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  Citation statistics : Table of Contents
   2015| July-September  | Volume 9 | Issue 3  
    Online since June 11, 2015

 
 
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ORIGINAL ARTICLES
Femoral nerve block versus adductor canal block for postoperative pain control after anterior cruciate ligament reconstruction: A randomized controlled double blind study
Mohamed Sayed El Ahl
July-September 2015, 9(3):279-282
DOI:10.4103/1658-354X.154708  PMID:26240546
Background: The objective of this study was to evaluate the reliability of the postoperative pain control using adductor canal block (ACB) compared that using the femoral nerve block (FNB) in patients with anterior cruciate ligament reconstructions (ACLR). Materials and methods: One hundred and twenty-eight patients who had been scheduled to patellar graft ACLR were included in this double blind study, and were randomly allocated into two groups; group ACB and group FNB (64 patients each). All patients received general anesthesia. At the end of the surgery, patients in group FNB received a FNB and those in group ACB received an ACB. The postoperative pain (visual analog scale [VAS]) and muscle weakness were assessed in the postoperative care unit and every 6 h thereafter for 24 h. The total morphine requirements were also recorded. Results: Patients in group ACB had significantly higher VAS (at 18 h and 24 h), higher morphine consumption, but significantly less quadriceps weakness than those in group FNB. Conclusion: In patients with patellar graft ACLR, the ACB can maintain a higher quadriceps power, but with lesser analgesia compared with the FNB.
  2 4,193 340
CASE REPORTS
A case of anesthesia mumps after sacral laminectomy under general anesthesia
Ali Asghar, Karima Karam, Saima Rashid
July-September 2015, 9(3):332-333
DOI:10.4103/1658-354X.154743  PMID:26240559
Acute transient parotid gland enlargement in association with general anesthesia is a rare complication and has also been called anesthesia mumps. Unilateral or bilateral parotid or submandibular swelling usually develops during surgery under anesthesia or, a few hours later and usually resolves in a few days with no sequelae. It has been reported as a complication after general anesthesia in patients undergoing spinal surgeries in prone and lateral decubitus position, even after cesarean section in the supine position and also reported in Intensive Care Unit patients. We present a case of a unilateral parotid swelling noticed in immediate postoperative course, in a patient who underwent spine surgery.
  1 2,289 128
ORIGINAL ARTICLES
Ultrasound-guided ilioinguinal and iliohypogastric nerve block, a comparison with the conventional technique: An observational study
Sunita Milind Khedkar, Pradnya Milind Bhalerao, Shweta Rahul Yemul-Golhar, Kalpana Vinod Kelkar
July-September 2015, 9(3):293-297
DOI:10.4103/1658-354X.154730  PMID:26240549
Background: The conventional technique of ilioinguinal and iliohypogastric nerve block may be associated with drug toxicity, block failure and needs large drug volume. The ultrasound-guided (USG) nerve block enables accurate needle positioning that may reduce the chances of drug toxicity, drug dose and block failure. Aim: In this study, we compared the onset and duration of the motor and sensory nerve block, the drug volume required and time to rescue analgesic between USG and conventional technique. Settings and Design: Sixty male patients aged between 18 and 60 years, belonging to American society of Anesthesiology I-II, scheduled for inguinal hernia repair were enrolled in this prospective study and were randomly allocated into two groups of thirty each by computerized method. Materials and Methods: Group A patients received hernia block by conventional method using 0.75% ropivacaine 15 ml, and Group B patients were given the block guided by ultrasound using 0.75% ropivacaine, till the nerves were surrounded on all sides by the drug. Statistical Analysis: The data were analyzed using two independent sample t-tests for demographic and hemodynamic parameters. Nonparametric test (Mann-Whitney U-test) was used to find the significance between visual analog scale. Results: There was significantly early onset of sensory block in Group B 14.03 ± 2.82 min as compared to Group A 15.57 ± 1.52 min (P = 0.047). The onset of motor block was also earlier in Group B 19.40 ± 2.85 min as compared to Group A 20.67 ± 1.90 min. The time to rescue analgesia was more in Group B 7.22 ± 0.97 h as compared to Group A 6.80 ± 0.70 h (P = 0.062). The volume of drug required was less with ultrasound guided block. Conclusions: Ultrasound-guided hernia block thus has the advantage of early onset, less dose requirement and increase in time to rescue analgesia.
