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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 13 | Issue 2
Page Nos. 93-176

Online since Tuesday, March 19, 2019

Accessed 1,344 times.

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ORIGINAL ARTICLES  

Prediction of endotracheal tube size in children by predicting subglottic diameter using ultrasonographic measurement versus traditional formulas Highly accessed article p. 93
Shubhi Singh, Parul Jindal, Priya Ramakrishnan, Shailendra Raghuvanshi
DOI:10.4103/sja.SJA_390_18  
Background: Paediatric airway assessment remains the most challenging task before the anaesthesiologists. Recent advancement in ultrasonography techniques should now allow for accurate and descriptive evaluation of paediatric airway. To compare calculated external diameters of the endotracheal tube from physical indices of traditional formulas and predetermined by ultrasound. Materials and Methods: 100 subjects of either sex between 12-60 months of age, undergoing various elective surgeries under general anaesthesia requiring endotracheal intubation were enrolled in the study. The transverse diameter was measured at the level of cricoids cartilage by ultrasonography. The tracheal tube was considered best fit if air leak was satisfactory at 15-20 cm H2O of airway pressure. The obtained values were compared with the values of endotracheal tube size calculated by various age, height, weight based formulas and diameter of right and left little finger. The correlation of size of Endotracheal tube by different modalities was done and Pearson's correlation coefficient was obtained. Results: According to Pearson's correlation there was a moderate correlation of best fit Endotracheal tube with endotracheal tube size by age based formula (r = 0.743), body length based formula (r = 0.683), right little finger based formula (r = 0.587), left little finger based formula (r = 0.587) and multivariate formula (r = 0.741). There was a strong correlation with ultrasonography (r = 0.943). Conclusion: Ultrasonography is a reliable method of estimation of subglottic diameter and for prediction of endotracheal tube size in children.
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Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery Highly accessed article p. 100
Ying Li, Jun Geng, Laiyou Wen, Jianqing Chen, Zhen Wu
DOI:10.4103/sja.SJA_533_18  
Objective: The objective of this study is to evaluate the postoperative analgesic effect of a combination of ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block (FICB) after knee arthroscopy. Materials and Methods: Forty patients scheduled for knee arthroscopy were randomized to receive either 30 ml of 0.25% ropivacaine alone (Group A, n = 20) or combined with dexmedetomidine 1 μg/kg (Group B, n = 20). Pain intensity was evaluated using the visual analogue scale (VAS), at rest and during activity at 4, 6, 8, 12, and 24 h after surgery. Level of consciousness was evaluated using the Ramsay sedation score. Time to first analgesic request after surgery, the dose of analgesic used in the first 24 h after surgery, variation of heart rate, and adverse reactions were also recorded. Results: VAS scores at 6 and 12 h after surgery were significantly lower in Group B compared to Group A (P < 0.05). No significant difference was observed in the Ramsay sedation score or time to first analgesic request after surgery (P > 0.05). The total dose of analgesic used in the first 24 h after surgery was higher in Group A than in Group B. The incidence of bradycardia was higher in Group B compared to Group A. No adverse reactions were observed in either group. Conclusion: FICB with a combination of ropivacaine and dexmedetomidine resulted in significant reduction of VAS scores with lower postoperative analgesic requirement after arthroscopic knee surgery. No adverse reactions or complications were noted except for lower heart rate in Group B patients.
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Knowledge of patients on safe medication use in relation to nonsteroidal anti-inflammatory drugs Highly accessed article p. 106
Salmeen D Babelghaith, Mohamed N Alarifi, Syed Wajid, Tariq M Alhawassi, Sara K Alqahtani, Sultan M Alghadeer
DOI:10.4103/sja.SJA_557_18  
Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and used medications that are used as analgesic, antipyretic, or anti-inflammatory agents, but have a high risk of adverse effects. Objective: The main purpose of this study is to evaluate the knowledge of patients toward the risks and safe usage of NSAIDs. Methods: A descriptive cross-sectional study was conducted among patients who attended orthopedic clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, during December 2017 to February 2018. A self-administered questionnaire comprising three sections [sociodemographic information, patients' knowledge of NSAIDs, and the attitude toward receiving information about NSAIDs' adverse drug reactions (ADRs)] was used. The attitude was measured with a 5-point Likert scale. Results: The mean duration of NSAIDs usage was 7.3 ± 6.9 years. Only 45% of the respondents used NSAIDs daily, while 38% said they only used NSAIDs as needed. Nearly one-quarter of patients (25.5%) were counseled by a healthcare provider on the risks of NSAIDs. Almost 94% and 90.5% of the study subjects agreed that physicians and pharmacists, respectively, should play an essential role in providing information regarding ADRs to their patients. More than half of the respondents claimed that information about ADRs might lead them to discontinue their medicines. More than one-third of respondents stated that their healthcare setting provided them with insufficient knowledge of ADRs. Conclusion: Counseling of patients may diminish potentially inappropriate use and increase risk awareness. Healthcare providers can improve their role in identifying and counseling patients on NSAIDs.
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Role of academic anesthesiology department in introducing patient safety module into medical school curriculum: 5 years-experience at King Abdulaziz University, Saudi Arabia p. 112
Abeer A Arab
DOI:10.4103/sja.SJA_586_18  
