Indian Journal of Clinical Anaesthesia

119-125

Authors: Ankur Khandelwal, Abhijit Tarat, Rupankar Nath3, Shrikant Subhash Kote

The rationale of this study was to evaluate the efficacy of intrathecal hyperbaric ropivacaine for day case pelvic, perenial and lower limb surgeries. Methods: Seventy ASA physical status I-II patients undergoing the above mentioned surgeries were enrolled for the study. Hyperbaric ropivacaine in a dose of 15 mg was injected intrathecally in each of the patients. The primary outcome variables of the study were- duration of sensory and motor block. Secondary outcome variables were- time for onset of sensory block to T10 dermatomal level and motor block to Bromage Score 3, maximum spread of sensory block, time to reach maximum sensory level, quality of intraoperative analgesia and muscle relaxation, time to mobilize, time to spontaneous voiding and side effects. Results: The mean time for onset of sensory block to T10 dermatome level and motor block to Bromage Score 3 were 3.25 + 0.84 mins and 5.12 + 0.76 mins respectively. The median value of HSL was T5 (T4 - T6) and mean time to reach HSL was 9.08 + 1.05 mins. The total duration of sensory and motor block (mean) were 132.22 + 8.44 mins and 104 + 8.56 mins respectively. The time needed to mobilize the patients and spontaneous voiding (mean) were 206 + 9.26 and 230 + 10.33 mins respectively. Based on Modified Postanesthesia Discharge Scoring System (PADS) in addition to spontaneous micturition, 61 (87.14%) patients were discharged on the same day of operation. Conclusion: Results have demonstrated that 15 mg of hyperbaric ropivacaine when injected intrathecally is sufficient to produce anesthesia for day case pelvic, perineal and lower limb surgeries.

131-136

Authors: Rakesh Sadhu, Pradeep Goyal, Leena Jad, Sanjay Raina, Beena Jad

Post-operative pain is a major concern for patients undergoing surgery. The fear of pain keeps on preying on their minds leading to various stress related dysfunctions. The present study was designed to compare the efficacy and safety of two combinations of Ropivacaine & Tramadol in preventing post-operative pain in patients undergoing lower abdominal surgery. Patients and Methods: 60 ASA I and II patients undergoing lower abdominal surgery were randomly assigned to two groups of thirty patients each, receiving either 50mg Tramadol with 0.2% Ropivacaine (Group A) or 100mg Tramadol with 0.2% Ropivacaine (Group B) epidurally. Total volume injected was 10ml in each case. Epidural top-ups were given every 8 hourly for post-operative analgesia till 48 hrs after surgery. VAS was used to assess analgesia. Results: Demographic data and baseline parameters were comparable in both the groups. Better analgesia, as seen by lower VAS scores, was observed in Group B. Side-effects were similar in both the groups. Conclusion: 100mg Tramadol as an adjuvant to Ropivacaine 0.2% provides better analgesia as compared to 50mg Tramadol, without significant side-effects.

141-146

Authors: Soma C Cham, Umesh Ramtani, Shubhangi Kamble, Chandrashekharan Cham

Background & Objectives: Spinal anaesthesia reduces the incidence of morbidity that follows general anaesthesia in children with good efficacy and safety record. Racemic bupivacaine is the widely used local anaesthetic for paediatric spinal anaesthesia. Local anaesthetic levobupivacaine has an equivalent potency to that of racemic bupivacaine but with a greater safety margin. Limited duration of surgical anaesthesia is however, one of the major deterrents for widespread use of spinal anesthesia in children. Clonidine lengthens spinal anaesthesia in adults and in children. We conducted a prospective, randomized clinical trial to study the effect of the addition of clonidine to 0.5% isobaric levobupivacaine induced spinal anaesthesia in children undergoing infra-umbilical procedures. Methods: Sixty patients between 5 to 10 years, posted for infra-umbilical surgeries were given spinal anaesthesia with either 0.5% plain isobaric levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) or levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) with clonidine (1μg/kg). Blockade characteristics and duration of analgesia were recorded along with mean arterial pressure, heart rate, respiratory rate and SpO2. Results: Satisfactory surgical anaesthesia was achieved in all 60 patients with comparable mean arterial pressure, heart rate, respiratory rate and SpO2. Block extension was 2 segments higher in patients given intrathecal clonidine. Duration of spinal anaesthesia (2 segment regression) increased from (90.3 ± 7.2 min) in the control group to (143.5 ± 8.7 min) in the group receiving clonidine 1μg/kg (p<0.001) and postoperative analgesia from 228 ± 14 min to 360 ± 31min (p<0.001). Sedation was the most common side effect observed in children receiving intrathecal clonidine. Conclusion: We conclude that clonidine 1μg/kg provides a significant improvement in spinal anesthesia and analgesic duration without undesirable side-effects.

