Indian Journal of Clinical Anaesthesia

461-464

Authors: Atlanta Talukdar,Sara Mary Thomas*,Akhilesh Chhaya,Dinesh K Chauhan

Aim: To study the efficacy of two different time duration of venous occlusion in preventing propofol injection pain. Materials and Methods: In this prospective, randomized controlled study patients of either gender, scheduled to undergo elective surgery under general anaesthesia were randomly assigned into 2 groups (Group L30 and Group L60) of 25 patients each. Group L30 and Group L60 received Injection (Inj) Lignocaine 40mg intravenously under venous occlusion for 30 seconds and 60 seconds respectively followed by Inj propofol for induction. propofol induced pain was assessed after administration of 25% of total calculated dose of propofol. Results: In our study, significantly more patients in Group L30 (72%) reported pain as compared to Group L60 (32%). (p < 0> Considering the severity of pain, in Group L30, out of 72% who had pain; 64% had mild pain and 8% had moderate pain. Whereas in Group L60, 32% had pain and all had mild pain only. Conclusion: The study found that pretreatment with Inj Lignocaine 40 mg under venous occlusion for 60 seconds followed by Inj propofol for induction significantly reduced the incidence and the severity of pain of propofol injection when compared with the group who received 40 mg of Inj. Lignocaine under venous occlusion for 30 seconds.

469-472

Authors: Durga Shankar Patel,Omprakash Sundrani*,Sanjay Goyal,A M. Lakara

Introduction: Breast cancer is one of the most common cancers in middle and old aged females. Oncological breast surgeries have commonly been performed under General Anaesthesia (GA). Thoracic Epidural Anaesthesia (TEA) is a safe and advantageous technique associated with fewer post surgical recovery complications, shorter hospital stay and consequently, decreased health care costs. TEA provides better control of pain and provides satisfactory analgesia in postoperative period without any respiratory complications. Materials and Methods: A prospective study was carried out in Anaesthesiology and Critical care department of Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) in 40 female patients aged between 30 and 60 years with ASA grade I, II, III underwent for breast surgeries during February 2007 to July 2008. Pre operative assessment of the patient including history, clinical examination and relevant investigations were done. Pre operative assessment of the patient including history, clinical examination and relevant investigations were done. Explanation regarding procedure and consent was taken from all the patients. The procedure and techniques were performed as per standard protocol. Observations: Maximum numbers of cases (32 cases, 80%) were in the age group of 45-60 yrs. Mean age in our study was 49.0 ± 6.6 yrs. The mean duration of onset of block was 7.67±1.14min. The mean duration was 117.12±28.90min. In maximum number of patients (21), duration of surgery was 91-120 min and mean duration of surgery was 123.1.±13.16min.Preoperative mean SBP was 120 ± 7.45mm of Hg. Intraoperative SBP ranged from 119.8 ±7.02mm of Hg to 125.15 ±8.43mm of Hg. Preoperative mean DBP was 77.6 ±4.34mm of Hg. Introperative DBP ranged from 71.±5.61mm of Hg to 77. ±4.63mm of Hg. Preoperative mean of PR was 84.1 ±5.12/min. Intraoperative mean PR ranged from 80.4 ±4.41/min to 83.35 ±4.54/min and minimum PR was 80.4 ±4.41/min. Preoperative mean of RR was 14.52 ±1.3/min. It ranged between 13.35 ±0.97/min to 14.27 ±0.93/min. Conclusion: It is concluded that TEA for breast surgeries is a safe and a reliable alternative of GA.

479-485

Authors: Arpana Kedlaya,Rashmi Rani*,Uma Devaraj,Priya Ramachandran,Uma Maheshwari