Background: Medical schools' curricula face increasing number of must to add-on components. Although the World Health Organization has emphasized integrating teaching patient safety and quality improvement in medical curricula, only few medical schools have responded and included these topics in their curricula. Objective: This article aimed to describe the process of foundation and integration of patient safety module led by academic anaesthesiology department at King Abdulaziz's Faculty of Medicine. It also describes the main achievements and the most important challenges faced during implementation of this module during the last 5 academic years to guide other aspiring academic anaesthesiology departments in other medical schools for them to replicate the success. Methods and Subjects: Patient safety module was designed to be interprofessional and multidisciplinary module that depends on evidence-based approach to patient safety. It was offered during the 6th year medical study started in 2011–2012 as part of an integrated, hybrid, system-based curriculum at King Abdulaziz's Faculty of Medicine. The mode was delivered through interactive lecture (15% of the module contact hours), e-learning (15%), and practical sessions (70%). Student's assessment during the module included written exams and presentation of a patient safety advocacy project on group base. Results: The module committee continuously assessed the outcome measures of the module that included results of student's assessment, student's satisfaction, as well as student's self-reported learning of the module outcome. The module committee continuously revised the module in the light of these outcomes. Conclusion: Today medical school curricula aspire to graduate market-place ready safe and efficient future physicians. This requires implementation of effective programs that help students to recognize and show appropriate clinical and patient safety skills early and continuously in their professional education.
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Dexmedetomidine versus fentanyl added to bupivacaine for epidural analgesia in combination with general anesthesia for elective lumbar disc operations: A prospective, randomized double-blinded study p. 119
Amin Mohammed Alansary, Marwa Ahmed Khairy Elbeialy
DOI:10.4103/sja.SJA_600_18  
Background: The literature on drugs used for combined general anesthesia and epidural analgesia (CGE) in lumbar operations is scarce. The purpose of the study was to compare the addition of either dexmedetomidine or fentanyl to bupivacaine for epidural analgesia in combination with general anesthesia with regard to efficacy and adverse events in such operations. Materials and Methods: This prospective, randomized, double-blinded study was conducted on 80 patients who were scheduled for an elective lumbar disc operation, age 20–65 years, of either sex and American Society of Anesthesiologists physical status I or II. They were randomly allocated into one of the two groups – group bupivacaine-dexmedetomidine (BD) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg of dexmedetomidine and group bupivacaine-fentanyl (BF) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg fentanyl. The primary outcome was time to first analgesic requirement, whereas the secondary outcomes were the total opioid consumption and pain scores during the first 24 h. The incidence of adverse postoperative (PO) effects related to the study drugs, such as sedation, nausea and vomiting, pruritus, shivering, and respiratory depression, was also documented. Results: Patients in the BD group experienced a significantly prolonged pain-free period, lower total opioid consumption, and lower pain scores than patients in the BF group (P < 0.001). Patients in the BD group showed a significantly lower intraoperative heart rate and mean blood pressure (P < 0.001). Regarding adverse events, there were greater PO sedation scores (P < 0.001) and less frequent episodes of PO nausea and vomiting in the BD group. In addition, patients in the BD group showed less pruritis and shivering. There were no reported cases of respiratory depression in either group. Conclusion: CGE with bupivacaine plus dexmedetomidine provided better PO pain control than bupivacaine plus fentanyl, with fewer adverse events overall.
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A prospective study to evaluate the efficacy of ultrasound-guided ganglion impar block in patients with chronic perineal pain p. 126
Anju Ghai, Priti Jangra, Sarthak Wadhera, Nandita Kad, RK Karwasra, Ankur Sahu, Rajmala Jaiswal
DOI:10.4103/sja.SJA_667_18  
Background: The blockade of the ganglion impar has been described to relieve the intractable perineal pain of sympathetic origin in patients with coccydynia. Chronic perineal pain (CPP) has been effectively managed by ganglion impar block. The feasibility, safety, and efficacy of ultrasound (US)-guided ganglion impar block by transsacrococcygeal approach was analyzed in the present study. Methods: A total of 15 patients with CPP were administered US-guided ganglion impar block using out of plane approach. Patients were followed for VAS and quality of life using Karnofsky performance status (KS), Linear Analog Scale Assessment (LASA), and constipation score up to 2 months at different time intervals. Time required to perform the procedure, number of attempts, and any complications were also noted. Results: The mean time required to perform the procedure was 7.67 ± 1.23 min. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (P < 0.05 compared to baseline VAS). The KS and LASA score improved post block which was statistically significant. The dose of nonsteroidal anti-inflammatory drugs (NSAIDS) decreased from preblock state with statistically significant difference, while the difference in dose of tramadol and morphine was statistically insignificant. Conclusion: US-guided ganglion impar block is technically feasible and safe technique. USG can be used to locate sacrococcygeal junction (SCJ) and facilitate the performance of ganglion impar block. The efficacy and safety of the US-guided ganglion impar blockades needs a proper evaluation in the randomized controlled trials.
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CASE REPORTS Top

