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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  CASE REPORT
A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block
Sindil Kumar Sahu, Usha Badole
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:30-31] [No of Hits : 1420]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0008 | FREE

ABSTRACT

Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block.

Keywords: Recurrent laryngeal nerve palsy, Supraclavicular brachial plexus block, Ultrasound guidance.

How to cite the article: Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.

Source of support: Nil

Conflict of interest: None

 
2.  ORIGINAL ARTICLE
Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries
Naina P Dalvi, Narendra Patil
[Year:2016] [Month:July-December] [Volume:1 ] [Number:2] [Pages:40] [Pages No:35-40] [No of Hits : 1061]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0010 | FREE

ABSTRACT

Introduction: This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanyl-bupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries.

Materials and methods: Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine +0.5 mL (25 µg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine +0.5 mL (25 mg) of tramadol (group T) intrathecally.
Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals.

Results: Sixty patients were randomized to the group F (n=30) and group T (n=30). The duration of sensory blockade was significantly prolonged in group F (314.66±49.25 minutes) as compared to group T (261.66±27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66±40.97 minutes) compared to group T (214.66±26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301±38.75 minutes).
Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients.

Discussion: Fentanyl 25 µg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia.

Keywords: Fentanyl, Intrathecal adjuvant, Postoperative analgesia, Tramadol.

How to cite this article: Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

Source of support: Nil

Conflict of interest: None.

 
3.  CASE REPORT
Pneumothorax in a Patient Posted for Cervical Spine Surgery
Naina P Dalvi, Nilam D Virkar
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:32-34] [No of Hits : 989]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0009 | FREE

ABSTRACT

A 54-year-old female posted for cervical laminectomy was started on antihypertensive drugs on admission. Magnetic resonance imaging showed cervical degeneration with posterior disk herniation at C3-C4 and disk bulge at L5-S1. After attaching the monitors, patient was premedicated and anesthetized. During mask ventilation, abdomen gradually distended. After intubation under vision, reduced air entry on right side and increased resistance was felt during manual ventilation. Salbutamol puff was given through endotracheal tube. Still air entry remained decreased on right side. X-ray and C-arm showed right-sided pneumothorax. Inter-costal drainage (ICD) was inserted in right 5th intercostal space in midaxillary line. Post-ICD X-ray showed significant expansion of right lung. Patient was ventilated and extubated after 4 hours. Highresolution computerized tomography confirmed the diagnosis. Surgery was rescheduled. On the 8th day, patient developed purulent drainage through ICD in the ward. She was diagnosed to have pulmonary Koch’s and was treated successfully.

Keywords: Laminectomy, Tension pneumothorax, Tuberculosis.

How to cite this article: Dalvi NP, Virkar ND. Pneumothorax in a Patient Posted for Cervical Spine Surgery. Res Inno Anaesth 2016;1(1):32-34.

Source of support: Nil

Conflict of interest: None

 
4.  CASE REPORT
Left Ventricular Rupture during Balloon Mitral Valvuloplasty
Tazeen Sarguroh, Dipti Kotwani, Shakuntala Basantwani, Bharati Tendolkar
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:28-29] [No of Hits : 584]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0007 | FREE

ABSTRACT

Balloon mitral valvuloplasty (BMV) is a viable alternative to valve replacement surgery in patients with mitral stenosis. One of the rare complications of the procedure requiring immediate resuscitation and surgical repair is cardiac tamponade due to ventricular rupture. We report the anesthetic management of a 38 year old female with hemopericardium during BMV due to left ventricular rupture.

Keywords: BMV, Capnography, Electrocardiogram, Left ventricular rupture.

How to cite this article: Sarguroh T, Kotwani D, Basantwani S, Tendolkar B. Left Ventricular Rupture during Balloon Mitral Valvuloplasty. Res Inno Anaesth 2016;1(1):28-29.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients
Johann Mathew, SK Gvalani
[Year:2016] [Month:July-December] [Volume:1 ] [Number:2] [Pages:40] [Pages No:41-44] [No of Hits : 580]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0011 | FREE

ABSTRACT

Background: Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation.

Study design: Prospective observational study.

Materials and methods: About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience.

Statistical analysis used: Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test.

Results: The incidence of difficult intubation determined by the IDS (=5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of =5 gives high false positive for our population.

Keywords: Airway management, Difficult tracheal intubation, Obesity.

How to cite this article: Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

Source of support: Nil

Conflict of interest: None.

