:45-51]


ABSTRACT

Context: The duration of neuromuscular block with rocuronium is affected by old age as well as renal impairment. It would be helpful for anesthetists to know the variation in the block in elderly patients with renal failure and the significance of neuromuscular monitoring in this group.

Aim: The aim of our study is to investigate the neuromuscular effects of 0.6 mg/kg rocuronium under general anesthesia in young adults and elderly patients with or without renal failure.

Study design: Prospective randomized controlled study.

Materials and methods: Young and elderly 100 patients were divided into 4 groups of 25 each, with or without renal failure. General anesthesia with propofol 2 mg kg intravenous (iv), fentanyl 2 µg kg iv, and 60% N2O in O2 were given. Neuromuscular monitoring was started immediately after the induction of anesthesia and before the administration of muscle relaxant. After the stabilization of control responses, 0.6 mg kg rocuronium was injected intravenously. The onset time, time to achieve maximum block, and the recovery times were noted.

Statistical analysis used: The statistical analysis of the data from the study was performed with the Statistical Package for the Social Sciences (SPSS) software for Window Release 14.0. One-way analysis of variance, Bonferroni’s, and chi-square test were used to compare patients’ characteristics.

Results: The duration of block as well as the recovery indices were significantly prolonged in the elderly compared to the young patients. Maximum prolongation was observed in the elderly group with renal failure. This underlines the importance of neuromuscular monitoring in these patients.

Keywords: Neuromuscular block, Renal failure, Rocuronium.

How to cite this article: Gvalani SK, Pradeep L. Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure. Res Inno in Anesth 2016;1(2):45-51.

Source of support: Nil

Conflict of interest: None.

425

CASE REPORT
Anjana S Wajekar, Anita N Shetty, Shrikanta P Oak, Ruchi A Jain

Anesthetic Management of a Sellar Mass Excision in a Patient of Multiple Endocrine Neoplasia Type 1 Syndrome: A Rare Case

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:65-68]


ABSTRACT

Multiple endocrine neoplasia (MEN) type 1 is an autosomal dominant disease, commonly characterized by neoplasms of parathyroid glands, pituitary gland and pancreas islet cells. The anesthesia management in such patients for surgical procedures is challenging due to multiple endocrine gland involvement and its resultant implications, making every case a unique entity. The anesthesia management for MEN type I patients pose unique challenges to the anesthesiologist requiring meticulous preoperative evaluation, intraoperative anticipation, prevention and management of potential complications along with postoperative monitoring. We present a case of successful management of excision of a sellar mass in a patient with MEN type I syndrome with full postoperative recovery with the use of propofol, dexmedetomidine and desflurane anesthesia.

Keywords: Dexmedetomidine, Hormones, Multiple endocrine neoplasia (MEN) type 1, Pituitary.

How to cite this article: Wajekar AS, Shetty AN, Oak SP, Jain RA. Anesthetic Management of a Sellar Mass Excision in a Patient of Multiple Endocrine Neoplasia Type 1 Syndrome: A Rare Case. Res Inno in Anesth 2016;1(2):65-68.

Source of support: Nil

Conflict of interest: None.

358

CASE REPORT
Preeti Rustagi, Naina P Dalvi, Bharati A Tendolkar, Suhas Kotak

Acute Hyponatremia following Hypotonic Intravenous Fluid in a 4-year-old Child

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:63-64]


ABSTRACT

Hyponatremia is the most frequently encountered electrolyte disorder in hospitalized patients. It develops due to either surplus water or decreased sodium in the extracellular fluid. In children, the source of excess water is frequently the administration of hypotonic intravenous fluids. The current recommendations of hypotonic maintenance fluids may be appropriate for a healthy child, but may not apply to hospitalized children who are more likely to have a nonosmotic stimulus for antidiuretic hormone (ADH) production, such as anxiety, stress, pain, etc. Fall in plasma sodium concentration acutely to < 130 mmol/L leads to brain cell swelling and devastating neurological outcome. Previous studies have reported the potential harm with these solutions and the need to reconsider their routine use in children. We present a case report of 4-year-old child, admitted with head injury and normal CT brain, who developed hyponatremic convulsions following administration of Isolyte-P as maintenance fluid as per standard guidelines.

Keywords: Hyponatremia, Hypotonic intravenous fluid, Nonosmotic stimulus for antidiuretic hormone.

How to cite this article: Rustagi P, Dalvi NP, Tendolkar BA, Kotak S. Acute Hyponatremia following Hypotonic Intravenous Fluid in a 4-year-old. Res Inno in Anesth 2016;1(2):63-64.

Source of support: Nil

Conflict of interest: None.

348

CASE REPORT
Namita Baldwa, Sona Dave, Pinakin Gujjar

Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:58-60]


ABSTRACT

We report the successful management of an emergency craniotomy performed for extradural hematoma (EDH) evacuation in a known case of von Willebrand disease (vWD).
The case presented a challenge because vWD is associated with extensive bleeding, which was compounded by the emergency nature and type of the surgery. Extensive laboratory investigations could not be carried out, and preoperative optimization was limited.