Introduction: Endobronchial Ultrasound Guided Trans bronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic modality for evaluating intra thoracic lymph nodes, becoming one of the important tool in the armamentarium of pulmonologists. The size of the fiberscope and sharing of the airway with the bronchoscopist poses unique challenges to the anesthesiologist. In light of these developments it is important to develop an office based anesthesia technique for this relatively new procedure. Hence we did this descriptive cohort study. Aim: To describe the accuracy and anaesthetic management of EBUS-TBNA as a day care procedure, done with general anesthesia (GA). Materials and Methods: Data was collected from January 2017 to December 2017 at our institute from patients who underwent EBUS-TBNA under GA using second generation laryngeal mask airway (LMA). Specifically, hemodynamic status, Oxygen saturation, duration of the procedure, diagnostic yield and complications of the procedure were recorded. Results: 23 patients underwent EBUS-TBNA under GA. All patients were found to be hemodynamically stable with fluctuations in blood pressure and heart rate being less than 20% from the baseline with no episodes of desaturation .The average number of biopsies taken is 3.3, with average duration of the procedure being 67.0±17.6 (mean±SD) minutes. The incidence of post procedural complications like cough and sore throat were minimal. Successful diagnostic yield was found in all cases with no incidence of recall of the procedure. Conclusion: The performance of EBUS-TBNA under general anesthesia with LMA provides great hemodynamic stability and adequate ventilation in a shared airway. It demonstrates excellent diagnostic accuracy. It provides comfort to the patient and the good examination conditions to the bronchoscopist. Clinical Significance: Use of P-LMA solves the dilemma of managing ventilation during EBUS TBNA without affecting the diagnostic yield of the procedure.

491-495

Authors: Bhavani Vaidiyanathan,Sangeeta Dhanger*,Joseph Raajesh I

Introduction: The role of ultrasound in central neuraxial blockade has been underappreciated, partly because of the relative ease of the landmark-guided technique and falsely perceived difficulty in imaging through the narrow acoustic windows. This study was designed to compare conventional landmark technique with preprocedural ultrasonography for identification of the subarachnoid space in patients for elective surgeries under spinal anaesthesia. Materials and Methods: Total 120 patients who were scheduled for elective surgery under spinal anaesthesia were included in this prospective randomised control trial and divided into 2 group, Group L (n = 60) (landmark guided technique) and Group U (n = 60) (ultrasound guided technique). Parameters such as time taken for the identification of the interspace, number of insertion attempts (the primary outcome), number of passes and time taken were recorded in both the groups. Result: The time taken for identification of interspinous space was significantly more in Group U (4.7 ± 2.1 mins) as compared to Group L (1.17 ± 0.52 min) but the number of attempts for needle insertion (1.12 ± 0.41 vs. 1.86 ± 0.91), number of passes in the same interspinous space (3.32 ± 1.44 vs. 6.98 ± 2.51) and the total time for successful lumbar puncture (38.72 ± 12.30 vs. 56.65 ± 11.32 s) were significantly less in Group U as compared to Group L. Conclusion: The ultrasound guided identification of subarachanoid space was time consuming, but resulted in fewer attempts to enter the subarachnoid space when compared to the conventional landmark-based approach.

501-504

Authors: Sarita Gohiya*,Vineet Kumar Gohiya,Nisha Singh

Introduction: The most restricting component of regional anaesthesia in geriatric patients is hypotension inspite of several advantages. The present study aimed to reduce hypotensive effect of local anaesthetics by reducing their dose and by adding fentanyl. Materials and Methods: We selected 120 elderly patients (?65 years) scheduled for cemented bipolar prosthesis under spinal anaesthesia. They were randomized into two groups (Group - I: n=60, Group - II: n=60). Group I patients received 2.5 ml of 0.5% hyperbaric Bupivacaine and Group II patients received 2 ml of 0.5% hyperbaric Bupivacaine plus 25 µgm fentanyl. Duration of surgery, hemodynamic variables, adverse effect, need for analgesic supplementation were recorded. Result: Hypotension was more frequent in Group-I than Group-II (83.3% versus 8.33%). Bradycardia is more in Group-I than in Group-II (66.67% versus 5%). Need of I. V. Fentanyl for alleviation of discomfort was same in both groups. Conclusion: Addition of intrathecal fentanyl provides better hemodynamic stability without compromising quality of anaesthesia.