151-155

Authors: Ajay Kumar Chaudhary*, Reetu Verma, Jaishri Bogra, Prithvi Kumar Singh, Girish Chandra, Vinod Kumar Bhatia

Background: The aim of this prospective, randomised double-blinded study was to explore the effects of clonidine with ropivacaine in intrathecal anesthesia, concerning the onset and regression of sensory and motor blockade and analgesic effects and improved the quality of recovery after ambulatory anorectal surgery. Methods: We randomly selected 120 patients from the ASA grade I-III; these patients were scheduled for elective anorectal surgery. These patients were randomly select for two groups (n=60 in each group). In the group I: 0.75% ropivacaine (1ml) with isotonic saline and group II 0.75% ropivacaine (1ml) with 30 μg clonidine. An oral 7.5 mg midazolam premedication was given 2 hours preoperatively. Ringer’s lactate hydration solution (15ml/kg body weight), a midline spinal puncture was performed at L4/L5 with the patient in the lateral decubitus position using a 26-gauge Quincke spinal needle. We assessed the sensory block with a pinprick, the motor block using the modified Bromage scale, analgesia with the visual analog scale and sedation with the modified Ramsay scale. We also recorded the hemodynamic parameters. Results: The both groups were demographically similar. The time to two segment S2 regression, and rescue analgesia were significant prolonged in group II as compared to group II (p<0.001). Modified Bromage score was significantly higher in group II (3.92 ± 0.15) as compared to group I (2.32 ± 0.19). Patients of both groups were hemodynamically stable throughout the surgery. Conclusion: The intrathecal clonidine in combination with ropivacaine prolongs the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without side effects.

161-168

Authors: Mohandeep Kaur, Vinod Bala Dhir, Michell Gulabani, Ira Balakrishnan

Introduction Stress related issues among the family members of patients admitted to intensive care units are often ignored entities. Indian data on these issues is scarce. The study evaluates the various factors contributing to anxiety and depression among the attendants of ICU patients through a validated questionnaire and helps in understanding the communication and counseling by ICU staff as an important measure to reduce these entities. Materials and Methods A prospective observational study was carried out after obtaining ethical committee clearance and informed written consent for the study. It was planned as a questionnaire based study using Hospital Anxiety and Depression Scale (HADS) proforma. Our study was conducted in an 1100 bedded tertiary care government hospital in Northern India which has a 10 bedded open ICU catering to multispeciality patients. Results From observations of the present study it was inferred that there is a high prevalence of anxiety and depression among the relatives of patients in ICU. Conclusion Majority of the attendants visiting patients in ICU suffer from symptoms of anxiety or depression. The major factors contributing to this include male patient, dependence of the attendants on the patient, inadequate information given by ICU doctors and poor financial status of the family. Recognition of abnormal signs of anxiety and depression, adequate counselling or even professional help by psychologists should be provided at the earliest possible which may help in reducing long term consequences like Post Traumatic Stress Disorder

173-179

Authors: Pradnya Milind Bhalerao

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 anesthesiology 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 anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists 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 anesthesiology and perioperative medicine and making them freely available worldwide. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice

182-183

Authors: Surya Prakash Singh, Ram Badan Singh, Yashpal Singh, Shashi Prakash

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 anesthesiology 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 anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists 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 anesthesiology and perioperative medicine and making them freely available worldwide. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice

188-189

Authors: Boopathi Sivarajan1, Andras Farkas

Hyperkalemia, Hypokalemia, Hypovolemia, Acidosis, hypoxia, Hypothermia, thrombosis-coronary and pulmonary, Cardiac tamponade, toxins and tension pneumothorax are the reversible causes of cardiac arrest. We report a case of successful resuscitation of cardiac arrest due to severe hyperkalemia, hypovolemia and severe metabolic acidosis in a patient of Diabetic Keto Acidosis. Our patient is unique for the fact that he had multiple long standing co morbidities, in prolonged cardiac arrest for about 45 minutes with non-shockable cardiac rhythm with multiple reversible causes such as hyperkalemia, hypovolemia and severe metabolic acidosis and was successfully resuscitated with the complete neurological recovery