Keywords: Emergency, Extradural hematoma, Von Willebrand disease.

How to cite this article: Baldwa N, Dave S, Gujjar P. Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications. Res Inno in Anesth 2016;1(2):58-60.

Source of support: Nil

Conflict of interest: None.

325

CASE REPORT
Neeraj Barnwal, Raylene Dias, Rahul Mamde

Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:61-62]


ABSTRACT

Cushing’s syndrome in an acromegalic patient is a very rare presentation. To differentiate a Cushing’s disease from Cushing’s syndrome due to ectopic adrenocorticotropic hormone (ACTH) secreting tumors, inferior petrosal sinus sampling (IPSS) is required. Acromegaly patients have associated airway abnormalities posing a challenge to administration of anesthesia. Traditionally, most IPSS was done under general anesthesia. But now it is being recognized that general anesthesia for this procedure has its own implications and hence conscious sedation is being used for this purpose. We describe our experience with the novel agent dexmedetomidine for conscious sedation in this procedure.

Keywords: Acromegaly, Cushing’s syndrome, Dexmedetomidine, Inferior petrosal sinus sampling.

How to cite this article: Barnwal N, Dias R, Mamde R. Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling. Res Inno in Anesth 2016;1(2):61-62.

Source of support: Nil

Conflict of interest: None.

306

ORIGINAL ARTICLE
Meenoti Pramod Potdar, Laxmi Laxman Kamat, Manjeet Prakash Save, Tanya R Jha

Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:52-57]


ABSTRACT

Introduction: The addition of neuraxial fentanyl or clonidine potentiates the effect of local anesthetic and increases the duration of action and quality of intraoperative and postoperative analgesia. We decided to conduct this study to analyze the synergistic effect of clonidine and fentanyl with bupivacaine on the duration of analgesia surgies. The primary aim is to determine the duration of analgesia for a combination of intrathecal clonidine and fentanyl with bupivacaine in knee arthroscopic surgeries.

Materials and methods: We included 100 patients undergoing operative arthroscopio procedure and randomly allocated the patients into four different groups of 25 each.

Group S: 15 mg 0.5% hyperbaric bupivacaine with 1.0 mL normal saline (NS).
Group F: 15 mg 0.5% HB with 25 µcg fentanyl citrate and 0.5 mL NS.
Group C: 15 mg 0.5% HB with 75 µcg clonidine and 0.5 mL NS.
Group FC: 15 mg 0.5% HB with 25 µcg fentanyl citrate and 75 µcg clonidine.
All the patients received the spinal dosage of 4 mL.

Results: The duration of spinal analgesia was greatest in group FC (458.4±179.96 minutes, p-value 0.001). The rescue analgesic requirement in 24 hours was significantly less in group FC, and the incidence of side effects was comparable.

Conclusion: The combination of clonidine and fentanyl with bupivacaine intrathecally does augment its sensory, motor, and analgesic action further, and hence it has an additional advantage with similar side effects.

Keywords: Arthroscopic, Bupivacaine, Clonidine fentanyl, Intrathecal, Postoperative analgesia.

How to cite this article: Potdar MP, Kamat LL, Save MP, Jha TR. Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure. Res Inno in Anesth 2016;1(2):52-57.

Source of support: Nil

Conflict of interest: None.

305

CASE REPORT
Sonia Nayak

Pneumothorax during Cardiomyotomy: Management

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:71-72]


ABSTRACT

Laparoscopic cardiomyotomy is the surgical mode of treatment for patients suffering from achalasia cardia. These patients are at a risk of developing intraoperative pneumothorax with hemodynamic and respiratory changes. We reported case of pneumothorax during laparoscopic cardiomyotomy. Patient developed hypotension, tachycardia, decreased air entry and increased peak airway pressure. We managed that case successfully. Hemodynamics was maintained with fluid and ephedrine. Patient was ventilated with 100% Oxygen and put on pressure cycled ventilator mode. Postoperatively patient was observed in ICU. While managing such cases, anesthetists should be aware of this complication and be vigilant.

Keywords: Achalasia cardia, Laparoscopic cardiomyotomy, Pneumothorax.

How to cite this article: Nayak S. Pneumothorax during Cardiomyotomy: Management. Res Inno in Anesth 2016;1(2):71-72.

Source of support: Nil

Conflict of interest: None.

259

EDITORIAL
Sunil Gvalani

Editorial

[Year:2016] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:iv]


ABSTRACT

ANESTHESIOLOGY: A Spurt of Growth

The last four decades have witnessed a remarkable growth in anesthesiology as a specialty in India. The changes have been varied and remarkable.

A simple combination of a basic anesthesia machine and an electrocardiogram (ECG) monitor has now evolved into an anesthesia workstation with all possible parameters monitored. Intensive monitoring definitely allows us to achieve greater safety assuming proper vigilance.

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