512-517

Authors: Padmini ,Sevagamoorthy ,Rajaprabhu*

Introduction and Aims: ultrasound had revolutionized the nerve block by, increasing the reliability with less complications. This study evaluates the block characteristics and efficacy between perivascular and perineural ultrasound guided axillary brachial plexus block for upper limb surgeries. Materials and Methods: 100 patients in the age group of 18-60 years belonging to ASA I,II physical status undergoing axillary block in upper limb surgeries were randomly allocated into Group PN- perineural (n=50) and Group PV- perivascular (n=50). In both the groups Musculocutaneous nerve block done with 6ml of local anaesthetic mixture. In perineural group, radial nerve, median nerve and the ulnar nerve were anaesthetized separately with 8ml of local anaesthetic mixture respectively. In perivascular group, the needle tip was then advanced dorsal to the artery, corresponding to 6’o clock position. 24ml of local anaesthetic mixture was incremently injected. The primary objective was to assess the success rate of blockade for surgery. The secondary objectives were to assess the onset and duration of sensory and motor block and to study the incidence of adverse effects. Results: There was no statistical significance in the success rate of blockade between the techniques (PN-98% and PV 96% with P value is 0.362).The sensory and motor onset time in PN group(6.98 min,10.22 min) is faster than PV group(10.96 min,13.50) with P value was<0> Conclusion: we conclude that the USG guided perineural technique as more reliable than the USG guided perivascular technique of axillary block.

523-528

Authors: Jigisha B Mehta*,Vandana Parmar,Vrinda Oza

Introduction and Aims: Functional Endoscopic Sinus Surgery (FESS) is minimal invasive technique for management of chronic sinusitis. Controlled hypotension is required in FESS for bloodless field, better visualization, reduce operative time and bleeding. Various agents like ? blockers, ?+? blockers, magnesium sulfate etc. used to achieve controlled hypotension. The aim of study was to produce controlled hypotension with propofol and isoflurane and to compare intraoperative blood loss, duration of surgery, operative field condition. Materials and Methods: Sixty patients were assigned in either group by computer generated random number table. Patients in Group A received propofol infusion and in group B received isoflurane in concentration to achieve MBP between 60 to 70 mmHg. Bispectral index value was also maintained between 40 to 60. Statistical difference between two groups was determined using unpaired student t test except for surgical field condition, for which Median test for two populations was used. A “p” value <0> Result: There was no statistically significant difference in MBP between both groups. Mean intra-operative blood loss was less in group A (115.17±12.07 ml) compared to group B (140.5±15.83 ml). Mean duration of surgery was shorter in group A (109±9.32 min) compared to group B (131.67±12.82 min). Operative field condition was better in Group A compared to Group B (p=0.0026). Conclusion: Both propofol and isoflurane effective in producing controlled hypotension, but anaesthesia with propofol is associated with less blood loss, shorter duration of surgery and better surgical field condition compared to isoflurane.

538-542

Authors: Shilpa Acharya,Kavita Adate*

Introduction: Ondansetron is widely used perioperative antiemetic. In this study, we have assessed the anti-emetic efficacy of orally disintegrating film (ODF) in middle ear surgeries, associated with higher incidence of PONV. Materials and Methods: We studied two doses of ODF (4 and 8 mg) and compared it with IV ondansetron and placebo. All 120 cases were done under general anesthesia with standard anesthesia technique. Results: Oral intake was significantly delayed in placebo group. (p= 0.001) During first 6hrs, the PONV score was significantly low (p<0> Conclusion: We conclude that all patients undergoing surgeries of middle ear should receive prophylactic antiemetic. Ondansetron in the form of orally disintegrating film is an effective as well as safe choice for PONV prevention in middle ear surgery with 8 mg to be the desired dose as compared to placebo and IV ondansetron.

549-555

Authors: Madhanmohan C,Udita Naithani*,Megha Gupta,Virendra Verma,Pankaj Damor

Introduction: Isobaric levobupivacaine is now being investigated in spinal anesthesia owing to its better safety profile; however, the studies are sparse which show clinical efficacy of intrathecal isobaric levobupivacaine alone in its ED95 dose (12.5-13.5mg) for cesarean sections (CS) and its comparison with most commonly used regime of hyperbaric bupivacaine (10mg). Objective and Methods: 100 parturients undergoing CS in spinal anesthesia were randomized in two equal groups to receive either 12.5mg isobaric levobupivacaine (group L) or 10mg hyperbaric bupivacaine (group B). Sensory – motor block characteristics (onset, extent, and duration), hemodynamic profile, adverse effects and success rate of the two drugs were compared. Results: All patients in both groups achieved target sensory level of T6 and Bromage score of 3 (complete motor block) hence no patient required anesthetic supplementation resulting in 100% success rate in both groups. Sensory onset (Time to T6) was significantly faster in group B (3.8±0.81 min) than in Group L (4.28±1.04 min) p = 0.011. Motor onset (Time to B3) was also significantly faster in Group B (3.04±0.69) than in group L (3.56±0.63), p = 0.0002. However this difference of < 1 xss=removed> Conclusion: Isobaric levobupivacaine (12.5mg) can be used as an alternative to hyperbaric bupivacaine (10mg) in spinal anesthesia for cesarean section as it offers effective sensory motor blockade with clinically comparable onset time.