  1 3,416 246
Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial
Uma Srivastava, Shilpi Verma, Tapas Kumar Singh, Amrita Gupta, Avanish Saxsena, Keshav Dev Jagar, Mihir Gupta
July-September 2015, 9(3):298-302
DOI:10.4103/1658-354X.154732  PMID:26240550
Background: The transverse abdominis plane (TAP) block, a regional block provides effective analgesia after lower abdominal surgeries if used as part of multimodal analgesia. In this prospective, randomized double-blind study, we determined the efficacy of TAP block in patients undergoing cesarean section. Materials and Methods: Totally, 62 parturients undergoing cesarean section were randomized in a double-blind manner to receive either bilateral TAP block at the end of surgery with 20 ml of 0.25% bupivacaine or no TAP block, in addition to standard analgesic comprising 75 mg diclofenac 8 hourly and intravenous patient-controlled analgesia (PCA) tramadol. Each patient was assessed at 0, 4, 8, 12, 24, 36, and 48 h after surgery by an independent observer for pain at rest and on movement using numeric rating scale of 0-10, time of 1 st demand for tramadol, total consumption of PCA tramadol, satisfaction with pain management and side effects. Results: Use of tramadol was reduced in patients given TAP block by 50% compared to patients given no block during 48 h after surgery (P < 0.001). Pain scores were lower both on rest and activity at each time point for 24 h in study group (P < 0.001), time of first analgesia was significantly longer, satisfaction was higher, and side effects were less in study group compared to control group. Conclusion: Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 48 h after cesarean section when used as adjunctive to standard analgesia.
  1 3,940 403
CASE REPORTS
Chronic visceral pain secondary to ventral disc herniation: Development of visceral complex regional pain syndrome
Gabriela Rocha Lauretti, Raquel de Oliveira
July-September 2015, 9(3):314-317
DOI:10.4103/1658-354X.154735  PMID:26240553
When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation. As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction. We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).
  - 2,246 97
Pediatric patient with Bombay blood group: A rare case report
Sudeshna Bhar (Kundu), Anisha De, Anindita Saha, Chiranjib Bhattacharyya
July-September 2015, 9(3):318-320
DOI:10.4103/1658-354X.154738  PMID:26240554
Bombay blood group is a rare blood group in which there is the absence of H antigen and presence of anti-H antibodies. At the time of blood grouping, this blood group mimics O blood group due to the absence of H antigen, but it shows incompatibility with O group blood during cross matching. Serum grouping or reverse grouping are essential for confirmation of the diagnosis. Patients carrying this blood group can receive blood only from a person with this blood group. Reported cases of anesthesia in the pediatric patient with Bombay blood group are relatively rare. Here, we present successful anesthetic management along with intraoperative blood transfusion in a pediatric patient with Bombay blood group posted for ovarian cystectomy.
  - 2,726 146
Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail
Appavoo Arulvelan, Madhusudhan Soumya, Kannath Santhosh
July-September 2015, 9(3):321-323
DOI:10.4103/1658-354X.154739  PMID:26240555
Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured.
  - 2,006 89
Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?
Amir Poya Zanjani, Babak Mirzashahi, Ali Emami, Motahareh Hassani
July-September 2015, 9(3):324-326
DOI:10.4103/1658-354X.154740  PMID:26240556
Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.
  - 2,203 89
Airway management in a patient of ankylosing spondylitis with traumatic cervical spine injury
Nilesh Kumar, Ashish Bindra, Charu Mahajan, Naveen Yadav
July-September 2015, 9(3):327-329
DOI:10.4103/1658-354X.154741  PMID:26240557
Traumatic cervical lesions compressing the spinal cord pose a significant risk of exacerbating the existing neurological condition during tracheal intubation and subsequent positioning. Preexisting ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient with traumatic cervical spinal cord. To improve ease and success, and reduce cervical spine movement, awake fibreoptic intubation (FOI) is considered the gold standard technique for airway management in such cases. Attaining appropriate position for intubation was challenge in this case due to rigid curvature of the ankylosed spinal column. To prevent neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and attaining appropriate position was of prime concern. Optimal sedation with self-positioning by the patient in a comfortable posture is quite imperative and assures both airway as well as neurological protection in such expected difficult situations. We report the use of dexmedetomidine for self-positioning and awake FOI in a patient with ankylosing spondylitis having traumatic cervical spine who was otherwise neither able to co-operative nor able to give appropriate position for FOI.