 
6.  ORIGINAL ARTICLE
Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 µg vs Sufentanyl 5 µg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries
Sanjeeta R Umbarkar, Manju N Gandhi, Hemlata R Iyer, Roshan S Thawale
[Year:2016] [Month:January-June] [Volume:1 ] [Number:1] [Pages:34] [Pages No:1-4] [No of Hits : 560]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0001 | FREE

ABSTRACT

Aim: To compare the efficacy and safety of intrathecal fentanyl 20 µg vs sufentanil 5 µg as adjuvant to bupivacaine 0.5% (12.5 mg) using combined spinal epidural (CSE) technique for lower limb orthopedic surgeries.

Background: Use of local anesthetics along with opioids intrathecally has been widely reported. We aimed to compare two commonly used opioids as adjuvants to local anesthetic agents in combined spinal epidural techniques.

Materials and methods: A total of 60 patients were recruited in this prospective, randomized, double-blind study to receive either intrathecal sufentanil 5 µg (Group S) or fentanyl 20 µg (Group F) as adjuvants to 12.5 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block and the pain scores were assessed perioperatively. Duration of analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering. and postdural puncture headache (PDPH) were recorded.

Results: Demographic data and hemodynamic and respiratory parameters were comparable in both the groups. Onset of analgesia-time to reach highest level of analgesia-was faster in the sufentanil group. Sufentanil group patients had higher grade of motor block. Patients in fentanyl group had higher score of sedation than those of sufentanil group. None of the patients in any group had nausea, vomiting, or pruritus.

Conclusion: Addition of either fentanyl or sufentanil to intrathecal bupivacaine as an adjuvant in CSE technique enhances the quality of analgesia and motor block with minimal side effects. Hence, this is useful in orthopedic patients, especially in the geriatric age group.

Keywords: Combined spinal epidural technique, Fentanyl, Intrathecal adjuvant, Lower limb surgeries, Sufentanil.

How to cite this article: Umbarkar SR, Gandhi MN, Iyer HR, Thawale RS. Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 µg vs Sufentanil 5 µg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries. Res Inno Anaesth 2016;1(1): 1-4.

Source of support: Funding by Research Society of TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
Effect of Single-dose Preoperative Pregabalin on Postoperative Pain after Cardiac Surgery: A Prospective Observational Randomized Double-blind Study
Shilpa S Bhojraj, Rajashree D Agaskar, Savi J Kapila, Shital K Patil, Ali A Behranwala
[Year:2017] [Month:January-June] [Volume:2 ] [Number:1] [Pages:27] [Pages No:4-8] [No of Hits : 437]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0022 | FREE

ABSTRACT

Aim and objective: We evaluated the effect of preoperative single-dose pregabalin (PG) on postoperative pain in patients undergoing on-pump coronary artery bypass graft (CABG) surgery.

Materials and methods: In this double-blind study, 60 adult patients scheduled for elective on-pump CABG surgery were randomized into two groups of 30 each, viz., PG and placebo (PL). Patients received either oral PG 150 mg or a PL, 1 hour before surgery. All patients received general anesthesia. Postoperative pain relief was provided with intravenous tramadol 50 mg 8 hourly. Postoperative pain was assessed, both at rest and during coughing, with the 10-point verbal rating scale (VRS) at 6, 12, 18, and 24 hours after extubation. Time to extubation, pain scores, requirement of additional analgesics, and adverse effects were compared using chi-square test, unpaired t test, and Mann-Whitney U test.

Results: The time to extubation was significantly prolonged in the PG group compared with PL (9.84 ± 1.88 vs 8.66 ± 2.12 hours, p = 0.027). The mean VRS scores at rest and during coughing were significantly lower in the PG group compared with PL (p < 0.05). However, the requirement of additional analgesics, such as paracetamol or tramadol was similar in the two groups.

Conclusion: A single preoperative oral dose of PG 150 mg was effective in reducing postoperative pain in patients undergoing on-pump CABG compared with a PL.

Keywords: On-pump coronary artery bypass graft, Postoperative pain, Preemptive analgesia, Pregabalin.

How to cite this article: Bhojraj SS, Agaskar RD, Kapila SJ, Patil SK, Behranwala AA. Effect of Single-dose Preoperative Pregabalin on Postoperative Pain after Cardiac Surgery: A Prospective Observational Randomized Double-blind Study. Res Inno in Anesth 2017;2(1):4-8.