561-565

Authors: Chetan Shukla,Raksha Kumari Bairwa*

Introduction: Intraperitoneal administration of local anesthetic found to be effective in controlling postoperative pain in laparoscopic surgeries. So, this prospective study was conducted to compare antinociceptive effect of intraperitoneal administration of bupivacaine and bupivacaine with dexmedetomidine in patients after undergoing Laparoscopic Cholecystectomy. Materials and Methods: A total of 60 patients of either sex undergoing laparoscopic cholecystectomy were randomly divided into two groups 30 patients in each. Group B received intraperitoneal 50ml bupivacaine 0.25 % (125mg). Group BD received intraperitoneal 50ml bupivacaine 0.25 % (125mg) and 50µg dexmedetomidine before removal of trocar at end of the surgery. Post op analgesia (VAS Score), sedation, Vitals was assessed at different time intervals. Time to first rescue analgesia, total dose of analgesic and adverse effect were noted. Results: We observed significant difference in mean VAS score at 8hr, 12hr, 16hr and 20hr between two group with 2.27+0.74, 3.03+0.67, 3.5+0.63, 4.03+0.72 in group B and 1.7+1.36, 2.1+1.09, 2.6+1.22, 3.03+1.09 in group BD respectively. The mean time to first rescue analgesia in group B was 8.86+ 4.13hrs and 11.64+ 3.95hrs in group BD. Total analgesic consumption was less in Group BD. Conclusion: Intraperitoneal instillation of bupivacaine with dexmedetomedine is superior to bupivacaine alone in terms of duration of post operative analgesia, total analgesic consumption in the post laparoscopic cholecystectomy patients.

569-575

Authors: Gaurav Dwivedi,Lalit Gupta*

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in 90 patients (ASA-I & II) posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts and duration of laryngoscopy and intubation attempts along with hemodynamic variability associated with the three blades- Macintosh, McCoy and Miller laryngoscope blade. Patients were randomly allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with Miller blade, in third group with McCoy blade. In this study it was found that McCoy laryngoscope is distinctly superior to the Macintosh and Miller with less hemodynamic changes and better glottic visualization. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant (p value < 0>

582-590

Authors: Yasha V Kameshwar*,M R Upadhyay

Introduction: Dexmedetomidine has been shown to blunt the stress response to surgery and reduce the consumption of inhalational anaesthetic agents. Hence, we designed this study to observe the effects of IV Dexmedetomidine infusion on stress-induced blood glucose levels and intra operative Sevoflurane requirement during laparoscopic surgery. Materials and Methods: Sixty patients between the ages of 18-60 years, of either gender, ASA Grade I & II, posted for elective laparoscopic surgical procedures under general anaesthesia were divided into two groups of 30 each. Group D received loading dose of Inj. Dexmedetomidine at 1µg/kg diluted to 50 ml and given over 10 minutes; followed by maintenance with 0.5µg/kg/hour, till the end of surgery. Group P received similar volume of normal saline. Anaesthesia was maintained with Nitrous oxide in oxygen (50:50) and Sevoflurane keeping BIS 40 - 60. Serial blood glucose levels, sevoflurane requirement by Dion’s method, extubation time, sedation score and adverse effects were observed. The data was analyzed using student t test. Results: Blood glucose levels at first hour post operatively in group P and in group D, were 136.7±6.30 mg/dl and 103.8±8.28 mg/dl respectively (P<0> Conclusion: IV Dexmedetomidine infusion was effective in attenuating stress induced blood glucose levels and it also reduced Sevoflurane requirement without affecting the time for extubation.