Cytoreductive onco-surgery with combined hyperthermic intraperitoneal chemotherapy and hyperthermic intrathoracic chemotherapy: Perioperative challenges p. 131
Rohini Dattatri, Rakesh Garg, Mukur Dipi Ray
DOI:10.4103/sja.SJA_545_18  
Cytoreductive surgeries (CRSs) are the common management modality for advanced cancers. The perioperative period is impacted by major surgical resection and its associated effects. The surgical morbidity is further enhanced when the resection of abdominal and thoracic cavity is required simultaneously. It is added on by the effects of hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intrathoracic chemotherapy (HITHOC). These procedures are technically challenging with potential for high perioperative morbidity and mortality. We report a case of 56-year-old female diagnosed with carcinoma ovary with pleural metastases and malignant right pleural effusion and scheduled for CRS with HIPEC together with HITHOC.
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Giant meningoencephalocele with Arnold-Chiari type III malformation and anaesthetic challenges: A rare case report p. 136
Veena Ganeriwal, Paulomi Dey, Rupali Bawage, Baburao Gore
DOI:10.4103/sja.SJA_616_18  
Meningoencephalocele means protrusion or herniation of brain (neural) tissue along with meninges through a defect in the cranium into a swelling filled with cerebrospinal fluid (CSF). It is very rarely associated with Arnold-Chiari type III (ACM type III). Size, location and type of content of the swelling determine the surgical as well as anaesthetic problems. The most common challenges faced by anaesthesiologist in managing these patients are related to positioning of head and prevention of rupture of swelling, airway management, fluid and blood loss and maintenance of body temperature. In order to manage huge meningoencephalocele, you need a well-planned approach amongst anaesthesiologist and surgeon.
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Anesthetic management of separation of conjoint twins: Challenges and limitations p. 140
Choudhary Deepak, Sharma Vandana, Bhatia Pradeep, Kothari Nikhil
DOI:10.4103/sja.SJA_589_18  
A conjoint twin is a rare congenital anomaly. The separation of conjoint twins presents a unique challenge to anesthesiologists. We report the anesthetic management of successful separation of thoraco-omphalopagus conjoint twins, along with challenges and limitations that we faced in perioperative period. We highlight the importance of a multidisciplinary approach, proper preoperative planning, and perioperative vigilance regarding monitoring and complication.
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LETTERS TO EDITOR Top