Source of support: Nil

Conflict of interest: None

 
8.  ORIGINAL ARTICLE
Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy
Valmik Avhad, Shrikanta Oak, Anita Shetty
[Year:2017] [Month:January-June] [Volume:2 ] [Number:1] [Pages:27] [Pages No:9-13] [No of Hits : 382]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0023 | FREE

ABSTRACT

This was a prospective randomized study comparing the safety and efficacy of ProSeal laryngeal mask array (PLMA) vs endotracheal intubation (ETT) in gynecological laparoscopic surgeries undertaken in 80 patients with American Society of Anesthesiologist I and II divided into two groups. The parameters assessed were insertion characteristics, hemodynamic response to insertion, gastric distension, and perioperative complications.
The demographic data were comparable. The first-time success rate was slightly higher for PLMA than for ETT. The time required for achieving effective airway was longer in ETT than in PLMA (25.6 ± 8.1 seconds for ETT vs 18.2 ± 5 seconds for PLMA).
The hemodynamic response to intubation/insertion was more in ETT group than in PLMA group, i.e., there was more rise in pulse rate and mean arterial pressure following ETT than PLMA insertion.
Intraoperatively, no episodes of laryngospasm, bronchospasm, desaturation, and inadequate ventilation were observed in both the groups. Postoperatively, sore throat complaints were observed more with ETT than with PLMA.

Keywords: Endotracheal tube, Hemodynamic parameters, Laparoscopic surgery, ProSeal laryngeal mask array.

How to cite this article: Avhad V, Oak S, Shetty A. Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy. Res Inno in Anesth 2017;2(1):9-13.

Source of support: Nil

Conflict of interest: None

 
9.  ORIGINAL ARTICLE
A Prospective, Pre- and Post-comparative Study to assess Knowledge about Medical Writing
Sweta Salgaonkar, Anjana S Wajekar, Aditi Lakhotia
[Year:2017] [Month:January-June] [Volume:2 ] [Number:1] [Pages:27] [Pages No:1-3] [No of Hits : 333]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0021 | FREE

ABSTRACT

Background: Medical writing is an important component of any research starting with writing a research protocol up to its culmination into presentations and publications. In spite of numerous mandatory academic projects being undertaken in India, the research output in peer-reviewed journals remains low. Lack of proficiency in medical writing has been cited as one of the important causes for same. We conducted a pre and post continued medical education (CME) multiple choice question (MCQ) questionnaire test to assess the baseline knowledge of the participants in this field and observe their improvement after the CME.

Materials and methods: 210 medical students and faculty from various medical disciplines participated in the workshop. Responses to a 15 item validated MCQ questionnaire under various headings such as literature search, spectrum of formats, statistics, references and reporting were collected from the participants of the CME.

Results: 40.48% of the participants responded for pre-CME questionnaire forms and 36.67% for the post-CME questionnaire forms. In the post-CME questionnaire, a vast improvement was obtained in almost all questions, observed most prominently in the sections on literature search, referencing and reporting guidelines.

Conclusion: Training programs in medical writing should be included as a part of the curriculum from undergraduate days. Till the time that this becomes a reality, we should continue to equip ourselves with good medical writing skills by organizing such educative programs.

Keywords: Publications, Medical writing, Questionnaire, Research.

How to cite this article: Salgaonkar S, Wajekar AS, Lakhotia A. A Prospective, Pre- and Post-comparative Study to assess Knowledge about Medical Writing. Res Inno in Anesth 2017;2(1):1-3.

Source of support: Nil

Conflict of interest: None

 
10.  CASE REPORT
Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section
Priti Devalkar, Sweta Salgaonkar, Vasundhara V Dhale
[Year:2017] [Month:January-June] [Volume:2 ] [Number:1] [Pages:27] [Pages No:18-20] [No of Hits : 315]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10049-0025 | FREE

ABSTRACT

The pregnant patient with sickle hemoglobinopathy (SCD) and mitral stenosis (MS) presenting for emergency lower (uterine) segment cesarean section (LSCS) represents a challenge to the anesthesiologist. In such a case, the choice of anesthesia is dependent on the patient’s clinical condition, urgency of surgery, and the reports of laboratory investigations. An understanding of physiological changes in pregnancy and the pathological impact of MS and SCD on pregnancy will help the administration of safe anesthesia for mother and baby. We have discussed the management of a pregnant patient with SCD and MS for emergency LSCS.

Keywords: Emergency lower (uterine) segment cesarean section, Mitral stenosis, Sickle hemoglobinopathy.

How to cite this article: Devalkar P, Salgaonkar S, Dhale VV. Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section. Res Inno in Anesth 2017;2(1):18-20.

Source of support: Nil

Conflict of interest: None

 
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