596-602

Authors: S Sindhuja*

Introduction: Spine surgeries, especially spine fusion surgeries cause severe postoperative pain, hampering convalescence. This is a randomized double blind controlled study comparing the analgesic efficacy of postoperative intravenous pethidine and dexmedetomidine in patients undergoing lumbosacral spine surgeries. Materials and Methods: After connecting patients to vital parameters monitor, patients were given general anaesthesia, induced with fentanyl 2mcg/kg, propofol 2mg/kg in graded doses and rocuronium 0.6mg/kg to facilitate tracheal intubation. All patients received 1 gram paracetamol iv slow infusion intraoperatively. After one and a half hours of surgery, injection fentanyl 1mcg/kg was repeated. After extubation and shifting the patients to PACU, patients were randomly allotted either group P/pethidine group or group D/dexmedetomidine group by computerised randomization. Group P patients received injection pethidine 0.5mg/kg loading dose diluted in 5 ml of distilled water slow iv, followed by 0.15mg/kg/hr infusion for 24hrs. Group D patients received injection dexmedetomidine 1mcg/kg bolus over 15 minutes followed by infusion of 0.5mcg/kg/min. Pulse rate, blood pressure, oxygen saturation, respiratory rate, VAS score and sedation score were monitored every 5 minutes for first 15 minutes, every 15 minutes for 1 hour, every hour till 6th hour, then 12th hour, and 24th hour. Results: Dexmedetomidine has a faster on set of analgesic effect (10 minutes) compared to pethidine (30 minutes), provides better analgesia and manageable hemodynamics but, causes more sedation with an average sedation score of 2.83 compared to pethidine. Conclusion: Dexmedetomidine is a better analgesic in the postoperative period compared to pethidine.

609-613

Authors: Madhavi Sanjay Chaudhari,Piyush Bansal*,Birva Khara

Introduction: Preoxygenation is a routine practice prior to induction of general anaesthesia. The fresh gas flow (FGF) of oxygen used is an important factor for an effective preoxygenation, and the end tidal oxygen fraction (FeO2) is the most sensitive indicator for its adequacy. This study determines the ideal time for preoxygenation at different FGFs, and the effect of increasing the FGF on the time for preoxygenation. Materials and Methods: Ninety patients of ASA grade I/II, aged 18-65yr, weighing 50-80 kg and scheduled for elective surgery under general anaesthesia were divided by a computer generated random allocation table into three study groups (30 each) - Group 8, Group 10 and Group 12, according to the FGF used. A circle absorber system and a face mask were used for preoxygenation with one of the FGFs and tidal volume breathing technique. The values of FeO2 and blood peripheral oxygen saturation (SpO2) were recorded at prefixed intervals. The primary outcome variable i.e., time (sec) required for achieving FeO2 of ?90% was recorded. The secondary outcome variable i.e., the effect on the time to reach FeO2 ?90% with change in FGF was noted. All continuous variables across the 3 groups were compared by applying ANOVA test. Results: All the groups showed statistically significant difference among each other for the time to reach FeO2 ?90% (P= 0.000). The Mean (±SD) time taken to achieve FeO2 ?90% was, Group 8= 284.07±36.92 sec, Group 10= 199.87±20.71 sec, and Group 12= 140.67±27.88 sec. The secondary outcome is that the Group 12 took the least time and Group 8 took the maximum time. Conclusions: The time for preoxygenation ranges between 2 to 5 min depending on the FGF, and this time decrease with an increase in the FGF.

620-624

Authors: Shailendra Pareek,Lalit Kumar Raiger,Yogendra Singhal*

Introduction: Tracheoesophageal fistula (TEF) is one of the common congenital anomalies presented at birth. Management of TEF is a challenging task as outcome of these cases not only depends on surgeon and anaesthesiologist’s skills but also depends on various factors associated with new born. This prospective study evaluates the association of various factors on survival of TEF patients. Materials and Methods: 16 newborn patients in a calendar year were enrolled in this prospective study and impact of various factors like age, weight, parity of mother, associated congenital anomalies and family history, mode of delivery, place of delivery, associated hydramnios and type of TEF were evaluated on the survival of neonates born with TEF. Results: Male, female ratio was equal. Patient with birth weight >2.5 kg had higher survival rate (100%) compared to patient <2> Conclusion: Birth weight remains the single most important predictor of mortality among TEF patients, as suggested with Waterston risk classification.

627-628

Authors: Lalit Gupta,Tarang Jain*

Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with child physiology is a common error made. Circulation changes at birth from the foetal to adult type, but neonates are prone to revert to foetal circulation with disastrous effects. This phenomenon is known as flip flop or YoYo circulation. We report a case of a premature neonate, being operated for intestinal perforation, with Yo Yo circulation intraoperatively.