  - 2,648 152
A delayed spontaneous expulsion of a three teeth bridge after 6 months period of aspiration in the right lung following cardiac surgery
El Tayeb Areeg Magzoub, Saleh Ahmed Al Ghamdi, Khalid Dagriri, Ahmed Al Fagih
July-September 2015, 9(3):330-331
DOI:10.4103/1658-354X.154742  PMID:26240558
Aspiration of loose teeth is a well-known complication of endo-tracheal intubation hence the importance of oral check by anesthetist prior to ventilation. Artificaial teeth crown (single) or bridges (multiple) can be fixed or removable by the patient. The presence of a foreign body in the lung tissue or airways is a clinical situation that needs aggressive management as it can lead to refractory infections and possible death. We report this unique case of aspirarin of a three bridge teeth (10 mm × 30 mm) following cardiac surgery. The case is complicated by pneumonia, chronic cough and severe bouts of cyanosis and finally removed by spontaneous expulsion after 6 months following forceful cough.
  - 2,082 74
EDITORIAL
Anesthesia for gastrointestinal endoscopy: A subspecialty in evolution?
Basavana Goudra, Preet Mohinder Singh
July-September 2015, 9(3):237-238
DOI:10.4103/1658-354X.154691  PMID:26240538
  - 3,031 264
LETTERS TO EDITOR
On table confirmation of the catheter tip: A requirement in times of multiple catheters in the same central vein
Shweta A Singh, AN Anil Kumar
July-September 2015, 9(3):334-335
DOI:10.4103/1658-354X.154744  PMID:26240560
  - 2,053 97
Resistant hypercarbia in a patient with interstitial lung disease undergoing resection for right parietoccipital meningioma
Zulfiqar Ali, Talib Khan, Sumaya Syed, Bashir Ahmad Dar, Syed Amir Zahoor
July-September 2015, 9(3):335-336
DOI:10.4103/1658-354X.154745  PMID:26240561
  - 2,065 93
Unusual delayed presentation of cauda equina syndrome after failed spinal anesthesia
Kewal Krishan Gupta, Gurpreet Singh, Amanjot Singh, Mukesh Kumar
July-September 2015, 9(3):336-337
DOI:10.4103/1658-354X.154747  PMID:26240562
  - 2,307 126
Anesthetic management of a pregnant female posted for caesarean section with biopsy proven polymyositis
Kirti Kamal, Teena Bansal, Savita Saini, Sheenam Walia
July-September 2015, 9(3):338-339
DOI:10.4103/1658-354X.154748  PMID:26240563
  - 2,168 118
ORIGINAL ARTICLES
Evaluation of minimal dose of atracurium for cataract surgery in children: A prospective randomized double-blind study
Vanlal Darlong, Rakesh Garg, Ravinder Pandey, Sudarshan Khokhar, Chandralekha , Renu Sinha, Jyotsna Punj, Rajesh Sinha
July-September 2015, 9(3):283-288
DOI:10.4103/1658-354X.154711  PMID:26240547
Background: Cataract surgery when performed under general anesthesia, especially without neuromuscular blocking agents, eccentric position of the eye has been reported. However, no evidence exists for the need and optimal dose of neuromuscular blocking agents for surgical reasons when the anesthetic management may be done without its need. We hypothesize that the minimal dose atracurium may accomplish the surgical requirement of cataract surgery in children. Materials and Methods: After ethical committee approval, this double-blind, prospective, randomized study was conducted in children scheduled for cataract surgery under general anesthesia. Anesthesia was induced in a standardized manner and using laryngeal mask airway. The patients were randomized into four groups of 55 patients each and atracurium was administered as per group allocation: Group 0: No atracurium was administered; Group 50: Received atracurium at 50% dose of ED 95 ; Group 75: Received atracurium at 75% dose of ED 95 ; Group 100: Received atracurium of 100% dose of ED 95 . Surgeon was asked to grade surgical condition just after the stab incision in the cornea. The primary outcome variable included the need of atracurium supplementation based on grading of surgical conditions by the operating surgeon who was blinded to the randomized group. Results: The need of atracurium due to unacceptable surgical conditions based on surgeon satisfaction score was statistically significant when compared among the groups being maximum in Group 0 (P < 0.001). Also, the surgeon satisfaction score was statistically significant among the groups (P < 0.0001) with the least satisfaction in Group 0. The laryngeal mask airway (LMA) insertion score was statistically significant in the four groups (P - 0.001). However, number of attempts for LMA placement was comparable among the four groups (P - 0.766). Conclusion: We conclude that a balanced anesthetic technique including atracurium provided better surgical condition for cataract procedures in children. The surgical condition improved with increasing dose of atracurium from 25% to 100% ED 95 dose.