Unexpected difficult airway caused by prior wide neck surgery p. 144
Daeseok Oh
DOI:10.4103/sja.SJA_581_18  
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Ultrasound for predicting the suitable nostril for nasotracheal intubation: Look before you leap! p. 145
Shagun B Shah, Akhilesh Pahade, Rajiv Chawla, Nitesh Goel
DOI:10.4103/sja.SJA_553_18  
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Comment on “Schwartz–Jampel syndrome: Is risk of malignant hyperthermia the same as that of the general population?” p. 147
Godai Kohei
DOI:10.4103/sja.SJA_650_18  
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Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect p. 148
Madan M Maddali, Salim N Al-Maskari, Pranav S Kandachar, Nishant R Arora, Francois Lacour-Gayet
DOI:10.4103/sja.SJA_625_18  
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Perioperative lidocaine in ambulatory surgery: A useful addition p. 150
Abhijit S Nair
DOI:10.4103/sja.SJA_629_18  
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Dexmedetomidine nebulization as adjuvant to lignocaine during awake flexible fiberoptic intubation p. 152
Amarjeet Kumar, Poonam Kumari, Chandni Sinha, Ajeet Kumar, Rajnish Kumar, Abhyuday Kumar
DOI:10.4103/sja.SJA_579_18  
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Epidural catheter as an alternative for umbilical vein catheterization p. 153
Amiya K Barik, Gaurav Jain
DOI:10.4103/sja.SJA_701_18  
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Spinal cord compression following excision of posterior mediastinal tumor - Anesthesia concerns of a rare complication p. 155
Aditi Suri, Vinod Kumar, Nishkarsh Gupta, Varnika Minhas
DOI:10.4103/sja.SJA_689_18  
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Too much of anything is bad: An unusual case of a stuck endotracheal tube with deflated cuff p. 156
Chinmaya K Panda, Habib M R Karim
DOI:10.4103/sja.SJA_741_18  
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A kinked epidural catheter p. 158
Onur Baran, Bunyamin Kir, Irem Ateş, Ayhan Şahin
DOI:10.4103/sja.SJA_738_18  
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Oblique-axis view should be the preferred view for ultrasound-guided internal jugular vein cannulation in intensive care unit p. 159
Swati Singh, Raja Avinash
DOI:10.4103/sja.SJA_744_18  
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Guidewire-assisted fiberoptic bronchoscope-guided tracheal intubation: A novel airway management in an invasive thyroid malignancy p. 160
Jagadish Anguraj, Sakthirajan Panneerselvam, Priya Rudingwa, Ranjith Kumar Sivakumar
DOI:10.4103/sja.SJA_729_18  
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Emergency airway management in a child with malignant infantile osteopetrosis p. 162
Mohamed Amin Elbouaychi, Youssef Motiaa, Aalae Elkoraichi, Salma Ec-Chrif El Kettani
DOI:10.4103/sja.SJA_746_18  
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Comment on published article: Cannot intubate and cannot ventilate scenario in an infant for airway assessment p. 164
Sohan Lal Solanki, Jeson R Doctor
DOI:10.4103/sja.SJA_1_19  
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A rare cause of desaturation in an infant after anesthesia induction p. 164
Shwetha Seetharamaiah, Rajkumar Subramanian, Ankur Sharma, Varuna Vyas
DOI:10.4103/sja.SJA_841_18  
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A case of misplaced epidural catheter p. 165
Priyanka Pavithran, Preetha Chandran, Kishore Kaniachalil
DOI:10.4103/sja.SJA_687_18  
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Apnoeic oxygenation during rigid bronchoscopy: An unconventional and novel technique p. 167
Deepti Ahuja, Wasimul Hoda, Abhishek Kumar, Sachidanand J Bharati
DOI:10.4103/sja.SJA_406_18  
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Anaesthesia concerns for Peritonectomy with Hyperthermic Intraoperative Peritoneal Chemotherapy p. 169
Namita Saraswat, Akhilesh Gupta, Mohandeep Kaur, Sakshi Mahajan
DOI:10.4103/sja.SJA_12_17  
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USG-guided jelly injection: An answer to leaking cuff p. 171
Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Poonam Kumari, Sailesh Mukul
DOI:10.4103/sja.SJA_742_18  
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Epigastric compressions facilitate complicated tracheal location during fiberoptic bronchoscopy: An unique rescue maneuver p. 172
Rudrashish Haldar, Ashish Kannaujia
DOI:10.4103/sja.SJA_703_18  
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NOTICE OF RETRACTION Top

Retraction: Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study Highly accessed article p. 174

DOI:10.4103/1658-354X.254539  
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Retraction: Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study p. 175

DOI:10.4103/1658-354X.254540  
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OBITUARIES Top

Obituary: Dr. Mohamed Taha Aljasser p. 176
Abdelazeem A Eldawlatly
DOI:10.4103/1658-354X.254570  
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