Indian Journal of Clinical Anaesthesia

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Authors: Dr. Rakesh Sadhu

Indian Journal of Clinical Anaesthesia (IJCA) publishes definitive, peer-reviewed articles devoted to the clinical practice of anaesthesia. IJCA publishes a wide range of articles in the discipline of anaesthesiology including basic science, translational medicine, education, and clinical research to create a platform for the authors to make their contribution towards the field without restrictions/barriers of subscription and language. IJCA addresses all aspects of anaesthesia practice, including anaesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anaesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. This Journal is an Open Access journal and aims to publish research articles, reviews, case studies, commentaries, short communications, and letters to the editor on various aspects of anaesthesiology and perioperative medicine and making them freely available worldwide.

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Authors: Sarvesh Pal Singh2,*, Minati Choudhury1, Ujjwal Kumar Chowdhury3, Sandeep Chauhan1

Background: Cerebral protection has always been an important concern during cardiac surgery. Near infrared spectroscopy (NIRS) can continuously monitor cerebral oxygenation and is increasingly being used as a surrogate measure to ensure the wellbeing of brain. This prospective observational study was designed to observe the changes in cerebral oxygenation in patients undergoing coronary artery bypass surgery (CABG) with the aid of cardiopulmonary bypass (CPB) during hypothermia and normothermia, and to determine if there was any correlation between the cerebral oximetry values and variables like hematocrit (Hct), mean arterial pressure (MAP), partial pressure of oxygen in blood (PaO2), CPB flows and temperature. Methods: Forty patients scheduled to undergo elective CABG with the aid of CPB were enrolled in this study. The regional cerebral oxygen saturation (rso2), haematocrit, (MAP), PaO2, temperature and pump flows during CPB were measured at following time points during the surgery -T1:Baseline before induction of anaesthesia (on room air), T2:After induction of anaesthesia with a FiO2 of 100% , T3:After induction of anaesthesia with a FiO2 of 50% , T4:At the initiation of CPB (the lowest value of rso2 at the time of initiation of CPB), T5:On CPB at 35°C , T6:On CPB at 32°C, T7:On CPB after rewarming at 36°C , T8:After weaning from CPB with a FiO2 of 100% (after protamine administration) and T9:After weaning from CPB with a FiO2 of 50% (just before sternal closure). During CPB, pump flows were also recorded to find any deviation from the standard protocol. Results: The mean baseline rso2 values were 64.35 and 64.97 for right and left frontal lobes, respectively and there was a relative increase in rso2 values with increase in PaO2 levels in the preCPB period. There was a maximum relative decrease of 12% in rso2 values with the initiation of CPB and the values remained below baseline throughout the hypothermic CPB. An insignificant decrease in rso2 values occurred with hypothermia which reversed at rewarming. The rso2 values reached baseline values in the post-CPB period. Based on post hoc analysis we observed that rso2 values could be predicted as 0.329 X per unit change in haematocrit; 0.133 X per unit change in MAP and 0.005 X per unit change in PaO2. Conclusion: In patients undergoing cardiac surgery with CPB cerebral oximetry values were well maintained with maximal decrease of 12% at the time of initiation of CPB. Mild decrease in rso2 occurred with institution of CPB which reversed by the end of rewarming. The rso2 values differ insignificantly during hypothermic CPB. Cerebral oxygenation appears to be influenced by haematocrit, mean arterial pressure and partial pressure of oxygen in blood in pre, during and post CPB period.

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Authors: Dr. Ram Badan Singh1,*, Dr. Richa Prabhakae2, Rajiv Kumar Dubey3, Prof. TB Singh4

Aim of Study: To find out effect of clonidine on fentanyl and Ropivacaine requirement to produce Epidural Anesthesia. Material and Method: After Institute ethical clearance and consent from patient, 60 patients of ASA I and II were studied in 3 groups. All patients were premedicated with ranitidine and metoclopramide. In operation room epidural catheter was placed. After recording base line hemodynamic parameters, drugs were mixed in 20ml syringe according to 3 different groups and given through epidural catheter. Observation and Result: All patients were monitored for hemodynamic changes and recorded at different time interval. Data were analyzed using different tests. Patients of all 3 group have similar level of anesthesia with lower adverse effects hypotension which was more in clonidine, fentanyl and ropivacaine group. Conclusion: With this study we concluded that adition of clonidine in fentanyl and ropivacaine significantly reduces the amount of ropivacaine and fentanyl required to produce epidural anesthesia.

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Authors: Dr. Bharat Paliwal, Dr. Manoj Kamal, Dr. Anamika Purohit, Dr. Geeta Singaniya

Central venous catheterization (CVC) has become an integral part for management of patients in intensive care units. It enables invasive monitoring, facilitate atrial pacing and permit delivery of parenteral alimentations and medications. Notwithstanding, CVCs are associated with numerous complications such as mechanical complications, infections and thrombotic complications. We presented a case of 17-year-old male patient who developed massive central venous thrombosis causing superior vena cava (SVC) syndrome after sequential placement of a right and left subclavian vein central venous catheter. Colour Doppler and Computed tomography (CT) angiography showed thrombosis of bilateral subclavian, internal jugular and axillary veins with minimal blood flow. Patient was treated with low molecular weight heparin (LMWH) and warfarin with partial recanalization of veins and resolution of symptoms.

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Authors: Dr. Lalit Gupta, Dr. Gaurav Dwivedi

Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. This technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of an entrapped guidewire during central venous catheter insertion followed by a review of the literature on this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.