  - 2,403 134
Repeated dose of ketamine effect to the rat hippocampus tissue
Mehtap Okyay Karaca, Mustafa Süren, Zafer Ismail Karaca, Semih Arici, Serkan Karaman, Hüseyin Aslan, Ziya Kaya, Serkan Dogru
July-September 2015, 9(3):289-292
DOI:10.4103/1658-354X.154726  PMID:26240548
Aim: We aimed to determine the neurotoxic effect of repeated ketamine administration on brain tissue and if neurotoxic effect was present, whether this effect continued 16 days later using histological stereological method, a quantitative and objective method. Materials and Methods: Female rats were divided into three groups, each containing five rats. Rats in Group I were given 0.9% saline solution 4 times a day for 5 days. The rats in Groups II and III were given ketamine as intraperitoneal injections. Rats in Groups I and II were sacrificed on 5 th day while the ones in Group III on 21 st day. Cornu ammonis (CA) and gyrus dentatus (GD) regions in hippocampus tissue of rats were studied using optic fractionation method. Findings: There were significantly less number of cells in hippocampal CA and GD regions of rats from Groups II and III compared to the ones from Group I. Difference in cell number was also significantly higher in Group III than in Group II, but this difference was not as pronounced as the one between Groups III and I. Conclusion: Repeated ketamine doses caused neurotoxicity in rat hippocampus.
  - 2,617 109
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position
Shagun Bhatia Shah, Ajay Kumar Bhargava, Itee Choudhury
July-September 2015, 9(3):239-246
DOI:10.4103/1658-354X.154693  PMID:26240539
Background: Recent reports of increased intracranial pressure (ICP) due to steep Trendelenburg (ST) position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD) in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated. Materials and Methods: Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions. Statistics: Student's t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis. Result: Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position), the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group) while 4.3 mm was the corresponding value in control Group-O. Conclusion: ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position.
  - 3,608 309
Comparative study between sugammadex and neostigmine in neurosurgical anesthesia in pediatric patients
Ayman A Ghoneim, Mohammed A El Beltagy
July-September 2015, 9(3):247-252
DOI:10.4103/1658-354X.154696  PMID:26240540
Background: Postoperative recurarization remains a risk following the use of the conventional neuromuscular blocking agents. In addition, none of the commonly used reversal agents, such as neostigmine or edrophonium are capable of reliably reversing profound blockade. The present comparative and randomized study investigated the use of sugammadex for reversing profound neuromuscular blockade (NMB) in pediatric neurosurgical patients undergone posterior fossa tumor excision. Patients and Methods: Forty pediatric patients undergoing elective craniotomy for posterior fossa tumor excision were randomly divided into either of neostigmine or sugammadex group in which muscle relaxant was reversed at the end of anesthesia either with neostigmine 0.04 mg/kg added to atropine 0.02 mg/kg or sugammadex 4 mg/kg alone, respectively. The primary endpoint was the time from the administration of sugammadex or neostigmine to recovery of the train of four (TOF) ratio to 90% after rocuronium-induced neuromuscular block. Unpaired t-test was used to compare continuous variables between groups. Meanwhile, repeated ANOVA was used to detect intragroup differences. Results: Patients in sugammadex group attained a TOF ratio 90% in statistically shorter time (1.4 ± 1.2 min) than those in neostigmine group (25.16 ± 6.49 min) for reversal of the rocuronium. Mean arterial pressure and heart rate were significantly higher in neostigmine group at 2, 5 and 10 min after administration of the reversal agents and returned nonsignificantly different after that. With no recurarization in any patient throughout the study period. Conclusion: Sugammadex rapidly and effectively reverses rocuronium-induced NMB in pediatric patients undergoing neurosurgery when administered at reappearance of T2 of TOF at dose 4 mg/kg.
  - 3,448 303
Comparison of pregabalin versus ketamine in postoperative pain management in breast cancer surgery
Essam Mahran, Mohamed Elsayed Hassan
July-September 2015, 9(3):253-257
DOI:10.4103/1658-354X.154697  PMID:26240541
Background: Breast surgery compromises one of the most common cancer surgeries in females and commonly followed by acute postoperative pain. Pregabalin and ketamine have been used in many previous studies and was found to have a good analgesic profile. We assumed that pregabalin and ketamine can be used in control of postoperative pain in female patients undergoing breast cancer surgery. Material and Methods: Ninety female patients scheduled for cancer breast surgery were allocated in three groups (30 patients each), control group (group c) received preoperative placebo, pregabalin group (group p) received oral 150 mg pregabalin 1 h before surgery, ketamine group (group k) received intravenous (IV) 0.5 mg/kg ketamine with induction of anesthesia followed by 0.25 mg/kg/h IV throughout the surgery. All patients received general anesthesia and after recovery, the three groups were assessed in the first postoperative 24 h for postoperative visual analog scale (VAS) , total 24 h morphine consumption, incidence of postoperative nausea and vomiting (PONV), sedation score >2 and any complications from the drugs used in the study. Results: The use of pregabalin or ketamine was found to reduce total postoperative morphine consumption with P < 0.001. There was no difference between pregabalin and ketamine groups in opioid requirement. There was no difference between the three groups in postoperative VAS scores or incidence of PONV and sedation score >2. Conclusion: The use of preoperative oral 150 mg pregabalin 1 h before surgery or IV 0.5 mg ketamine with induction of anesthesia can reduce postoperative opioid consumption in breast cancer surgery without change in sedation or PONV and with a good safety profile.
  - 2,976 262
Dexmedetomidine versus propofol in dilatation and curettage: An open-label pilot randomized controlled trial
Priyanka Sethi, Sunil Sindhi, Ankita Verma, KL Tulsiani
July-September 2015, 9(3):258-262
DOI:10.4103/1658-354X.154699  PMID:26240542
Background: Traditionally propofol has been used for providing sedation in dilatation and curettage (D and C). Recently, dexmedetomidine has been tried, but very little evidence exists to support its use. Aims: The aim was to compare hemodynamic and recovery profile of both the drugs along with a degree of comfort experienced by patients and the usefulness of the drug to surgeons. Settings and Design: Tertiary care center and open-label randomized controlled trial. Materials and Methods: Patients posted for D and C were enrolled in two groups (25 each). Both groups received fentanyl 1 μg/kg intravenous (IV) at the beginning of the procedure. Group P received IV propofol in dose of 1.5 mg/kg over 10-15 min and Group D received dexmedetomidine at a loading dose of 1 μg/kg over 10 min, followed by 0.5 μg/kg/h infusion until Ramsay sedation score reached 3-4. Hemodynamic vitals were compared during and after the procedure. In the recovery room time to reach modified Aldrete score (MAS) of 9-10 and patient's and surgeon's satisfaction scores were also recorded and compared. Results: In Group D, patients had statistically significant lower heart rate at 2, 5, 10 and 15 min as compared to Group P. Hypotension was present in 52% in Group P and 4% in Group D (P < 0.05). MAS of 9-10 was achieved in 4.4 min in subjects in Group D in contrast to 16.2 min in Group P (P < 0.05). Group D showed higher patient and surgeon satisfaction scores (P < 0.05). Conclusion: Dexmedetomidine provide better hemodynamic and recovery profile than propofol. It can be a superior alternative for short surgical day care procedures.
  - 2,743 233
Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor
Veena Chatrath, Ranjana Khetarpal, Sujata Sharma, Pratibha Kumari, Sudha , Kusum Bali
July-September 2015, 9(3):263-267
DOI:10.4103/1658-354X.154700  PMID:26240543
Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA) has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4). Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes) than in Group I (95 ± 7 minutes). Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.
  - 3,817 326
Regional anesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block
Susmita Bhattacharyya, Subrata Bisai, Hirak Biswas, Mandeep Kumar Tiwary, Suchismita Mallik, Swarna Mukul Saha
July-September 2015, 9(3):268-271
DOI:10.4103/1658-354X.158497  PMID:26240544
Background: Spinal anesthesia is the technique of choice in transurethral resection of prostate (TURP). The major complication of spinal technique is risk of hypotension. Saddle block paralyzed pelvic muscles and sacral nerve roots and hemodynamic derangement is less. Aims and objectives: To compare the hemodynamic changes and adequate surgical condition between saddle block and subarachnoid block for TURP. Material and methods: Ninety patients of aged between 50 to 70 years of ASA-PS I, II scheduled for TURP were randomly allocated into 2 groups of 45 in each group. Group A patients were received spinal (2 ml of hyperbaric bupivacaine) and Group B were received saddle block (2 ml of hyperbaric bupivacaine). Baseline systolic, diastolic and mean arterial pressure, heart rate, oxygen saturation were recorded and measured subsequently. The height of block was noted in both groups. Hypotension was corrected by administration of phenylephrine 50 mcg bolus and total requirement of vasopressor was noted. Complications (volume overload, TURP syndrome etc.) were noted. Results: Incidence of hypotension and vasopressor requirement was less (P < 0.01) in Gr B patients.Adequate surgical condition was achieved in both groups. There was no incidence of volume overload, TURP syndrome, and bladder perforation. Conclusion: TURP can be safely performed under saddle block without hypotension and less vasopressor requirement.
  - 5,259 564
Effectiveness of intravenous infusion of N-acetylcysteine in cirrhotic patients undergoing major abdominal surgeries
Eman Sayed Ibrahim, Ahmed Sharawy
July-September 2015, 9(3):272-278
DOI:10.4103/1658-354X.154706  PMID:26240545
Background: Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries. Materials and Methods: A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each.NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups. Results: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m 2 ). Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00). Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group. Conclusion: Intravenous administration of NAC NAC in cirrhotic patients undergoing major abdominal surgeries reduces the incidence of cystatin C GFR-based AKI, postoperative renal and liver functions were well-preserved and improved outcome.
  - 4,218 167
A survey on postanesthetic patient satisfaction in a university hospital
Adel Ali Alshehri, Yasser Mohammed Alomar, Ghali Abdulrahman Mohammed, Mazen Saud Al-Fozan, Mohammed Saleh Al-Harbi, Khalid Abduraziz Alrobai, Haroon Zahoor
July-September 2015, 9(3):303-305
DOI:10.4103/1658-354X.158499  PMID:26240551
Background and Objectives: Patient satisfaction after anesthesia is an important outcome of hospital care. The aim is to evaluate the postoperative patient satisfaction during the patient stay at King Khalid University Hospital in Riyadh, Saudi Arabia. Patients and Methods: Three hundred and fifty-three patients who underwent surgery under general/regional anesthesia were surveyed. They were interviewed face to face on the first postoperative day. We recorded pain and pain controls in addition to some common complication of anesthesia like nausea and vomiting (postoperative nausea and vomiting) as a parameter to assess the rate of patient's satisfaction. Results: The overall level of satisfaction was high (95.2%); 17 (4.8%) patients were dissatisfied with their anesthetic care. There was a strong relation between patient dissatisfaction and: (i) Patients with poor postoperative pain control 13 (12.4%), (ii) patients with moderate nausea 8 (11.1%) and (iii) patients with static and dynamic severe pain 6 (21.4). Several factors were associated with dissatisfaction can be prevented, or better treated. Conclusion: We concluded that the patient satisfaction was high. Postoperative visit should be routinely performed in order to assess the quality and severity of postoperative pain, nausea and vomiting and the other side-effects postoperatively.
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REVIEW ARTICLE
Concerns and challenges during anesthetic management of aneurysmal subarachnoid hemorrhage
Kamath Sriganesh, Sudhir Venkataramaiah
July-September 2015, 9(3):306-313
DOI:10.4103/1658-354X.154733  PMID:26240552
Anesthetic management of patients with aneurysmal subarachnoid hemorrhage is challenging because of the emergency nature of the presentation, complex pathology, varied intracranial and systemic manifestations and need for special requirements during the course of management. Successful perioperative outcome depends on overcoming these challenges by thorough understanding of pathophysiology of Subarachnoid hemorrhage, knowledge about associated complications, preoperative optimization, choice of definitive therapy, a good anesthetic and surgical technique, vigilant monitoring and optimal postoperative care. Guidelines based on randomized studies and provided by various societies are helpful in the routine management of these patients and wherever there is a lack of high quality evidence, the available data is provided for practical management.
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